Description

Differences (Disorders) of Sex Development (DSD) refer to a heterogeneous group of congenital conditions affecting human chromosomal, gonadal, or anatomical sex determination and differentiation. Several reports highlighting suboptimal physical and psychosexual results of individuals who have a DSD led to a radical revision of management 15 years ago.

Genital surgery has always been a substantial part of DSD care and remained so for many years, seemingly undebated. This has changed dramatically, following disquieting reports of unfavorable outcomes, including high complication /re-operation rates and patient dissatisfaction. There are hardly any good long-term follow-up data on surgery, and prospective randomized trials are impossible to conduct. Therefore, there is no consensus on indication, timing, and outcome measures.

Surgery is one of the most controversial issues in the field of DSD. Adolescent and adult patients, parents, self-support groups, peer groups, activists, and officials have raised concerns about the current medical practice and there is major discussion on human rights and ethical questions. Intersex institutions have issued statements about human right violations (i.e., Malta declaration, International Intersex Forum, Council of Europe Human Rights Commissioner's Issue Paper on Human Rights and Intersex People). The concerns of intersex activists regarding the discomfort of society towards gender variances is appreciated widely within Western societies.

There is enormous heterogeneity in DSD and the discussion of important stakeholders such as support and advocacy groups and associated health care professionals is urgently needed. Moreover, the world is diverse and we have to take into account different societies, religions, cultural views, and recognize the diversity of humanity in promoting the wellbeing and human rights of intersex people.

In this Research Topic we want to highlight all relevant aspects of the topic “Surgery in DSD” and present a well-balanced base for further discussion.