Читать книгу Handbook of Clinical Gender Medicine - Группа авторов - Страница 78

Feminization surgery is the ultimate alternative in patients carrying Y material. This surgery was common in the past in groups of patients with severe genital ambiguities for whom female assignment was the usual ‘by default’ response. The rationale was that it is surgically easier to create a penetrative conduit than a penetrating organ. Nowadays this option is much rarer even in mixed gonadal dysgenesis patients. The remaining indications are essentially represented by the complete androgen insensitivity syndrome, extreme forms of micropenis or PAIS with poor response to androgen stimulation, 5-α reductase deficiency, 17-hydroxysteroid dehydrogenase deficiency, LH receptor deficiency, and complete gonadal dysgenesis.

This surgery includes three main steps. The first step involves creation of a vaginal conduit by connecting an existing müllerian cavity to the pelvic floor, or by dilating an existing vaginal cup, or by creating a penetrative conduit de novo. There is no consensus regarding the timing of this surgery. The second step consists of GT reduction which is also subject to controversies as this surgery may jeopardize GT sensitivity. A better understanding of the nerve distribution of the GT has led to major changes in the surgical procedures (a paradox of this surgery is that outcomes will be assessed many years in the future, when the patient becomes an adult). The third step is refashioning the perineal anatomy.

Other procedures essentially include gonadal surgery and surgery of the müllerian remnants.