How often are clinicians performing genital exams in children with disorders of sex development?

Stefani S. Tica; Erica A. Eugster

doi:10.1515/jpem-2017-0055

Article

How often are clinicians performing genital exams in children with disorders of sex development?

Stefani S. Tica and Erica A. Eugster

Published/Copyright: November 25, 2017

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From the journal Journal of Pediatric Endocrinology and Metabolism Volume 30 Issue 12

Abstract

Background:

We sought to determine the frequency with which genital exams (GEs) are performed in children with disorders of sex development (DSD) and ambiguous genitalia (AG) during routine visits to the pediatric endocrine clinic.

Methods:

Medical records of children with DSD and AG seen at one large academic center since 2007 were reviewed. Data analyzed included diagnosis, sex of rearing, age, initial or follow up visit, number of individuals present and sex of the pediatric endocrinologist. Repeated measures analysis was performed to evaluate associations between GEs and patient/physician factors.

Results:

Eighty-two children with DSD and AG who had a total of 632 visits were identified. Sex of rearing was female in 78% and the most common diagnosis was congenital adrenal hyperplasia (CAH) (68%). GEs were performed in 35.6% of visits. GEs were more likely in patients with male sex of rearing (odds ratio [OR] 17.81, p=0.006), during initial vs. follow-up visits (OR 5.99, p=0.012), and when the examining endocrinologist was female (OR 3.71, p=0.014). As patients aged, GEs were less likely (OR 0.76, p<0.0001).

Conclusions:

GEs were performed in approximately one-third of clinic visits in children with DSD and AG. Male sex of rearing, initial visits and female pediatric endocrinologist were associated with more frequent GEs.

Keywords: ambiguous genitalia (AG); clinical decision making; clinical management of disorders of sex differentiation; congenital adrenal hyperplasia; disorders of sex development (DSD)

*Corresponding author: Stefani S. Tica, MD, Indiana University School of Medicine, 340 W 10th St #6200, Indianapolis, IN 46202, USA, Phone: +219-746-3051

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Received: 2017-2-3

Accepted: 2017-10-2

Published Online: 2017-11-25

Published in Print: 2017-11-27

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Articles in the same Issue

https://doi.org/10.1515/jpem-2017-0055

Keywords for this article

ambiguous genitalia (AG); clinical decision making; clinical management of disorders of sex differentiation; congenital adrenal hyperplasia; disorders of sex development (DSD)