File:Complications from infant genitoplasty.jpg

A 15-year-old female with a history of CAH who underwent a single-stage feminizing genitoplasty-reduction clitoroplasty and a pull-though vaginoplasty at 2 years of age. She presented with pain and enlargement of the clitoral region.

Breech LL. Complications of vaginoplasty and clitoroplasty. In: Teich S, Caniano DA, eds. Reoperative pediatric surgery. Totowa, New Jersey: Humana Press. 2008, pp. 499-514.

Partial androgen insensitivity syndrome

Single image from an article in a medical journal.

Resolution of this image will not affect journal subscriptions (i.e. revenue).

Many patient advocacy groups, as well as physicians and researches, have repeatedly stressed the importance of delaying genitoplastic surgery in infants born with ambiguous genitalia until after puberty, unless it is absolutely necessary. The reasons are that scarring and loss of function can result, as well as the certainty that surgery will need to be repeated when the infant reaches maturity. This image clearly shows the type of complications that these groups are trying to protect patients from. Images of this kind are of a very sensitive nature, and call for medical quality photography.

PAIS is a very rare disorder, affecting approximately 1 in 100,000 births. Images that clearly illustrate complications from feminizing genitoplasty in this population are understandably very rare.

Sources that describe PAIS and its rarity include: (1:) Quigley CA, De Bellis A, Marschke KB, El-Awady MK, Wilson EM, French FS. Androgen receptor defects: historical, clinical, and molecular perspectives. Endocr Rev. 1995;16:271–321. (2:)Mazen I, El-Ruby M, Kamal R, El-Nekhely I, El-Ghandour M, Tantawy S, El-Gammal M. Screening of Genital Anomalies in Newborns and Infants in Two Egyptian Governorates. Horm Res Paediatr. 2010;73:438-442.