Article: Neurological Considerations for ‘‘Nerve-Sparing’’ Cosmetic Genital Surgeries Performed on Children with XX Chromosomes Diagnosed with 21-Hydroxylase Congenital Adrenal Hyperplasia and Clitoromegaly

Recent studies with congenital adrenal hyperplasia (CAH) patients indicate gender diversity and a lower prevalence of female gender identification than is often cited to justify feminizing surgery. The most effective and ethical “Nerve-Sparing” (NS) technique for CAH may be acceptance of gender, sexual, and genital diversity as the infant develops into childhood, adolescence, and adulthood. Decades of advocacy against medically unnecessary childhood genital surgeries have highlighted the subsequent physical and psychological harm. There are decades of advocacy working against nonconsensual clitoral reduction and other childhood genital modifications, which multiple United Nations councils have determined constitute human rights violations. Clinicians and investigators should consider the neuropsychological consequences of surgeries and research that intersex people have described as traumatic, and instead engage in affirming and community based research and care. Consent-based and age-appropriate care that affirms genital, sexual, and gender diversity is likely healthier for the developing nervous system than nonconsensual ‘‘nerve-sparing surgeries”.
View the article now in the Journal of LGBT Health ahead of print