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.
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REFERENCES
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th ed., rev., APA, Washington, DC.
Berenbaum, S. A., and Hines, M. (1992). Early androgens are related to childhood sex-typed toy preferences. Psychol. Sci. 3: 203-206.
Berkovitz, G. D. (1995). Gender assignment in newborns with ambiguous genitalia. Dialog. Pediat. Urol. 18: 7-8.
Diamond, M. (1982). Sexual identity, monozygotic twins reared in discordant sex roles, and a BBC follow-up. Arch. Sex. Behav. 11: 181-185.
Diamond, M. (1996). Sex assignment considerations. J. Sex Res. 22: 161-174.
Diamond, M., and Sigmundson, K. (1997). Sex reassignment at birth. Arch. Pediat. Adolescent Med. 151: 298-304.
Dittmann, R. W., Kappes, M., and Kappes, M. H. (1992). Sexual behavior in adolescent and adult females with congenital adrenal hyperplasia. Psychoneuroendoc rinology 17: 153-170.
Dittmann, R. W., Kappes, M. H., Kappes, M. E., Börger, D., Stegner, H., Willig, R. H., and Wallis, H. (1990a). Congenital adrenal hyperplasia: II Gender-related behavior and attitudes in female saltwasting and simple virilizing patients. Psychoneuroendoc rinology 15: 421-434.
Dittmann, R. W., Kappes, M. H., Kappes, M. E., Börger, D., Stegner, H., Willig, R. H., and Wallis, H. (1990b). Congenital adrenal hyperplasia: I. Gender-related behavior and attitudes in female patients and sisters. Psychoneuroend ocrinology 15: 401-420.
Ehrhardt, A. A., and Baker, S. W. (1974). Fetal androgens, human central nervous system differentiation, and behavior sex differences. In Friedman, R. C., Richart, R. M., and van de Wiele, R. L. (eds.), Sex Differences in Behavior, Wiley, New York.
Gooren, L., and Cohen-Kettenis, P. T. (1991). Development of male gender identity/role and sexual orientation towards women in a 46,XY subject with an incomplete form of the androgen insensitivity syndrome. Arch. Sex. Behav. 20: 459-471.
Hines, M., and Kaufman, F. R. (1994). Androgen and the development of human sex-typical behavior: rough-and-tumble play and sex of preferred playmates in children with congenital adrenal hyperplasia (CAH). Child Dev. 65: 1042-1053.
Horton, C. E., Jr. (1995). Total phallic reconstruction. Dialog. Pediat. Urol. 18: 4-7.
Imperato-Mc Ginley, J., Peterson, R. E., Gautier, T. (1979). Androgens and the evolution of male-gender identity among male pseuodohermaphrodites with 5 alphareductase deficiency. New Engl. J. Med. 300: 1233-1237.
Meyer-Bahlburg, H. F. L. (1994). Intersexuality and the diagnosis of gender identity disorder. Arch. Sex. Behav. 23: 21-40.
Meyer-Bahlburg, H. F. L., Gruen, R. S., New, M. I., Bell, J. J., Morishima, A., Shimshi, M., Bueno, Y., Vargas, I., Baker, S. W. (1996). Gender change from female to male in classical congenital adrenal hyperplasia. Horm. Behav. 30: 319-332.
Money, J. (1992). Psychological aspects of disorder of sexual differentiation. In Carpenter, S. E., and Rock, J. A. (Eds.), Pediatric and Adolescent Gynecology, Raven, New York.
Money, J., Devore, H., and Norman, B. P. (1986). Gender identity and gender transposition: longitudinal outcome study of 32 male hermaphrodites assigned as girls. J. Sex Marital Ther. 12: 165-178.
Money, J., and Ehrhardt, A. A. (1968). Prenatal hormonal exposure: Possible effects on behaviour in men. In Michael, R. P (ed.), Endocrinology and Human Behavior, Oxford Press, London.
Money, J., Hampson, J. G., and Hampson, J. L. (1955). Hermaphroditism: Recommendations concerning assignment of sex, change of sex and psychological management. Bull. Johns Hopkins Hosp. 97: 284-300.
Money, J., Hampson, J. G., and Hampson, J. L. (1957). Imprinting and the establishment of gender role. Arch. Neurol. Psychiat. 79: 333-337.
Money, J., and Norman, B. P. (1987). Gender identity and gender transposition: longitudinal outcome study of 24 male hermaphrodites assigned as boys. J. Sex Marital Ther. 13: 75-92.
Money, J., Schwartz, M., and Lewis, V. (1984). Adult erotosexual status and fetal hormonal masculinization and demasculinization: 46,XX congenital virilizing adrenal hyperplasia and 46,XY androgen-insensitivity syndrome compared. Psychoneuroen docrinology 9: 405-414.
Money, J., and Tucker, P. (1975). Sexual Signatures: On Being a Man or Woman, Little, Brown, Boston.
Mureau, M. A. M., Slijper, F. M. E., van der Meulen, J. C., Verhulst, F. C., and Slob, A. K. (1995). Psychosexual adjustment of men who underwent hypospadias repair: A norm-related study. J. Urol. 154: 1351-1355.
Reiner, W. G. (1996). Case study: sex reassignment in a teenage girl. J. Am. Acad. Child Adolescent Psychiat. 35: 799-804.
Slijper, F. M. E. (1984). Androgens and gender role behavior in girls with congenital adrenal hyperplasia (CAH). In de Vries, G. J, de Bruin, J. P. C, Uylings, H. B. M, and Corner, M. A. (eds.), Progress in Brain Research, Vol. 61, Elsevier, Amsterdam.
Slijper, F. M. E., Drop, S. L. S., Molenaar, J. C., and Scholtmeijer, R. J (1994). Neonates with abnormal genital development assigned the female sex: parent counselling. J. Sex Educ. Ther. 20: 9-17.
Slijper, F. M. E., van der Kamp, H. J., Brandenburg, H., de Muinck Keizer-Schrama, S. M. P. F., Drop, S. L. S., and Molenaar, J. C. (1992). Evaluation of psychosexual development of young women with congenital adrenal hyperplasia; a pilot study. J. Sex Educ. Ther. 18: 200-207.
Verhulst, F. C., Akkerhuis, G. W., and Althaus, M. (1985). Mental health in Dutch children: I. A cross-cultural comparison. Acta Psychiat. Scand. 72(Suppl. No. 323).
Wallander, J. L., and Thompson R. J. (1995). Psychosocial adjustment of children with chronic physical conditions. In Roberts, M. C. (Ed.), Handbook of Pediatric Psychology, Guilford, New York.
Zucker, K. J., and Bradley, S. J. (1995). Gender Identity Disorder and Psychosexual Problem s in Children and Adolescents, Guilford, New York.
Zucker, K. J., Bradley, S. J., and Huges, H. E. (1987). Gender dysphoria in a child with true hermaphroditism. Can. J. Psychiat. 32: 602-609.
Zucker, K. J., Bradley, S. J., Oliver, G., Blake, J., Fleming, S., and Hood, J. (1996). Psychosexual development of women with congenital adrenal hyperplasia. Horm. Behav. 30: 300-318.
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Slijper, F.M.E., Drop, S.L.S. Long-Term Psychological Evaluation of Intersex Children. Arch Sex Behav 27, 125–144 (1998). https://doi.org/10.1023/A:1018670129611
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DOI: https://doi.org/10.1023/A:1018670129611