Pediatric Surgery Department, Motol University Hospital, Charles University in Prague, V Uvalu 84, Prague, 15600, Czech Republic.
Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
J Pediatr Urol. 2022 Jun;18(3):282-286. doi: 10.1016/j.jpurol.2022.02.005. Epub 2022 Feb 14.
To investigate sexual function and subjective attitudes towards surgery in adult women after feminizing genitoplasty (FG) for congenital adrenal hyperplasia (CAH).
We retrospectively reviewed the medical files of patients who underwent FG from 1996 to 2018. Of those, patients older than 16 years of age were asked to answer non-standardized questions aiming at the awareness of genital surgery and standardized questionnaire evaluating sexual function (GRISS). The anonymized answers were compared to a control group of 50 healthy females. Student's t-test, Pearson's χ test, Fisher's exact test and Spearman's rank correlation coefficient were performed. A P-value less than 0.05 was considered significant.
Out of 106 patients who underwent FG, 64 were included, 55 successfully contacted and 32, aged 17-40 years (median 25.5), answered the questionnaires (58% response rate). In all, 11 patients underwent historical clitorectomy in early childhood by a pediatric gynecologist before 1996 and pull-through vaginoplasty at puberty. A total of 21 patients underwent modern one- or two-staged FG. There were statistically significant differences between the CAH group and controls as to the proportion living in committed partnerships (28% and 84%, respectively; p = 0.0000), having sexual intercourse (41% and 92%, respectively; p = 0.0000) and having their own children (13% and 36%, respectively; p = 0.0369). The median overall GRISS score was 4 (range 1-7) in the CAH group compared to 1 (range 1-9) in the control group, with infrequency and vaginismus representing the least favorable subscales (median 5). In all, 81% of the women operated on for CAH would recommend such an operation to any other individual with CAH and 66% of them suggested the surgery should be performed in early childhood.
By this study we have contributed to the debate over suggestions that FG may cause adverse effects on sexual life of the patients in adulthood, beside already published effects on their mental well-being and LUTS. Despite possible selection bias due to only 58% response rate the comparison with control group shows only a moderate sexual dysfunction and more significant impact on long-term partnership that might be caused by other factors related to CAH beside FG itself.
Partnership, offspring, sexual frequency and function were impaired in adult females with CAH after FG. However, the median GRISS score was below the pathological level of 5.
研究先天性肾上腺增生症（CAH）女性成年患者行女性生殖器成形术后的性功能和对手术的主观态度。
我们回顾性分析了 1996 年至 2018 年期间行女性生殖器成形术的患者的病历。其中，年龄大于 16 岁的患者被要求回答非标准化问题，以了解对生殖器手术的认识，并回答评估性功能的标准化问卷（GRISS）。将匿名答案与 50 名健康女性的对照组进行比较。采用学生 t 检验、Pearson χ 检验、Fisher 确切检验和 Spearman 秩相关系数进行分析。P 值小于 0.05 被认为有统计学意义。
在 106 例行女性生殖器成形术的患者中，纳入 64 例，其中 55 例成功联系，32 例（年龄 17-40 岁，中位数 25.5 岁）回答了问卷（58%的应答率）。共有 11 例患者在 1996 年前因儿科妇科医生行早期阴蒂切除术，青春期行经阴道成形术。21 例行现代单期或两期女性生殖器成形术。CAH 组与对照组在以下方面存在统计学差异：处于承诺关系中的比例（分别为 28%和 84%；p=0.0000）、有性行为的比例（分别为 41%和 92%；p=0.0000）和有自己孩子的比例（分别为 13%和 36%；p=0.0369）。CAH 组的整体 GRISS 评分中位数为 4（范围 1-7），而对照组为 1（范围 1-9），不频繁和阴道痉挛代表最不利的亚量表（中位数 5）。所有接受 CAH 手术的女性中，81%会向任何其他患有 CAH 的人推荐这种手术，66%的人建议在儿童早期进行手术。
通过这项研究，我们对女性生殖器成形术可能对成年患者的性生活产生不良影响的观点做出了贡献，除了已发表的对心理健康和下尿路症状的影响之外。尽管由于应答率仅为 58%，可能存在选择偏倚，但与对照组的比较显示，只有中度性功能障碍，而对长期伴侣关系的影响可能更大，这可能是由 CAH 以外的其他因素引起的，而不仅仅是女性生殖器成形术本身。
行女性生殖器成形术的 CAH 成年女性的伴侣关系、后代、性频率和功能受损。然而，GRISS 评分中位数低于 5 的病理性水平。
