Lih-Mei Liao

Female genital appearance: "normality" unfolds.

Objective  To describe variations in genital dimensions of normal women.

Requests for cosmetic genitoplasty: how should healthcare providers respond?

Demand for cosmetic genitoplasty is increasing. Lih Mei Liao and Sarah M Creighton argue that surgery carries risks and that alternative solutions to womens concerns about the appearance of their genitals should be developed

Congenital adrenal hyperplasia in adults: a review of medical, surgical and psychological issues

Our knowledge of the experience of adults with congenital adrenal hyperplasia (CAH) as they pass through life is only now emerging. In this review we gather medical, surgical and psychological literature pertaining to adults with CAH and consider this alongside practical experience gained from a dedicated adult CAH clinic. There is increasing awareness for the need for multidisciplinary teams who have knowledge of CAH particularly with respect to gynaecological surgery and clinical psychology for women and testicular function in men.

Global Disorders of Sex Development Update since 2006: Perceptions, Approach and Care

The goal of this update regarding the diagnosis and care of persons with disorders of sex development (DSDs) is to address changes in the clinical approach since the 2005 Consensus Conference, since knowledge and viewpoints change. An effort was made to include representatives from a broad perspective including support and advocacy groups. The goal of patient care is focused upon the best possible quality of life (QoL). The field of DSD is continuously developing. An update on the clinical evaluation of infants and older individuals with ambiguous genitalia including perceptions regarding male or female assignment is discussed. Topics include biochemical and genetic assessment, the risk of germ cell tumor development, approaches to psychosocial and psychosexual well-being and an update on support groups. Open and on-going communication with patients and parents must involve full disclosure, with the recognition that, while DSD conditions are life-long, enhancement of the best possible outcome improves QoL. The evolution of diagnosis and care continues, while it is still impossible to predict gender development in an individual case with certainty. Such decisions and decisions regarding surgery during infancy that alters external genital anatomy or removes germ cells continue to carry risk.

ESHRE Guideline: management of women with premature ovarian insufficiency

STUDY QUESTION What is the optimal management of women with premature ovarian insufficiency (POI) based on the best available evidence in the literature? SUMMARY ANSWER The guideline development group (GDG) formulated 99 recommendations answering 31 key questions on the diagnosis and treatment of women with POI. WHAT IS KNOWN ALREADY NA. STUDY DESIGN, SIZE, DURATION This guideline was produced by a multidisciplinary group of experts in the field using the methodology of the Manual for ESHRE Guideline Development, including a thorough systematic search of the literature, quality assessment of the included papers up to September 2014 and consensus within the guideline group on all recommendations. The GDG included a patient representative to ensure input from women with POI. After finalization of the draft, the European Society for Human Reproduction and Embryology (ESHRE) members and professional organizations were asked to review the guideline. PARTICIPANTS/MATERIALS, SETTING, METHODS NA. MAIN RESULTS AND THE ROLE OF CHANCE The guideline provides 17 recommendations on diagnosis and assessment of POI and 46 recommendations on the different sequelae of POI and their consequences for monitoring and treatment. Furthermore, 24 recommendations were formulated on hormone replacement therapy in women with POI, and two on alternative and complementary treatment. A chapter on puberty induction resulted in five recommendations. LIMITATIONS, REASONS FOR CAUTION The main limitation of the guideline is that, due to the lack of data, many of the recommendations are based on expert opinion or indirect evidence from studies on post-menopausal women or women with Turner Syndrome. WIDER IMPLICATIONS OF THE FINDINGS Despite the limitations, the guideline group is confident that this document will be able to guide health care professionals in providing the best practice for managing women with POI given current evidence. Furthermore, the guideline group has formulated research recommendations on the gaps in knowledge identified in the literature searches, in an attempt to stimulate research on the key issues in POI. STUDY FUNDING/COMPETING INTERESTS The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, with the literature searches and with the implementation of the guideline. The guideline group members did not receive payment. Dr Davies reports non-financial support from Novo Nordisk, outside the submitted work; the other authors had nothing to disclose. TRIAL REGISTRATION NUMBER NA.

Clinical characteristics of well women seeking labial reduction surgery: a prospective study

Please cite this paper as: Crouch N, Deans R, Michala L‐M, Liao L, Creighton S. Clinical characteristics of well women seeking labial reduction surgery: a prospective study. BJOG 2011;118:1507–1510.

Timing of gonadectomy in adult women with complete androgen insensitivity syndrome (CAIS): patient preferences and clinical evidence

Objective  Adult women with complete androgen insensitivity syndrome (CAIS) are increasingly likely to defer or decline gonadectomy despite counselling about malignancy risk. The objectives of this study were to review the evidence on the risk of gonadal malignancy in adult women with CAIS and to explore women’s reasons for deferring gonadectomy.

Labial surgery for well women: a review of the literature

This review investigates the quality and content of published reports relating to labial surgery for well women. Electronic databases were searched for relevant articles between 1950 and April 2009. Forty articles were identified, 18 of which included patient data. The specification of the study design was unavailable in 15 of the 18 papers; the remaining three were retrospective reports. No prospective, randomised or controlled studies were found. All reports claimed high levels of patient satisfaction and contained anecdotes pertaining to success. Medically nonessential surgery to the labia minora is being promoted as an effective treatment for women’s complaints, but no data on clinical effectiveness exist.

Changing attitudes to sex assignment in intersex.

The existence of people who are neither ‘all male’ nor ‘all female’ has long been recognized in many societies and, with the advent of scientific medicine in European societies in the 19th century, effort has been directed at determining the ‘true sex’ of such individuals [5]. Taxonomy was a new and exciting intellectual activity, and cases of ‘doubtful sex’ were a challenge to science and medicine. According to Dreger [5], factors then accepted as indicative of true sex included appearance of the head, timbre of voice, lack of breast development, presence of penis and absence of periods . Personality traits were also considered important demarcators of sex, e.g. bravery was considered a male attribute, and modesty female . Likewise, ‘true males’ were thought to desire only ‘true females’ and vice versa. In contrast to today, the role of surgery then was to confirm a hermaphroditic diagnosis rather than to change or reinforce the ‘true sex’.

Service users’ experiences of obtaining and giving information about disorders of sex development

Please cite this paper as: Liao L, Green H, Creighton S, Crouch N, Conway G. Service users’ experiences of obtaining and giving information about disorders of sex development. BJOG 2010;117:193–199.