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I went to the Australian CAH symposium last weekend and the particular surgical team who spoke said that they have very good surgical outcomes in planned single stage surgery in infancy. With the experienced team/surgeon operating, their research shows that 94% had good cosmetic outcomes with preservation of sensation and only 6% required redo surgery in adolescence. On the other hand with an inexperienced surgeon their research shows only a 42% good cosmetic outcome (no stats for sensation mentioned).
Interestingly this surgical/endocrinology team have made a firm decision that it is best if no genital surgery is performed on children between 2 and 12 years of age. Before two years old where the child has no memory of the event lessens the trauma and after twelve when the child can be involved in the decision. The years between according to their research have shown surgery to be quite traumatic in terms of memories and confusion. They also do not endorse dilatations in childhood.
In this centre all girls after about twelve years (flexibility according to need - earlier if required) are followed up for several years or as long as they need with an adolescent gynaecologist (female). After the first visit the adolescent gynae sees the girl without her parents and builds rapport and trust over quite a few years. Until complete trust is established no vaginal examinations are performed by the gynaecologist.
