Advice on the Management of Ambiguous Genitalia to a Young Endocrinologist From Experienced Clinicians

Jean D. Wilson, M.D.; Marco A. Rivarola, M.D.; Berenice B. Mendonca, M.D., Ph.D.; Garry L. Warne, A.M., M.B.B.S., F.R.A.C.P.; Nathalie Josso, M.D., Ph.D.; Stenvert L.S. Drop, M.D., Ph.D.; Melvin M. Grumbach, M.D.


Semin Reprod Med. 2012;30(5):339-350. 

In This Article

Sex Assignment

A variety of considerations influence sex assignment ( Table 1 ). The most critical of these is the diagnosis, which in many instances (and as elaborated below) makes gender assignment clear-cut. Other considerations include the anatomy of the external genitalia that may limit surgical options, the question of the need for long-term hormone therapy, the views of the family, and (sometimes) cultural and/or ethnic considerations and religious beliefs. The issue of potential fertility can be particularly vexing because in some societies telling parents that a girl will (or may) be infertile will automatically make her ineligible for marriage and condemn her to a life of spinsterhood. Fortunately, with advances in assisted reproduction techniques, this particular problem—although far from solved—is now mitigated in many circumstances.