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Representatives for congenital adrenal hyperplasia (CAH) continue to desire early feminizing surgery in girls with 46,XX-CAH. The aim of this analysis, which included 174 46,XX- individuals with salt-wasting (SW) or simple-virilizing (SV) CAH, a female gender identity, and an age > 16 years participating in a multicenter cross-sectional clinical evaluation study (dsd-LIFE), was to evaluate the long-term results of surgery and patient-reported outcomes (PRO). The gynecological examination (n = 84) revealed some shortcomings concerning surgical feminization. A clitoris was absent in 9.5% of cases, while a clitoral hood was missing in 36.7% of cases. Though all women had large labia, they didn’t look normal in 22.6% of cases. Small labia were absent in 23.8% of cases. There was no introitus vaginae, and the urethra and vagina had no separate opening in 5.1% of cases. A mucosal lining was missing in 15.4% of cases. Furthermore, 86.2% of the women had scars at the region of their external genitalia. A vaginal stenosis was described in 16.5% of cases, and a meatal stenosis was described in 2.6% of cases. Additionally, PRO data showed a very-/high satisfaction rate of 21.3%/40.2% with cosmesis and 23.8%/38.1% with functionality, while 3.3%/10.7% showed a very-/low satisfaction with cosmesis as well as 5.6%/10.3% with functionality. The remaining women—24.6% and 23.8%—were indifferent. Satisfaction concerning sex life was very-/high in 9.6%/27.7%. In 12.0%/16.9% it was very-/low. Furthermore, 33.7% had no opinion. Furthermore, 27.0%/31.6% of the women reported that clitoriplasty, but not clitoridectomy, had a very-/positive influence on their lives, while 1.3%/8.9% felt it to be very-/negative, and 28.4% were indifferent. Vaginoplasty had a very-/positive influence in 25.7%/33.8% and a very-/negative effect in 3.6%/6.8%. 29.7% had no opinion. Additionally, 75.7% of the women preferred feminizing surgery during infancy/childhood, especially concerning clitoreduction. In conclusion, though the majority of the participants (76%) preferred early feminizing surgery and 60% described a positive effect on their lives, about 10% felt it to have been negative. About 15% of the women suffered from insufficient cosmesis and functionality after surgery. Sex life was even described as poor in nearly 30%. Therefore, the decision about early genital surgery in 46,XX-CAH girls should be considered carefully. Parents should get detailed information about possible complications of surgery and should receive support to understand that postponing surgery does not inevitably cause harm for their child. Importantly, genital surgery when performed in children should only be performed in expert centers with a specialized team including surgeons who are trained in feminizing surgery.
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http://dx.doi.org/10.3390/jcm11154629 | DOI Listing |
Ann Plast Surg
January 2025
Department of Nutrition and Dietetics, Saint Louis University, St. Louis, MO.
Purpose: To determine the relationship between body mass index (BMI) and complication rates among patients undergoing gender-affirming surgeries (GAS).
Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried from 2015 to 2021. Patients who underwent a GAS were identified using International Classification of Diseases Ninth (ICD-9) and Tenth (ICD-10) codes.
Ann Plast Surg
January 2025
From the Plastic and Reconstruction Surgery, Department of Precision Medicine in Medical, Surgical and Critical Care, University of Palermo, Palermo, Italy.
Plast Reconstr Surg Glob Open
December 2024
Mexican Association of Plastic Esthetic and Reconstructive Surgery, International Society of Aesthetic Plastic Surgery, Monterrey, Nuevo León, Mexico.
Background: Despite the increasing demand, the combination of lip feminization and rejuvenation in patients assigned male at birth with gender dysphoria is rarely reported in the medical literature. We present our 27 years of experience performing these procedures in this patient population.
Methods: All patients assigned male at birth with gender dysphoria from 1997 to 2023 were included and grouped into 4 age categories.
J Craniofac Surg
October 2024
Department of Surgery, Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT.
Objective: While studies have shown that access to facial feminization surgery can be restricted by financial and geographic limitations, there is a lack of information on the impact of surgery on the most vulnerable patients. Therefore, this study assessed the impact of social vulnerability and neighborhood socioeconomic disadvantage on patient-reported outcomes after facial feminization surgery.
Methods: Patients were surveyed pre and postoperatively using the FACE-Q Aesthetics Questionnaire and geo-coded using home addresses to obtain social vulnerability index (SVI) and Area Deprivation Index scores.
Facial Plast Surg Aesthet Med
December 2024
Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA.
At present, there is no gender-affirming facial surgery that offers feminization of the lateral neck. To demonstrate reliable relationship between the great auricular nerve point (GAP) and spinal accessory nerve along the sternocleidomastoid muscle (SCM) in human anatomical specimens and demonstrate feasibility of muscle transection in one transgender female patient. A total of 14 human anatomical specimen dissections were performed to determine if a transection of the SCM perpendicular to the GAP could be performed without potential compromise of the spinal accessory nerve.
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