HERMAPHRODISM: RECOMMENDATIONS CONCERNING CASE MANAGEMENT

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Abstract
Studies of the psychology of hermaphroditic people have led to the elucidation of 7 variables of sex: (1) Chromosomal sex, (2) gonadal sex, (3) hormonal sex, (4) internal accessory genital morphology, (5) external genital morphology, (6) sex of assignment and rearing and (7) gender role and orientation[long dash]the psychosexual outlook[long dash]established while growing up. In practical decisions about assignment or reassignment of the sex of rearing, the gonadal, chromosomal and hormonal criteria, singly or together, are never sufficient. For neonatal and very young infant hermaphrodites it is recommended that sex be assigned primarily, though not exclusively, on the basis of the appearance of external genitalia and how well they lend themselves to surgical reconstruction in conformity with the sex of assignment, due allowance being made for a program of hormonal intervention, if such is indicated. For older hermaphroditic infants, children and adults, it is recommended that first consideration be given to the degree that a gender role has been indelibly established in the sex previously assigned, and further, that reassignment of sex be scrupulously avoided except in rare and carefully appraised instances, in order to avoid injurious psychologic sequelae. Psychologic management of the parents of hermaphrodites and of the patients themselves derives in its specific details from a policy of frank and straightforward discussion and explanation.