Timing of Surgery: Do We Have a Consensus?

Despite the multitude of literature and data, the timing of surgery for a neonate who is born with ambiguous genitalia is still in debate. Surgical interventions for these children, apart from those with outflow obstruction, are generally elective. There is an important matter of consent, and whether by providing early surgery, the parents should get to decide the genital phenotype or should the child be involved in this important process of decision-making once he can understand the consequences of it. There exist certain forms of DSD where the choice of rearing may differ from the choice of rearing, which may lead to gender dysphoria and dissatisfaction later on. A combination and interplay of several factors influence the decision-making including not only the endocrinological, psychological, and surgical aspects, but also the parental, societal, and legal points of view. All these factors must be considered, with great emphasis on parental counselling, while deciding the surgical procedure and interventions, which may often be irreversible.