Penile Reconstruction with a Free Sensate Osteocutaneous Fibula Flap in the Surgical Management of the Intersex Patient

Abstract

The birth of an infant with ambiguous genitalia presents an urgent dilemma, perhaps more complex today than previously. Prior to the past 20 years, the prevailing belief was that infants were essentially psychosexually neutral at birth and the child could be “nurtured” in either the male or female direction if the decision was made early and the genitalia were appropriate (Diamond and Sigmundson, 1997). Accordingly, the appearance of the genitalia became a stronger influence than the chromosomal karyotype in the decision as how to proceed with gender assignment and genitoplasty. The child was raised male if the phallic size portended adequate urinary and sexual function. If the phallus was deemed inadequate, the operative belief was that it was far simpler to construct a functional vagina and normal appearing vulva than to attempt to fashion a functional and cosmetically acceptable penis from inadequate tissue.