Dear Julia,

I did not know your child was so young, sorry. When you mentioned menstruation I supposed her being a teenager...

There is absolutely no need for surgery at this time. I know that this is not a popular consept in America but I hope you can find a surgeon there that is aware about the recent alarming news about early  reconstructive genital surgery.

If vaginoplasty - that is widening the vaginal entrance - is done in early years you can allmost be certain that she needs a redo operation in her teens. This is because the natural tendency of scar tissue to shrink. There was an article - in Journal of Urology which your urologist most certainly reads- a couple of years ago where about 20 teenagers were inspected again about 15 years later they had had their vaginoplasties done. Even the surgeons that made these vaginoplasties thought the results were disastrous. Their patients opinions were not even asked! More than 80% of those patients needed a second operation. This has been confirmed in several other studies after that. And our surgical techniques have not developed so much since then that these results should be any better now...

About surgery in general: it is allways irreversible. Once we take out something it can never be gained back again. Surgery leaves allways scar tissue no matter how delicate procedure your surgeon uses. Scar is at least little numb and does not function the way healthy tissue does. And when these operations are done in order to alter their cosmesis you should all take a mirror in your hand and ask were is the norm that is pursued here. There is no such thing as a average clitoral size or vagina or labia minora/ majora size/shape!! So if everybody is naturaly unique why surgically try to alter this natural fenomenon? Surgery is sometimes necessary- if the girl herself is not pleased with her cosmesis or in few occasions were there are some physiological needs - but it should be done after informed consent by the patient, this your baby can not give yet.

Those that plea for early surgery in order to avoid the pain and psychological stress in teen years should bear in mind that the stress may be even bigger when your child finds out that something has been done to her/him which s/he thinks is harmful. An as the ones that were operated on the 60`s and 70`s tell now their stories there seems to be an alarming dissatisfaction to early surgery. So think twice.

I am sorry to stir up your minds with these very difficult issues but I hope I can point out some crucial aspects of the benefits and drawbacks of surgery.

With best regards,

Mika