Materiały źródłowe

• #1 Atypical genitalia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/atypical-genitalia/diagnosis-treatment/drc-20369278

  The goal of treatment is long-term mental health and social well-being, as well as having as much sexual function and fertility as possible. When to begin treatment depends on your child’s specific situation. […] Atypical genitalia is complex and not common. Managing it may require a team of experts. The team might include: Pediatricians, Experts in newborns born early or with medical conditions, also called neonatologists, Experts in children’s urinary systems, also called pediatric urologists, Pediatric general surgeons, Experts in the body’s hormones, also called endocrinologists, Medical geneticists, Mental health professionals, such as psychologists or social workers. […] Hormone medicines may help correct or manage hormones that are out of balance. For example, in a genetic female with a slightly enlarged clitoris caused by mild congenital adrenal hyperplasia, hormone replacement maybe the only treatment needed.

• #1 Management of the infant with atypical genital appearance (difference of sex development) – UpToDate

  https://www.uptodate.com/contents/management-of-the-infant-with-atypical-genital-appearance-difference-of-sex-development

  Management of the infant with atypical genital appearance (difference of sex development) […] The management of infants with clinically significant DSD will be discussed here. […] Long-term outcome data are now available to help predict gender identity for many infants with specific DSD diagnoses and provide insight into appropriate early management decisions. […] Management at centers of excellence is associated with improved medical, surgical, and psychosexual outcomes. […] Each child and family will have unique characteristics, so all decisions must be made on a case-by-case basis. […] In the past, decisions about sex of rearing were usually based on potential for reproduction and traditional sexual function and were often accompanied by complex genital surgery that can be difficult to reverse.

• #1 Ambiguous Genitalia | Doctor

  https://patient.info/doctor/ambiguous-genitalia

  The four key issues in management are: Accurate diagnosis, Gender assignment, Indications and timing of major surgery, Sharing of medical information with patient and parents. […] Parents should be advised to delay registering the birth (it can be legally difficult to alter later) and naming the baby, until the sex of rearing is decided. […] This should be done after completion of the diagnostic process, including full clinical, genetic and biochemical investigation. […] Surgical treatment may be required. The timing of surgery can be controversial. Examples of the requirement for surgery include: Hypospadias in males, Vaginoplasty and clitoroplasty, which may be required In virilised females, Gender reassignment, which may require surgery (multiple procedures), Gonadectomy, which may be advisable for patients with dysgenetic or nonfunctional gonads because of the risk of malignant change. […] Psychological support. Families will need intensive support, full explanations and information. This helps bonding with their child and probably the development of the child.

• #1 Disorders of Sex Development – Stanford Medicine Children’s Health

  https://deprod.stanfordchildrens.org/en/topic/default?id=disorders-of-sex-development-90-P03079

  Sometimes a child with atypical genitalia is at higher risk for tumors in the sex organs. Treatment for atypical genitalia depends of the type of the disorder. But it often includes surgery to remove or create sex organs appropriate for the child’s gender. Treatment may also include hormone therapy. […] Most important, you and your family should be included early in the decision of assigning the child’s sex. Ask your healthcare provider about what is available for long-term psychological support.

• #1 Treatments for Ambiguous Genitalia | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/atypical-genitalia-differences-of-sex-development/treatments/

  When a child is born with atypical (sometimes referred to as ambiguous) genitalia, a sex should not be designated until the proper information is available. This allows the medical team to gather information and help the family make the best long-term decision for their child. […] In some DSD conditions, hormone therapy may be recommended. Two types of hormone treatments may be needed or considered. The first type replaces life-sustaining hormones. […] The second type replaces hormones such as estrogen and testosterone. […] In some cases, surgical procedures may be considered. […] We presently utilize the expertise of our multidisciplinary team to ensure that patients are provided with compassionate care and that information is provided to parents and patients in a transparent nature that helps determine if any surgical care should be considered.

• #1 Ambiguous Genitalia and Disorders of Sexual Differentiation – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557435/

  The management of individuals with disorders of sexual development can be complex. Psychosexual development is dependent on factors such as societal and cultural norms, in utero exposure to androgen, genetic differences, and familial dynamics. The previous management guidelines of early genital surgery based on expected fertility outcomes and phallic functionality are being challenged due to evolving evidence. A need to move away from physician-directed early gender assignment surgeries is warranted because of poor long-term outcomes.[29][30][31] […] The management should be focused on three main domains; initial stabilization, accurate diagnosis, and decisions on the gender of rearing and planning of surgical intervention and hormonal treatment. […] Congenital adrenal hyperplasia, which is the most common cause of ambiguous genitalia, can present as life-threatening salt-wasting crises. Prompt diagnosis and treatment with glucocorticoids should be instituted.

• #1 Ambiguous Genitalia: Causes, Diagnosis, and Management of Intersex Conditions

  https://www.labtestsguide.com/ambiguous-genitalia

  Hormone therapy may be used to address hormonal imbalances and achieve a hormone profile more aligned with the individuals gender identity. […] Hormonal treatment can play a role in the development of secondary sexual characteristics during puberty. […] Intersex individuals and their families may benefit from psychological counseling and support to navigate the emotional and psychosocial challenges associated with intersexuality. […] Providing gender-affirming care involves respecting an individuals self-identified gender and supporting their gender expression. […] Some intersex conditions may require surgical interventions to address medical issues or improve urinary and reproductive function. […] Whenever surgery is considered, the risks, benefits, and potential outcomes should be thoroughly discussed with the individual or their parents/guardians.

• #1 Atypical genitalia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/atypical-genitalia/diagnosis-treatment/drc-20369278

  In children with atypical genitalia, surgery may be used to: Keep healthy sexual function, Create genitals that appear more typical. […] The timing of surgery depends on your child’s specific situation. Some healthcare professionals prefer to postpone surgery done only for appearance. They suggest waiting until the person with atypical genitalia is mature enough to be part of the decision about sex assignment. […] For children with atypical genitalia, the sex organs may work properly in spite of how the genitals look on the outside. For girls, if the vagina is hidden under the skin, for example, surgery in childhood can help with sexual function later. For boys, surgery to reconstruct a partially developed penis may create a more typical appearance and make erections possible. Surgery to move the testicles into the scrotum may be needed.

• #1 What Is Ambiguous Genitalia? Symptoms, Side Effects, and More

  https://www.webmd.com/children/what-is-ambiguous-genitalia

  Ambiguous genitalia treatment starts by determining the cause of the condition. After they determine the cause, your childs health care provider will help you figure out a treatment plan and a sex assignment. You might need to meet with specialists like: […] The team of health care providers will support you as you decide the best way to approach your childs condition, sexual function, gender identity, and chances for fertility in the long term. You might be looking at hormone replacement therapy or reconstructive surgery. You might need to consider surgery when your child is still an infant if its medically important (like the absence of a urethral opening). If youre concerned about cosmetic appearance, you may decide to wait on surgery until your child can decide for themselves. […] Treatment for ambiguous genitalia has many layers. In addition to the factors mentioned above, you should keep your childs emotional health at the top of your priority list.

• #1 Disorders of Sex Development | UMass Memorial Health

  https://www.harringtonhospital.org/health-library/disorders-of-sex-development

  Sometimes a child with atypical genitalia is at higher risk for tumors in the sex organs. Treatment for atypical genitalia depends on the type of the disorder. But it often includes surgery to remove or create sex organs appropriate for the child’s gender. Treatment may also include hormone therapy. […] Most important, you and your family should be included early in the decision of assigning the child’s sex. Ask your healthcare provider about what is available for long-term psychological support.

• #1 Ambiguous Genitalia and Disorders of Sexual Differentiation – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557435/

  The basic principles of surgery are to ensure the best cosmetic results, preserve sexual functioning, preserve fertility if possible, and decrease the risk of malignancy in the dysgenetic gonad. Deferring surgery is often advocated until the child is old enough to confirm their gender identity. […] Surgical management of certain common DSDs is listed below. […] Congenital adrenal hyperplasia 46XX: The management of individuals is straightforward. Those up to Prader stage 1 to 4 virilizations are recommended for a female gender of rearing. However, for individuals with severe virilization and those in whom the diagnosis is delayed, male rearing should be considered. Surgery is aimed to restore the vaginal and urethral position and to correct the fistula between the vagina and urogenital sinus. Preservation of clitoral function is another important consideration.[35][36]

• #1 Pediatric ambiguous genitalia (Adrenogenital syndrome, Morris syndrome, gonadal dysgenesis) – Treatment abroad

  https://www.gsdinternational.com/conditions/pediatric-ambiguous-genitalia-adrenogenital-syndrome-morris-syndrome-gonadal-dysgenesis

  How is it treated? […] Treatment involves a number of closely related factors: hormonal balance, anatomical appearance and psychological aspects. For this reason, it is important to go to specialized centers with a medical team consisting of several specialists, including a pediatric endocrinologist, pediatric urologist and psychologist. […] Genitoplasty is a surgical procedure performed to correct the external genitalia in the female sense, by: […] possible removal of the changed gonads; […] creation of a clitoris of the correct size and sensitivity; […] creation of two separate openings for the urethra and the vagina; […] reconstruction of the labia minora and labia majora. […] These goals are achieved through a single surgical intervention, performed at about 6 months of age.

• #1 Ambiguous Genitalia and Disorders of Sexual Differentiation – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557435/

  Gonadal dysgenesis 45X/46XY mosaic: These individuals have virilization, a Y chromosome, and exposure to androgens in utero. Therefore, the male gender of rearing is recommended. A hypospadias correction and removal of streak gonad is recommended. These individuals are at increased risk of malignancy. Therefore post-puberty biopsy and gonadectomy are recommended if the biopsy is positive.[37] […] 46 XY DSD: For individuals with a deficiency of 17 beta-hydroxy dehydrogenase or deficiency of 5 alpha-reductase, a male gender of rearing is recommended. Hormonal stimulation for phallic growth followed by hypospadias correction and orchidopexy is advocated. […] Certain DSDs predispose to an increased risk of gonadal cancer. Mixed gonadal dysgenesis and partial androgen insensitivity are associated with higher oncologic risk. The timing of gonadectomy depends on the risk, gender of rearing, and functionality of the gonad. Individuals to be raised as females removal is advocated at the time of genitoplasty. For males, orchidopexy and biopsy after puberty are recommended. Streak gonads are preferably removed as early as possible. […] In addition, psychosocial support and education should be provided to both parents as well as children with DSD.

• #1 Atypical genitalia

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20369257

  Children with atypical genitalia need ongoing medical care. […] Mental health professionals can help you deal with this difference that you didn’t expect. […] Your child may find ongoing counseling by mental health professionals helpful and may choose to be a part of support groups into adulthood.

• #1 Medical and psychosexual aspects of a child with ambiguous genitalia: A case report

  https://jmpcr.samipubco.com/article_195505.html

  The patient is not included in gender dysphoria, but can be at risk of experiencing gender dysphoria if the patient cannot accept the sex change conditions experienced, so psychological counseling is needed that focuses on gender identity and roles and tasks according to the gender chosen by the patient. […] The patient was planned for a feminization reconstructive surgery. […] At the end of the observation period, the patient’s psychosocial has improved. The patient is classified as having mild depression and low anxiety. […] Successful treatment of depression and anxiety disorders in youth either psychotherapy or psychopharmacology should restore function, establish remission, and reduce the likelihood of relapse and recurrence.

• #1 Atypical genitalia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/atypical-genitalia/diagnosis-treatment/drc-20369278

  Results of surgery are often satisfying. But repeat surgeries may be needed. Risks include a disappointing appearance or problems with sexual function, such as trouble reaching an orgasm. […] Children with atypical genitalia need ongoing medical care. This includes watching for complications, such as getting cancer screenings into adulthood.

• #1 The surgical management of infants and children with ambiguous genitalia. Lessons learned from 25 years.

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1242521/

  Over a 25-year period, 91 children with ambiguous genitalia have received surgical management. Female sex assignment was made for 79. Of these, 60 patients underwent extensive clitoral reconstruction consonant with the female assignment. Forty-two patients had vaginal reconstruction. Factors relating to success include: (1) prompt and appropriate sex assignment; (2) early and accurate diagnosis; (3) conservative reconstruction of the clitoris at an early age (less than 1 year); and (4) choice of vaginal reconstruction based on the severity of the malformation. […] Long-term follow-up demonstrates satisfactory anatomic and functional results when clitoral surgery alone was required. Functional results for patients with extensive vaginal reconstruction have been compromised. […] The management plan must be flexible and individualized, incorporating long-term follow-up to adulthood.

• #1 Ambiguous Genitalia and Disorders of Sexual Differentiation – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557435/

  Accurate diagnosis is essential; in some cases, diagnosis may be obvious; however, it is prudent to transfer cases to a center experienced in the management of DSDs. A frank and honest discussion with the parents regarding the delay of gender assignment until the diagnosis is clear is warranted. […] The decision for gender assignment should be made upon the best available evidence and considerations of such as type of DSD, prenatal androgen exposure, the possibility of fertility and sexual functionality, and psychosocial factors.[32][33][34]. There are strongly differing viewpoints regarding the timing of gender assignment. The first is to assign complete genital reconstruction after birth to avoid internal conflicts with the patient or external societal conflicts as the child develops. The opposing viewpoint is that gender assignment is a shared decision that the affected individual participates in during puberty- essentially, physicians and family cannot predict future gender identity or sexual orientation.

• #1 Ambiguous genitalia: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/003269.htm

  Many experts now urge delaying definitive surgery for as long as is healthy, and ideally involving the child in the decision, unless surgery is needed for the health of the infant. Working with your child’s heath care team can help you make the best choices for your child. In addition, a DSD support group can help provide families with the latest research and offer a community of other families, children, and adult individuals who have faced the same issues.

• #1 Genetic counseling in atypical genitalia: Challenges and proposed communication approach – Wadia Journal of Women and Child Health

  https://wjwch.com/genetic-counseling-in-atypical-genitalia-challenges-and-proposed-communication-approach/

  Atypical genitalia (AG) is a rare condition in which a child’s external genitals are not properly distinguished. […] Identification of genetic causes in such children is important for appropriate genetic counseling. Genetic counseling in AG is very crucial and sensitive. […] The article highlights the importance of genetic counseling, challenges in genetic counseling, and proposes a simple but effective communication approach in AG. […] Genetic counseling for the parents and conveying the test results is very challenging considering the complexity and sensitivity of the information to be shared. […] Improved genetic testing services, increased attention toward patients, understanding AG in a broader aspect, education of parents, and the formation of parent support groups have significantly improved care of such children.

• #1 Genetic counseling in atypical genitalia: Challenges and proposed communication approach – Wadia Journal of Women and Child Health

  https://wjwch.com/genetic-counseling-in-atypical-genitalia-challenges-and-proposed-communication-approach/

  Laboratory genetic diagnosis is very important for counseling parents or patient. […] Since genetic reports are complex and not applicable to the patient, only genetic counseling should be carried out by a trained genetic counselor or a medical geneticist. All clinics for individuals born with DSD should have genetic counselors and geneticists who are adept at explaining the clinical condition of the patient.

• #1 The Fetal Medicine Foundation

  https://fetalmedicine.org/education/fetal-abnormalities/genital-tract/ambiguous-genitalia

  Ambiguous genitalia […] Prevalence: 1 in 5,000 births. […] Ultrasound diagnosis: […] On the basis of the cause, the condition is divided into: […] Follow up: In families with congenital adrenal hyperplasia, administering dexamethasome to the pregnant woman from 6 weeks gestation can minimize the effect of androgens on the genitalia and the developing brain. If the fetus is male, steroids should be discontinued. […] Prognosis: Treatment of a neonate with ambiguous genitalia should be performed by a multidisciplinary team, including geneticists, pediatric endocrinologists, and pediatric urologist. There is controversy concerning sex assignment and the need or not of reconstructive surgery.

• #1 Hormone treatment to prevent ambiguous genitalia in baby girls spurs debate

  https://medicalxpress.com/news/2010-08-hormone-treatment-ambiguous-genitalia-baby.html

  Hormonal treatment to prevent ambiguous genitalia can now be offered to women who may be carrying such infants. […] The treatment is a step toward „engineering in the womb for sexual orientation,” said Alice Dreger, a professor of clinical medical humanities and bioethics at Northwestern University and the most outspoken opponent

• #1 Ambiguous genitalia: clinical management of adult female with male assigned gender: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-021-02914-2

  Since all the internal female genital organs were found to be normal, the second decision of the surgical team was the assignment of the external genitalia to correspond with the internal organs; thus, construction of the vulva was indicated. […] The surgery was scheduled and duly performed with successful separation, vaginoplasty, and neoclitoroplasty. […] Managing an adult with ambiguous external genitalia requiring surgical intervention is extremely rare as patients with various spectra of the disease requiring surgical intervention most probably would have received it during childhood or adolescence. […] The current practice for managing these diseases is an early multidisciplinary approach that often includes early surgical evaluation and possible reconstruction, at most deferring until adolescence.

• #1 Ambiguous genitalia: clinical management of adult female with male assigned gender: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-021-02914-2

  Continuous psychological counseling while delaying vaginoplasty is currently considered. […] The optimal timing of the surgery remains unclear. […] It demonstrates the relative ease of surgical intervention as a result of well-developed structures at the perineal area for dissection and raising of flaps during vaginoplasty and neoclitoroplasty. […] The advantages of deferring surgical reconstruction with psychological counseling after early assessment need to be considered to prevent inappropriate gender assignment.

• #1 Ambiguous genitalia: clinical management of adult female with male assigned gender: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-021-02914-2

  Disorders of sex development are anomalies in which the development of urogenital ridge is undifferentiated for the male and female child. […] Early multidisciplinary approach in the management of ambiguous genitalia including early surgical intervention is the predominant practice, with few current considerations on deferral of genital reconstruction until adolescent age. […] The surgical team decided to assign external genitalia to correspond with the already intact internal organs, thus constructing the vulva. […] The management of patients with DSD and related conditions is focused on four aspects: (1) etiological diagnosis, (2) assignment of gender, (3) indication for and timing of genital surgery, and (4) disclosure of medical information to the patient. […] The management of the DSD in this case was focused on first ascertaining the etiological diagnosis.

• #1 Ambiguous Genitalia: Causes, Diagnosis, and Management of Intersex Conditions

  https://www.labtestsguide.com/ambiguous-genitalia

  Ethical considerations are paramount in the management of intersex conditions. Healthcare professionals must prioritize the individuals well-being, autonomy, and right to self-determination throughout the process. […] Advocacy organizations play a crucial role in raising awareness about intersex issues, promoting the rights of intersex individuals, and challenging harmful practices.

• #2 Atypical genitalia

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20369257

  Atypical genitalia is not a disease; it’s a difference of sex development. […] Your medical team looks for the cause of atypical genitalia and provides information and counseling that can help guide decisions about your baby’s sex and any needed treatment. […] The goal of treatment is long-term mental health and social well-being, as well as having as much sexual function and fertility as possible. When to begin treatment depends on your child’s specific situation. […] Managing it may require a team of experts. […] Hormone medicines may help correct or manage hormones that are out of balance. […] In children with atypical genitalia, surgery may be used to keep healthy sexual function and create genitals that appear more typical. […] The timing of surgery depends on your child’s specific situation.

• #2

  https://www.kuh.ku.edu.tr/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/ambiguous-genitalia

  Ambiguous genitalia is a rare condition in which an infant’s external genitals don’t appear to be clearly either male or female. […] Your medical team will look for the cause of ambiguous genitalia and provide information and counseling that can help guide decisions about your baby’s gender and any necessary treatment. […] Once you and your doctor have chosen a gender for your baby, you may choose to begin treatment for ambiguous genitalia. The goal of treatment is long-term psychological and social well-being, as well as to enable sexual function and fertility to the greatest extent possible. […] Ambiguous genitalia is uncommon and complex, and it may require a team of experts. The team might include a pediatrician, neonatologist, pediatric urologist, pediatric general surgeon, endocrinologist, geneticist, and psychologist or social worker.

• #2 Ambiguous genitalia Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/symptoms/ambiguous-genitalia

  Ambiguous genitalia is a rare condition where a child is born with outer genitals that do not clearly look either male or female. […] With a few exceptions, ambiguous genitalia is most often not life-threatening. However, its treatment has short- and long-term consequences. For this reason, a team of health care professionals with expertise in DSD will work together to understand and treat the child and support the family. This team may include neonatologists, geneticists, endocrinologists, and psychiatrists or social workers. The specific treatment will depend on the specific cause of the ambiguous genitalia. […] Depending on the cause, surgery, hormone replacement, or other treatments are used to treat conditions that can cause ambiguous genitalia. […] Many experts now urge delaying definitive surgery for as long as is healthy, and ideally involving the child in the decision, unless surgery is needed for the health of the infant. Working with your child’s heath care team can help you make the best choices for your child.

• #2 Management of the infant with atypical genital appearance (difference of sex development) – UpToDate

  https://www.uptodate.com/contents/management-of-the-infant-with-atypical-genital-appearance-difference-of-sex-development

  Nonetheless, there is ongoing controversy about some aspects of management. […] The uncertainties about adult gender identity, optimal timing of surgery, and surgical outcomes including timing of surgery should be included in informed decision-making by the parents and patient (when age appropriate).

• #2 Disorders of Sex Development | UMass Memorial Health

  https://www.harringtonhospital.org/health-library/disorders-of-sex-development

  Sometimes a child with atypical genitalia is at higher risk for tumors in the sex organs. Treatment for atypical genitalia depends on the type of the disorder. But it often includes surgery to remove or create sex organs appropriate for the child’s gender. Treatment may also include hormone therapy. […] Most important, you and your family should be included early in the decision of assigning the child’s sex. Ask your healthcare provider about what is available for long-term psychological support.

• #2 Ambiguous Genitalia | Doctor

  https://patient.info/doctor/ambiguous-genitalia

  The four key issues in management are: Accurate diagnosis, Gender assignment, Indications and timing of major surgery, Sharing of medical information with patient and parents. […] Parents should be advised to delay registering the birth (it can be legally difficult to alter later) and naming the baby, until the sex of rearing is decided. […] This should be done after completion of the diagnostic process, including full clinical, genetic and biochemical investigation. […] Surgical treatment may be required. The timing of surgery can be controversial. Examples of the requirement for surgery include: Hypospadias in males, Vaginoplasty and clitoroplasty, which may be required In virilised females, Gender reassignment, which may require surgery (multiple procedures), Gonadectomy, which may be advisable for patients with dysgenetic or nonfunctional gonads because of the risk of malignant change. […] Psychological support. Families will need intensive support, full explanations and information. This helps bonding with their child and probably the development of the child.

• #2 Congenital Adrenal Hyperplasia Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/919218-treatment

  Infants with ambiguous genitalia should be closely observed for symptoms and signs of salt wasting while a diagnosis is being established. […] Patients with dehydration, hyponatremia, or hyperkalemia and a possible salt-wasting form of adrenal hyperplasia should receive an intravenous (IV) bolus of isotonic sodium chloride solution (20 mL/kg or 450 mL/m2) over the first hour, as needed, to restore their intravascular volume and blood pressure. […] After the patient’s condition is stabilized, treat all patients who have adrenal hyperplasia with long-term glucocorticoid or aldosterone replacement (or both), depending on which enzyme is involved and on whether cortisol and/or aldosterone synthesis is affected. […] Infants with ambiguous genitalia require surgical evaluation and, if needed, plans for corrective surgery.

• #2 Intersex Conditions Treatment

  https://www.urologists.org/article/treatments/intersex-conditions-treatment

  A physician will conduct extensive testing concerning hormones and anatomy. […] Another approach to managing intersex conditions is using hormone therapy to compensate for the sex hormones a child may not be producing. […] Most surgical treatments to address DSD as a baby are related to a possible medical emergency, such as when the abnormally formed tissue has cancerous cells present. […] Physicians and parents can work together to determine if surgeries to reinforce gender assignment at a young age are appropriate. […] In females with male-looking genitalia, surgical treatment may be done to reconstruct the labia, reduce the size of an abnormally enlarged clitoris, or increase the length or opening of the vagina. […] The outlook of treatment for intersex conditions depends upon the type of disorder of sexual development and the course of treatment. […] For this, long-term counseling is often provided.

• #2 Ambiguous Genitalia and Disorders of Sexual Differentiation – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557435/

  Gonadal dysgenesis 45X/46XY mosaic: These individuals have virilization, a Y chromosome, and exposure to androgens in utero. Therefore, the male gender of rearing is recommended. A hypospadias correction and removal of streak gonad is recommended. These individuals are at increased risk of malignancy. Therefore post-puberty biopsy and gonadectomy are recommended if the biopsy is positive.[37] […] 46 XY DSD: For individuals with a deficiency of 17 beta-hydroxy dehydrogenase or deficiency of 5 alpha-reductase, a male gender of rearing is recommended. Hormonal stimulation for phallic growth followed by hypospadias correction and orchidopexy is advocated. […] Certain DSDs predispose to an increased risk of gonadal cancer. Mixed gonadal dysgenesis and partial androgen insensitivity are associated with higher oncologic risk. The timing of gonadectomy depends on the risk, gender of rearing, and functionality of the gonad. Individuals to be raised as females removal is advocated at the time of genitoplasty. For males, orchidopexy and biopsy after puberty are recommended. Streak gonads are preferably removed as early as possible. […] In addition, psychosocial support and education should be provided to both parents as well as children with DSD.

• #2 Ambiguous Genitalia | Doctor

  https://patient.info/doctor/ambiguous-genitalia

  Ambiguous genitalia may be a result of a disorder of sexual development (DSD), previously called intersex conditions. The ability to diagnose these conditions has improved greatly in recent years, due to advances in molecular genetics. Prompt, accurate diagnosis and counselling about therapeutic options should be available to parents soon after the baby’s birth. […] Recent research has challenged this thinking, so reconstructive surgery may now be deferred until psychological and social implications can be considered. Evidence about long-term outcomes for people with DSD who undergo gender assignment and reconstructive surgery is still lacking. […] Gender assignment of infants with DSD will involve discussion with a team including geneticists, neonatologists, endocrinologists, surgeons, ethicists and counsellors. The timing of both gender assignment and surgery is still under debate and further trials are needed to clarify these difficult decisions.

• #2 Congenital Adrenal Hyperplasia Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/919218-treatment

  Some female infants with adrenal hyperplasia have only mild virilization and may not require corrective surgery if they receive adequate medical therapy to prevent further virilization. […] A retrospective study by Dangle et al on feminizing reconstructive surgery in 26 toddlers with congenital adrenal hyperplasia reported that the procedures are typically well tolerated and successful. […] Bilateral adrenalectomies have been suggested in the management of virilizing forms of adrenal hyperplasia in order to prevent further virilization and advancement of skeletal maturation. […] It is suggested that bilateral adrenalectomy not be performed in patients with congenital adrenal hyperplasia. […] It is advised that parents of all pediatric patients with congenital adrenal hyperplasia, especially those of minimally virilized girls, be informed about surgical options, including delaying surgery and/or observation until the child is older.

• #2 Ambiguous Genitalia: Causes, Diagnosis, and Management of Intersex Conditions

  https://www.labtestsguide.com/ambiguous-genitalia

  Hormone therapy may be used to address hormonal imbalances and achieve a hormone profile more aligned with the individuals gender identity. […] Hormonal treatment can play a role in the development of secondary sexual characteristics during puberty. […] Intersex individuals and their families may benefit from psychological counseling and support to navigate the emotional and psychosocial challenges associated with intersexuality. […] Providing gender-affirming care involves respecting an individuals self-identified gender and supporting their gender expression. […] Some intersex conditions may require surgical interventions to address medical issues or improve urinary and reproductive function. […] Whenever surgery is considered, the risks, benefits, and potential outcomes should be thoroughly discussed with the individual or their parents/guardians.

• #2

  https://www.kuh.ku.edu.tr/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/ambiguous-genitalia

  Hormone medications may help correct or compensate for the hormonal imbalance. […] In children with ambiguous genitalia, surgery may be used to preserve normal sexual function and create genitals that appear more typical. […] The timing of surgery will depend on your child’s specific situation. […] Children with ambiguous genitalia require ongoing medical care and monitoring for complications, such as cancer screenings, into adulthood. […] Mental health professionals can help you deal with this difficult and unexpected challenge. […] Your medical team will provide you with updates and information as quickly as possible to help settle any questions about your child’s health.

• #2 Ambiguous genitalia: clinical management of adult female with male assigned gender: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-021-02914-2

  Continuous psychological counseling while delaying vaginoplasty is currently considered. […] The optimal timing of the surgery remains unclear. […] It demonstrates the relative ease of surgical intervention as a result of well-developed structures at the perineal area for dissection and raising of flaps during vaginoplasty and neoclitoroplasty. […] The advantages of deferring surgical reconstruction with psychological counseling after early assessment need to be considered to prevent inappropriate gender assignment.

• #2 FloridaHealthFinder | Ambiguous genitalia | Health Encyclopedia | FloridaHealthFinder

  https://quality.healthfinder.fl.gov/health-encyclopedia/HIE/1/003269

  With a few exceptions, ambiguous genitalia is most often not life-threatening. However, its treatment has short- and long-term consequences. For this reason, a team of health care professionals with expertise in DSD will work together to understand and treat the child and support the family. This team may include neonatologists, geneticists, endocrinologists, and psychiatrists or social workers. The specific treatment will depend on the specific cause of the ambiguous genitalia. […] Depending on the cause, surgery, hormone replacement, or other treatments are used to treat conditions that can cause ambiguous genitalia. […] Many experts now urge delaying definitive surgery for as long as is healthy, and ideally involving the child in the decision, unless surgery is needed for the health of the infant. Working with your child’s heath care team can help you make the best choices for your child.

• #2 Prevention of ambiguous genitalia by prenatal treatment with dexamethasone in pregnancies at risk for congenital adrenal hyperplasia

  https://www.degruyterbrill.com/document/doi/10.1351/pac200375112013/html

  Prevention of ambiguous genitalia by prenatal treatment with dexamethasone in pregnancies at risk for congenital adrenal hyperplasia. […] Prevention of ambiguous genitalia by prenatal treatment with dexamethasone in pregnancies at risk for congenital adrenal hyperplasia.

• #2 Intersex Conditions Treatment

  https://www.urologists.org/article/treatments/intersex-conditions-treatment

  Intersex conditions also known as disorders of sex development (DSD) occur when a child’s internal and external reproductive organs develop abnormally. […] While surgery and other medical treatments are available for intersex conditions, but can be delayed to give the child a chance to participate in decisions about their gender. […] Treatment ideally involves a team of health care professionals who have experience in treating intersex conditions. […] Decisions concerning treatment typically center around four major factors: first, the child’s diagnosis and its causes; second, gender assignment or deciding if a child will be considered male or female; third, when genital surgeries or treatments may be appropriate; and four, how and when information about the child’s medical condition will be disclosed to the child.

• #2 Ambiguous Genitalia: Causes, Diagnosis, and Management of Intersex Conditions

  https://www.labtestsguide.com/ambiguous-genitalia

  Management and Treatment: Here are some key considerations in the management and treatment of intersex conditions. […] Intersex conditions often require the expertise of a multidisciplinary team of healthcare professionals, including pediatric endocrinologists, urologists, gynecologists, psychologists, and geneticists. […] The team collaboratively evaluates the individuals medical and psychological needs to create a comprehensive and personalized care plan. […] Involving the individual (if they are capable of making decisions) or their parents/guardians in the decision-making process is essential. Providing them with clear and unbiased information about available options empowers them to make informed choices about their care. […] In many cases, surgical interventions on intersex children are not medically urgent. It is crucial to avoid unnecessary and irreversible procedures until the individual can actively participate in decision-making.

• #2 Ambiguous Genitalia and Disorders of Sexual Differentiation – MD Searchlight

  https://mdsearchlight.com/sexual-health/ambiguous-genitalia-and-disorders-of-sexual-differentiation/

  Lastly, some conditions increase the risk of gonadal cancer. In these situations, the timing of a gonadectomy (removal of gonads) depends on the risk, the assigned gender, and the functionality of the gonad. Besides, both parents and children with such conditions should be provided with psychosocial support and education to help them understand and manage the situation.

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