Dear Kaye, You've expressed my concerns after my daughter was born very well. Janet D has some very good points on who really sees your child getting changed. I cried every day after I made an appointment to have surgery done. I only felt at peace when I cancelled the surgery. This is the absolute hardest decision I ever had to make. We decided that we would wait on it. I must admit that if she were severly virilized and voiding from her clitoris the decision would have been even tougher. I think this decision must be individulized. We all want what's best for our children. But if your daughter is on the mild to moderate end of the scale, waiting would be best according to many many abstracts I've read from doctor's research. All through school I never really saw another's private parts up close and feel that my daughter will be just fine. The following is an abstract I found very interesting about estrogen playing a part in keeping the newly molded skin soft and plyable. I asked my sister who is a nurse what stenosis is and it's a hardening and nonstretching of the skin shich causes a need for more surgeries. Please know that this decision does not need to be made now. You can take time to research and also as Janet D suggested, your daughter may "grow into" her clitoris a bit. When my daughter was first born, hers was much more engorged and seemed larger. Now that she's been on medication for 14 months, her clitoris has become smaller in diameter and you can only see it if you seperate her legs while changing her diaper. I wish you all the best! Blessings! Julia S BJU Int 2000 Aug;86(3):253-8; discussion 258-9   (ISSN: 1464-4096) Krege S; Walz KH; Hauffa BP; Korner I; Rubben H [Find other articles with these Authors] Clinics of Urology, Gynaecology and Obstetrics, and Paediatric Endocrinology, University of Essen Medical School, Essen, Germany. OBJECTIVE: To assess, in a long-term follow-up, female patients with congenital adrenal hyperplasia (CAH), with special emphasis on vaginal functional outcome and sexual activity after vaginoplasty. PATIENTS AND METHODS: Twenty-seven patients with CAH (aged 14-33 years; six Prader grade II, 14 grade III, six grade IV and one grade V) underwent surgery between 1972 and 1988. Three of the patients underwent clitoridectomy, 24 clitoroplasty and 25 vaginoplasty (24 with a Fortunoff flap and one a 'pull through' procedure). In 20 patients the vaginoplasty was a one-stage procedure, undertaken at a mean (range) age of 3.6 (1-9) years, and in five patients a two-stage operation. The analysis was based on the patients' history and examination; the patients also completed a questionnaire, including a psychological profile. RESULTS: Nine of the 25 patients (36%) who underwent vaginoplasty developed intravaginal stenosis; of these nine, six were Prader grade III and three grade IV. All had undergone a single-stage procedure at a mean (range) age of 4.7 (2-9) years. Of the 16 patients who answered the questionnaire, 14 had problems with their overall body image; patients in whom vaginal stenosis was corrected were particularly anxious about sexual intercourse and had problems with orgasm. CONCLUSION: The main problem during the long-term follow-up was intravaginal stenosis; all the affected patients had undergone a single-stage procedure early in life to correct ambiguous genitalia. This high rate of vaginal stenosis suggests that vaginoplasty should be undertaken at the beginning of puberty, because higher oestrogen levels may prevent stenosis and, if necessary, dilatation can be performed by the patient. These data also underscore the importance of psychological support in the treatment of children with CAH.