The Intersex Society of North America calls attention to an article by Catherine Minto, Christopher Woodhouse, Phillip Ransley, and
Sarah Creighton, published in the current issue of The Lancet.
The article, 'The effect of clitoral surgery on sexual outcome in individuals who have intersex conditions with ambiguous genitalia:
A cross-sectional study,' offers evidence that 'sexual function could be compromised by clitoral surgery.' Minto and her colleagues
argue that ' [ d ] ebate on the ethics of the use of this surgery in children should be promoted and further multicentre research is needed
to ensure representative samples and comprehensive outcome assessment. Meanwhile, parents and patients who consent to clitoral
surgery should be fully informed of the potential risks to sexual function' ( page 2 ) .
The research was based on the experiences of 39 adult women with intersex conditions and ambiguous genitalia, recruited from
both clinical and peer-support settings in the UK. Data were obtained via questionnaire, hospital notes, and genital examinations.
Sexual problems in relation to surgical history were assessed and compared to a healthy control group. Of the 39 individuals in the
study group, 28 had been sexually active and all had experienced sexual difficulties. Of the women who had undergone clitoral
surgery and were sexually active, 78% had higher rates of non-sensuality and 39% reported an inability to achieve orgasm as
compared to those who had not had surgery. Sexual function data were available for only 28 participants of the original 39 because
11 women ( 28% ) had never been sexually active.
Subjects in the study who had undergone clitoral surgery were treated with different techniques depending on when the surgeries
were performed. Those women operated on prior to 1979 had clitorectomies ( removal of the clitoris ) , while those operated on after
1980 underwent clitoral reduction with corporal excision ( which is thought to be nerve-sparing ) . Four women had experienced more
than one clitoral operation depending on their specific intersex condition and circumstances, and 64% of the women had also had
vaginoplasties. Age at surgery varied from one month to 23 years.
This study is significant for many reasons, according to Intersex Society Executive Director Monica J. Casper, Ph.D.:
The authors offer evidence of a negative relationship between clitoral surgery and sexual function.
The authors offer evidence that differences in surgical technique ( clitorectomy vs. clitoral reduction ) do not seem to matter with
respect to sexual function; indeed, three women who had experienced clitoral reduction and were sexually active had the worst
possible scores for orgasm difficulty.
The authors reject the claim that clitoral surgery has no long-term effect on sexual function, asserting instead that a ) there has
not been sufficient research to address this, and b ) clinicians involved in adult care should assess their patients for potential sexual
problems and provide healthcare services accordingly.
The authors recommend better informed consent about the effects of surgery on sexual function, and call for additional
research on psychological, sexual, and quality of life outcomes of clitoral surgery for intersex conditions.
See www.isna.org .