Issues relating to sexual function and sexual identity, endocrinology and fertility in young women need to be addressed with particular sensitivity.
It is imperative that disorders of sexual development (DSD, formerly known as “intersex” conditions) should be managed in centres by a multi-disciplinary team that includes an expert gynaecologist, paediatric surgeon, urologists (paediatric and adult), endocrinologists (paediatric and adult), plastic surgeon, specialist nurses and, most importantly, skilled psychologists. The focus should be on helping to co-ordinate the transition from childhood through adolescence and then to womanhood and ensuring that appropriate hormonal control of puberty and development is maintained alongside corrective surgery when necessary.
Professor Balen featured in a BBC Documentary called “Me, My sex and I”, in 2011. This 50 minute documentary includes stories of people who are born with disorders of sexual development.
Disorders of sexual development may result in ambiguous genitalia or anomalies of the internal genital tract. The age of the patient reporting the problem will depend upon the degree of dysfunction caused. Ambiguous genitalia occur in approximately one in 30,000 newborns.
Professor Balen established a multi-disciplinary clinic in Leeds in 1997, which is now one of the largest in the UK. The clinic cares for complex cases from around the country and is the supra-regional referral centre for the north of England.
Professor Balen was also a founding member and secretary of The British Society for Paediatric & Adolescent Gynaecology, which has become established as a multi-disciplinary society. The society has developed a network of clinical centres that help manage disorders of sexual differentiation and development. Some centres, such as that in Leeds, treat more complex and rare cases. Patients may be referred directly by their GP or from consultants in paediatric clinics.
The main conditions that are managed include:
Disorders of puberty and adolescence
• Delayed puberty & variants
• Underweight / intense exercise / eating disorders
• Turners syndrome
• Premature ovarian failure/insufficiency
• Precocious puberty and variants
• Polycystic ovary syndrome
• Adolescent menstrual disorders / pelvic pain
• Congenital absence of the vagina
• Mullerian / uterine anomalies
• Fusion abnormalities of the vagina (transverse septa)
• Androgen Insensitivity Syndrome
• Congenital adrenal hyperplasia
• Other rare disorders