The anatomy and reconstruction of the adult female genitalia in classical exstrophy.

[OBJECTIVE] To review the anatomy and reconstruction of the external genitalia in adult females born with exstrophy.

[PATIENTS AND METHODS] Between 1981 and 1995, 47 females (born between 1953 and 1980) were seen in the adolescent clinic at St Peter's Hospital. The notes of 42 were reviewed to obtain data on genital reconstruction and sexual function. When patients were no longer under personal review, a telephone contact was made to obtain further information.

[RESULTS] The pelvic structures were displaced forwards so that the introitus was a structure of the lower abdominal wall. The clitoris was bifid and the labia were not united anteriorly; the introitus was very narrow. The pubic hair lay on either side of the introitus. Twenty-eight patients had a modified episiotomy and two a vaginoplasty to allow penetrative intercourse. Fifteen patients had a vulvoplasty and a monsplasty. The surgical results were good in all but one case. One patient had partial necrosis of the skin flaps for the monsplasty. All patients who had an episiotomy were able to have intercourse while only four unreconstructed cases could do so.

[CONCLUSIONS] The genital anatomy in females with exstrophy is abnormal. Reconstructive surgery can improve the appearances and allows penetrative sexual intercourse.