A Practical Approach to Intersex

M. David Bomalaski

Disclosures

Urol Nurs. 2005;25(1):11-18, 23-24. 

In This Article

Abstract and Introduction

The realm of intersex presents a challenge to the family as well the health care provider. As the physical aspects of diagnosis and management have become better understood, it has become apparent that there are psychological and social aspects that we have only begun to understand. A general overview of intersex issues that may confront the urologic practitioner, and the current concepts of diagnosis and management, are provided.

When a child is born, the first question often asked, "Is it a girl or a boy?" Society is organized around the distinction of the sexes and our treatment of the infant from day 1 is influenced by the assigned gender. Huge societal pressures, both overt and unconscious, come to bear on the child and family based on this designation. This is not a modern 21st century phenomenon. Nearly all societies throughout history have been captivated by the psychological and physical mysteries of reproduction and the different roles of the sexes. The physical appearance of the genitalia was and remains a prime concern to societies. Surrounded by mystery, religion, and societal identity, male and female genitalia surgery remains a cultural phenomenon sparked with emotion. How much more confusing when altered anatomy exists!

Today, with ambiguous genitalia, we have biochemical insight that provides a scientific explanation and surgical expertise that allows us to define physical "normalcy." Yet, despite our increased understanding of the biochemical factors involved in the regulation of sexual differentiation, the practical management of ambiguous genitalia remains fraught with uncertainties. We are only beginning to understand the factors behind sexual identity and behavior, and how this may be independent of physical appearance. As both male and female genitalia arise from a common physical structure, ambiguity arises out of incomplete or altered differentiation. There are a number of different published classification systems categorizing the different types of patients with ambiguous genitalia. A basic background to the phenomenon of ambiguous genitalia is provided, and the biochemical steps which lead to altered external genitalia, and surgical options are reviewed. The controversies involved in the modern care of these patients are also discussed.

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