Sex Assignment in the Neonate With Intersex or Inadequate Genitalia

Abstract

Clinical decisions about the newborn with ambiguous genitalia should not be approached dogmatically. Data on the psychosexual and psychosocial outcomes of these children are quite simply lacking. Personal experience with 18 children who are 46,XY males with totally inadequate phalluses but normal testes, sex reassigned to female, demonstrates that parents tend to be uncomfortable with sex reassignment and that the children do not behave as typical little girls. Intersexual children present an equally distressing dilemma. Ongoing research should soon add valuable data,¹ which is insufficient at present. Nevertheless, a data-oriented approach is feasible, if necessarily tentative. Assigning a sex-of-rearing to an intersexual neonate must take 1 of 2 directions: treat or do not treat. Sociocultural norms and family demands are likely to push the parents into a treatment mode of thinking. My data implies that older children and young adolescents want cosmetically "appropriate" genitalia. Recognizing the need for a