Matched pair of siblings concordant for 46,XY hermaphroditism with female sex assignment, and discordant for erotosexual outcome

Ambiguous genitalia, gender-identity problems, and sex reassignment

This article discusses general issues with regard to gender-identity problems, sex reassignment, and clinical management in patients with ambiguous genitalia, based on a detailed case history of a patient with penile agenesis who has been followed more than 20 years. After initial uncertainty, the patient began to grow up as a boy, lived from the fourth year of life as a girl and young woman, and lived from late puberty on as a man. Over his lifetime he experienced extensive corrective surgery plus hormonal substitution therapy. Pre- and perinatal hormonal conditions, phenomenology of the genitalia, sex of rearing, timing of sex reassignment and corrective surgery, for example, appear to be important components for the development of gender-role behavior, gender identity, and sexual orientation of intersex patients. Findings and retrospective considerations for this patient suggest the need for careful differential activities in diagnostic workup, approaches to sex assignment and possible reassignment, and the clinical management of patients and families.

Commentary on McGlashan/Nayfack and Money/Lobato case studies

In this initial discussion for Psychiatry's series of case studies, I will be emphasizing two special contributions that can be made by single case and small sample reports, which are exemplified by the McGlashan/Nayfack paper and by the Money/Lobato study that appeared in the February 1988 issue of Psychiatry. The first contribution provides a unique perspective on the significance of therapist orientation in influencing the course of a patient's disorder and life. The second illustrates the use of a small sample study for understanding complex processes determining the onset and evolution of disorder. The McGlashan/Nayfack report is one of those rare case histories in which we have the opportunity to see the completion of a life, extending our vision far beyond the usual therapeutic frame. The Money report exemplifies the way in which small sample reports can provide a powerful approach to making the detailed comparisons needed to clarify multidetermined processes.