Childhood surgery for ambiguous genitalia: glimpses of practice changes or more of the same?

The Chicago consensus statement of 2005 was created at the point of cumulative criticisms and debates around the clinical practice of childhood genital surgery. It was drawn up at a time when it had become clearer that medically non-essential paediatric genital operations were associated with poor adult cosmetic outcomes and sexual functioning. However, data were not available for non-intervention. Therefore, parents and clinicians had no reliable information on how a child growing up with atypical genitalia might fare. The most positive recommendation in the consensus statement was the strong recommendation for decisions to be reached by a multidisciplinary team in collaboration with affected families. Importantly, the value of user groups was likewise formally acknowledged. For many services, there has been a sea change in the way surgeons work. Whilst some surgeons may continue with the standard practice of childhood genital surgery, it is becoming clearer that with adequate support, more individuals and families choose to postpone elective interventions. However, these are our observations only. Authoritative evidence must be based on high-quality multi-centre multidisciplinary research to prospectively monitor the long-term multiple outcomes of surgery and no surgery. There is as yet no obvious move towards such an endeavour.