Recently an article in the Journal has drawn attention (“Results from a pediatric surgical centre justify early intervention in  disorders of sex development” J Pediatr Surg. 2009 Feb;44(2):413-6.)


Dear Editor,

Studies such as this are little use unless they evaluate persons who have reached the age of sexual maturity and attempted to have intimate personal and sexual relationships. The cosmetic appearance of a girl’s or boy’s genitals is largely irrelevant in evaluating sexual functionality. This is often overlooked.  It may be easier to fashion a cosmetically satisfactory vulva and vagina than a penis and scrotum but it is difficult to make genitals that allow comfortable, practical and painless heterosexual sex.

A similar criticism is true in this study’ s evaluations of gender identity.  This can be a relatively meaningless concept to 5 to 10 year old children unless it takes account of the nature of their sexuality and if it ever were consciously or unconsciously challenged.

Many of the people we know with DSDs (Differences of Sex Development) who reassigned themselves had told their doctors they were happy with their original assignments.  Either they didn't want to express their problems to people who they do not trust or they weren’t totally aware of the full nature of the question.

Consequent studies done with adults with DSDs who are living with all of the socio-sexual sequelae of early surgical interventions, will, we predict, find that things are not quite as rosy as this study claims.

What do children with DSD do when, after years of medicalization by curious interns, residents and other hospital staff and possibly public exhibition and photography of their bodies, tell adults who ask probing questions?  Often times they tell them what they think they want to hear so they can please them and “get the hell out of there.”

Person with DSD

William G. Reiner, M.D.
Director, Psychosexual Development Clinic
University of Oklahoma Health Sciences Center

Milton Diamond, Ph.D.
Director, Pacific Center for Sex and Society
University of Hawaii, John A. Burns School of Medicine

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