Genetic aspects of ambiguous genitalia

Androgen insensitivity syndrome and Klinefelter's syndrome: sex and gender considerations

Two of the most common intersex conditions, androgen insensitivity and Klinefelter's syndrome, are described with an emphasis on aspects that are of relevance to psychiatrists. Attention is focused on commonalities and differences between these syndromes and particular attention is given to how persons who have these conditions manifest sexual and gender adjustments to their situations. Tips on counseling and medical management are offered.

A late sex reassignment in 5-alpha reductase deficiency: case report

The syndrome of male pseudohermaphroditism, caused by a deficiency of the enzyme 5-alpha reductase, results in a selective decrease in dihyrotestosterone. Culture is an important part of the context in which decisions are made on sex assignment of patients with abnormalities of the external genitalia. In Turkey, patients with ambiguious genitalia are diagnosed very late and corrective surgery is usually performed during or after puberty. Here we present a case with 5-alpha reductase deficiency who was diagnosed at puberty and followed-up for 10 years.

Psychosexual dysfunction in males with genital anomalies: late adolescence, Tanner stages IV to VI

OBJECTIVE

To assess psychosexual function in adolescent males with genital anomalies.

METHOD

Fourteen consecutive males with bladder exstrophy-epispadias, 14 to 19 years old, Tanner stages IV to VI, were assessed along with their parents, using a developmental questionnaire, Hollingshead socioeconomic status rating, Child Behavior Checklist, Youth Self-Report, semistructured psychiatric interview, detailed sexual history, and 5 written, open-ended questions.

RESULTS

All subjects showed psychosexual dysfunction in terms of genital satisfaction and genital touching; only 2 had ever undressed in front of anyone; only 2 had ever masturbated and only after age 16; 8 had few friends and only 5 considered any girls as friends; all expressed heterosexuality but only 4 had dated, 1 at age 17 and 2 after age 18; only the two 19-year-olds had experienced sexual intercourse, at the age of 19. All had an anxiety disorder. Half had experienced a major depressive disorder.

CONCLUSIONS

Psychosexual dysfunction and anxiety were universal and chronic in these males with genital anomalies, leading to social and sexual developmental impairment. Half had a mood disorder. Implications for adulthood as well as for children with other genital anomalies are unclear but deserve further study. Males with genital anomalies should be evaluated for psychosexual developmental impairment.

Ambiguous genitalia: etiology, treatment, and nursing implications

The infant presenting with ambiguous genitalia is a challenge to both the medical and nursing staff. The birth of any infant with ambiguous genitalia is considered a physical and psychologic emergency requiring prompt recognition and treatment for a positive outcome. A review of the etiology, presentation, diagnosis, and treatment of ambiguous genitalia is presented. The important aspects of family care also are discussed.

Case study: sex reassignment in a teenage girl

The etiology of gender identity is explored through the case history of a teenager with intersex raised without stigmatization as a girl but who declared himself male at age 14 years. Psychological ramifications of such complex medical anomalies as ambiguous genitalia demand a role for child psychiatry.