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Gender Reassignment and Ambiguous Sexuality

Is it a Baby Boy or Baby Girl?

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Updated January 05, 2007

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
  • [/br]
  • 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.

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