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Background: Further attention to genital organs has become a concern for women in line with changes in society's culture. In recent years, the number of surgeries has grown increasingly. The aim of this study was to investigate the relationship between body image and satisfaction with sexual life of female genital cosmetic surgery volunteers in reproductive age women in Shiraz. Methods: This cross-sectional study was performed on 160 women referring to Shiraz Health and Medical Centers willing to undergo female genital cosmetic surgery. Data collection was performed using Demographic Information Questionnaire, SWBI and Enrich Marital Satisfaction Questionnaire. The data were analyzed through Spss24 software using Pearson statistical methods of correlation coefficient and one-sample t-test. Results: This cross-sectional study was conducted on 160 women (average age of 30.83 ± 5.48) willing to undergo genital cosmetic surgery at Shiraz health and medical centers. The results of this study showed that women willing to undergo female genital cosmetic surgery are satisfied with their physical appearance. Correlation coefficient test between body image and satisfaction with marital life also showed that there is a significant relationship between these two variables (p < 0.001). This means that with the satisfaction of body image, the level of satisfaction with marital life also increases. Conclusion: The most important findings of this study included no correlation between women's negative perceptions of their bodies and dissatisfaction with sexual life with a tendency to cosmetic surgery on the genital area. Therefore, it is necessary to understand the factors influencing this decision. [ABSTRACT FROM AUTHOR]

Medical intervention in the context of variations in sex characteristics (intersex variations) has been addressed by many academic disciplines, including medical research, human rights law, and psychosocial research, but few studies bring these diverse disciplines into substantive dialogue. Recent years have seen an increase in human rights statements about the indefensibility of some surgical interventions carried out on children with variations in sex characteristics. This has prompted attempts in some jurisdictions to move towards human rights-based healthcare for people with intersex variations. Such a move will require better dialogue across legal and health-related disciplines, as well as a clearer overview of which and how many surgical interventions are at issue. The present paper initiates the dialogue across disciplines and quantifies surgical interventions carried out on the sexual and reproductive organs of minors in Aotearoa New Zealand, over a five-year period. We suggest that, for the purpose of monitoring any shift towards human rights-based healthcare, national healthcare data will need to more clearly identify diagnoses and interventions relating to minors with variations in sex characteristics. [ABSTRACT FROM AUTHOR]

In the last two decades, genital transplants have emerged as another type of quality‐of‐life transplants. Successful allogenic transplantations of the uterus, ovary, testicle, and penis have all been reported. Yet, there is no discussion of clitoris transplantation in the medical literature, mass media, and everywhere else I searched. This surgery could be used for cisgender women who have a clitoral injury or disease or who have undergone female genital cutting. I examine the gender norms regarding sexuality and reproduction to show how they shape surgical advancements. My point in this paper is not to take a normative position on status of current genital transplantations. Rather, I highlight that their existence is due, at least in part, because they align with dominant gender norms: penis and testicle transplantations reinforce the importance of men's virility and the existence of "normal" male genitalia, whereas uterus and ovary transplantations uphold the conflation of women and reproduction and the strong valuing of women's fertility. That medical advances reflect cultural values is not a new claim. What is new in this paper is the discussion of how sexism norms—regarding the invisibility of the clitoris and the devaluing of women's sexual pleasure— has engendered various types of genital transplants, but not clitoris transplantation. [ABSTRACT FROM AUTHOR]

Vulva's Crohn's disease (CD) is a rare condition that can be easily misdiagnosed if not thoroughly investigated. The typical presentation of the disease is swelling, deep linear fissures, erythema and painful, and progressive ulceration of the labia. There are various treatment protocols, yet none of them have been established as gold standard. Surgery is not recommended, and medical treatment is the current standard of care. We aim to report an unusual presentation of vulvar CD and discuss the treatment option of surgery, a valuable alternative when medical therapy yields ineffective results. A 36-year-old patient, whose initial symptoms had begun 7 years ago, presented with labial fistulas and multiple tissue papillomas. During the disease course, the patient had previously received corticosteroid and antibiotic treatments of limited benefit. Vulvar hypertrophy was significant, and papilloma formation related to the extension of the knife-like ulcers had left the outer genitals dysmorphic. The patient underwent two consecutive partial vulvectomies with 1 year apart, along with oral moxifloxacin treatment. Partial vulvectomies reduced the amount of hypertrophic tissues and papillomas and allowed for asymptomatic urine output. The patient also had psychological relief and experienced less intervening intertriginous fungal infections. Due to the ongoing inflammatory process of CD, symptomatic and clinical relief by stabilizing the condition is of utmost importance. Although medical treatment is frequently sufficient to stabilize symptoms of vulvar CD, surgery certainly reserves a place in the treatment algorithm when the patient is unresponsive to other treatment modalities. [ABSTRACT FROM AUTHOR]

IntroductionElective aspects of surgical management of pediatric differences of sex development (DSD) are associated with controversy. We examined North American pediatric urologist and endocrinologist perspectives regarding recommended and existing informed consent elements for written consent documents prior to pediatric genital surgery.MethodsFocus groups with pediatric urologist and endocrinologist members of the Societies for Pediatric Urology (SPU, n=8) or Pediatric Endocrine Society (PES, n=8) were held to identify elements of informed consent for DSD-related urogenital surgery. Elements were subsequently included in web-based surveys in 2003 and 2020 (SPU: n=121 and 143; PES: n=287 and 111, respectively). Participants rated their level of agreement with including each element in informed consent documents. In 2020, participants reported whether documents they use in clinical practice incorporate these elements.ResultsFocus groups identified four elements of informed consent: on-going debate over pediatric genital surgery; potential needs for multiple procedures; possible gender change and surgical reversal; and non-surgical alternatives. Across both years and both specialties, a majority (79% to 98%) endorsed the four elements, with significant between-group differences. Significantly more PES than SPU participants reported not knowing whether specific elements were included in current written informed consent; of those who knew, the majority (66% to 91%) reported inclusion.DiscussionSpecialists agree with including these four elements in written informed consent documents. Endocrinologists are not always familiar with the exact elements included. The degree to which non-surgeon members of the care team should be involved in the written informed consent process is an open question.

Phalloplasty in the female to male transgender patient is a complex operation aimed at creating a functional and aesthetic phallus, external genitalia, and perineum. Functional goals include standing micturition and sexual function with erogenous and tactile sensation as well as the ability to participate in penetrative intercourse. Functional genital reconstruction relies on creating of a fully lengthened urethra from local tissues as well as the provision for additional length via tissue transplantation. This manuscript will review techniques for the creation of perineal urethral segment as well as primary flaps available for the creation of neophallus. Particular emphasis is given to our preferred method of reconstruction: single-stage urethral lengthening with radial forearm flap phalloplasty including a review of surgical techniques and complications. [ABSTRACT FROM AUTHOR]

Most minors and young transgender persons wishing to undergo gender-affirming surgery need to seek specialists affiliated with gender affirmation programs in adult hospitals. Research suggests gender affirmation surgery has been established as an effective and medically indicated treatment for gender dysphoria. Although most data on gender-affirming surgeries are from adult populations, there is growing literature establishing their effectiveness in adolescents and young adults. Therefore, it is critical to evaluate the perioperative outcomes for gender-diverse youth to deliver safe and affirming care. The primary objective of this retrospective case series is to examine the perioperative characteristics and outcomes of patients with gender identity disorders (International Classification of Diseases [ICD]-10-code F64) who underwent chest reconstruction (mastectomy) and genital surgery (phalloplasty, metoidioplasty, and vaginoplasty) in a pediatric academic hospital. The secondary aim is to evaluate the value of a specialized anesthesia team for improving clinical outcomes, interdisciplinary communication, and further advancing the transgender perioperative experience. We identified 204 gender affirmation surgical cases, 177 chests/top surgeries, and 27 genital/bottom surgeries. These findings indicate gender-diverse individuals who underwent life-changing surgery at our institution had a median age of 18 years old, with many patients identifying as transmen. Our data suggests that postoperative pain was significant, but adverse events were minimal. The evolution of a specialty anesthesia team and initiatives (anesthesia management guidelines, scheduling, continuity, and education) necessitate direct care coordination and multidisciplinary planning for gender affirmation surgery in transgender youth. [ABSTRACT FROM AUTHOR]

Introduction: Diverse sex development (dsd) is an umbrella term for different congenital conditions with incongruence of chromosomal, gonadal, and phenotypic sex characteristics. These are accompanied by various uncertainties concerning health-related, medical, psychosocial, and legal issues that raise controversial discussion. Aim: The aim of this exploratory study was to investigate 3 questions: What are the most controversial and disputed issues in the context of intersex/dsd? Which issues are associated with the biggest knowledge gaps? Which issues involve the greatest difficulty or uncertainty in decision-making? A further aim was to investigate whether the group of persons concerned, the parents of intersex children, and the group of experts in the field had differing views regarding these questions. Methods: A self-developed questionnaire was distributed among persons concerned, parents of children with intersex/dsd, and experts in the field. It contained open and multiple-choice questions. The answers from 29 participants were entered into data analysis. A mixed-method approach was applied. Quantitative data were analysed descriptively. Qualitative data were analysed according to the principles of qualitative content analysis. Main Outcome Measure: Participants answered questions on the most controversial and disputed issues, issues associated with the biggest knowledge gaps, and issues associated with the most difficulty or uncertainty in decision-making. Results: The findings indicate that controversial issues and uncertainties mainly revolve around surgical interventions but also around the question of how to adequately consider the consent of minors and how to deal with intersex in the family. Significant differences were found between persons concerned and parents vs academic experts in the field regarding the perceptions of procedure of diagnostic investigation and/or treatment in adulthood, on legal questions concerning marriage/registered civil partnerships, and on lack of psychosocial counseling close to place of residence. Conclusion: The necessity of irreversible gonadal and genital surgery in early childhood is still a matter of strong controversy. To ensure the improvement in well-being of intersex persons, including a sexual health perspective, the positive acceptance of bodily variance is an important prerequisite. Psychosocial support regarding one-time decisions as well as ongoing and changing issues of everyday life appears to be an important means in reaching overall quality of life.Lampalzer U, Briken P, Schweizer K. Dealing With Uncertainty and Lack of Knowledge in Diverse Sex Development: Controversies on Early Surgery and Questions of Consent—A Pilot Study. Sex Med 2020;8:472–489.

A major complication of feminizing genitoplasty in children is the loss of clitoral sensation with serious impact at adult life. We suggest a new method to evaluate the surgical results during childhood based on the bulbocavernosus or clitoro-perineal reflex (CPR). The afferent pathway of CPR implies the intact sensory receptors on the clitoral glans. Girls with congenital adrenal hyperplasia who were followed-up medically without surgery or who underwent feminizing genitoplasty with or without clitoroplasty were included (2002–2018). All clitoroplasties were standardized reduction clitoroplasty with preservation of neurovascular bundles associated with vaginoplasty and vestibuloplasty. Standardized examinations were prospectively performed including the CPR starting at one year postoperatively. The reflex was triggered by gentle touch of the glans by a cotton swab. Contraction of the perineal muscles was considered positive. Thirty-two children were operated at a median age of 8.6 months (5.8–12.1). Median follow-up (FU) was 3.9 years (1.3–6.4). Twenty-four patients had clitoroplasties: 17 were tested for CPR at one-year FU, and all had a positive test. Eight girls had genitoplasty without clitoral surgery, two of them were tested and were positive. Ten patients were managed without surgery, two of them were tested for the CPR and were positive. The reflex was always triggered easily and repeated at least twice during the FU. The clitoro-perineal reflex is a simple, non-invasive and reproducible test in early childhood and may serve as an early evaluation tool of clitoral innervation after feminizing genitoplasty. These results need to be confirmed at long term and completed at adult life. [ABSTRACT FROM AUTHOR]

In the 11th version of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) there has been a significant change in the placement of gender identity conditions. Gender incongruence will now be reclassified within the chapter «Conditions Relating to Sexual Health». In this paper we suggest that there are a number of potential ethical and clinical problems with this. One problem is that sexual health conditions are often assumed to have psychofunctional aetiology, so the rejected psychiatric classification may reemerge regardless of reclassification. The second problem is that reclassifying gender incongruence as a condition relating to sexual health could lead to a misguided understanding of gender identity as an issue that is necessarily or inherently related to one’s sexuality and subsequently to an imprudent focus on genital incongruence. We suggest that understanding gender incongruence as something relating to one’s sexuality and thus becoming ultimately integral to a person’s sexual health may shape the perception of what is proper medical treatment. To explain how this may happen we, in part, consider the case of intersex conditions and specifically so-called «genital-normalising» surgery. We do not want to compare intersex with gender variance, yet we argue that there is a lesson to be learnt from the way clinical nomenclature may shape the understanding of human diversity and health and disease, and therefore influence the provision of medical care, specifically genital surgery. Using the case of intersex conditions or variations of sex characteristics, pathologised as Disorders of Sex Development, we can further argue that focusing on medical anatomical or functional sexual health prognosis fails to consider gender identity in its entirety. We therefore suggest an alternative chapter entitled «Conditions Relating to Sex and Gender Identity».

Copyright of Droit et Cultures is the property of Revue Droit et Cultures - Universite Paris Nanterre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article draws on fieldwork I conducted on the case management of variations of sex development in surgical missions in West Africa. My analysis will focus on two kinds of situations encountered at the missions: “undervirilized boys” who present with a rather common variation of sex development called hypospadias; and “girls raised as boys,” i.e., children with more complex intersex conditions who would have been assigned to the female sex in the North, but were raised as boys in West Africa in the absence of an early diagnosis. The analysis of the surgical and nonsurgical management of these situations in a postcolonial context and within the Western paradigm of evidence-based medicine makes it possible to cast a new light on clinical practices and questions that are central to the current debates for the recognition of human rights for intersex people: the issue of performing or not “normalizing” genital surgeries, and the best criteria for sex assignment.

ABSTRACT Allah SWT has set the rules on the issue of inheritance clearly and firmly in Al-Qur'an Surah An-Nisa article 11. It explains about the division of inheritance based on male and female sex, that is 2:1 (Das Sollen). But in fact there is a group of people called Khuntsa (double sex). Neither in Al-Qur‘an nor Hadist explains the provisions of inheritance for khuntsa heirs and the large number of parts they receive (Das Sein). The formulation of the problem in this study is how inheritance for the heirs who perform double genital surgery (khuntsa) according to KHI and how the right should be given to the heirs who perform double genital adjustment surgery (khuntsa) in accordance with Islamic Law. This research uses juridical normative approach method with analytical descriptive research specification. Sources and types of data are secondary data obtained from Islamic legal norms on inheritance and khuntsa obtained from Al-Quran, Hadist, KHI, and fuqaha and experts opinions in various literature on inheritance and khuntsa. Based on the research result, khuntsa inheritance right is not regulated in KHI. Theredore if khuntsa conducts genital adjustment surgery, and get the clarity of its legal status hence its right of inheritance is as specified in Article 176 KHI. The provision of inheritance for khuntsa heirs in Islamic Law is khuntsa first predicted as male then female. Khuntsa and other heirs share the smallest and most convincing estimates, while the remaining doubts are held until the status of the khuntsa law is clear. If the khuntsa matter is clear, the acceptance of all the heirs is perfected by adding share to those who are reduced according to the acceptance they should receive. In the future, the formulation of KHI should regulate the right of khuntsa inheritance along with the amount of the inheritance received.

Background: Nowadays, spinal anesthesia is commonly being used in infants and children for infraumblical surgeries. Intrathecal adjuvants such as clonidine and fentanyl are used with local anesthetics for additive effects. Aim: The present study aims to assess and compare the effects of adding clonidine versus fentanyl to bupivacaine intrathecally in terms of propofol consumption, hemodynamic profile, adverse events, and complications intraoperatively in pediatric patients. Settings and Design: A prospective randomized controlled trial was conducted between June 2016 and October 2018 in pediatric patients aged 3-8 years undergoing hernia repair or genital surgery under spinal anesthesia after approval of the Institutional Ethical Committee (Reference No: SGRR/IEC/04/16). Materials and Methods: Patients were randomly divided into two equal sized (n = 42) study groups, while analysis was done in (n = 40) each group. Group 1 (BC) received clonidine 1 µg/kg with 0.5% bupivacaine (heavy) and Group 2 (BF) received fentanyl 0.5 µg/kg with 0.5% bupivacaine (heavy). Statistical Analysis: Quantitative data were expressed in mean and standard deviation. Qualitative data were expressed in proportion and percentages. Independent t-test was applied to compare the means of quantitative data, and Chi-square test was used to compare categorical data. P < 0.05 was considered statistically significant. Results: Patient characteristics regarding age, weight, and surgical time were comparable in the two groups. The maintenance dose and bolus dose of propofol consumed during surgery were less in Group 1 than that in the Group 2 and were found to be statistically insignificant. The values of hemodynamic parameters such as heart rate, systolic blood pressure, and diastolic blood pressure were less in Group 1 and were statistically significant at different time intervals. Sedation scores were comparable in both groups. Intraoperative incidence of bradycardia, systolic hypotension, and diastolic hypotension were high in Group 1, whereas the incidence of desaturation was high in Group 2. Intraoperative complications such as apnea and respiratory obstruction were high in Group 2, but were statistically insignificant. Conclusion: We conclude that intrathecal adjuvant fentanyl maintains a better hemodynamic profile in terms of adverse events such as bradycardia, systolic hypotension, and diastolic hypotension. Intrathecal clonidine maintains a better sedation level requiring less propofol for sedation. Complications such as apnea and respiratory obstruction can be attributed more to the deep sedation caused by bolus of propofol rather than the inherent properties of intrathecal adjuvant clonidine or fentanyl. [ABSTRACT FROM AUTHOR]

Introduction: Research on long-term results of hypospadias has focused on surgical techniques and functional outcomes, and it is only recently that patient satisfaction with appearance and psychosocial outcomes have been considered. The aim of this study was to provide an evidence-based systematic review of adolescent and adult patient perceptions of cosmetic outcomes following childhood surgery for hypospadias. Methods: A systematic review was performed in accordance with the PRISMA and PICO guidelines, and studies assessed using the Oxford Centre for Evidence-Based Medicine system. MEDLINE, PsycInfo, EMBASE, and CINAHL databases were searched from 1974 to 2014 for clinical studies containing patient perceptions of appearance, deformity, and social embarrassment following hypospadias surgery. Results: A total of 495 publications were retrieved, of which 28 met the inclusion criteria. Due to study design/outcome measure, heterogeneity data were synthesized narratively. Results indicate (i) patient perceptions of penile size do not differ greatly from the norm; (ii) perceptions of appearance findings are inconsistent, partially due to improving surgical techniques; (iii) patients who are approaching, or have reached, sexual maturity hold more negative perceptions and are more critical about the cosmetic outcomes of surgery than their prepubertal counterparts; (iv) patients report high levels of perceptions of deformity and social embarrassment; and (v) there is a lack of data using validated measurement tools assessing long-term patient perceptions of cosmetic outcomes, particularly with patients who have reached genital maturity. Conclusions: Protocols for clinical postpuberty follow-up and methodologically sound studies, using validated assessment tools, are required for the accurate assessment of cosmetic and psychological outcomes of hypospadias surgery.

The article presents the discussion on applied medical ethics for suggesting consideration of Uterus transplantation (UTx) for transgender women. Topics include cross-sex hormone treatments limiting fertility and completing gender affirming genital surgeries precluding it; and creation of adequate uterine vascularization de novo which being the necessity for appropriate hormone replacement in sustaining implantation and pregnancy.

Background: A significant percent of infertile varicocele patients remained infertile after varicocelectomy and finally most of them refer for assisted reproductive technique (ART) procedures as intra uterine insemination (IUI), in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). In order to achieve the best results, more strict and accurate standards for assessment of sperm parameters, as Kruger standards, are required. Objective: The main goal of this study was to evaluate the efficacy of varicocelectomy on improving selection of ARTs on the base of Kruger strict morphology test. The main goal of this study was to evaluate the efficacy of varicocelectomy on improving selection of ARTs on the base of Kruger strict morphology test. Method: In a randomized clinical trial study, the results of sperm parameters analysis by Kruger strict morphology test were compared between a group of 67 infertile operated patients and a group of 71 matched no operated men in one-year duration. Results: The selection of better ART levels (IUI vs. ICSI) after varicocelectomy was higher in the operated group than controls (p<0.05). Pregnancy rates (achieving full-term pregnancy by natural cycle intercourse), after one year, were respectively 53.84% and 42.25% in the two groups of operated and non-operated (p=0.082). Conclusion: According to our results, varicocelectomy improves the ART level selection and also may improve pregnancy success rates (both by natural cycle intercourse and ART procedures). [ABSTRACT FROM AUTHOR]

The copulatory organs of male insects are generally complex, speciesspecific arrangements of hardened sclerotized plates bound together by flexible, less sclerotized cuticle. Their extensive morphological diversification is a recurrent pattern in the evolutionary radiation of animals, yet a clear consensus as towhat selection pressures drive this divergence is still to emerge. In part, this stems from the fact that the function of individual sclerites that integrate to form the aedeagus are poorly understood. In insects, the male copulatory organ is often bounded by two lateral parameres tipped with setae. In a number of species, these have been observed to brush against the terminal abdominal sclerites of the female, suggesting a role in pre- and/or postcopulatory female choice. However, in the absence of experimental manipulation, their function remains elusive. Here, we used microsurgery to reduce paramere length and show that males with one or both paramere tips removed were less likely to achieve genital coupling than sham-operated male control groups. Where treatment males did achieve copulation, surgical removal of the paramere tip(s) had no detectable effect on copulation duration or on the outcome of sperm competition. Surgical manipulation of the end-plate, a genital sclerite that covers the ostium of the median lobe (the non-intromittent section of the aedeagus), resulted in near-complete failure of males to achieve copulation. Our experimental manipulations show that the parameres and end-plate function during pre-copulatory sexual interactions and thus most likely evolved in response to sexual selection occurring prior to insemination. [ABSTRACT FROM AUTHOR]

This article explores and analyses the discourse presented on clinics’ and doctor’s offices’ websites that promote genital improvement surgeries in French-speaking Switzerland. Paying particular attention to power relations and to the articulation of the biological and the social, it aims at understanding how genitals and sexuality are presented. Using an analysis based on the identification of discursive processes and lexical fields, the authors identify three main themes : the promotion of sexual fulfillment and two types of obstacles understood as preventing its achievement. These obstacles are, on the one hand, innate or acquired morphological abnormalities and, on the other hand, discourses and practices considered oppressive and of a ‘cultural’ nature. The article develops the idea that, through the imperative to ‘become our true selves’, gender, culture and class intersect with the process of individualization of social norms.

Introduction Understanding the variability in circulating herpes simplex virus type 2 (HSV-2) genomic sequences is critical to the development of HSV-2 vaccines. Methods Genital lesion swabs containing ≥ 10 7 log 10 copies HSV DNA collected from Africa, the USA, and South America underwent next-generation sequencing, followed by K-mer based filtering and de novo genomic assembly. Sites of heterogeneity within coding regions in unique long and unique short (U L _U S ) regions were identified. Phylogenetic trees were created using maximum likelihood reconstruction. Results Among 46 samples from 38 persons, 1468 intragenic base-pair substitutions were identified. The maximum nucleotide distance between strains for concatenated U L_ U S segments was 0.4%. Phylogeny did not reveal geographic clustering. The most variable proteins had non-synonymous mutations in < 3% of amino acids. Conclusions Unenriched HSV-2 DNA can undergo next-generation sequencing to identify intragenic variability. The use of clinical swabs for sequencing expands the information that can be gathered directly from these specimens. [ABSTRACT FROM AUTHOR]

Female genital cosmetic surgery includes several procedures aimed at reaching better female genital appearance and/or improved sexual functioning. Among these procedures, vaginal rejuvenation is considered as one of the most controversial genital cosmetic surgical interventions and involves a range of surgical procedures performed by gynecologists or plastic surgeons to decrease the average diameter of the vagina, mainly for sexual reasons. In this narrative review, vaginal rejuvenation outcomes are examined in order to clarify the current scenario of the different vaginal rejuvenation techniques, as well as their effectiveness and associated complications. Psychological and ethical issues linked to these procedures are also addressed. [ABSTRACT FROM AUTHOR]

Soft tissue defects in the genito-perineal region are predominantly because of trauma, infections, neoplasms or iatrogenic causes. As a result of the region's urological, reproductive and gastrointestinal function, defects in this area may cause devastating physical and psychological consequences as well as diminished sexual functioning. The purpose of this study was to examine the efficacy of implementing a medial thigh lift for defect coverage in the perineal region. A retrospective analysis of all medial thigh lift procedures for defect coverage in the genito-perineal region between November 2010 and March 2015 was conducted at three institutions. Ten consecutive patients underwent a medial thigh lift for defect coverage in the genito-perineal region. Nine patients were male, and one was female. The causative factors were Fournier's gangrene in eight patients, one patient had a straddle injury, and one suffered from extramammary Paget's disease. The mean follow-up time was 19·8 months. The average total defect size was 11·1 × 11 cm (length × width). The medial thigh lift procedure is a safe, technically easy and reliable technique with discrete scars. Outstanding aesthetic and functional outcomes result in a high rate of patient satisfaction. Through immediate wound closure, a reduction of recovery time can be achieved. [ABSTRACT FROM AUTHOR]

Penile transplantation is an emerging option for patients with severe genital defects not amenable to traditional reconstructive options. In this article, we discuss the burgeoning problem of severe male genitourinary trauma in the military, the limitations of traditional reconstructive options in addressing these problems, and the potential for penile transplantation to provide improved outcomes. We also review the preclinical research and limited worldwide experience with penile transplantation to date, including lessons learned, and discuss the many important technical, logistical, and ethical considerations pertaining to penile transplantation that must be addressed to maximize the likelihood of successful implementation. [ABSTRACT FROM AUTHOR]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction. Hypospadias is a male congenital condition where the opening of the urethral meatus is not located in the typical anatomical position. It has been a challenge for empirical studies to ascertain the level of concordance of opinion among parents and urologists with regard to surgical outcomes according to hypospadias severity. Materials and Methods. Parents of children who had undergone hypospadias repair were recruited for this study (n=104). A set of questionnaires that included some items with Likert scale were created to evaluate postsurgical satisfaction by parents and urologists. SAHLSA-50, a validated instrument for adult Spanish-speaking adults, was used to assess health literacy. Cohen’s Kappa (k) coefficient was used to assess inter-observer agreement and Chi Square Goodness of Fit Test was used to determine probability of satisfaction. Findings. Concordance on the level of satisfaction with surgical outcomes for Type cases I was slight (k=0.20; CI 95% 0-0.60), for Type II cases was moderate (k= 0.54; CI 95% 0.13-0.94), and for Type III cases was substantial (k=0.62; CI 95% 0-0.56). However, the probability of satisfaction did not change according to severity (Chi Square Goodness of Fit Test; parents, p=0.84; pediatric urologists, p=0.92). These results cannot be explained by parental health literacy according to SAHLSA-50 test scores. Conclusions. The level of concordance of opinion among parents and urologists with regard to their level of satisfaction with surgical outcomes is related to hypospadias severity, whereby the greatest level of concordance of opinion was achieved among most severe cases. This study underscores the need for longer follow-up to properly assess satisfaction with hypospadias repair, especially for the less severe forms of the condition.

Background: Genital surgery in Disorders of Sex Development (DSD) has been an area of debate over the past 20 years. Emerging scientific evidence in the late 1990s defied the then routine practice to surgically align genitalia to the sex of rearing, as early as possible. However, despite multitude of data showing detrimental effects to genital sensation and sexuality, few patients born with ambiguous genitalia have remained unoperated into adolescence. Methods: We followed up girls with 21 hydroxylase deficiency (21-OHD) in genital morphology during childhood and acceptability among patients and parents of such an approach. Results: Preliminary results from 7 children, aged 1-8 years (median 4.5 years), suggest that it is acceptable among patients and families to defer genital operation in 21-OHD. All patients had a Prader stage III and above. Median clitoral length at birth was 24 mm (20-28 mm) and had diminished to a median of 9 mm (5-15 mm) at their last visit. Height and weight have remained strictly normal in all patients. So far girls and their parents have not expressed significant concerns regarding genital ambiguity. Conclusions: With this encouraging data at hand, we propose to formally address levels of anxiety, adaptation and quality of life during childhood, with an ultimate goal to assess long term satisfaction and effects on sexuality through deferring genital surgery for adolescence. [ABSTRACT FROM AUTHOR]

Objective: To investigate patients' satisfaction and perceived utility for psychological consultations delivered by clinical psychologists in a sample of gynaecological cancer patients hospitalised for surgery. Methods: A total of 51 gynaecological cancer patients who scored higher than four on the distress thermometer (DT) were proposed and received a psychological consultation during hospitalisation for surgery. After six months from discharge, patients were asked, during a telephone interview, to rate their level of distress post-treatment, their perceived satisfaction, and usefulness of the psychological intervention received. Results: At the time of the telephone interview, the distress levels stated by patients tended to be lower than those at hospital admission, and around 61% of the patients expressed maximum satisfaction with psychological intervention. Among these, 60.8% rated the psychological consultation useful for dealing with the hospitalisation itself, 45.1% useful for dealing with personal issues and 58.8% for dealing with issues related to returning home. People who were at their first diagnosis and those who had no other reason to be distressed beyond their cancer found psychological support significantly more useful for facing up to personal issues. Conclusions: Patients are highly satisfied with integrative psychological interventions delivered by clinical psychologists in a medical setting such as that of gynaecological cancer surgery and from the six-month follow-up, it emerged that such interventions help in promoting patients' adjustment to the phase of hospitalisation and post-hospital discharge. [ABSTRACT FROM AUTHOR]

Background: Chlamydia is one of the most common sexually transmitted diseases in humans worldwide, causing chronic lesions in the reproductive tract. Due to its often asymptomatic course, there is limited knowledge about the initial changes in the genital tract following infection. This study employs a novel sexually mature minipig model to investigate the initial histopathological changes following vaginal infection with Chlamydia trachomatis serovar D. Results: A vaginal inoculation resulted in an infection primarily affecting the lower genital tract. The histopathological changes were characterized by a subepithelial inflammation consisting of neutrophils and mononuclear cells, followed by an increase in the number of plasma cells within the sub-epithelial stroma of the vagina. Detection of Chlamydia was associated with expression of cyclooxygenase-2 and interleukin-8 by superficial epithelial cells. The infection was self-limiting, with a duration of 7 days. Conclusion: Neutrophils, plasma cells and IL-8 have been linked with Chlamydia genital infection of unknown duration in human patients. In this study, we observe a similar pattern of local immune response/inflammation following experimental inoculation suggesting this porcine model shows promise as a model for translational chlamydia research. [ABSTRACT FROM AUTHOR]

Background: Aphallia or penile agenesis is a rare malformation accompanying with no phallus. This anomaly is extremely rare with abnormality of urogenital system and psychological consequences. Its outbreak is estimated 1 out of 10-30 million births. Case: Reviewing 3 cases of male external genitalia agenesis, which associated with multiple anomalies of musculoskeletal, cardiovascular and genitourinary system. Conclusion: Aphallia has psychosocial consequences and a guarded prognosis. This study showed that if the kidney failure is due to its obstruction, these patients will be born in more favorable conditions and the future treatment measures will be directed to keep the external genitalia (male) through timely diagnosis and prenatal surgery and timely bladder drainage. [ABSTRACT FROM AUTHOR]

Introduction: Research on long-term results of hypospadias has focused on surgical techniques and functional outcomes, and it is only recently that patient satisfaction with appearance and psychosocial outcomes have been considered. The aim of this study was to provide an evidence-based systematic review of adolescent and adult patient perceptions of cosmetic outcomes following childhood surgery for hypospadias. Methods: A systematic review was performed in accordance with the PRISMA and PICO guidelines, and studies assessed using the Oxford Centre for Evidence-Based Medicine system. MEDLINE, PsycInfo, EMBASE, and CINAHL databases were searched from 1974 to 2014 for clinical studies containing patient perceptions of appearance, deformity, and social embarrassment following hypospadias surgery. Results: A total of 495 publications were retrieved, of which 28 met the inclusion criteria. Due to study design/outcome measure, heterogeneity data were synthesized narratively. Results indicate (i) patient perceptions of penile size do not differ greatly from the norm; (ii) perceptions of appearance findings are inconsistent, partially due to improving surgical techniques; (iii) patients who are approaching, or have reached, sexual maturity hold more negative perceptions and are more critical about the cosmetic outcomes of surgery than their prepubertal counterparts; (iv) patients report high levels of perceptions of deformity and social embarrassment; and (v) there is a lack of data using validated measurement tools assessing long-term patient perceptions of cosmetic outcomes, particularly with patients who have reached genital maturity. Conclusions: Protocols for clinical postpuberty follow-up and methodologically sound studies, using validated assessment tools, are required for the accurate assessment of cosmetic and psychological outcomes of hypospadias surgery [ABSTRACT FROM AUTHOR]

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Objectives: To evaluate the etiology, clinical presentations, investigations and surgical management of patients presenting with atypical genitalia in Pediatric surgery department. Disorders of Sexual development are one of the most complex congenital disorders encountered by the treating physicians. In recent years, the diagnostic ability and surgical techniques of gender reconstructions have improved remarkably. The spectrum includes chromosomal, genotype and phenotype abnormalities. The birth of a baby with atypical genitalia poses diagnostic and treatment challenges. This article focuses on etiology, clinical presentations, investigations and surgical management of patients presenting with ambiguous genitalia. Study Design: A descriptive, prospective case series. Setting: Department of Pediatric Surgery, Military Hospital, Rawalpindi, Pakistan. Period: October 2010 to June 2014. Methods: All patients with atypical genitalia, who underwent any kind of genital reconstruction surgery were included in the study. Results: A total of 28 patients were operated upon during the study period. Age ranged from 11months to 12 years. Patients were divided into two groups on the basis of their karyotyping. Seventeen patients had 46 XY and 11 had 46 XX. No mosaic pattern was seen. Male genital reconstructive surgery was done in 16 patients while 12 underwent female genital reconstructive surgery. Conclusions: Disorders of sexual development present as a complex spectrum of psychosocial, sexual, endocrine and surgical implications, thus management demands a multidisciplinary team approach. Appropriately timed surgical intervention after thorough work up and detailed counseling, produce excellent cosmetic and functional results. [ABSTRACT FROM AUTHOR]

The aim of this work was to study the occurrence of BHV-1 as a serious viral pathogen in the genitalia of she camels. Out of 120 female genitalia (vulva-vagina-cervix and uterus), 13 (10.83%) samples contained suspected viral agents which induced cytophathic effects on MDBK cell line. Five out of 13 suspected viral isolates could be completely neutralized using virus neutralization test (VNT). Seven out of 13 CPE positive viral agents were confirmed to be BHV-1 by PCR assay. IFAT revealed the presence of BHV-1in the epithelial lining of the vulva and vagina of BHV-1 positive tissue specimens. The percentage of positive serum reactors was 17 (14.16%). Gross examination of BHV-1 positive samples showed swollen endometrium and congested vulva with apparent laceration and papules. The vagina showed congested mucosa with multiple vesicles. Histopathlogical examination of the genitalia of the affected she camels revealed vulvitis, vaginitis, cervicitis and endometritis. In conclusion, the occurrence of the genital form of BHV-1 (infectious pustular vulvovaginitis, IPV) in she camels was declared. Accordingly, the role played by BHV-1 in causation of infertility and abortion in she camels should be investigated. Also, attention must be paid toward the possibility of infected she camels to transmit such virus infection to farm animals in contact. [ABSTRACT FROM AUTHOR]