I've cut and pasted these from Intersex Initiative (http://www.ipdx.org) The citations are included and you can buy each article from the publishing journal.
Recent Vaginoplasties: Still Risky Despite Claims to the Contrary
ipdxWIRE Intersex News
Jun 2, 2005June 2005 issue of BJU International published a new study from our favourite intersex research team from the University College London (Melissa Davies, Sarah Creighton and Christopher Woodhouse in this case), which evaluates results of relatively recent vaginal (re)construction surgeries performed between 1997 and 2004. According to the paper, the 15 women in the study, who received 31 surgeries combined, exhibited many major complications, despite all the "progress" in the surgical techniques that doctors often brag about.
Davies et al. state "Complications are common and can be major; most patients require many repeat operations to achieve a patent vagina" and call for clear and honest pre-operative discussion and psychological support to give the patient realistic expectations about the benefits and risks of the surgery.
ALSO: another paper in the same issue of BJU International by Davies, Creighton, Woodhouse and Naomi Crouch (another regular from our favourite research team), reports that over two-third of women who had been diagnosed with congenital adrenal hyperplasia (CAH) and had received feminizing surgeries reported experiencing urinary tract symptoms, which is more than four times as prevalent as in the non-CAH population. It is still unclear if the problems are the effects of having CAH or caused by surgeries, however. The study was also presented at the annual meeting of the American Urology Association, which was held last month.
Source:
Davies MC, Creighton SM, Woodhouse CRJ (2005). "The pitfalls of vaginal construction." BJU International. 95(9):1293-1298.
Davies MC, Crouch NS, Woodhouse CRJ, Creighton SM (2005). "Congenital adrenal hyperplasia and lower urinary tract symptoms." BJU International. 95(9):1263-1266.
"Non-Medical Reasons" for Early Surgery: Unproven and Unethical
ipdxWIRE Intersex News
Jun 2, 2005
In the February 2005 issue of Journal of Pediatric and Adolescent Gynecology, gynecologist Sarah Creighton and pediatric urologist Walid Farhat offer competing views on whether feminizing genital surgeries should be performed early or it should be delayed until the patient is old enough to consent to it.
Creighton, while admitting that evidence is still inconclusive, insist that the "review of the current liteerature does not support the use of feminizing infant genitoplasty as an effective treatment for stable gender or psychosexual development." Creighton points out that young girls have no use for "functional" vagina until they start menstruation or having intercourse, and argues that by delaying the vaginoplasty we could reduce the total number of operations needed to achieve vaginal length, while reducing risk of stenosis and give patients greater control over their lives. Regarding clitoral reduction/recession surgeries, Creighton stops short of arguing against it but stresses that families need to be aware of the damages clitoral surgeries may cause to the child's sexual functioning.
Farhat on the other hand argues that there is not enough evidence for "recommending a systematic policy change at this stage." Farhat discusses that there are non-medical reasons for the early intervention, such as "lessening the mental anguish of the parents about their anomalous child" and "the assumption that the child may not remember being born with a genital anomaly." "Both these assumptions have yet to be proven," admits Farhat, but there are some things seriously wrong with these assumptions as reasons for early intervention even if they were proven to be true.
First, surgeries on a child should only be performed if doctors feel that it is in the best interest of the child. That the procedure might help someone other than the patient does not justify performing such invasive and irreversible surgery on the child. Mental anguish experienced by the parents is a real clinical concern, and it should be dealt as a psychological need rather than a justification to alter the child's genitalia.
Second, the idea it is better to keep the child in the dark about the condition they were born with seems like a plan to deprive patients from learning about our own bodies and managing our health with all the knowledge that we can find. In fact, it's a return to the 1950s when secrecy and deception were endorsed as a treatment protocol in dealing with intersex patients under the belief that ignorance is a bliss. One of the most significant victories for the intersex movement has been that medical associations such as American Academy of Pediatrics no longer openly advocate for secrecy and deception--but some doctors still think that secrecy is a good practice, apparently.
In the end, Farhat states "we recommend that assignment of gender be done on an individual basis." Of course, the actual practice should always be done on an individual basis. But we are recently finding out that when doctors say "on an individual basis" in regards to intersex treatment, they don't really mean "on the basis of individual patients' needs and circumstances." What they actually mean is "on the basis of what patients' parents want and need." But why is it always about the parents? If any surgeries were to happen, we'd like it to be because the best available evidence suggested that surgery is in the best interest of the child, at least in the minds of the doctors performing it, and not simply because parents demanded it.
Source:
Creighton SM (2005). "Early intervention of CAH surgical management." Journal of Pediatric and Adolescent Gynecology. 18(1):63-66.
Farhat WA (2005). "Early intervention of CAH surgical management." Journal of Pediatric and Adolescent Gynecology. 18(1):66-9.
