Management of Differences in Sexual Development: Evolution of an Approach for a Resource-Limited Setting

Erik Hansen, Eric Irungu, John Muma Nyagetuba, Joyce Mbogo

Research output: Contribution to journalArticlepeer-review


Background: The approach to management of patients with disorders of sex development (DSD) has been refined over the past two decades. We sought to review DSD cases at our hospital and hypothesized that age at presentation would decline over time. Methods: A retrospective review of patients presenting to our hospital between January 1, 2005 and July 31, 2018, with findings of ambiguous genitalia was performed. Results: A total of 44 patients were identified, 3 with cloacal exstrophy. Of the 41 remaining patients, the majority (n = 24) had ovotesticular DSD. Three time periods in the evolution to a multidisciplinary team (MDT) approach were identified: Period 1 (2003-2009), Period 2 (2010- 2013), and Period 3 (2014-present). Median presenting age in Periods 1, 2, and 3 were 7 years (95% CI: 0.5-15), 6.5 years (95% CI: 1-19), and 11 years (95% CI: 2-17), respectively, and were not statistically different. Conclusion: Management of patients with DSD poses a challenge to healthcare providers across the globe. The gradual evolution of patient management with incorporation of MDTs and progression toward delayed surgery is seen in this study. There is indeed a need to set up regional centers of excellence, public awareness programs, and healthcare personnel training programs for optimal management of these patients in low- and middle-income countries (LMICs).

Original languageEnglish (US)
Pages (from-to)186-192
Number of pages7
JournalAnnals of African Surgery
Issue number4
StatePublished - 2022
Externally publishedYes


  • Ambiguous genitalia
  • Disorders of sex development (DSD)
  • Intersex
  • LMIC
  • Ovotesticular

ASJC Scopus subject areas

  • Surgery


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