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re: re: New vs. old techniques of surgery Feb. 11th, 2005 5:14pm
Actually, I think technique matters a lot. If there were absolutely NO risk to genital surgery, then by all accounts it would be a win-win situation for everyone....patient, parent, doctor. The problem comes because there IS risk. And, in the past, the risk was HUGE.
Like you, I happen to think that loss of clitoral sensation and especially the ability to have an orgasm is a major big deal. So, for me personally, if I were forced to choose between form (making it "look" good) and function (making it "work") there is no question in my mind that I would choose function. On the other hand, if I can have my cake and eat it too, then why wouldn't I want that....for myself or my daughter?
I recognize the fact that long term studies of modern surgical techniques are not yet available, and that---yes---we still need to wait until many of these girls grow up to completely understand all the ramifications. At the same time, I don't think that means we necessarily have to go back to square one. With a basic understanding of human anatomy and physiology, it may be possible to make some reasonable assumptions. For example, if we are still essentially talking about clitorectomy..i.e, amputation of the clitoris...then we really don't need to wait even another day to know what the results are going to be. It doesn't take a rocket scientist to figure out that that ain't going to work, no matter how positive of a spin we put on it. But, if there really ARE ways to save the nerve bundles, blood supply, etc. then I think we should also be open minded enough to listen. Granted, there will always be some loss of sensation with any surgery, but what exactly are we talking about? Losing 5% sensation or 95%? It's a big difference, and yes, I believe the answer matters.
I'm also not so sure that most surgery is completely cosmetic. Anatomically, the clitoris is connected to the vagina, which is normally completely separate from the urinary tract. In many CAH girls, the vagina and urethra end up connecting internally and forming one structure called an urogenital sinus. No, I don't understand all the problems that can occur when you have an urogenital sinus, but I can imagine what some of them might be. I.e. normally, blood and urine come down separate channels....it's not hard to imagine that there may be serious functional problems if they have to share the same space. Does that mean then that surgery is inevitable, and the question just becomes....is it better in infancy or in adolescence?
