The Diagnosis and Treatment of Ambisexualism in Children
THE concept of what constitutes the sex of an individual has changed considerably in recent years. In most cases, the sex of a newborn infant is decided in the delivery room, and it is usually an obvious decision based on the type of external genitalia. In some instances, abnormal development of the external genitalia makes it difficult to determine the sex, and it is these cases of ambisexualism that are discussed in this paper.
The primary factors that determine the sex of an individual are: (1) the chromosomal pattern of the individual cells; (2) the type of gonad; (3) the hormonal pattern and its effect on various tissues and organs; (4) the external genitalia, internal genital ducts, and secondary sexual characteristics; (5) the psychic reactions that are influenced by the environmental experiences of the individual. Since each person is a combination of the male and the female elements, it appears that the sex of any one person is the algebraic sum of all the factors mentioned above and not just any one of them.1,2
Types of Ambisexualism
Because of the problems in the clinical determination of sex, it is important to develop a working classification of ambisexualism. In general, patients whose sex is in question may be classified according to four large clinical groups: (1) adrenogenital syndrome, (2) gonadal dysgenesis, (3) pseudohermaphroditism, and (4) true hermaphroditism.
Adrenogenital syndrome. Hyperadrenocorticism will produce any one of a variety of syndromes, but the discussion in this report will be confined to . . .