Genital Surgery

Risks for genital surgery vary depending on what kind of procedure your child has. Circumcision is one of the most common, low-risk surgeries and is usually performed in the first few days of an infant’s life. Other surgeries are more complicated. Some common risks can include:

• Damage to the genitals
• Infection
• Pain
• Fatigue
• Constipation
• Vaginal discharge
• Bleeding

Talk to your child’s doctor about other potential risks and side effects of the specific surgery your child will have.

Pediatric genital surgery can help your child’s genitals to function correctly. It can also help your child with their sense of personal identity.

Preparation for genital surgery varies from procedure to procedure. Talk to your doctor about how you need to prepare your child for their specific procedure. Some common preparations include:

• Your child may have blood or urine tests.
• The day of the surgery, your child will need to fast (not eat anything), and they may be given a special liquid to help empty their bowels.
• Hair around the area where the surgery will be done might need to be shaved or clipped.
• Your child will receive an IV to give them fluids, medicine, or blood as needed.
• A catheter may be put into your child’s bladder to drain fluid during the procedure.

Genital surgery is different depending on the condition being treated as well as the outcome that the surgery is meant to achieve. Some procedures for different conditions are described below.

Circumcision is done with different kinds of techniques, including:

• The Gomco [GOM-ko] method. The doctor clamps the Gomco device to your child’s foreskin. This holds the foreskin away from the glans and protects the glans during the procedure. The doctor removes the foreskin. The doctor takes the Gomco device off and covers the incision with antibiotic ointment and a gauze bandage coated with petroleum jelly.
• The Plastibell [plas-TEE-bell] technique. The doctor puts the Plastibell device on the penis. The Plastibell device clamps the foreskin edge as it heals, then slowly detaches from the penis. Your child will go home with this plastic cap in place. It will have a string tied around it to secure it in place.

Rectocele repair surgeries are usually done through the vagina. The approach your doctor recommends will depend, in part, on the severity of the rectocele. Once the area of the rectocele is reached, surgery includes these general steps:

• The surgeon makes one or more incisions (cuts) along the back wall of the vagina.
• Stitches are sewn into the weakened tissue around the vagina and rectum and along the vaginal wall. These stitches can strengthen your child’s tissues by closing any tears and encouraging scar tissue to form in the area for extra support.
• If necessary, the perineum (the area between the vaginal opening and the anus) will be repaired with deep stitches.
• The vaginal incisions are closed with stitches, and the vagina may be packed with gauze.

Surgery to repair the anterior vaginal wall includes these general steps:

• The surgeon makes a cut through the front wall of your child’s vagina.
• Your child’s bladder is moved to its normal position.
• Stitches are sewn in the tissue between your child’s vagina and bladder. These stitches hold the walls of your child’s vagina in the correct position.
• The vaginal cuts are closed with stitches and your child’s vagina may be packed with gauze.

The internal stitches in this surgery will be absorbed by the body. They don’t need to be removed.

Other types of genital surgery have their own specific procedures. Talk to your doctor about the exact process that your child will undergo during their surgery.

In some cases, the results of genital surgery can be seen right away. Ask your child’s doctor what to expect in terms of long-term results.

More check-ups and tests may be needed to make sure the genital surgery was a success. Follow your doctor’s instructions on how to care for your child after their procedure.

Call your child’s doctor right away if they have symptoms like vaginal discharge or blood in their urine after a genital surgery.

Genital surgery is surgery that is done to correct genital deformities that can cause problems with your child’s sexual function later in life. Genital surgery may also be done to make the genitals look more normal. Genital surgery may be a difficult decision for you to make for your child, especially if your child has genitals that are not clearly male or female.

Some examples of genital surgery include:

• Anterior vaginal wall repair surgery. This surgery strengthens the front wall of the vagina. It is done to treat sinking or bulging of the bladder into the vagina or sinking of the urethra into the vagina.
• Rectocele [REK-tuh-seel] repair surgery. A rectocele [REK-tuh-seel] is a bulging of the rectum into the vagina. It happens when the tissues that support the rectum and vagina are weakened and torn. Rectocele repair surgery (also called posterior wall repair) can strengthen and repair the damaged tissue and restore the rectum to its normal position.
• Circumcision [sur-kuh m-SIZH-uhn]. Circumcision is a surgery to remove a fold of skin (the foreskin) from the tip (glans) of the penis. Boys are born with this skin fold. In circumcision, the foreskin is removed, exposing the tip of the penis.
• Intersex surgery. In children with genitalia that are not clearly male or female, surgery may be needed to allow the child to function normally during sex later in life, or to make the genitalia look normal.

In children who are born with ambiguous genitalia (genitals that are not clearly male or female), atypical genitalia (genitals that are either male or female but look different from what most people expect), or intersex genitalia (also referred to as hermaphroditism [hur-MAF-ruh-dahyt-ism]), genital surgery may be postponed until the child can help decide what action should be taken.

There are several kinds of genital abnormalities, some of which are explained below.

True hermaphroditism is a condition where children may have:

• Tissue that comes from both ovaries and testes
• Sex organs for both genders
• Genitals on the outside of their body that are not clearly male or female
• Genetics that are either normal female, normal male, or a mix of the two
• Male chromosomes and female organs inside their body

Pseudohermaphroditism [SOO-do-hur-MAF-ruh-dahyt-ism] is a condition that shows up in boys. Boys with this condition have genitalia on the outside of their body that are hard to distinguish, and sex organs on the inside of their body that are male.

Children with androgen insensitivity syndrome have female genitalia on the outside of their body and male chromosomes. This is an inherited condition.

Gonadal dysgenesis [GOH-nad-al dis-jen-uh-sis] is a condition where children have:

• A sex organ that isn’t fully developed
• Sex organs inside their body that are likely female
• Genitals outside their body that may be normal female or normal male

There are many kinds of genital deformity that have different consequences and require different kinds of treatment. If your child has a genital deformity, talk to your doctor about the best way to treat it, so that your child’s genitalia can function normally throughout their life.