Vaginal reconstruction not needed for most inter-sex females

Dispelling a common myth, researchers from the Johns Hopkins Children's Center say vaginal reconstruction should be a matter of preference for most teens or adult women born with a type of inter-sex condition marked by the presence of both female and male genitals.

The findings of the research are being presented at the American Academy of Pediatrics Conference Oct. 26 through Oct. 30 in San Francisco.

Women with complete androgen insensitivity are born with relatively shallow vaginas that may or may not require surgical repair and with undescended testes that do require removal.

Vaginal surgery, if needed or wanted, should be done after puberty, when physical development is complete and a girl or a woman is mature enough to make a decision, researchers say.

“It is a common misconception in the general public — and quite often among doctors — that most girls born with this condition should have vaginal reconstruction in order to be sexually active,” says lead investigator Todd Purves, M.D. Ph.D., a urologist at Hopkins Children's. “Our findings show that, on the contrary, most young women choose not to have the surgery, have vaginal depths that are within normal parameters and can lead active sexual lives.”

In their study of 29 women born with the syndrome, researchers found that 38 percent chose to have vaginal surgery. Comparing those who had surgery with those who did not, researchers found that both groups had similar rates of sexual activity: Eighty percent of those who chose not to have surgery were sexually active, compared to 70 percent of those who had surgery.

“As surgeons, we need to make sure that the parents of babies with this disorder understand that their daughter may not even need vaginal surgery, and if she does, it is a decision that should wait until after adolescence,” Purves says.

Gender identity in women born with this condition is almost always female.