It will be a matter of luck whether skilled counselling is there when it's needed. A woman in this situation faces the implications of a condition which sets her apart in a unique way throughout her life. If she is offered a vaginoplasty operation, a teenage girl may feel under pressure from parents and consultant to undergo surgery at a time when she can hardly imagine the long term consequences. She knows that choices lie ahead she hardly knows the names for, let alone what they imply. In the 1960's or 70's, on the other hand, she was likely to be told, 'Come back if you're thinking of getting married, and we'll see what we can do'.
Few women feel safe to risk such an intimate disclosure to anyone.
The effect on life and relationships can only be imagined. Some women describe a habitual 'holding back' from any kind of closeness for most of their adult life. I work now as an independent infertility counsellor, but during the 17 years I was employed in an adoption agency, I met three women who had married following vaginoplasty surgery. Within the process of an adoption assessment they earned my undying respect for their courage and that of their partners, and concern for their isolation. Nevertheless I am limited.