Reconstructive Surgery for Intersex and Micropenis

Kim, Kun Suk; Han, Jiyeon

Abstract

The management of children with intersex or micropenis is an ongoing challenge to clinicians. Topics including the recent surgical developments and controversies of management are reviewed. In feminizing genitoplasty, clitoroplasty is done as early as the first few months of life, however there are controversy in vaginal reconstruction for high vaginal confluence. In the patients with complete androgen insensitivity the testes are left intact until after puberty, so that hormone replacement therapy may be delayed. The sex assignment and surgical management of patients with intersex is very complex and should be made by the intersex team and family. Micropenis should be diagnosed by measuring stretched penile length and differentiated from buried penis which has basically normal penile size. In most boys with small penis, the size of penis reaches the normal range through a catch-up growth after puberty. Therefore close observation is a general rule in management of small penis. However low dose androgen treatment can be applied without complication in children with micropenis, especially who have severe psychological stress.