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October 1997

Sex Reassignment at Birth: Long-term Review and Clinical Implications

Author Affiliations

Marshfield Clinic 9601 Townline Rd PO Box 1390 Minocqua, WI 54548-1390

Arch Pediatr Adolesc Med. 1997;151(10):1062. doi:10.1001/archpedi.1997.02170470096021

The tragic story of John/Joan/John1 should come as no surprise to anyone who has been paying attention. In the United States, the medical profession has a compulsive need to surgically alter male genitalia. This takes on several forms: routine neonatal circumcision, surgery to correct "phimosis" in boys at an age at which it is a nonpathologic finding,2 surgical corrections of mild hypospadias, or castrating boys whose phallus does not "measure up" to certain standards (ie, micropenis). Unfortunately, in most of these cases, what the surgeon deems a success is not viewed as such by the patient.3 As John adroitly pointed out, "You can't argue with a bunch of doctors in white coats; you're just a little kid and their minds are already made up. They didn't want to listen."

The authors overlooked the most important lesson to be learned from this tragedy—consent was never given by the