Dear folks,

sorry about my previous blanc message I just accidentally hit the enter button...I seem to have all kinds of trouble with my computer  ;)

Before I stop commenting on this issue I would like to write some explanations to my beliefs..

As my vocation is healing children my job is to be their advocate. Sometimes this means confronting their parents with my disagreeing views and opinions. I know I can not please all and I do not even want to. My concern are the children. My knowledge about CAH comes from books, collegues, my patients and the stories that adult CAH people tell. I do not know what it is like to have CAH or have CAH children. I can only magine and try to understand. So I am "an outsider" and you can well consider me and my thoughts that way  ;) And I know that I am dropping a bomb here with my letter but that is partly my meaning.

As a finn I am not used to chatting so I shall get to the point I have here...

First of all yes, it is easier for me to comment on these issues because I live in Finland. But no, I would not be quiet even if I lived in America. I would still say what I feel has to be said.

My first statement is that there is no need for early surgery. By this I mean surgery before teenage. There is absolutely no physiological or medical reason -as general-for clitoral or vaginal surgery during the first 10 years of age. Just make sure your child gets his/her medication and good follow up by his/her endo. Rise and love him/her as s/he is. When she becomes older she can make her own decisions. But remember that puberty is hard even without CAH and every child has questions about his/her sexuality and identity. So I think that if possible I would even wait after puberty before starting any cosmetic surgeries. I know this is a hard consept to approve but I strongly suggest you to read and follow the adult discussion lists and read what adult CAH people have to say about their childhood surgeries. But still you have to make your own decisions....

Frequently I see views and comments that clitoral surgery was done because the clitoris was like a little penis and that upset parents, nurses, doctors or baby sitters and so on... This comment makes me outrageous and sad. I ask myself again and again why, oh why do people( by this I mean all people, doctors, nurses, parents etc..) try to cure their insecurity of sexual identity by cutting off a girlīs clitoris?? Who told you what a boy or a girl should look like?? What is the proper size then?? As nature has so much variation in every detail why do we try to achieve eugenistic goals in the size and shape of our childrens outer genitalia. Please, let them be as long as your children can decide themselves.

I see also comments that vaginal surgery is needed in order the child to be able to have sex. Oh my, oh my! The heterosexual penetrating sex we have is by far not the only thing on earth! Who told you your girl will ever need her vagina to be any bigger than to let the menstruation happen? No one can tell you that but your own girl! And she can tell you that when she starts her active sexual life. What if she is lesbian or decided to choose some other kind of sexual pleasure? Then the surgery was unnecessary and caused her more pain and discomfort that any good if it was done before she could decide herself. So think twice.

I am sorry I have to rush to work now, I could write this a mile long manifesto...

It sounds absurd that a surgeon is against surgery, doesn`t it!!? (I assure you that I am not insane). So I hope my words have even stronger message because of the evident conflict between my profession and what I have stated here about genital surgeries on children.

I wish all the best to you all,

Mika Venhola

Ped surgeon

Finland