What We're Reading

The American College of Obstetricians and Gynecologists (ACOG) is the main professional association for the specialty of obststrics and gynecology. They recently published a paper in the journal Obstetrics and Gynecology condemning the practice of cosmetic gynecologic surgery. This article gives a
good discussion of ACOG’s opinion:

http://www.chicagotribune.com/news/local/chi-cosmetic_31aug31,0,7734462.story?coll=chi-unitednavover-misc

“Our results indicate that individuals who have had clitoral surgery are more likely than those who have not to report a complete failure to achieve orgasm and higher rates of non-sensuality—in particular, a lack of enjoyment in being caressed and in caressing their partner’s body.”

“Our findings suggest that adult sexual function could be compromised by feminising clitoral surgery. Infants and young children are powerless to oppose any procedures, so genital surgery for them is not just a medical issue but also a moral one. Debate over ethics with interested parties should be encouraged and clinicians should advance the debate and help individuals and families to make the best possible decisions by producing reliable information. Many surgeons will undoubtedly feel justified in doubting the findings of this study, and will fall back on the traditional response of claiming that current techniques are more advanced than the surgical procedures we assessed. Although surgery has advanced in many ways, this is not a valid reason for complacency. In this study surgery was done 8-40 years ago, and most individuals had undergone clitorectomy. Of the three sexually active participants who had undergone the newer technique of nerve-sparing clitoral reduction, however, two had the worst possible score for orgasm difficulties(orgasm subscale score of 9).”

Paediatric and Adolescent Gynaecology : A Multidisciplinary Approach. Essentially an intersex textbook with a significant emphasis on psychological care (and on issues such as psychological support) with chapters by clinical psychologists like Lih-Mei Liao, Julie Alderson and Polly Carmichael.

• Order from Amazon.

Balen, Adam H., Sarah M. Creighton, Melanie C. Davies, Jane MacDougall, and Richard Stanhope, eds. 2004. Paediatric and Adolescent Gynaecology : A Multidisciplinary Approach: Cambridge University Press.

The June 2007 issue of Scientific American features a profile of Eric Vilain MD (a world renowned genetic researcher, pediatric endocrinologist, and member of ISNA’s Medical Advisory Board). The article, Going beyond X and Y, discusses the recent international medical consensus which agreed to drop the term “hermaphrodite” in favor of the more neutral “disorders of sex development” (DSD).

On Friday, September 21, 2007, the Oprah Winfrey Show interviewed Katie, Lynnell, Hida, and Arlene about their experiences of growing up with intersex conditions. Marcia from Madison Wisconsin took advantage of the attention to the issue to tell her story to the Wisconsin State Journal.

Marcia says the Oprah show is an important milestone in talking about a condition that caused so much shame that her family and doctor hid the truth from her. She didn’t learn that she had XY chromosomes until she read her own medical records at age 35.

“I hope there will be other girls like me out there watching this and knowing they aren’t alone,” she said.

Read the rest of the story at Orchid ladies test gender perception.

Congratulations, Marcia!

Many U.S. physicians continue to dismiss the results from the London group of researchers, documenting poor outcomes from early genital surgery, as irrelevant. At a recent European Society for Pediatric Urology conference, a Swedish group reported similarly poor genitoplasty outcomes.

RESULTS:47 women had been operated, more than 50% had been operated at two or more occasions. 11 patients had only vaginoplasty done and in the remaining women it was combined with clitoroplasty. The cosmetic appearance as well as the function of clitoris and vagina are often not optimal. There is also a need from these patients to be able to discuss former surgery, especially since it was common in this group to state that the functional result has influenced their sexual life negatively.

I’ve been updating my references database, and I continue to be impressed by the sophistication of the work coming from UK professionals on intersex issues. These articles are a great example.

• Alderson, J, A Madill, and A Balen. 2004. Fear of devaluation: Understanding the experience of women with androgen insensitivity syndrome. BJ Health Psychol 9 (1):81-100.

• Liao, Lih-Mei. 2003. Learning to assist women with atypical genitalia: journey through ignorance, taboo and dilemma. J Reprod Infant Psychol 21:229- 38.
  
• Boyle, Mary E., Susan Smith, and Lih-Mei Liao. 2005. Adult Genital Surgery for Intersex: A Solution to What Problem? Journal of Health Psychology 10 (4):573-584.