Intersex issues: a series of continuing conundrums.

Abstract

The term “intersex,” as defined in Stedman’s Medical Dictionary and in the Compact Oxford English Dictionary , is “one having characteristics of both sexes.” Unfortunately the characteristics are not defined in any manner. Therefore, the interpretation may be physical, mental, in personality, or in other ways. Despite this confusion, the term today is used primarily, but not exclusively, to denote physical ambiguity-having the genital/gonadal/reproductive structures characteristic of both sexes. It is this interpretation that is referred to in this commentary. A purpose of this commentary, which relates to articles by Migeon et al1,2 in this month’s Pediatrics electronic pages , is to highlight the complexities and conundrums of intersex issues prevalent in our society that affect urologists, surgeons, endocrinologists, geneticists, and pediatricians. The conundrums deal with gender assignment of neonates with ambiguous genitalia of whatever cause but most particularly those with a 46,XY karyotype. The questions include: “When should surgical procedures be undertaken?” “What are the ethics and legal consequences of proceeding with the current standard of care when that standard of care has been loudly challenged by displeased adult individuals who are displeased because of decisions and surgery rendered to them as infants with ambiguous genitalia?” A second purpose of this commentary is to provide insight into what we know from the past, what we currently know, what we need to know, and what I believe we should be doing in our practices between today and the time in the future when we are reasonably sure that what we are doing is correct. The 2 articles1,2 from Johns Hopkins University provide data that set the stage for helping the reader better understand the continuing conundrums of intersex issues. Even pediatricians who have never seen an intersex patient in their practice may do so … Address correspondence to Robert M. Blizzard, MD, Department of Pediatrics, University of Virginia Health Sciences Center, 1224 W Main St, Suite 701, Charlottesville, VA 22903