Gender Reassignment and Ambiguous Sexuality

Is it a Baby Boy or Baby Girl?

When an infant is born, we expect to hear, 'it's a boy' or 'it's a girl'. When this can't be done, it poses a dilemma for both parents and medical staff.

Fetal development and genital abnormality
Because of the complexity of fetal development, things can, and do, sometimes go wrong. There are many different types of genital abnormality. Males can be born with undescended testicles (testicles still contained within the pelvis) but with female looking genitalia; a condition known as male pseudohermaphroditism.

Babies can have ovaries and testicles as well as ambiguous looking genitals and this is what is known as hermaphroditism.

Gender Choice
Infants born with a micropenis were, until quite recently, gender assigned as female. The very small penis was amputated and the infant brought up as a girl.

Arguably, this type of treatment became the treatment of choice because of the work and stature of a doctor called John Money. Dr Money and colleagues, worked with sexually ambiguous infants at the John Hopkins Medical Center, from about the mid 1950s until quite recently. The work was generally highly regarded and Dr Money gave leadership in a field of medicine that was, and remains, highly contentious. This type of treatment has to be put in the social and cultural context of the time.

Key Points in Decision Making at the Time:

  • People are psychologically neutral at birth, so if treated and socialized as a male, a child will grow up as a male.

  • Psychosexual development is related to the external appearance of the sex organs, so if you look down and see a penis, you will grow up like a boy.

  • If sex can be decided as soon as possible or, at most between 18 months to 2 years, there will optimum success. Language was also thought to be an important factor. So when the child understands language, they come to understand what gender they are.

  • Parents must believe in the gender that is selected and the doctors job is to promote the certainty of the gender. To allow doubt was seen to cause traumatic problems both for the parents and the infant.
  • Ambiguous Sexual Organs
    Can a female become a male simply by surgical enhancement of the enlarged or ambiguous phallus? The answer is that surgery can often make the external sexual organs look either male or female. Hormones can be given in the first few months of life and again at puberty in order to assist gender alignment. This can work so long as things go smoothly, i.e.[

  • if the hormones are tolerated well and do their work
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  • if the parents believe in the sex given to their baby

  • the gender realigned individual feels that they are the gender assigned to them.

  • At the time, and in the absence of perceived alternatives, this approach was generally considered to be the best option available.

    History of the Treatment of Intersex (ambiguous genitalia)
    The treatment of intersex was strongly influenced by the case study of a boy whose penis was accidentally amputated during a circumcision; the so-called, John/Joan case. His subsequent treatment after castration at two years of age included female hormones at puberty that allowed the growth of breasts. His socialization as a girl was thought, for many years, to have been successful and therefore guided the treatment of other cases.

    However he rejected his gender reassignment and, in his late teens, reverted to living as a male.

    Is There a Third Sex - an Intersex?
    More recently, the debate about gender assignment has shifted towards looking at things in a new way. This comes at a time when society is more willing to acknowledge sexuality as more complex than just being male or female. Most importantly, the people who have experience of intersex, are finding a voice that is becoming increasingly influential. Some of them are saying that society should not interfere with naturally occurring phenomena, and that the answer is to acknowledge that there is, in fact, a third sex.

    The Right to Decide your own Sex
    One of the main issues now centers on the right of the individual to decide. The question is whether surgically changes should be made before people can decide for themselves, or is the potential for psychological harm such that early intervention is the most humane way to proceed?

    Article Sources Include:

    Milton Diamond (1997)Sexual Identity and Sexual Orientation in Children with Traumatized or Ambiguous Genitalia. The Journal of Sex Research, Vol. 34, 1997

    Milton Diamond, Ph.D. and H. Keith Sigmundson, M.D. (1997) MANAGEMENT of INTERSEXUALITY: Guidelines for dealing with individuals with ambiguous genitalia Archives of Pediatrics and Adolescent Medicine, Volume 151: Pages 1046-1050,

    Suzanne J. Kessler (1990)The Medical Construction of Gender: Case Management of Intersexed Infants. Signs, Vol. 16, No. 1, From Hard Drive to Software: Gender, Computers, and Difference (Autumn, 1990), pp. 3-26

    Summary of Consensus Statement on Intersex Disorders and Their Management. Christopher P. Houk, MD, PhDAa, Ieuan A. Hughes, FMedSci, FRCPCHb,c, S. Faisal Ahmed, FRCPCHd, Peter A. Lee, MD, PhDe,c and Writing Committee for the International Intersex Consensus Conference Participants. PEDIATRICS Vol. 118 No. 2 August 2006, pp. 753-757 (doi:10.1542/peds.2006-0737)

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