Let’s now talk about the sexual function in congenital adrenal hyperplasia. There are lots of anxieties
that occur about sexual performance and appearance of their genitalia. Likely, these patients have had
some type of genitoplasty and may remain very sensitive as well. The patient may also experience
sexual debut much later in life than is typical. Sexual debut refers to the first time that they have
sexual intercourse. The patients may also have increased dyspareunia or pain with sex
secondary to a small vaginal introitus or the lack of lubrication. Despite nerve sparing surgery,
patients still report decreased sensitivity which may actually decrease their ability to become aroused
and to have enjoyable, pleasurable sexual experience. Let’s now review the obstetric concerns in CAH.
These patients are at increased risk of glucose intolerance. This translates to increased gestational
diabetes which can lead to long term complications in the fetus and to complications in the mother as well.
These patients, remember, are on chronic steroids and will need stress dose steroids upon delivery.
Typically, these patients are likely to have a cesarean section due to the previous vaginal surgery
that they have had and the cephalopelvic disproportion that they most likely have. There are long-term
health consequences associated with CAH. Insulin resistance is one, increased risk of cardiovascular
disease, and increased prevalence of osteoporosis from long-term steroid use. So, a quick clinical tip
is that these patients will require a DEXA scan earlier in life and have increased risk of fracture overall.
Thank you for listening. Good luck on your exam.