Department of Pediatrics, Division of Pediatric Endocrinology, Erasmus MC-Sophia, Rotterdam, The Netherlands.
J Sex Med. 2013 Mar;10(3):866-75. doi: 10.1111/jsm.12028. Epub 2012 Dec 13.
Women with the classical form of congenital adrenal hyperplasia (CAH) are born with different degrees of virilization of the external genitalia. Feminizing surgery is often performed in childhood to change the appearance of the genitalia and to enable penile-vaginal intercourse later in life. There are suggestions that this affects sexual functioning.
The aim is to study the anatomical, surgical, cosmetic, and psychosexual outcomes in women with CAH.
Forty women with CAH, aged over 15 years, from two referral centers for management of Disorders of Sex Development in the Netherlands were included. Physical and functional status were assessed by a gynecological interview and examination. Sexual functioning was assessed with the Female Sexual Function Index and Female Sexual Distress Scale-Revised scales and compared with a reference group.
Surgery performed, anatomy, cosmetic score, sexual function and distress.
Thirty-six of the 40 women had undergone feminizing surgery; 25 women (69%) underwent more than one operation. Resurgery was performed in seven of the 13 (54%) women who had had a single-stage procedure. Anatomical assessment showed reasonable outcomes. Multiple linear regression showed that only level of confluence had a significant effect on cosmetic outcome, the impact depending on the number of surgeries performed. Cosmetic evaluations did not differ between the women and the gynecologists. Only 20 women had experience of intercourse. Eight women reported dyspareunia; seven women reported urinary incontinence. The women's perceived sexual functioning was less satisfactory than in the reference group, and they reported more sexual distress.
The level of confluence was the major determinant for cosmetic outcome; the impact depended on the number of surgeries performed. Fifty-four percent of the women required resurgery after a single-stage procedure in childhood. Anatomical assessment showed reasonable outcomes. The women evaluated their sexual functioning and functional outcome less favorable than the reference group, and they experienced less often sexual intercourse.
患有经典型先天性肾上腺皮质增生症（CAH）的女性出生时外生殖器具有不同程度的男性化。为了改变生殖器的外观并使其在以后的生活中能够进行阴茎阴道性交，通常会在儿童期进行女性化手术。有研究表明，这会影响性功能。
旨在研究 CAH 女性的解剖学、手术、美容和心理社会结局。
荷兰两家性别发育障碍管理转诊中心纳入了 40 名年龄在 15 岁以上的 CAH 女性。通过妇科访谈和检查评估身体和功能状况。使用女性性功能指数和女性性功能障碍-修订版量表评估性功能，并与参考组进行比较。
手术类型、解剖结构、美容评分、性功能和性功能障碍。
36 名女性接受了女性化手术；25 名女性（69%）接受了超过一次手术。在接受单阶段手术的 13 名女性中，有 7 名女性（54%）需要再次手术。解剖评估显示结果合理。多元线性回归显示，只有汇合程度对美容结果有显著影响，影响取决于手术次数。女性和妇科医生的美容评估没有差异。只有 20 名女性有过性交经验。8 名女性报告性交痛；7 名女性报告尿失禁。女性感知的性功能不如参考组满意，且她们报告的性功能障碍更多。
汇合程度是美容结果的主要决定因素；影响取决于手术次数。54%的女性在儿童期单阶段手术后需要再次手术。解剖评估显示结果合理。女性对性功能和功能结局的评价不如参考组，且较少进行性交。
