Early in my career, the treatment of an infant born with ambiguous genitalia was straightforward. To overcome the issue of phallic inadequacy, assignment to female sex was made even in genetic boys. It was thought that environmental influences along with hormones and reconstructive genital surgery would be most apt to produce a happy and healthy woman. That thinking has gone by the wayside. In a recent study of 14 genetic boys with cloacal exstrophy who were assigned to female sex at birth, Reiner and Gearhart1 found that 8 declared themselves as male during the course of the 8-year study. Philosophical differences about treatment still exist, as illustrated by the 2 commentaries appearing in this issue.2,3
Bergman A. Middlesex. Arch Pediatr Adolesc Med. 2004;158(5):500. doi:https://doi.org/10.1001/archpedi.158.5.500
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