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Copyright of Canadian Veterinary Journal / Revue Vétérinaire Canadienne is the property of Canadian Veterinary Medical Association 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.)

In recent years increased numbers of healthy women and girls have been seeking female genital cosmetic surgery for esthetic reasons and/or to enhance sexual functioning. This phenomenon is associated with the development of a new vulvovaginal standard due to Internet pornography and the increased exposure of female genitalia. This strict standard may negatively affect women's psychological health and cause increased insecurity, which may drive even teenagers to seek female genital cosmetic surgery. Psychological counseling is recommended to inform women that surgery is not a definitive solution to treat psychologically based pain or dysfunction. Moreover, there is no robust evidence supporting the effectiveness of female genital cosmetic surgery, especially regarding sexual enhancement, as underlined by major scientific societies. The importance of a definite regulation of female genital cosmetic surgery should be emphasized and be based on an ethically oriented, multidisciplinary model aimed at providing exhaustive information on all gynecological, sexological, and psychological concerns raised by this type of surgery. [ABSTRACT FROM AUTHOR]

Objective To assess the prevalence, outcomes and cost associated with acute kidney injury ( AKI) defined by consensus risk, injury, failure, loss, and end-stage kidney ( RIFLE) criteria after gynaecologic surgery. Design Retrospective single-centre cohort study. Setting Academic medical centre. Sample Two thousand three hundred and forty-one adult women undergoing major inpatient gynaecologic surgery between January 2000 and November 2010. Methods AKI was defined by RIFLE criteria as an increase in serum creatinine greater than or equal to 50% from the reference creatinine. We used multivariable regression analyses to determine the association between perioperative factors, AKI, mortality and cost. Main outcome measures AKI, combined major adverse events (hospital mortality, sepsis or mechanical ventilation), 90-day mortality and hospital cost. Results Overall prevalence of AKI was 13%. The prevalence of AKI was associated with the primary diagnosis. Of women with benign tumour surgeries, 5% (43/801) experienced AKI compared with 18% (211/1159) of women with malignant disease ( P < 0.001). Only 1.3% of the whole cohort had evidence of urologic mechanical injury. In a multivariable logistic regression analysis, AKI patients had nine times the odds of a major adverse event compared to patients without AKI (adjusted odds ratio 8.95, 95% confidence interval 5.27-15.22). We have identified several readily available perioperative factors that can be used to identify patients at high risk for AKI after in-hospital gynaecologic surgery. Conclusions AKI is a common complication after major inpatient gynaecologic surgery associated with an increase in resource utilisation and hospital cost, morbidity and mortality. [ABSTRACT FROM AUTHOR]

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]

Aim To understand the experiences of young women with a disorder of sex development when sharing information about their body with healthcare professionals, friends and intimate partners. Background Disorders of sex development are lifelong conditions that create bodily difference such as absence of reproductive organs which can impact on young women's fertility and sexual experiences. Design Interpretive phenomenological analysis with thirteen young women (14-19 years old) with a disorder of sex development. Methods The young women chose to participate in either a face-to-face semi-structured interview or to complete a paper diary between 2011-2012. Results A superordinate theme focusing on the meaning bodily differences held for these young women is presented through three themes: self-awareness and communicating this to others; actualizing intimacy; and expressing meaning of altered fertility to self or professionals or partners. During early adolescence, the young women were guarded and reticent about sharing personal information about their disorder of sex development but as they moved towards adulthood, some of the young women learnt to engage in conversations with more confidence. Frustrations about their bodily differences and the limitations of their bodies were talked about as factors which limited physical spontaneity, impacted on their perceived sexual fulfilment and challenged the development or sustainability of close friendships or intimate partnerships. The young women wanted empathic, sensitive support from knowledgeable health professionals to help them understand their bodies. Conclusion Attachment and a 'sense of being' were the concepts that were closely linked to the young women's development of a secure identity. [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]

The article focuses on central wedge technique for central wedge labiaplasty due to increase of labia minora and genitalia in women. Topics discussed include causes of large labia minora such as discomfort during exercise and sexual intercourse, decrease chances for over-resecting labial tissue, and disadvantages of central wedge technique such as labial hyperpigmentation, and use of general anesthesia during the surgery.

The author reflects on the topic related to transsexuality and also provides an analysis of transgendered patients seeking sexual reassignment surgery (SRS). Topics discussed include role of biology and neuroscience in imagining SRS-seeking patients, correlation of early transgendered play patterns in girls with prenatal exposure to androgens, and no role of gender and sexuality in Western monotheistic cultures.

Doctoring the genitals is compatible with a recognizable conception of social medicine. This commentary critically examines the distinction between medical and nonmedical procedures; presents an alternative account of Sohaila Bastami's personal reaction to the anonymous caller's request for referral information concerning hymen reconstruction surgery; and makes use of Yelp to simulate the caller's procedure for locating a helpful practitioner. Yelp is a very useful informational search engine that does not subject its users to a moral examination. [ABSTRACT FROM AUTHOR]

Introduction A number of studies have proven that mechanical bowel preparation ( MBP) has no benefits in elective colorectal surgery. However, studies specifically related to gynecologic laparoscopic surgery are scant. We undertook a meta-analysis to assess the necessity of MBP before gynecologic laparoscopic surgery. Methods The electronic databases MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were systematically searched to identify relevant randomized controlled trials. Two authors independently extracted data from each study. The primary outcome of interest was the quality of surgical field. Secondary outcomes of interest included postoperative pain, abdominal swelling, nausea/vomiting, and length of hospital stay. Results Three studies involving 372 participants were included in the meta-analysis. The results showed that MBP did not significantly increase the overall quality of surgical field exposure (odds ratio, 0.82; 95% confidence interval [ CI], 0.46-1.49; P = 0.52). MBP also did not appear to significantly change the mean scores of postoperative pain (weighted mean difference, 0.09; 95% CI, −0.54-0.71; P = 0.79), the incidence of nausea/vomiting (odds ratio, 1.56; 95% CI, 0.80 to 3.03; P = 0.19), the mean scores of abdominal swelling (weighted mean difference, −0.26; 95% CI, −0.83-0.30; P = 0.36), and length of hospital stay (weighted mean difference, 0.05; 95% CI, −0.13-0.22; P = 0.62). Conclusions Our results suggest that routine use of MBP for gynecologic laparoscopic surgery should not be recommended. However, additional randomized controlled trials using large samples are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Specific complaints and grievances from adult patients with disorders of sex development (DSD), and their advocates center around the lack of information or misinformation they were given about their condition and feeling stigmatized and shamed by the secrecy surrounding their condition and its management. Many also attribute poor sexual function to damaging genital surgery and/or repeated, insensitive genital examinations. These reports suggest the need to reconsider the decision-making process for the treatment of children born with DSD. This paper proposes that shared decision making, an important concept in adult health care, be operationalized for the major decisions commonly encountered in DSD care and facilitated through the utilization of decision aids and support tools. This approach may help patients and their families make informed decisions that are better aligned with their personal values and goals. It may also lead to greater confidence in decision making with greater satisfaction and less regret. A brief review of the past and current approach to DSD decision making is provided, along with a review of shared decision making and decision aids and support tools. A case study explores the need and potential utility of this suggested new approach. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Accurate and comprehensive measurements of the external genitalia in female adults are of great significance in surgery designs and for aesthetic evaluation in genital plastic surgeries. The authors carried out a 319-case study and provided baseline data and morphometric reference for plastic surgery involving the genital deformity caused by trauma or burns and male-to-female transsexual operations. Methods: Our study design recruited 319 women referred to the out-patient clinic from August 2010 to August 2013. From each individual we measured 16 parameters and assessed the significance of variations in age, height, weight, BMI, and marital status (as a proxy for parity). We tried to establish a female external genitalia database of the population presenting for cosmetic surgery and define the general proportions of female genitalia in Chinese adults from the data we obtained. Results: A wide range of values was noted in female genital measurements especially in labia minora parameters. Four parameters, including clitoral prepuce length, clitoris to urethra, labial length, and perineal body length had a proportional relationship to some extent. The position of the clitoris and urethral orifice was found to be regular in female adults. Compared with unmarried women, perineal body length decreased ( P = 0.048), while the apex to perineum (bilateral) and labial length increased ( P = 0.005, 0.006, <0.0001) in those who were married. Several parameters were statistically significantly associated with age, height, weight, BMI, and marital status. Conclusions: We presented an external genitalia database of Chinese female adults asking for cosmetic surgery. Although the ranges of genital measurements vary, there is a proportional relationship in female genital appearance, which should be heeded in surgical designs and genital aesthetic evaluation. [ABSTRACT FROM AUTHOR]

The author reflects on the role of decision on the case M.C. v. Aaronson for protecting intersex children from genital surgeries. Topics discussed include claims of violating due process of law clause of Fourteenth Amendment of the U.S. Constitution, claims of medical malpractice against the physicians, and denial of defendant's motion to dismiss.

Within feminist and queer studies, age is rarely explored or theorized, and ageing is to a great extent ignored, while social gerontology tends to rest on assumptions of stable binary gender categories. This article starts with older trans people's life stories to explore intersections between (old) age, gender, and embodiment. The analysis, using a theoretical framework developed within critical gerontology, queer theory, and feminist theory, illustrates what ageing and old age may mean for transgender people. Bodily ageing is perceived very differently by trans people, depending on bodily conditions and on how they can and want to perform gender. While some experience what they perceive as the androgyny of age positively, other narratives illustrate how ageing can complicate the possibilities of performing linear gender. The ageing body can limit prospects for undergoing sex reassignment surgery (SRS). The analysis illustrates how older trans people may face ageist attitudes during the transition processes. Later life and the future might also bring fears about situations in which one will need care. For older trans people, this could mean fears of being discriminated against, having fewer possibilities to choose which contexts to be in, and which persons to have in one's home and close to one's body. A Baradian approach, in which bodies are seen as agential and performativity as material-discursive, offers complex understandings of older transgender people's experiences. The results trouble previous theoretical concepts, while highlighting the importance of broadening understandings of age, gender, and embodiment that do not take their starting-points in younger or middle age, linear gender, or abled congruent bodies. [ABSTRACT FROM PUBLISHER]

The article presents a case study of a 44-year-old woman with male-to-female transgender treatment with genital reconstruction surgery. Topics discussed include her being diagnosed with distal deep vein thrombosis (DVT), and Venous thromboembolism increased in male-to-female people due to cross-sex hormone treatment like estrogen, and anticoagulation being the pillar of treatment for pulmonary embolism and proximal vein DVT.

Introduction: Advocacy and human rights organizations have called for a moratorium on elective surgical procedures until the patient is able to fully participate in the decision-making process. Due to the controversial nature surrounding surgery in differences of sex development (DSD) care, we aimed to assess the factors that teens and adults with DSD, parents, healthcare providers and other allied professionals consider pertinent to complex surgical decisions in DSD., Methods: Stakeholders (n=110) in DSD care participated in semi-structured interviews exploring features and potential determinants of successful healthcare outcomes. Audio-recordings were transcribed, coded, and analyzed using qualitative data software. Codes for "Process of Decision-Making" and "Successful Outcome-Surgery/Appearance/Function" were further searched using keywords "surgery," "procedure," and "timing.", Results: Several themes were identified: 1) The nature or type of the decision being made; 2) Who should be involved in the decision-making process; 3) Timing of conversations about surgery; 4) Barriers to decision-making surrounding surgery; 5) The elements of surgical decision-making; and 6) The optimal approach to surgical decision-making. Many stakeholders believed children and adolescents with DSD should be involved in the process as developmentally appropriate., Conclusion: DSD include a wide range of diagnoses, some of which may require urogenital reconstruction to relieve obstruction, achieve continence, and/or address other anatomical differences whether cosmetic or functional. Adolescents and adults with DSD desired autonomy and to be part of the decision-making process. Parents were divided in their opinion of who should be involved in making elective surgical decisions: the child or parents as proxy medical decision-makers. Providers and other professionals stressed the importance of process and education around surgical decisions. Ongoing research examines how decision-makers evaluate tradeoffs associated with decision options., Competing Interests: Conflict of Interest Erica M. Weidler is the paid Executive Director of Accord Alliance. No other conflicts to disclose.

This study was undertaken to investigate the bacterial and fungal microflora on the external genitalia of a population of healthy male donkeys in the state of Michigan, USA. The aim was to identify and determine the frequency of occurrence of these microorganisms using seven different isolation media and standard microbiological procedures. The sites (urethral fossa [fossa glandis], dorsal diverticulum of the urethral sinus, distal urethra, and penile surface) in the distal reproductive tract were cultured and each isolated microorganism identified. Ten different genera of gram-positive bacteria, eight different genera of gram-negative bacteria, and two genera of fungi were isolated from the external genitalia of the 43 donkeys in this study. All 43 donkeys yielded gram-positive bacteria (2–8 species) from all four sites sampled. Arcanobacterium spp., Corynebacterium spp., and Bacillus spp. were the most frequently isolated gram-positive bacteria. Gram-negative bacteria were cultured from 16 (37.2%) of the 43 donkeys, with Acinetobacter lwoffii (16.3%), Oligella urethralis (11.6%), and Taylorella asinigenitalis (9.3%), the most frequently isolated. Fungi were cultured from only 5 (11.6%) of the 43 donkeys, with Rhizopus spp. isolated from 3 (7.0%) and Cladosporium spp. from 2 (4.7%) individuals. The testes and epididymides collected from 40 donkeys at time of castration were culture negative. Few differences were found in the bacterial flora between prepubertal and mature intact and castrated donkeys. Of notable interest was the scarcity of known equine pathogens across the population tested and isolation of T. asinigenitalis from normal donkeys, especially prepubertal individuals and previously castrated males. [ABSTRACT FROM AUTHOR]

Summary Genital lymphedema is a debilitating condition. Currently, therapeutic concepts include conservative and surgical measures of genital volume reduction, but no therapy standards exist. The aim of this study was to analyze our experience with the treatment of male genital lymphedema and to describe our integrated concept, which combines perioperative complex decongestive physiotherapy (CDP) with surgical reduction. We conducted a retrospective study of 51 male patients who were treated in our clinic between 1998 and 2013, acquiring data on etiology, performed therapy, and complication rates. Forty-three (84%) of our patients suffered from primary and eight (16%) from secondary lymphedema. Two patients (4%) exhibited isolated penile affection and 22 (43%) isolated scrotal affection, while the majority (27 or 53%) exhibited penoscrotal lymphedema. All patients underwent inpatient CDP preceding and following surgery. Surgical therapy involved debulking the scrotum in 25 patients (49%), isolated penile reduction in two (4%), and penoscrotal reduction in 24 (47%). Hydrocoelectomy was performed in 22 (43%) patients. Following resection of the diseased tissue, the defects were closed primarily using adjacent healthy skin. There was no need for local flaps or skin grafts. Three patients suffered from complications requiring revision surgery: hematoma in two patients (4%) and wound dehiscence in one (2%). We measured the change in quality of life that was achieved by these procedures using the Glasgow Benefit Inventory questionnaire. The patients reported improvement in general functioning and physical health, whereas the social support score was largely unaffected by the procedure. Our results show that genital lymphedema patients can be reliably treated by combining conservative and surgical therapy. Prior conservative reduction of the genitals facilitates surgery and allows consistent results at a low complication rate, whereas surgical reduction serves to enhance and stabilize the results of conservative treatment. [ABSTRACT FROM AUTHOR]

In Indonesia, disorders of sex development (DSDs) are not well recognized and medical care for affected individuals is scarce. Consequently, many patients live with ambiguous genitalia and appearance. We compared reported outcomes on body image, sexual functioning, and sexual orientation of 39 adults with DSDs (aged 18 to 41) and 39 healthy controls matched for gender, age, and residential setting (urban, suburban, rural). Differences in gender and treatment status (treated or untreated) were also explored. On body image, adults with DSDs reported dissatisfaction with sex-related body parts. Compared to the matched controls, women with DSDs reported greater sexual distress, and men with DSDs reported lower erectile and ejaculation frequencies, and more dissatisfaction with sexual life but not with sexual desire and activities. Men with DSDs who had undergone genital surgery reported higher erectile and ejaculation frequencies than untreated men. More women than men in the DSDs group reported a nonexclusive heterosexual orientation. DSDs and infertility had a great impact on sexuality. Fear of ostracism complicated DSD acceptance. Findings were compared to those of Western studies. Based on these results, education about DSDs and their psychosexual consequences may help reduce the sexual distress and problems in adults with DSDs and improve quality of life. [ABSTRACT FROM AUTHOR]

Genital pain frequently causes sexual dysfunction and psychological distress that can impact every aspect of a woman's life. When conservative medical treatments do not adequately treat the genital pain, surgical procedures have the potential to significantly decrease the pain. The following review examines surgical procedures currently being used to treat pudendal neuralgia, scarring from lichen sclerosus, and provoked vestibulodynia. In addition, a diagnostic algorithm is included that can be used to identify specific causes of genital pain and to determining when surgery is an appropriate treatment option. [ABSTRACT FROM AUTHOR]

Trained fertility specialists possess a unique clinical perspective and an extensive medical and technological armamentarium to overcome reproductive dysfunction: it is their privilege and ethical duty to lead the field of reproductive surgery. However, modern reproductive surgery can no longer exist outside of the realm of advanced laparoscopy. This has been a major hurdle to the thriving of surgery within our subspecialty, owing to the time and effort required to achieve and maintain proficiency in the antiergonomic environment of conventional laparoscopy. Computer-assisted surgery minimizes aptitudinal restrictions to the adoption of advanced laparoscopy. As such, it promotes strategy over technique and may hold the key to the continued success of high-specialty reproductive surgery. [ABSTRACT FROM AUTHOR]

Copyright of Journal für Ästhetische Chirurgie is the property of Springer Nature 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.)

Copyright of Canadian Graduate Journal of Sociology & Criminology / Revue Canadienne des Études Supérieures en Sociologie et Criminologie is the property of Paladin Academic Press 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.)

Objective To describe the mortality risk associated with surgical treatment of female genital fistula and the contributory and contextual factors. Methods In a descriptive study, confidential inquiries and clinical audits were conducted at 14 fistula repair sites in seven resource-poor countries between January 2005 and March 2013. Data collection included interviews with key personnel involved in the clinical management of the deceased, and a review of hospital records and patient files following an audit protocol. Results Overall, 26060 fistula repairs were performed at 44 sites located in 13 countries; 30 deaths were reported in this period. Twenty-one deaths were attributable to surgery, yielding a case fatality of 0.08 per 100 procedures. The cause of death in nearly half of the cases was various manifestations of sepsis and inflammation. Conclusion The case fatality rate for fistula repair surgery in resource-poor countries was in the same range as that for comparable gynecologic operations in high-resource settings. Clinical and systemic issues to be addressed to reduce the case fatality rate include improvement of perioperative care and follow-up, assuring prudent referral or deferral of difficult cases, and maintaining better records. [ABSTRACT FROM AUTHOR]

Introduction Few studies explored multiple sensory detection thresholds on the perineum and breast, but these normative data may provide standards for clinical conditions such as aging, genital and breast surgeries, pathological conditions affecting the genitals, and sexual function. Aims The aim of this study was to provide normative data on sensory detection thresholds of three sensory modalities on the perineum and breast. Methods Thirty healthy women aged between 18 and 35 years were assessed on the perineum (clitoris, labia minora, vaginal, and anal margin), breast (lateral, areola, nipple), and control body locations (neck, forearm, abdomen) for three sensory modalities (light touch, pressure, vibration). Main Outcome Measures Average detection thresholds for each body location and sensory modality and statistical comparisons between the primary genital, secondary sexual, and neutral zones were the main outcome measures. Results Average detection thresholds for light touch suggest that the neck, forearm, and vaginal margin are most sensitive, and areola least sensitive. No statistical difference is found between the primary and secondary sexual zones, but the secondary sexual zone is significantly more sensitive than the neutral zone. Average detection thresholds for pressure suggest that the clitoris and nipple are most sensitive, and the lateral breast and abdomen least sensitive. No statistical difference is found between the primary and secondary sexual zone, but they are both significantly more sensitive than the neutral zone. Average detection thresholds for vibration suggest that the clitoris and nipple are most sensitive. The secondary sexual zone is significantly more sensitive than the primary and neutral zone, but the latter two show no difference. Conclusion The current normative data from sensory detection threshold are discussed in terms of providing standard values for research and clinical conditions. Additional analysis from breast volume, body mass index, hormonal contraception, menstrual cycle, and sexual orientation do not seem to influence the results. Sexual abstinence and body piercing may have some impact. Cordeau D, Bélanger M, Beaulieu-Prévost D, and Courtois F. The assessment of sensory detection thresholds on the perineum and breast compared with control body sites. J Sex Med 2014;11:1741-1748. [ABSTRACT FROM AUTHOR]

Objective: To report our successful experience in treating genital and perineal hidradenitis suppurativa (HS) and its sequelae including localized chronic lymphedema. We describe our method of diseased tissue resection and wound defect coverage with local flaps and split-thickness skin grafts (STSG). Methods: From 2004 to 2012, we treated 6 patients with genital and perineal HS with radical resection of diseased tissue. Wound coverage was performed with skin flaps and/or STSGs. Results: Two patients had enough normal neighboring skin for local flap coverage of their wound defect. Four others had more extensive disease requiring STSG coverage. Two patients with secondary penile skin lymphedema required STSG for penile shaft reconstruction. All patients achieved excellent cosmetic results. There was one recurrence that required repeat resection and wound coverage. No wound complications occurred at the STSG donor site. Successful STSG “take” on the scrotum and penis ranged from 90% to 100% (mean 98%). Wound complications from local flap closure were clinically insignificant and include small (≤2 cm) areas of wound breakdown with no evidence of infection in 3 patients (50%). Conclusion: Genitoperineal HS is a debilitating and disfiguring disease that results in the need for repeated abscess drainage operations, chronically painful skin boils, and chronic foul-smelling infectious discharge. It can be associated with lymphedema of surrounding tissues, requiring removal of tissues not originally affected by the disease. The use of complete resection and reconstruction with skin flaps and grafts provides a viable treatment option for these patients. [ABSTRACT FROM AUTHOR]

In this article, the authors consider how trans men’s decisions about physical body modifications impact their sense of themselves as gendered and sexual actors. Based on interviews with 74 trans men, the authors explore how their embodiment, gender identity, erotic ideation, lifetime of sexual practices, and domain of potential partners—what the authors term “sexual habitus”—can be affirmed, transformed, or challenged as their embodiment changes. These changes underscore the dynamic relationship between gender and sexuality and illustrate how bodies matter in sexual trajectories across the life course. [ABSTRACT FROM PUBLISHER]

Background: Gender reassignment surgery (i.e., male-to-female or female-to-male) entails a series of complex surgical procedures. We conducted a study to explore epidemiologic characteristics of patients who underwent genital reconstruction operations as components of gender reassignment and to analyze risk factors for surgical-site infections (SSIs) following these operations. Methods: The study was a retrospective cohort study conducted from 1984-2008 at Harper University Hospital, a tertiary hospital with 625 beds in Detroit, Michigan. Surgical site infection was defined according to established criteria. Results: Records were available for 82 patients who underwent a total of 1,383 operations as part of genital-reconstruction processes. Thirty-nine (47.6%) of the patients underwent female-to-male reassignment (FTM) and 43 (52.4%) underwent male-to-female reassignment (MTF). The average age of the study cohort was 39.5±9.8 y. Of the patients in the cohort, 56 (68.3%) were Caucasian and 67 (81.7%) were single. The average number of operative encounters per patient was 11.8±4.6 for FTM and 4.9±2.4 for MTF. Forty-three (52.4%) patients developed an SSI at least once during their genital reconstruction process, of whom 34 (87%) were in the FTM group and nine (21%) in the MTF group (p<0.001). Staphylococci were the most common pathogens (61%) isolated in these infections, followed by Enterobacteriaceae (50%), Enterococcus (39%), and Pseudomonas aeruginosa (33.3%). Surgical site infection was associated independently with an increased frequency of operative procedures and operating room encounters. Conclusions: More than 50% of patients who underwent genital reconstruction operations developed an SSI at some point during the genital reconstruction process. Surgical site infections are more common in FTM than in MTF reconstruction operations, and for both FTM and MTF, SSIs are associated independently with an increased frequency of total operative procedures and encounters. [ABSTRACT FROM AUTHOR]

Purpose: We investigated whether children getting ready for circumcision under local anesthesia had any additional genital region abnormalities not detected before the circumcision. Materials and Methods: We performed circumcision under local anesthesia for children with normal physical examination findings, and together with corrective surgery for those with other genital anomalies among the children aged 6 years old and over presenting at the pediatric surgery department of our hospital during the school break. Results: Circumcision was planned under local anesthesia in a total of 1,695 cases aged between 6 and 17 years during the June to September 2010 and 2011 periods. We found an external genital anomaly in the pre-circumcision physical examination in 58 patients (3.4%), with a mean age of 7.87 ± 1.49 years. These patients were operated on with corrective surgery while 1,637 children underwent circumcision under local anesthesia. The most common anomaly was inguinal hernia seen in 14 (24.1%), followed by hypospadias in 11 (18.9%), hydrocele in 9 (15.9%) and undescended testis in 8 (13.8%). Conclusion: In countries where circumcision is traditional, an intervention room within the hospital to perform circumcision under local anesthesia can enable many children to be circumcised under hospital conditions and previously undetected genital abnormalities to be found with a pre-circumcision genital region examination. [ABSTRACT FROM AUTHOR]

To determine the interest of using robotic laparoscopic surgery in the management of female infertility, we reviewed our own activity and searched the Medline database for publications on robotic technology in infertility surgery, with the use of the following search words: robotic laparoscopy, tubal anastomosis, myomectomy, deep infiltrating endometriosis, and adnexal surgery. Robot-assisted laparoscopic surgery has seen rapid progression over the past few years. It has been mostly used for myomectomy, proximal tubal reanastomosis, and deep endometriosis surgery. Despite its increased range of indications, no randomized control studies are available. The place of robotic surgery in the management of infertility remains undetermined. [ABSTRACT FROM AUTHOR]

The relationship between ovarian cysts and infertility is a subject of debate, mainly because it is difficult to determine the real impact of the cyst and its treatment on later fertility. For a long time it was hoped that surgical treatment could prevent potential complications (such as rupture or malignancy). For presumed benign ovarian tumors, fertility sparing should be the main concern. The goal of this survey of current knowledge on the subject is to thoroughly explore the potential relationship between cysts, their treatment, and infertility. Our study is based on a review of the literature dealing with the epidemiology of ovarian cysts and the effects of their surgical management in relation to infertility. Analysis of the epidemiologic data, drawn mainly from comparative studies and cohorts, shows that the role of cysts in infertility is controversial and that the effects of surgical treatment are often more harmful than the cyst itself to the ovarian reserve. Surgery does not seem to improve pregnancy rates. When a surgical option is nonetheless chosen, a conservative laparoscopic approach is more suitable. Besides excision, sclerotherapy and plasma vaporization are promising, offering a greater preservation of the ovarian parenchyma, especially in endometriomas. These techniques must be better defined. The context of the infertility is essential, and surgeons and specialists in reproductive medicine should decide management jointly. [ABSTRACT FROM AUTHOR]

Introduction Cross-sex hormonal treatment ( CHT) used for gender dysphoria ( GD) could by itself affect well-being without the use of genital surgery; however, to date, there is a paucity of studies investigating the effects of CHT alone. Aims This study aimed to assess differences in body uneasiness and psychiatric symptoms between GD clients taking CHT and those not taking hormones ( no CHT). A second aim was to assess whether length of CHT treatment and daily dose provided an explanation for levels of body uneasiness and psychiatric symptoms. Methods A consecutive series of 125 subjects meeting the criteria for GD who not had genital reassignment surgery were considered. Main Outcome Measures Subjects were asked to complete the Body Uneasiness Test ( BUT) to explore different areas of body-related psychopathology and the Symptom Checklist-90 Revised ( SCL-90-R) to measure psychological state. In addition, data on daily hormone dose and length of hormonal treatment (androgens, estrogens, and/or antiandrogens) were collected through an analysis of medical records. Results Among the male-to-female ( MtF) individuals, those using CHT reported less body uneasiness compared with individuals in the no-CHT group. No significant differences were observed between CHT and no-CHT groups in the female-to-male ( FtM) sample. Also, no significant differences in SCL score were observed with regard to gender ( MtF vs. FtM), hormone treatment ( CHT vs. no-CHT), or the interaction of these two variables. Moreover, a two-step hierarchical regression showed that cumulative dose of estradiol (daily dose of estradiol times days of treatment) and cumulative dose of androgen blockers (daily dose of androgen blockers times days of treatment) predicted BUT score even after controlling for age, gender role, cosmetic surgery, and BMI. Conclusions The differences observed between MtF and FtM individuals suggest that body-related uneasiness associated with GD may be effectively diminished with the administration of CHT even without the use of genital surgery for MtF clients. A discussion is provided on the importance of controlling both length and daily dose of treatment for the most effective impact on body uneasiness. Fisher AD, Castellini G, Bandini E, Casale H, Fanni E, Benni L, Ferruccio N, Meriggiola MC, Manieri C, Gualerzi A, Jannini E, Oppo A, Ricca V, Maggi M, and Rellini AH. Cross-sex hormonal treatment and body uneasiness in individuals with gender dysphoria. J Sex Med 2014;11:709-719. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the self-reported perceived quality of life (QoL) in transsexuals attending a Spanish gender identity unit before genital sex reassignment surgery, and to identify possible determinants that likely contribute to their QoL. Methods: A sample of 119 male-to-female (MF) and 74 female-to-male (FM) transsexuals were included in the study. The WHOQOL-BREF scale was used to evaluate self-reported QoL. Possible determinants included age, sex, education, employment, partnership status, undergoing cross-sex hormonal therapy, receiving at least one non-genital sex reassignment surgery, and family support (assessed with the family APGAR questionnaire). Results: Mean scores of all QoL domains ranged from 55.44 to 63.51. Linear regression analyses revealed that undergoing cross-sex hormonal treatment, having family support, and having an occupation were associated with a better QoL for all transsexuals. FM transsexuals have higher social domain QoL scores than MF transsexuals. The model accounts for 20.6 % of the variance in the physical, 32.5 % in the psychological, 21.9 % in the social, and 20.1 % in the environment domains, and 22.9 % in the global QoL factor. Conclusions: Cross-sex hormonal treatment, family support, and working or studying are linked to a better self-reported QoL in transsexuals. Healthcare providers should consider these factors when planning interventions to promote the health-related QoL of transsexuals. [ABSTRACT FROM AUTHOR]