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6. On average, how many surgeries are needed to obtain a desirable cosmetic and functional result?
In males, this depends on the location of the urethra, the amount of available skin and the degree of bending of the penis. In favorable cases, the maximum number of operations can be two or three.
In females with a low vagina and a slightly enlarged clitoris, usually one operation is performed in infancy, followed often by a "touch up" operation in adolescence. In females with a high vagina, surgery in infancy feminizes the external genitalia, with subsequent surgery to bring down the vagina in late childhood or
early adolescence, depending on the preference of the patient.
7. What is required for post-surgical maintenance in females?
We usually do not advise vaginal dilation in our young patients because we think this is stressful, both on parents and children. However, dilation may be needed in post-pubertal women. We do accept the fact that some patients may need touch up surgery when they are older.
Psychological Treatment For Intersex Patients
1. Who should receive counseling?
In our opinion, all intersex patients and family members should seriously consider counseling. Counseling can be provided by a pediatric endocrinologist, psychologist, psychiatrist, clergyman, genetic counselor or other individual the family is comfortable talking with. It is important, however, that the individual offering counseling services be very familiar with diagnostic and treatment issues related to intersex conditions. Additionally, it is helpful if the counselor has a background in sex therapy or sex counseling.
The following topics are often addressed during counseling sessions: knowledge about condition and treatment, infertility, sexual orientation, sexual function and genetic counseling. At different times throughout their lives, we think that all patients and parents are troubled by a number of these topics and could therefore benefit from counseling.
2. How long do patients and family members need to see a counselor?
Each person is different in their need for counseling. We believe individuals benefit from talking to a counselor throughout life, but that the need to do so may increase or decrease at different points in development. For example, parents may seek the service of a counselor more frequently as their child ages and subsequently asks more questions about their condition. Additionally, patients may find it particularly helpful to seek the services of a counselor once they have decided to become sexually active.
Glossary of Terms
- Adrenal glands:
- a pair of glands in males and females, located above the kidneys, which produce a number of hormones, including androgens
- Androgens:
- the main hormones testosterone and dihydrotestosterone secreted from the testes
- Estrogen:
- the primary hormones produced by the ovaries
- Genital folds:
- common to both males and females early in development. In males the genital folds develop into the scrotum and in females develop into the labia majora
- Genital ridges:
- fetal tissue that can develop into either an ovary or a testis
- Genital tubercle:
- common to both males and females early in development. In males the genital tubercle develops into a penis and in females develops into the clitoris.
- Intersexuality:
- An alternative term for hermaphroditism
- Karyotype:
- A photograph of a person's chromosomes, arranged according to size
- Mullerian ducts:
- A system present in both sexes early in fetal development. Upon development this system differentiates into a uterus, fallopian tubes and posterior portion of the vagina.
- Mullerian Inhibiting Substance (MIS):
- Produced by the Sertoli cells, and inhibits Mullerian duct formation
- Ovary:
- female gonad which manufactures estrogens and eggs
- SRY:
- a gene on the Y chromosome whose product instructs the fetal germinal ridge to develop into a testis
- Testes:
- male gonad which manufactures testosterone and sperm
- Urethral folds:
- common to both males and females early in development, in males the urethral folds develop into the urethra and corpora and in females into the labia minora.
- Wolffian ducts:
- a system present in both sexes early in fetal development; upon development, this system differentiates into the epididymis, vas deferens, and seminal vesicles
Intersex Support Group Contact Information
Some of the Available Support Groups for Individuals Affected by Syndromes of Abnormal Sexual Differentiation
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