ESPE Yearbook of Paediatric Endocrinology

Horm Res Paediatr. 2022;95(1):12-20. PMID: 35045418, doi: 10.1159/000521958.

Brief Summary: This comprehensive review summarizes surveys of affected DSD patients’ opinions on the timing of genital surgery published in the last 20 years.

The binary system of sex and gender has dominated human societies throughout history. In this regard, atypical secondary sex characteristics constitute a challenge to the binary system and are associated with variable degrees of psychosocial stigma. During the second half of the 20th century, with improved surgical techniques, even if usually not acutely medically necessary, “corrective” or “normalizing” genital surgery, in infancy and early childhood became widely accepted in Western societies, with the goals of reducing intersex-related stigma, minimizing parental anxiety, and facilitating gender development within the binary gender system. However, with the publication of examples of poor cosmetic and functional and unsatisfactory outcomes of early gender assignment and associated genital surgery, the timing of such surgery relative to the age of consent has become a highly controversial topic. Additionally, ethical concerns exist concerning elective medical procedures that are performed prior to the age of consent.

Overall, this review of surveys suggests that the movement against early genital surgery disregards the risk of the stigma associated with genital ambiguity at all stages of development and the wishes of most patients. Legislation that uniformly bans elective genital surgery in childhood is not based on scientific evidence and does not take into account the unique needs of each individual. The results of these surveys show that a case-specific individualized decision on the timing of surgery would be more appropriate.