Third physicians rated the cosmetic appearance of the

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Unformatted text preview: h their assignment as girls. But a nearly equal number of other 46,XY individuals were comfortable as girls. Once again, the odds of success seemed about the same as choosing heads at the opening coin toss of a football game. When Surgery Is Optional, Does Sex Matter? The results of studies of people with cloacal exstrophy and related disorders—disorders that demand reconstructive surgery—don’t seem to offer much insight into the best route to successful sex assignment. But what about other disorders of sex development—disorders in which surgery may be optional? One of the first large-scale studies of intersex people who’d had optional surgery was carried out at Johns Hopkins in 2002. The studies involved seventy-five adults with a 46,XY karyotype. Most of them were diagnosed with “undermasculinized genitalia” before they were Outcomes 133 two years old.9 The scientists performing these studies divided the participants into three groups. Group one contained eighteen people with normal-appearing female genitalia. These people looked like females because of either complete androgen insensitivity syndrome or complete gonadal dysgenesis. As mentioned previously, people with complete androgen insensitivity syndrome lack normal receptors for androgens including testosterone. And 46,XY people with complete gonadal dysgenesis have mutations in the SRY region or deletions of portions of the Y chromosome. All the people in group one were raised as females. Group two was composed of eighteen people diagnosed with micropenis. These people’s penises were less than three quarters of an inch long and with “male-typical urethral” openings (i.e., not enlarged clitorises with hypospadias). Micropenis can result from any of several different developmental alterations. Five of the people in group two had been assigned as females and thirteen as males. Group three had thirty-nine people with ambiguous genitalia. These people had both a small phallus and perineoscrotal hypospadias—meaning that the phallus was small for a penis, and the urethra opened in a more typically female fashion, making it likely that the phallus was a large clitoris rather than a small penis. This happens in people with partial androgen insensitivity syndrome, partial gonadal dysgenesis, and some other genetic mutations. In group three, eighteen people had been assigned as females and twenty-one as males. Basically, the purpose was to gather a group of people with different beginnings, surgeries, outcomes, upbringings, and expectations and ask them just how much they knew about their conditions and their chromosomes, how satisfied they were with what had been done to them as children, how their sex lives were, whether they felt they needed psychological help, and how much they enjoyed their lives. When asked if they were generally satisfied with the surgeries performed on them as children and with the adult lives they now led, most responded yes, suggesting that 46,XY children raised as either males or females could lead satisfying and productive lives. Second, among the thirty-nine 46,XY people with ambiguous genitalia, the twenty-one raised as men required a lot more genital surgeries 134 Between XX and XY than did the eighteen raised as women, which, considering the complexity of masculinizing surgeries, is not so surprising. Third, physicians rated the cosmetic appearance of the genitals of those raised as men as much more “abnormal” than the genitals of those raised as women. Again—given the complexity of the undertaking— this is not too surprising. Fourth, among the group of thirty-nine 46,XY people born with ambiguous genitalia, the majority (including nine of the twenty-one assigned as males and twelve of the eighteen assigned as females) were content with their body images. Among the others, only one in each sex group was totally dissatisfied with his or her body image. The rest (eleven of twenty-one raised as males and five of eighteen raised as females) were only somewhat dissatisfied with their body images. Among this same group of people, three of the twenty-one raised as males and three of eighteen raised as females were totally dissatisfied with their sexual function, six in each group were totally satisfied, and the rest somewhat dissatisfied. And finally, 90 percent of these men and 83 percent of these women reported that they had had a recent sexual experience with a partner. On the surface these results seem to say that, regardless of the underlying cause, the majority of 46,XY children who, for one reason or another, don’t quite merit the status of normal male can be arbitrarily surgically and socially assigned as either males or females with an equal probability of success. That interpretation supports John Money’s hypothesis that the sex of a child is amorphous, and it is only the fire of appearances and upbringing that forces the crystallization of male or female. Here at last, it seemed, there was solid evidence that surgery was, in fact, these children’s...
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This document was uploaded on 02/04/2014.

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