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Using a National Pediatric Hospital Database to Assess the Practice Pattern of Clitoroplasty From 1992-2011 In the United States

Monday, October 22, 2012: 9:03 AM
Grand Ballroom B (Hilton Riverside)
Blake W. Palmer, M.D.1, Amy B. Wisniewski, Ph.D.1, Kevin Kierl1, Dominic Frimberger, M.D.1, Bradley P. Kropp, M.D.1 and Christopher C. Roth, M.D.2, (1)Pediatric Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, (2)Urology, Louisiana State University Health Sciences Center, New Orleans, LA

Purpose - Much debate is had over the optimal time for female genitoplasty for girls with a Disorder of Sex Development (DSD).  The 2006 Consensus Statement on management of DSD cautioned on performing clitoral surgery on any girl except the most virilized (Prader III-IV) but cited literature to support that cosmetic surgery in infancy aids in parental distress and improves attachment.  To date however little has been reported to understand what the normative practice patterns are for clitoral surgery and whether those patterns have changed over time.

Methods -  We searched the Pediatric Health Information Systems hospital database to identify patients who had clitoral surgery between: 1992-2011.  We used associated procedure and diagnostic codes to describe the practice pattern of female genital surgery in the United States for the last 2 decades.

Results - The PHIS database query revealed 504 operations on the clitoris.  Clitoral procedures were done at less than 1 year of age in 29.2% (147/504) and at less than 3 in 49% (247/504) with only 11.3% (57/504) occurring after the age of 14.  In those patients with a specific diagnosis of CAH 60.0% vs 45.4% of non-CAH girls had surgery at <3 years of age (p=0.005; x2=8.037, df=1).   There is trend of decreasing incidence of clitoroplasty that occur at <3 years of age in the cohort when comparing 1992-1996 (62.5%), 1997-2001 (56.1%), 2002-2006 (47.5%), 2007-2011 (40.9%) (p<0.0005; x2=12.88, df=3).  There were no regional variations seen in the cohort with the incidence of clitoroplasty surgery at less than the age of 3 with the West (50.0%), Midwest (53.6%), South (47.1%) and Northeast (43.7%) (p=0.140).

Conclusion - Our study demonstrates that the incidence of clitoral surgery at ages less than 3 has been decreasing for the past 2 decades. The PHIS database does not offer the ability to assess why this change is occurring but emphasizes the importance of further study as to the long term impact and psychosocial factors associated with DSD surgery.