Genital Abnormalities and Psychological Problems

To the Editor.—  The article by Macfarlane et al (242:442, 1979), "Improved Life Expectancy for Children With Exstrophy of the Bladder," points out that long-term survival for children with surgical treatment of exstrophy of the bladder is now common. The authors allude to quality of life's being compromised by recurrent infection, repeated hospitalizations for plastic repair of accompanying congenital genitourinary deformities, and the presence of malodorous bowel and urinary products.Male adolescents with exstrophy and genital abnormalities suffer great problems in psychosexual adjustment. Important adolescent developmental tasks are achievement of a stable sexual identity role and, early in adolescence, becoming comfortable with pubertal body changes. Like many other chronic illnesses (juvenile-onset diabetes mellitus, cystic fibrosis, and asthma) in adolescents, attention must be paid to the psychological impact of these illnesses on normal developmental tasks. Maladaptive behavior is common in adolescents with congenital genitourinary problems. Delinquency, sexual promiscuity, lack of social