Complications of female genital surgery and disorders of sex development II

Feminizing genitoplasty can be divided into three fundamental procedures: clitoroplasty, labioplasty and vaginoplasty. Each of these procedures can be associated with short‐ and long‐term complications. The main complication associated with clitoroplasty acutely is ischemia and necrosis of the clitoris, a rare and devastating problem that is preventable by adequate surgical technique aimed at preserving the dorsal neurovascular bundle. In the long run, impaired clitoral sensitivity and thus sexual satisfaction, as well as unesthetic appearance are the main issues associated with clitoroplasty. New vaginoplasty techniques instated in the last decade, such as total and partial urogenital sinus mobilization as well as transrectal vaginal pull‐through are directed at preventing vaginal strictures, a significant complication associated with traditional flap‐based operations, which in turn have also been shown to harbor a significant impact on sexual activity and long‐term quality of life. Labioplasty complications are mainly in the cosmetic category (excess amount of tissue or lack thereof) and, as with clitoroplasty, are under the influence not only of surgical technique but also adequate hormonal control. The authors review key technical aspects for successful execution of these procedures and advocate for responsible follow‐up in a multidisciplinary setting to address long‐term outcomes and needs of this complex patient population. The authors also acknowledge the lack of consensus on the ideal timing for feminizing surgery.