Congenital micropenis: long-term medical, surgical and psychosexual follow-up of individuals raised male or female

OBJECTIVES

To document long-term medical, surgical and psychosexual outcome of individuals with congenital micropenis (13 males, 5 females).

METHODS

Physical measurements from childhood were collected retrospectively from medical records and at adulthood by physical examination. An adult psychosexual assessment was conducted with a written questionnaire and oral discussion.

RESULTS

Adult penile length was below the normal mean in all men. Three women had vaginoplasty resulting in normal length. All men reported good or fair erections but 50% were dissatisfied with their genitalia. Dissatisfaction with body image resulted from having a small penis (66%), inadequate body hair (50%), gynecomastia (33%) and youthful appearance (33%). Ten men were heterosexual, 1 homosexual and 2 bisexual. Among women, 4 (80%) were dissatisfied with their genitalia. Three women reported average libido with orgasm and were also heterosexual. Two women had no sexual interest or experience. Finally, males were masculine and females feminine in their gender-role identity, and both groups were satisfied with their sex of rearing.

CONCLUSIONS

Regarding choice of gender, male sex of rearing can result in satisfactory genito-sexual function. Female gender can also result in success, however it requires extensive feminizing surgery.

Effects of standard and eccentric overload strength training in young women

PURPOSE

According to the force-velocity relationship of human skeletal muscle, the maximal load one can lift is limited by the concentric movement phase, and the eccentric phase is always underloaded. In the present study, we hypothesized that acute exercise training using an eccentric overload compared with standard loading would lead to greater neuromuscular and strength adaptations.

METHODS

Sedentary women (age 20.9 yr) were tested for concentric and eccentric three-repetition maximum (3RM), maximal isokinetic eccentric and concentric and isometric force and associated EMG activity of selected thigh muscles before and after 7 consecutive days of exercise training of the left quadriceps. The exercise program was designed so that the total weight lifted was similar between the eccentric overload (EO, N = 10) and standard group (ST, N = 10), but EO exercised with about 50% greater eccentric load whereas the controls did not exercise (N = 10).

RESULTS

There was a 22% increase in the total weight lifted over 7 d. On the average, EOs compared with STs strength gains were approximately twofold greater. Changes in EMG paralleled the changes in muscle strength without changes in biceps femoris coactivity during knee extension.

CONCLUSION

Because the strength gains were achieved by exercising at low intensities and over a short time period, exercise prescription of eccentric overloading appears especially suitable for elders, individuals deconditioned due to an injury, and the chronically diseased.

Complete androgen insensitivity syndrome: long-term medical, surgical, and psychosexual outcome

Controversy concerning the most appropriate treatment guidelines for intersex children currently exists. This is due to a lack of long-term information regarding medical, surgical, and psychosexual outcome in affected adults. We have assessed by questionnaire and medical examination the physical and psychosexual status of 14 women with documented complete androgen insensitivity syndrome (CAIS). We have also determined participant knowledge of CAIS as well as opinion of medical and surgical treatment. As a whole, secondary sexual development of these women was satisfactory, as judged by both participants and physicians. In general, most women were satisfied with their psychosexual development and sexual function. Factors reported to contribute to dissatisfaction were sexual abuse in one case and marked obesity in another. All of the women who participated were satisfied with having been raised as females, and none desired a gender reassignment. Although not perfect, the medical, surgical, and psychosexual outcomes for women with CAIS were satisfactory; however, specific ways for improving long-term treatment of this population were identified.

New phylism theory and the homosexualization of the visualization of lust

Nature needs nurture is the paradigm that replaces nature versus nurture. Nature's determinants are phylismic, i.e. they belong to the person phylogenetically as a member of the species and are not individually fortuitous. Phylismically, in the human species, vision and contrectation supplant pheromones as procreative attractants. The primary visual attractant, the sexual body morphology of a potential partner, is in all likelihood hormonally encoded into the sexual brain in fetal and/or neonatal life. Should the prenatal or neonatal encoding of the visual attractant become transposed from the visual image of the body morphology of the other sex to that of the same sex, then the brain would be biased in subsequent development toward some degree or variation of homosexual or bisexual attraction.

Case consultation: ablatio penis

In male infants, traumatic ablation of the penis, with or without loss of the testicles may occur as a sequel to mutilatory violence, accidental injury, or circumcision error. Post-traumatically, one program of case management is surgical sex reassignment to live as a girl, with female hormonal therapy at the age of puberty. The other program is genital reconstructive surgery to live as a boy, with male hormonal therapy at puberty if the testicles are missing. In both programs, the long term outcome is less than perfect and is contingent on intervening variables that include societal ideology; surgical technology; juvenile and adolescent timing and frequency of hospital admissions construed by the child as nosocomial abuse; development of body image; health and sex education; fertility versus sterility; coitus and orgasm; possible lesbian orientation if living as a girl; and long-term cost accounting, including the psychic cost of being a pawn in possible malpractice litigation on whose disability a very large fortune in compensation may devolve. There is, as yet, no unanimously endorsed set of guidelines for the treatment of genital trauma and mutilation in infancy, and no provision for a statistical depository for outcome data.

Sibling sex ratio of boys with gender identity disorder

Sibling sex ratio (the ratio of brothers to sisters) was calculated for 444 boys with gender identity disorder (or with behaviors consistent with this diagnosis). The probands were ascertained from several researchers with expertise with this disorder and from the English language case report literature between 1938 and 1995. Among the probands with at least one sibling (N = 333), the results showed that boys with gender identity disorder had a significant excess of brothers to sisters, 131.1:100, when compared with the expected secondary sex ratio of 106:100. The excess of brothers replicated a previous study by Blanchard, Zucker, Bradley, and Hume (1995), in which the sibling sex ratio was 140.6:100. Further analyses showed that the probands were born later relative to their brothers than they were relative to their sisters. These findings are amenable to several psychosocial and biological explanations, which require further investigation.

Gait adaptations before and after anterior cruciate ligament reconstruction surgery

Gait analyses of rehabilitated individuals with anterior cruciate ligament (ACL) deficiency and reconstruction have identified the final adaptations of increased hip extensor torque and hamstring electromyography (EMG) and decreased knee extensor torque and quadriceps EMG during stance. The initial adaptations to injury and surgery are, however, unknown as are the factors that influence the development of the adaptations. Identification of the initial response to injury would provide a basis for determining whether the final adaptations are learned automatically or if they are the result of a lengthy training period in which various factors may affect their development. The purpose of the study was to evaluate the initial effects of ACL injury and reconstruction surgery on joint kinematics, kinetics, and energetics, during walking. Injured limbs from nine subjects with ACL injury were tested 2 wk after injury, and 3 and 5 wk after surgery. Ten healthy subjects were tested. Kinematic and ground reaction data were collected and combined with inverse dynamics to calculate the joint torques and powers. A knee extensor torque throughout most of stance was observed in the injured limbs at all test sessions. This result was in conflict with previous observations of reduced extensor torque or a flexor torque in rehabilitated patients with ACL reconstruction and patients with ACL deficiency. This result also differed from the typical midstance extensor then flexor torque in healthy control subjects. Trend analysis showed a significant (P < 0.001) change in average position at the hip and knee, extensor angular impulse at the hip, and positive work done at the hip 3 wk after surgery followed by a partial rehabilitation at 5 wk after surgery. Power and work produced at the knee were reduced fivefold (P < 0.001) after 5 wk of rehabilitation and did not recover to pre-surgical levels. The existence of a long-lasting knee extensor torque 2 wk after injury indicated that the adaptation process to ACL deficiency is lengthy, requiring many gait cycles, and that numerous factors could be involved in learning the adaptations.

Evolutionary sexology: the hypothesis of song and sex

In subhuman mammalian species, lovemaps are homogeneous and are more or less biorobotically fixed, whereas in the human species they are emancipated from biorobotism and are personalized, idiosyncratic, and heterogenous-as, for example, in the paraphilias. The evolutionary sexological hypothesis described herein proposes that emancipation of all of the biorobotic mindbrain maps, the mating map included, was essential for, and coincident with the evolution of the human speechmap from the songmap. Accordingly the first human language was a love song rather than a howl of warning. The bare essentials of sexuoerotic arousal and response are in three categories: haptoerotic (cutaneous), morphoerotic (visual), and gnomoerotic (narrative).

No vacancy: the political geography of immigration control in advanced industrial countries

This article examines the domestic political sources of immigration control in advanced market economy countries after World War II. Immigration control can be distinguished from the broader concept of immigration policy by its emphasis on state policies that define the permissible level of resident alien admissions. The analysis is based on the well-established fact that immigrant communities are geographically concentrated. I argue that this geographic concentration creates an uneven distribution of costs and benefits, providing a spatial context for immigration politics. In this context, net public demand for tighter immigration control increases in localities where immigrants concentrate when those areas experience higher unemployment, rapid increases in immigration, higher immigrant proportions, and more generous immigrant access to social services. Each of these conditions aggravates competition between immigrants and natives, and hence native hostility, in these communities while employer support for immigration usually diminishes. Yet national politicians may ignore changes in the demand for immigration control unless these constituencies are also able to swing a national election from one party to another. The larger and less “safe” the local constituencies, the greater their influence in this sense. Evidence from the United Kingdom between 1955 and 1981 is consistent with these propositions.

Sexology of ictal masturbation in infancy

In 1952, under the title of "Masturbation in Infants," Bakwin reported three cases of females all younger than one year of age. Bakwin's type of so-called masturbation has been considered in the differential diagnosis of epilepsy in several papers published since 1975. The cases reported display a great similarity and underscore an ictal explanation of the syndrome.

The concept of gender identity disorder in childhood and adolescence after 39 years

The term "gender role" appeared in print first in 1955. The term "gender identity" was used in a press release, November 21, 1966, to announce the new clinic for transsexuals at The Johns Hopkins Hospital. It was disseminated in the media worldwide, and soon entered the vernacular. The definitions of gender and gender identity vary on a doctrinal basis. In popularized and scientifically debased usage, sex is what you are biologically; gender is what you become socially; gender identity is your own sense or conviction of maleness or femaleness; and gender role is the cultural stereotype of what is masculine and feminine. Causality with respect to gender identity disorder is subdivisible into genetic, prenatal hormonal, postnatal social, and postpubertal hormonal determinants, but there is, as yet, no comprehensive and detailed theory of causality. Gender coding in the brain is bipolar. In gender identity disorder, there is discordancy between the natal sex of one's external genitalia and the brain coding of one's gender as masculine or feminine.

Sexual revolution and counter-revolution

Adolescents of today inherit the conflicting legacies of the sexual reformation of the 1960s and the counter-reformation of the 1980s/1990s. Sexual mores are influenced by a younger age of puberty than in earlier generations and by the availability of effective contraception and antibiotics to combat sexually transmitted diseases. In the era of acquired immune deficiency syndrome, however, absolutely safe sex cannot be guaranteed, only relative degrees of safety and risk. Masturbation may be one way of achieving safe sex. Advancing technology also allows greater equality of opportunity and economic emancipation for women, enabling men and women to share equally in the care of older infants and children, also influencing sexual roles. Sex education for adolescents is provided sporadically and inconsistently, being seen by opposing factions as either encouragement to early pregnancy or a means of preventing it. In particular, the images delivered by the mass media are blatantly contradictory, ranging from endorsement of teenage sexual expression to condemnation of abortion and teenage pregnancy. Cultural traditions have strong influences on the acceptability of early pregnancy and on family structure. Black American culture is based on the three-generational family as opposed to the white tradition of the nuclear, two-generational family. It is important to realize a social policy that will respect not only the sexual rights of young people, but also the sexual health of the community.

Specific neuro-cognitive impairments associated with Turner (45,X) and Klinefelter (47,XXY) syndromes: a review

In Turner syndrome, there is a high incidence of neuro-cognitive impairment specific to the mental processing and sequencing of rotational transformations of shapes in the spatial dimensions of left-right, up-down, and back-front. In Klinefelter syndrome, the corresponding neuro-cognitive impairment is specific to the mental processing of sequence and synchrony in the temporal dimension, including the temporal dimension of language.

Sexuality and menopause

Postmenopausal sexuoerotic health is multivariately determined by both intrinsic and extrinsic variables, some of which may predate the menopause. In a pilot study of 20 postmenopausal women, even when deterioration in sexual well-being was anticipated beforehand, it did not inevitably materialize, but if it did so, it was not inevitably correlated with diminished partner availability. Postmenopausal ratings of erotosexual ideation, imagery, and practices indicated nondeterioration markedly more often than they did deterioration. There is increasing professional agreement that androgen maintains erotosexual functioning in women as well as men; and that, in minimal nonmasculinizing dosage, it can be included with good therapeutic effect in postmenopausal steroid replacement therapy.

A case of autoerotic asphyxia associated with multiplex paraphilia

During the past 20 years, the sensational aspects of autoerotic fatalities have captured the attention of medical examiners, psychiatrists, law enforcement agents, and the public, as well as the individuals themselves who engage in these dangerous practices. Reports of deaths related to sexual asphyxia have been presented numerous times at national and international meetings and have been the topic of discussion on television talk shows and in the press. Autoerotic fatalities and all the sexual curiosities related to these activities have prompted death scene investigators to publish case reports, and even textbooks, on the subject. The case presented herein is one of a multicomponent paraphilia in which self-asphyxiation (autoasphyxiophilia) led to a fatal autoerotic event.

Semen-conservation doctrine from ancient Ayurvedic to modern sexological theory

The ancient doctrine of semen conservation has a long philosophical history in Europe and Asia. In Sanskrit, semen is equated with sukra, the life force. As early as 600 B.C., the Caraka Samhita taught the importance of sukra, and gave prescriptions to augment it. In the 18th century, semen conservation theory reentered Western medicine through Tissot's Treatise on the Diseases Produced by Onanism. It became the basis of the degeneracy theory of all disease, and of the masturbation hysteria of the 19th and 20th centuries.

Androgyne becomes bisexual in sexological theory: Plato to Freud and neuroscience

Plato conceptualized primordial humans as androgynes, the children of the moon. The primordial hermaphroditism of the mammalian embryo became known 2 1/2 millennia later in the mid-19th century. By 1864 Ulrichs had transposed the new knowledge from embryology to sexology to explain those to whom he gave the name Urnings (after Uranus who gave womanless birth to Venus from sea spume) as having "a woman's mind trapped in a man's body" (anima muliebris corpore virili inclusa). Urning became displaced by sexual inversion, and eventually by homosexual, a term coined together with heterosexual by Kertbeny as recently as 1869. The embryological principle of primordial hermaphroditism became linked to evolutionary Darwinism by way of Haeckel's principle of recapitulation, epitomized as "ontogeny recapitulates phylogeny." The recapitulation principle became linked, in turn, to the principle of intrapsychic primordial bisexuality, which became a cornerstone of Freud's psychoanalytic theory. Genetics influences the outcome of bipotentiality not directly but by way of hormonal programming of the brain, prenatally or neonatally, rather than pubertally and in maturity. Bipotentiality within the brain has been investigated chiefly in the hypothalamus where male/female dimorphism has been recognized, but its determinants and stages of differentiation, both prenatal and postnatal, remain to be fully ascertained. Neuroanatomical research on the outcome of male/female bipotentiality as gay, straight, or in between is politically and morally opposed by those who postulate a bipotential preference or voluntary choice. In stimulus-response associationism, to which behavior-modification theory belongs, bisexuality is equipotential, and either alternative may be evoked, ostensibly, dependent on the stimulus situation. In ethological theory, the effectiveness of stimulus-response bonding is confined chronologically to a critical period of development and is restricted phylogenetically by an innate recognition mechanism and an innate releasing mechanism. These limits are compatible, however, with some degree of both individual and ethnic variation.

Forensic sexology: paraphilic serial rape (biastophilia) and lust murder (erotophonophilia)

Forensic sexology is not synonymous with either forensic psychiatry or forensic psychology. It is a specialty in its own right, and is needed in the courtroom. Paraphilic sex offenders on trial are misrepresented as being, by their own choice, psychopathic or sociopathic deviates. They are unable to explain their paraphilic criminality to either themselves or society. In a case of serial rape and serial lust murder here presented, the contributory causes are examined and differentiated as hereditary predisposition, hormonal functioning; pathological relationships, sexual abuse; and syndrome overlap with bipolar disorder, schizoid disorder, antisocial personality disorder, epilepsy, and multiple personality. The precipitating causes were differentiated as childhood head injuries, and adult head injury at age 20. Left impact trauma and sexological trauma were sequelae of the adult injury. The full range of diagnostic resources was not available for a prisoner on death row. Capital punishment has not prevented the reemergence in each new generation of serial rape and serial lust murder as an epidemiological, public health problem. Punishment is an ineffectual substitute for epidemiological research into cause, effect, and prevention.

Paleodigms and paleodigmatics: a new theoretical construct applicable to Munchausen's syndrome by proxy, child-abuse dwarfism, paraphilias, anorexia nervosa, and other syndromes

A paleodigm is a formulation of ancient folk wisdom that encodes a causal explanation in a saying or story that penetrates the idiom of everyday language and influences behavior. Although paleodigms are not, per se, causative, they have diagnostic, prognostic, and therapeutic significance in syndromes like Munchausen's syndrome by proxy.

Pedagogical handicap associated with micropenis and other CHARGE syndrome anomalies of embryogenesis: four 46, XY cases reared as girls

Genital hypoplasia (micropenis) and CNS impairments are among multiple anomalies of embryogenesis that are found in association in a syndrome for which the acronym CHARGE has recently been coined. The CNS anomalies are either peripheral or central or both. Their various manifestations are impaired hearing and vision; impaired motor performance and visual-motor coordination; IQ deficit either overall or specific to verbal reasoning or praxic reasoning; and social ineptitude consequent on impaired social maturation. These various impairments constitute a pedagogical handicap which, even though of major severity, is not refractory to clinical treatment and educational therapy.

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

The two siblings in this comparison constitute a matched pair on the basis of concordance not only for prenatal history and diagnosis but also for assigned sex as girls, and for spontaneous hormonal puberty that was not feminizing, but masculinizing. They were further concordant in being surgically and hormonally feminized, with their own informed consent, early in adolescence. Subsequently, they became discordant, for the younger one has lived continuously as a woman, with a feminine gender-identity/role (G-I/R) socially and erotosexually, whereas the older one became self-reassigned to live as a man with a masculine G-I/R socially and erotosexually, hormonally supported on testosterone replacement therapy. Flattening of the chest was readily accomplished by plastic surgery, but phalloplasty was not attempted, primarily because of the technical obstacles and, to a lesser extent, the cost.

Genital examination and exposure experienced as nosocomial sexual abuse in childhood

Three pediatric cases of girls, one with idiopathic precocious puberty and two with a birth defect of the sex organs, exemplify the proposition that genital exposure and the physical examination of the genitals may be experienced subjectively as nosocomial sexual abuse. Negative sequelae persisted into adulthood. The dogma of the new victimology industry is that children never lie about sexual abuse. Consequently providers of pediatric and ephebiatric (pubertal and adolescent) sexual health care already are progressively at risk of being falsely accused of nosocomial (from the Greek nosokomeion, from nosos, disease, + komeion, to take care of: pertaining to or originating in a hospital, as nosocomial disease) sexual abuse.

Bisexually concordant, heterosexually and homosexually discordant: a matched-pair comparison of male and female adrenogenital syndrome

Prenatal hormonal experiments in subprimate species demonstrate conclusively that the pattern of adult mating behavior is masculinized or feminized as a function of prenatal hormonalization of the brain. In primates, especially human beings, postnatal socialization is superimposed on prenatal hormonalization. The syndrome of congenital virilizing adrenal hyperplasia [CVAH] is an experiment of nature in which the fetal brain is prenatally hormonalized by a masculinizing excess of androgen from abnormally functioning adrenal cortices. The syndrome was diagnosed in two children, one a chromosomal, 46,XX female, and one a 46,XY male, who amongst many others were psychoendocrinologically followed into adulthood. Each was able to fall in love exclusively with a female as a partner in sexuoerotic activity, though each experienced also, on an investigative basis, at least one genitosexual encounter with a male. On a behavioral technicality, therefore, each had a history of bisexual practices, whereas subjectively the woman identified herself as a lesbian, and the man as a Kinsey-one heterosexual. Hormonally, it may be inferred that in prenatal life both were ultramasculinized to such a degree that it was impossible for any postnatal interventions to permit the man to become a bona fide homosexual, or the woman a bona fide heterosexual. The full implication of these findings and those of similar cases for homosexual/heterosexual theory remains to be ascertained.

Adolescent sexology and ephebiatric sexual medicine

Ephebiatric sexual medicine is a specialty that still awaits its Vesalius. The age of onset of puberty has decreased by four years in the past two centuries, without a concordant change in social and legal institutions governing sexual and economic autonomy. Concomitant with the reintroduction of the ancient European betrothal system, the adolescent age of first coitus has lowered and averages two years earlier than first contraception. The hiatus is attributed to the moral sanctions against open access to contraception in adolescence. The neglect of sexual learning in teenage allows cases of suicidal and homicidal lovesickness to be undetected and likewise the mental template or "lovemap" of paraphilic pathology in adolescence lacks both preventive measures and treatment. The newest treatment of the paraphilias is with antiandrogen combined with counseling. Positive or negative preparedness for first orgasm or first coitus correlate with positive or negative outcome in subsequent sexuoerotic health. Knowing the sexology of syndromes, for example genetic and endocrine syndromes of childhood, expedites the delivery of sexological health care service in adolescence.

Longitudinal studies in clinical psychoendocrinology: methodology

There are five universal exigencies of being human, against which a person's existence can be evaluated: pairbondage, troopbondage, abidance, ycleptance, and foredoomance. They constitute a template from which a standardized agenda or schedule of inquiry is generated, as needed, for a particular research investigation. The schedule of inquiry is painstakingly designed ahead of time so as to ensure coverage of all the variables relevant to a particular study. For economy of expense and effort, subjects conclude their own prior interviews by summarizing it on tape, with the interviewer making a written record, verbatim, of what will become subheadings in the transcript. Inquiry progresses from an open-ended to a forced choice interrogatory. Topics in the public domain open the way to inquiry on personally sensitive issues. So also do parables drawn from actual cases and used as personalized narrative projective tests. A cumulative record, covering as many as 25 years, is indexed so that relevant material can be located, abstracted, and classified for any particular study. A jury of two or more then uses the abstracted data to fill out a prepared data schedule, using its own standardized scoring or rating criteria. By contrast, an ordinary questionnaire uses standardized questions, and each subject applies his or her own unstandardized scoring or rating criteria in answering them. In the final step, the jury's ratings are tabulated on a master chart that consolidates the scores of a group of subjects and controls, ready for statistical analysis.

Paraphilias: phenomenology and classification

DSM-III incorrectly designates the majority of paraphilias as atypical. Only eight are named, and those because of their forensic history, rather than their pathology and therapeutic need. In this paper, thirty-odd paraphilias are subdivided into six categories on the basis of their phenomenological dynamics. The new concept of the developmental lovemap is introduced for the first time. A new treatment originated by the author in 1966 combines an androgen agonist with counseling therapy.

Five universal exigencies, indicatrons and sexological theory

In sexology as science, except for the special case of introspection, on which the defense of mind-body dualism rests, raw data are obtained, like the raw data of all the other sciences, through the special senses and exteroceptive observation. In Table 1 are shown the verbs and nouns that are needed to relate the five special senses of the observer to the observed, as stimuli are transmitted to their destination from their source. Some of these terms sound somewhat unidiomatic, which is no accident. It is precisely because vernacular English was not designed for scientific usage that some needed terms have been lacking--to the detriment of theoretical mindbody unity. Another missing term in sexology as science is a generic one for any type of unit of raw data. The gap can be filled with the new term, indicatron, in recognition of the fact that sexology's units of raw data all serve to indicate something. Since exactly the same applies to the raw data of any science, then sexology and the other sciences share the same premise. The sociopsychological and the biomedical sciences from which sexology conjointly derives are not separated as being of the mind and the body respectively. They are unified in indicatronics, the science of indicatrons, in which the split between body and mind is semantically irrelevant. The indicatrons of sexology can be classified under five universal exigencies of being human: being pairbonded, troopbonded, abidant, yclept, and foredoomed.

Gender-transposition theory and homosexual genesis

The genesis of homosexuality, and therefore of heterosexuality also, has traditionally been argued as either wholly biological or wholly social-environmental. The theory of gender transposition integrates findings regarding both prenatal hormonal programming of the sexual brain, and postnatal social programming.

Adult erotosexual status and fetal hormonal masculinization and demasculinization: 46,XX congenital virilizing adrenal hyperplasia and 46,XY androgen-insensitivity syndrome compared

Among 30 young women with a history of the treated adrenogenital syndrome (CVAH), 11 (37%) rated themselves as bisexual or homosexual. Among a control group consisting of 15 women with the 46,XY androgen-insensitivity syndrome (AIS) plus 12 with the Rokitansky syndrome (MRKS), the corresponding figure was 2 (7%), both bisexual. Chi-square was significant beyond the 0.01 level. In Kinsey's 1953 sample 15% of women experienced homoerotic arousal imagery by age 20, and 10% had had homoerotic partner contact. The most likely hypothesis to explain the CVAH findings is that of a prenatal and/or neonatal masculinizing effect on sexual dimorphism of the brain in interaction with other developmental variables.

Micropenis: adult follow-up and comparison of size against new norms

In eight cases of micropenis, the follow-up period was from childhood through adulthood (age range 22 to 31). Topical treatment of the penis with testosterone propionate in childhood increased its size relative to the rest of the body before adolescence. In adolescence and adulthood, the penis with a prior history of treatment with testosterone (N = 5) had no size advantage over the untreated one (N = 3). Topical testosterone postponed the age of developing a coping strategy, but not the necessity of developing one. New data (N = 65) for the stretched length of the adult penis give a M +/- SD of 16.69 +/- 1.90 cm, or 6.57 +/- .75 inches.

Psychology of syndromes. IQ and micropenis

In 20 patients with a micropenis, IQs ranged from 81 to 137, with a mean of 117 +/- 14 and a median of 116. The distribution of IQs approximated a normal distribution except that the entire curve was skewed, with the majority (75%) of scores higher than 109. There was no clustering related to diagnosis, age, sex of rearing, or serial testing to account for the skew, which was stronger for verbal than for performance IQ. These findings negated the probability of an adverse intellectual prognosis for patients born with a micropenis.

New phylism theory and autism: pathognomonic impairment of troopbonding

A phylism is a unit of existence, part of an individual's species heritage. It is neither nature nor nurture, but a phyletically dictated product of the interaction of both at a crucial developmental period which may be either prenatal, postnatal, or both. In the syndrome of autism, the phylism of troopbonding is specifically impaired, and other phylisms may be hypertrophic. The phylism of limerent (lover-lover) pairbonding is not impaired, and it may be the source of discordance with other members of the troop. Shyness is an attenuated manifestation of autism. The etiology of impaired troopbonding may be heritable, and almost certainly will prove to be neurochemical also, probably as an analogue of the Lesch-Nyhan syndrome. The lives of autistic children are subject to secondary shaping by the environment of living.