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Impaired Sexual and Reproductive Outcomes in Women with Classical Forms of Congenital Adrenal Hyperplasia

Centre de Référence des Maladies Rares de la Différenciation Sexuelle (F.G., C.B., L.D., P.B.), Lyon-Paris, France; Department of Pediatric and Adult Endocrinology (R.B., E.T., F.K.), Necker Hospital, Paris V University, 75015 Paris, France; and Department of Pediatric Endocrinology (C.B., L.D., P.B.), Saint Vincent de Paul Hospital, Paris V University, 75014 Paris, France

Address all correspondence and requests for reprints to: Pierre Bougnères: Department of Paediatric Endocrinology, Hôpital Saint Vincent de Paul, 82 Avenue Denfert Rochereau, 75014 Paris, France. E-mail: bougneres{at}paris5.inserm.fr.

Objectives: The objectives of the study were 2-fold: 1) a detailed description of sexual and reproductive outcomes in adult women with congenital adrenal hyperplasia (CAH) of different phenotypic severity at birth; and 2) comparisons of these outcomes among CAH subtypes and between CAH women and non-CAH control women.

Design: This was a cross-sectional study using a face-to-face interview, a written questionnaire, the Female Sexual Function Index, and a gynecological examination.

Patients: Patients included 35 women with CAH, representing Prader stages I–V at birth, aged 18–43 yr, who had been treated from birth to adolescence in the same pediatric endocrine clinics. Sixty-nine non-CAH healthy control women were selected from hospital-staff families.

Results: None of the CAH women expressed doubts about their gender assignment. Twenty percent (seven of 35) had homosexual inclinations; 23% (eight of 35) were married; three reported a complete lack of sexual activity; and 37% (13 of 35) said they never had heterosexual intercourse with vaginal penetration. Sexual functioning as assessed by the Female Sexual Function Index was much lower in CAH women than controls and lowest in CAH women with high Prader stages. Eighty-one percent (18 of 22) experienced pain during vaginal penetration. Only eight women became pregnant, and 17% (six of 35) had children.

Conclusions: Despite expert medical and surgical care by physicians dedicated to this rare disease, women with CAH still suffer major limitations in their sexual function and reproductive life.

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