Long-term psychosocial adjustments, satisfaction related to gender and the family equations in disorders of sexual differentiation with male sex assignment.

PURPOSE: The varied management and counseling in disorders of sexual differentiation (DSD) depends a lot on the socioeconomic structure. A follow-up study was designed to evaluate the outcome in terms of patient satisfaction with strong socio-cultural issues. METHOD: Of the 1,134 DSD patients being followed up in pediatric intersex clinic, 60 adolescents and adults assigned male sex in childhood were called for follow-up. They were interviewed for psychosocial and family adjustments including level of acceptance of gender, social relationships and future expectations. RESULTS: The ages ranged from 15 to 25 years (mean, 19.3 ± 3.7 years). The disorders were male pseudo hermaphrodite (MPH)-43, mixed gonadal dysgenesis (MGD)-3, true hermaphrodite (TH)-7 and congenital adrenal hyperplasia (CAH)-7. Of all patients, 85% (51/60) felt satisfied with their gender assignment; 76.9% (46/60) did not feel comfortable with the opposite sex. Penile erections; ejaculation and masculine voice were present in 53, 44 and 47 patients. Facial hair was normal; sparse and absent in 16, 26 and 18 patients, respectively. Stretched penile length was 2.5-9 cm (median, 5.5 cm) and 16/60 patients were satisfied with their penile length; 28 patients required redo surgeries for scrotum diverticulum (1), proximal penile diverticulum (1), stricture urethra (2), hair in the urethra (3), vaginal pouch dilatation (1), orchiopexy (2), residual chordee correction (3), distal urethroplasty (4), urethral fistula repair (21), mastectomy (6) and testicular prosthesis (4). Family support was available to all 85% (51/60) of the patients who had good family relationships. However, only 15% (9/60) felt that they fitted into society. Peer relationships were considered 'good' by 43/60 and poor by 17/60. Two patients had got married and 44.8% (26/58) patients would consider marriage in future. Most patients (42/60) were worried about the smaller size of the phallus and lack of adequate semen, leading to apprehension before marriage. As much as 15 patients had jobs, 15 attended school, 3 attended colleges and 17 illiterate patients were dependent on their families. CONCLUSIONS: Despite moral, social and economic support provided by the parents, children with DSD continue to have apprehensions in social adjustments.

[Transsexualism as a clinical symptom of true hermaphroditism].

Transsexualism is incorrectly thought to be a disease of sexual centers (zones) of the brain but these sexual centers in the brain operate only in response to action of sexual hormones (androgens or estrogens) which are produced in the gonads and delivered to the brain by blood. In hermaphroditism the brain receives both androgens and estrogens. Transsexualism syndrome develops in cases when all sexual organs develop under the influence of one sex while sexual psychoorientation, sexual autoidentification and sexual behavior form under the influence of hormones of the other sex. Therefore, treatment of this syndrome should not consist of surgical correction of the sex according to psychic behavior of the patient but should be directed to detection of the gonad (or gonadal tissue) causing abnormal behavior and its removal. Gonad corresponding to sexual organs of the patient should be preserved. Of 19 patients with true hermaphroditism and 199 patients with false hermaphroditism observed by the authors 4 patients with true hermaphroditism had transsexualism.