Urogenital Outcome After Reconstructive Surgeries in DSD

This chapter delves into the intricate realm of Disorders of Sexual Differentiation (DSD), highlighting the challenges and impacts on patients’ urological, cosmetic, and sexual functions. The scarcity of standardized questionnaires for gathering long-term data hampers the evaluation of cosmetic, functional, and psychological outcomes. We have discussed surgical advancements aimed at improving physiological appearances and outcomes, such as preserving dorsal neurovascular bundles and inner preputial skin during feminizing genitoplasty, striving to achieve a more physiological appearance by creation of a mucosal lined vestibule and a natural-looking mons pubis. It is a challenging task to assess sexual function post-DSD surgery in the Indian subcontinent where societal stigma plays a significant role. The available limited data shows widespread dissatisfaction among operated DSD patients regarding their sex lives, including issues like global sexual dysfunction, low intercourse frequency, and dyspareunia. We have stressed the importance of addressing urinary outcomes in DSD patients by employing objective assessment tools like bladder diaries, uroflowmetry, and specific questionnaires. Furthermore, the complexities of managing proximal hypospadias are discussed, emphasizing the importance of employing self-reported measures to evaluate sexual function and satisfaction. We advocate for integrating a sexologist into the DSD care team to address potential mental health issues and enhance sexual quality of life. Highlighting the long-term psychosocial effects of DSD, the chapter acknowledges the myriad factors influencing patients’ quality of life, including the development of gender identities that may not align with their initial sex assignment.