IMPE Abstracts

Introduction: Differences of sexual development (DSD) define congenital diseases in which there is an atypical development of chromosomal, gonadal or anatomical sex, and may present varying degrees to genital atypia. There has been a discussion about the ideal time for surgical approach of atypical genitalia. Some non-governmental entities argue that the surgical approach should be delayed until adulthood after the patient's consent. Objective/methodology: To analyze the perspectives and feelings of adult DSD patients followed at a reference center in São Paulo regarding surgical approach. It was a transversal study and patients were submitted to individualized semi-directed interviews. Results: 72 patients were interviewed. Patients’ mean age was 37 years. 90% of the patients completed at least the high school. 39% male and 61% female. 76% 46XY DSD, 17% 46XX DSD and 7% chromosomal DSD. 62.5% of them had atypical genitalia diagnosed at birth. Considering patients with atypical genitalia at birth, the patients’ median age at the first genioplasty approach was 4 years (3.3 months-41.3 years). The patients’ median age at gonadectomy was 16.3 years. When asked about the ideal period/age for genitoplasty, 66.2% considered the childhood, 12.7% cited when they were teenagers, 9.7% in adulthood, 4.2% of them didn’t wish to undergo surgery or to have undergone surgery and 7% of them didn’t know, didn’t answer or were indifferent. The extreme discomfort reported by the patients related to atypical genitalia decreased after the surgical approach: from 75% to 36.5% p: 0.01 (on a scale of 1 “without discomfort’ to 4 “extreme discomfort”). Insecurity about the appearance of genitalia and functionality during sexual intercourse influences negatively affective relationships. 10.8% patients presented gender dysphoria, all of them with 46 XY DSD. Conclusion: Most 46 XY DSD patients considered childhood the ideal time to correct their atypical genitalia. An early follow-up in a reference center and an adequate evaluation by a multidisciplinary may influence the positive results associated to the surgical approach of the atypical genitalia in childhood and the low prevalence of gender dysphoria in adulthood.