Neonatal Sex Assignment in Disorders of Sex Development: A Philosophical Introspection

Perceiving gender while perceiving language: Integrating psycholinguistics and gender theory

There is a substantial body of literature showing that men and women speak differently and that these differences are endemic to the speech signal. However, the psycholinguistic mechanisms underlying the integration of social category perception and language are still poorly understood. Speaker attributes such as emotional state, age, sex, and race have often been treated in the literature as dissociable, but perceptual systems for social categories demonstrably rely on interdependent cognitive processes. We introduce a diversity science framework for evaluating the existing literature on gender and speech perception, arguing that differences in beliefs about gender may be defined as differences in beliefs about differences. Treating individual, group, and societal level contrasts in ideological patterns as phenomenologically distinctive, we enumerate six ideological arenas which define claims about gender and examine the literature for treatment of these issues. We argue that both participants and investigators predictably show evidence of differences in ideological attitudes toward the normative definition of persons. The influence of social knowledge on linguistic perception therefore occurs in the context of predictable variation in both attention and inattention to people and the distinguishing features which mark them salient as kinds. We link experiences of visibility, invisibility, and hypervisibility with ideological variation regarding the significance of physiological, linguistic, and social features, concluding that gender ideologies are implicated both in linguistic processing and in social judgments of value between groups. We conclude with a summary of the key gaps in the current literature and recommendations for best practices studies that may use in future investigations of socially meaningful variation in speech perception. This article is categorized under: Linguistics > Language in Mind and Brain Psychology > Language Linguistics > Language Acquisition Psychology > Perception and Psychophysics.

[Disorders of sex differentiation: state of the problem 15 years after the Chicago consensus]

It is well known that the nomenclature and classification were changed in 2005 at the international consensus conference on intersex disorders, held in Chicago, where, among others, the following recommendations were proposed: (1) all children should be assigned a gender identity, and this should be done as quickly as possible, taking into account the time required for the examination. (2) all infants with congenital adrenal hyperplasia and 46,XX karyotype, including those with pronounced masculinization, must be raised as women. (3) Surgical treatment should be performed early and in cases of feminizing genitoplasty, clitoral reduction should be performed simultaneously with reconstruction of the urogenital sinus (separation of the vagina and urethra). An analysis of contemporary literature shows that all these theories, proposed 15 years ago at the Chicago meeting, failed to stand the test of time. New nomenclature and classification are constantly being revised. Currently, many groups of patients want to abolish the term «sexual maturity disorders.» Recommendations regarding gender reassignment and appropriate early surgical treatment have been completely ignored in some countries. All this was largely facilitated by the confrontational activities of a number of support groups.

Management of 46,XY Differences/Disorders of Sex Development (DSD) Throughout Life

Differences/disorders of sex development (DSD) are a heterogeneous group of congenital conditions that result in discordance between an individual's sex chromosomes, gonads, and/or anatomic sex. Advances in the clinical care of patients and families affected by 46,XY DSD have been achieved since publication of the original Consensus meeting in 2006. The aims of this paper are to review what is known about morbidity and mortality, diagnostic tools and timing, sex of rearing, endocrine and surgical treatment, fertility and sexual function, and quality of life in people with 46,XY DSD. The role for interdisciplinary health care teams, importance of establishing a molecular diagnosis, and need for research collaborations using patient registries to better understand long-term outcomes of specific medical and surgical interventions are acknowledged and accepted. Topics that require further study include prevalence and incidence, understanding morbidity and mortality as these relate to specific etiologies underlying 46,XY DSD, appropriate and optimal options for genitoplasty, long-term quality of life, sexual function, involvement with intimate partners, and optimizing fertility potential.

Disorders of sex development

Normal sex development depends on the precise spatio-temporal sequence and coordination of mutually antagonistic activating and repressing factors. These factors regulate the commitment of the unipotential gonad into the binary pathways governing normal sex development. Typically, the presence of the SRY gene on the Y chromosome triggers the cascade of molecular events that lead to male sex development. Disorders of sex development comprise a heterogeneous group of congenital conditions associated with atypical development of internal and external genitalia. These disorders are generally attributed to deviations from the typical progression of sex development. Disorders of sex development can be classified into several categories including chromosomal, gonadal, and anatomic abnormalities. Genetic tools such as microarray analyses and next-generation sequencing techniques have identified novel genetic variants among patients with disorders of sexual development. Most importantly, patient management needs to be individualized, especially for decisions related to sex of rearing, surgical interventions, hormone treatment, and potential for fertility preservation.