Offer Counseling Early to Teens Who Have CAIS.

TORONTO-- Teenagers with complete androgen insensitivity syndrome need to be told that they are at high risk for sexual dysfunction, Dr. Cathy Minto advised.

"It's important that these patients have access to gynecologic and psychological expertise at a young age and for teenagers to be offered a genital exam to determine their vaginal potential," Dr. Minto said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

In a study presented by Dr. Minto, 60 of 67 patients with complete androgen insensitivity syndrome (CAIS) were sexually active; among these women, there was an 88% rate of sexual dysfunction and a 42% rate of severe dysfunction.

Children born with CAIS have a female phenotype and normal female secondary sexual characteristics, but they have an XY genotype, internal testes, no Mullerian structures, and an absent androgen receptor function. In addition, many CAIS patients also have short vaginal lengths (less than 10 cm), which they might not discover before attempting intercourse, said Dr. Minto, a research fellow in the department of gynecology at University College London.

"A genital examination in teenagers could detect those with short vaginal lengths who are at risk for penetration problems or vaginal tears during intercourse. Most of them would probably not be offered surgery at that point, but they could be given psychological counseling and dilators for when they feel ready to use them," she said in an interview with this newspaper.

Vaginal length is variable in CAIS, but it's believed that a length under 5-6 cm causes problems with penetration. Some women with CAIS have a nearly absent vagina (around 2 cm), which makes vaginal penetration impossible. Some women also ...