Intended for healthcare professionals


Parental choice on normalising cosmetic genital surgery

BMJ 2015; 351 doi: (Published 28 September 2015) Cite this as: BMJ 2015;351:h5124
  1. Lih-Mei Liao, consultant clinical psychologist,
  2. Dan Wood, consultant adolescent and reconstructive urologist,
  3. Sarah M Creighton, consultant gynaecologist
  1. 1University College London Hospitals, London NW1 2PG, UK
  1. Correspondence to S M Creighton sarah.creighton{at}

Between a rock and a hard place

About 1 in 2000 children are born with genitalia considered atypical enough to prompt medical investigation. Underlying causes include complex genetic and hormonal conditions as well as unexplained anatomical anomalies such as hypospadias.

Paediatricians have previously stated that the determining factor in deciding to raise a child as a boy is the “size of the phallus.”1 2 Newborn penile size charts were used in the 1960s, and any child with a penis of stretched length less than 2.5 cm was likely to be assigned female regardless of the underlying diagnosis; feminising genital surgery usually followed.1 Gender assignment has become less simplistic but normalising surgery remains common. As a result, little is known about the physical, psychological, social, and sexual effects of untreated atypical genitalia associated with different diagnoses. It has been impossible to determine to what extent difficulties reported by adults are caused by the anatomical difference, other aspects of the diagnosis, the imperfect results of surgery, poor psychological care, or a combination of these factors. …

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