Genitography in Intersexual States

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Abstract
The sex of an individual is made up of a number of variable components. Normally, these are in perfect agreement so that most persons are unisexual, completely masculine or completely feminine. An intersex state exists when there are contradictions in the morphology of the genital tract. Errors in the management of intersex problems have been difficult to avoid because of incomplete understanding of these problems. The resolution of clinical intersex problems requires two acts: the prompt assignment of a practical sex before gender role complicates matters and subsequent treatment, if necessary, to give the patient sexual adequacy in the assigned sex. The multiplicity and complexity of the irregularities of sexual differentiation require, for their precise diagnosis and management, an entire series of clinical studies. These include determination of (a) sex chromatin pattern, (b) external genitalia anatomy, (c) internal genitalia anatomy, (d) urinary hormonal excretion, and (e) gonadal nature by biopsy. Not all of these need to be determined in the neonatal period because they are not necessary for the prompt assignment of a practical sex. Knowledge of the anatomy of the genital make-up is necessary, and only that pertaining to the external genitalia is known. Of the internal genital anatomy, knowledge of the nature of the gonads is not essential, but it is needful to know the anatomical state of the genital passages; in particular, to establish whether or not there is a vaginal cavity. Genitography is the simplest and best procedure for providing this information. It assists in the assignment of a practical sex which will approach a genital life as close as possible to the anatomic capabilities, rather than one based on the nature of the chromatin sex or gonads. The demonstration of nuclear sex chromatin by Davidson and Smith (5) and Moore and Barr (18) and improved technics of human chromosome analysis by Tjio and Puck (20) have stimulated considerable literary interest in intersex. Few of the reported cases, however, show adequate radiographic visualization of the genital anatomy, and the last article to appear in the radiological literature was in 1956 (21). Many physicians are not aware that genitography can provide anatomical information frequently not afforded by catheterization, cystoscopy, rectal palpation, or even surgical exploration. For genitography to take its rightful place in the intersex problem, radiologists must assume an active consulting role, must have some knowledge of the basic problem, and must be familiar with the altered embryology responsible for the anatomy in the various abnormal conditions. Nature of Sex Hampson et al. (11) listed 7 components of sex (Table I).