Volume 73 Number 7 November 2006	back to contents

Associate Professor, Department of Psychiatry, Mount Sinai School of Medicine, New York, NY.

Address all correspondence to William Byne, M.D., Ph.D., Research Bldg, Room 2F39, Bronx VA Medical Center, 130 W. Kingsbridge Road, Bronx, NY 10468; email: william.byne@mssm.edu.

Abstract

When a baby is born, the first medical pronouncement is usually, “It’s a boy,” or “It’s a girl.” In most cases, this pronouncement is based simply upon the appearance of the child’s external genitalia. Due to variations in the process of sexual differentiation, sometimes the gender that should be assigned is not apparent from inspection of the external genitalia, either because they are “ambiguous” or because their appearance is not congruent with the internal anatomy. Decisions must be made not only about the most appropriate gender to assign the infant but also about the medical and rearing practices that will facilitate optimal psychological development and quality of life for the affected individual. This article will review the approach to managing gender disorders that has evolved since the 1950s. Three issues are identified as central to current shifts that are occurring in the management of these disorders: (a) increased understanding of the biological substrates of gender identity; (b) questions regarding the indications for irreversible cosmetic genital surgeries as a means of reinforcing gender assignments in infancy, and (c) ethical issues pertaining to informed consent and who is entitled to give it, particularly with regard to surgical gender reassignments in infancy. In keeping with the neuropsychiatry theme of this issue, the focus of this article is on prenatal sexual differentiation of the brain as it pertains to the question of psychosexual neutrality at birth.

Key Words

, sexual differentiation, sex assignment, gender assignment.

MSSM Home

Back Issues | Indexes | Search | Journal Home