Timing of surgery for feminizing genitoplasty in patients suffering from congenital adrenal hyperplasia.

This chapter refers only to female patients with congenital adrenal hyperplasia (CAH). CAH represents the largest subgroup of individuals with 46,XX disorders of sex development. The stimulation of the androgen production leads to a prenatal virilization among these girls. The phenotype is influenced by the severity of the enzyme defect, leading to a virilization of the external genitalia in varying degrees. On the other hand, the affected girls are clearly anatomically female with regularly developed female internal genitalia. Female puberty and potential female fertility are therefore to be expected. The operation to feminize the genitalia includes the separation of the sinus urogenitalis, the creation of a functionally wide enough vagina, the remodeling of the labioscrotal folds to create larger labia, and, if necessary, a reduction clitoroplasty. Considering the lack of scientific evidence, it is not possible to make definitive statements regarding the timing of surgery for girls with CAH. There are no studies that prove whether one- or two-stage surgery provides more or clearer advantages.