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Changes in the management of children with intersex conditions

Nature Clinical Practice Endocrinology & Metabolism volume 4, pages 4–5 (2008)Cite this article

About a decade ago, a spate of articles were published that reviewed and criticized the overall management of newborns with intersex conditions.1,2 These articles stimulated critical examination of the broad area of intersexuality and of its management. The following three specific recommendations were made: stop all infant cosmetic genital surgeries until evidence-based medicine proves their necessity; conduct research to assess whether such surgeries are justified; and practice complete honesty when advising parents and patients about intersex conditions. Further recommendations included the caution that a small or absent penis alone should not justify male-to-female sex reversals. Suggestions on management principles (made on the basis of the knowledge available at that time) were also offered.3 In this Viewpoint we review whether practices have changed in response to these early recommendations.

The call for a moratorium on all cosmetic genital surgeries certainly has not been realized; however, there is now a slower and more judicious approach to the decision to perform sex-assignment surgery. The practice of recommending sex reversal solely on the basis of a small or absent penis has been appreciably reduced, and most investigators now consider that males with micropenis or cloacal exstrophy should be raised as males.4 The decision to preserve female fertility is (without rationale) nonetheless still given more weight than that to preserve male fertility.5 This difference might be because physicians and parents believe that motherhood is more important to females than fatherhood is to males.

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Acknowledgements

The authors' work is supported by the Eugene Garfield Foundation of Philadelphia, PA, USA.

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  1. M Diamond is a Professor at the University of Hawaii John A Burns School of Medicine and HG Beh is a Professor at the University of Hawaii William S Richardson School of Law, Honolulu, HI, USA.,

    Milton Diamond & Hazel G Beh

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  1. Milton Diamond
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  2. Hazel G Beh
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Correspondence to Milton Diamond.

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The authors declare no competing financial interests.

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Diamond, M., Beh, H. Changes in the management of children with intersex conditions. Nat Rev Endocrinol 4, 4–5 (2008). https://doi.org/10.1038/ncpendmet0694

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