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Abstract

Treatment of psychological problems of 59 children with a physical intersex condition is described. The group consisted of 18 female pseudohermaphrodites with congenital adrenal hyperplasia (CAH), 20 male pseudohermaphrodites and 2 true hermaphrodites born with ambiguous external genitalia assigned the female sex (ambiguous girls), 14 male pseudohermaphrodites born with completely female external genitalia and assigned the female sex (completely female group), and 5 male pseudohermaphrodites born with ambiguous external genitalia and assigned the male sex. Despite the sex assignment, genital organ correction soon after birth, psychological counseling of parents and intensive psychotherapy of the children, general psychopathology developed equally in all 4 groups (39% of total group). Although 87% of the girls with a physical intersex condition developed in line with the assigned sex, 13% developed a gender identity disorder though only 1 girl (2%) failed to accept the assigned sex. Gender identity disorder and deviant gender role were in evidence only in girls with CAH and girls of the ambiguous group. Biological and social factors seem responsible for the development of gender identity disorder, such as pre- and postnatal hormonal influences on the brain enabling deviant gender role behavior to develop, and an inability on the part of parents to accept the sex assignment. A reconsideration of the sex assignment in male pseudohermaphrodites and true hermaphrodites born with ambiguous external genitalia is discussed.

Beyond Discrete Categories: Studying Multiracial, Intersex, and Transgender Children Will Strengthen Basic Developmental Science

“…Presently, intersex children are still considered in formal diagnostic manuals for pediatricians and clinicians to have a "disorders of sexual development," and many clinics conduct surgical or hormonal treatments to "correct" these "problems" (e.g., Slijper & Drop, 1998), with others working to prevent the birth of intersex babies in the first place (New et al, 2001). Thus, intersex children continue to be seen through a lens of "atypicality as pathology" though there is a growing movement to change this perception (Dreger, 1998).…”

“…Some number of children with ambiguous genitalia (one type of intersex condition) are raised as boys and some as girls, some are aware they were born intersex, some are not, yet within each group, some later identify as male, some as female, and some as something in between (e.g., Slijper & Drop, 1998). Although not a true experiment, this configuration of environments, perhaps in combination with the study of transgender children who, for example, are or are not allowed to "socially transition" to live as the "other" gender, could allow researchers to better separate the impact of gender socialization on gender outcomes.…”

“…Although there are now pushes to delay or even stop surgeries for intersex children altogether (e.g., Frader et al, 2004), research on early childhood development among intersex children could contribute by helping us to understand, at an earlier age, the nature of the child's gender identification and will therefore increase the likelihood that if the intersex child has a more binary identity, that child is raised as that identity insofar as possible (e.g., the roster at school or the child's passport lists the correct gender). This understanding in turn can be linked to better support strategies and can hopefully prevent some of the mental health challenges that emerge among misgendered intersex people (Slijper & Drop, 1998).…”

Androgen Insensitivity Syndrome (AIS): Emotional Reactions of Parents and Adult Patients to the Clinical Diagnosis of AIS and Its Confirmation by Androgen Receptor Gene Mutation Analysis

“…Patients with CAIS are always raised as girls, their gender role behavior and gender identity are female [2], their sexual orientation is heterosexual [3, 4, 5]. Children with partial androgen insensitivity (PAIS) usually present directly at birth because of ambiguous external genitalia.…”

Does Surgical Genitoplasty Affect Gender Identity in the Intersex Infant?

“…Froukje [2] and Meyer-Bahlburg et al [3] concluded from a study of gender change from female to male in four adult 46,XX patients with congenital adrenal hyperplasia (CAH) that gender atypical self and body images are the most important factors in the development of crossgender identity.…”