Should boys with micropenis be reared as girls?  

Oleh:

Wyk, Judson J. Van ; Calikoglu, Ali S.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The Journal of Pediatrics vol. 135 no. 05 (Nov. 1999), page 537-538.
Topik: micropenis

Ketersediaan

Perpustakaan FK Nomor Panggil: J45.K.1999.02 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

Micropenis, defined as a penis with stretched length >2.5 SDs below the mean for age (with or without cryptorchidism), may be viewed as a mild form of ambiguous genitalia with medical, psychologic, and social impacts similar to those of other intersex problems. A decision to rear a child with micropenis as a boy is beset with worries that the genitalia will prove inadequate for sexual intercourse and that he will not be able to assume a satisfactory masculine self-image. The choice of an appropriate sex of rearing for such an infant has been made difficult by conflicting and changing recommendations of authorities in this area. Money and Ehrhardt advanced the concept that gender identity is malleable during early infancy and that it is often preferable to rear an infant with a micropenis as a girl. Such a course of action requires castration, surgical modifications of the external genitalia, estrogen substitution at puberty, and a great deal of emotional support for the patient and family. In support of this recommendation, Money cites the case of an infant boy whose penis was accidentally amputated during circumcision. At the age of 22 months, he was castrated and reassigned a female sex of rearing that was reinforced by surgical reconstruction of the perineum and the administration of estrogens at puberty. Contrary to initial reports suggesting a very good psychosocial adjustment to the assigned female sex, it later became apparent that from an early age the child had rejected a female gender identification, and during his mid teens voluntarily reverted to living (and later marrying) as a man. Although the reasons for this outcome are not clear, Diamond and Sigmundson have used this case to emphasize their viewpoint that biologic factors in the prenatal and perinatal periods play a more major role in an individual’s gender identification than implied by Money’s concept1 of sexual neutrality at birth. Diamond and Sigmundson4 argue that no major surgery, particularly for cosmetic reasons alone, should be performed, which might later need to be undone.

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