Changes in the management of children with intersex conditions

  title={Changes in the management of children with intersex conditions},
  author={Milton Diamond and Hazel Glenn Beh},
  journal={Nature Clinical Practice Endocrinology \&Metabolism},
  • M. Diamond, H. Beh
  • Published 2008
  • Medicine
  • Nature Clinical Practice Endocrinology &Metabolism
Three broad recommendations have been made for the management of children with intersex conditions: halt all infant cosmetic genital surgery until evidence-based guidelines are available; conduct further research on the necessity of such surgery; and practice complete honesty with parents and patients. The authors discuss whether clinical practice has changed in response to these recommendations. 
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Patients with male sex assignment have more surgical complications and difficulties in psychosocial adjustment as compared to those with female sex assignment, and 136 patients withfemale sex assignment and 54 withmale sex assignment had favorable psychossocial adjustment.
Ethical principles and recommendations for the medical management of differences of sex development (DSD)/intersex in children and adolescents
Three leading ethical principles that apply to DSD management are identified: to foster the well-being of the child and the future adult, to uphold the rights of children and adolescents to participate in and/or self-determine decisions that affect them now or later, and to respect the family and parent–child relationships.
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It is concluded that, especially in a high consanguineous population, DSD can occur due to a wide spectrum of endocrine and non-endocrine causes and there is no substitute to careful history and physical examination to help the diagnosis and avoid unnecessary investigations.
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The inclusion of trained peer support in the multidisciplinary DSD team seems to be integral to the supportive management of patients with DSDs, which requires acceptance of the fact that deviation from the traditional definitions of gender is not necessarily pathologic.
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  • 2011
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The findings highlight the importance of close collaborations between different experts and a shift from the often simplified dispute about genital surgeries to a more holistic perspective with a long-term management strategy, which should serve as a cornerstone not only for clinical practice but also for future research and evaluation studies.
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    Perspectives in biology and medicine
  • 2010
If those who teach embryology to health-care professionals remain unaware of the controversies associated with the old terminology and continue to use it, they will perpetuate a nomenclature that can be destructive.


Consensus Statement on Management of Intersex Disorders
The Lawson Wilkins Paediatric Endocrine Society (LWPES) and the EPE considered it timely to review the management of intersex disorders from a broad perspective, to review data on longer term outcome and to formulate proposals for future studies.
Pediatric ethics and the surgical assignment of sex.
There should be a moratorium on surgery for infants with ambiguous genitalia or loss of the penis; it is argued that the medical profession should complete comprehensive lookback studies to assess the outcomes of past interventions; and efforts should be made to undo the effects of past deception.
Management of Intersexuality: Guidelines for Dealing With Persons With Ambiguous Genitalia
Suggestions on how to manage cases of traumatized or ambiguous genitalia are offered, based on experiences, the input of some trusted colleagues, the comments of intersexed persons of various origins, and the best interpretation of the reading of the literature.
Gender assignment and medical history of individuals with different forms of intersexuality: evaluation of medical records and the patients' perspective.
The majority of participants had genital surgery to correct the appearance of their genitalia and/or to enable sexual functioning and the diagnostic groups differ not only in amount and invasiveness of experienced surgical and medical treatment but also in the subjective and retrospective evaluation of the treatment measures and in the amount of reported psychological distress.
Psychosexual development in genetic males assigned female: the cloacal exstrophy experience.
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  • 2004
International Legal Developments Protecting the Autonomy Rights of Sexual Minorities: Who Should Decide the Appropriate Treatment for an Intersex Child?
Court decisions from Europe, Australia and the United States involving other sexual minorities are analyzed to determine how courts may resolve this issue if they are brought into the controversy and concludes that courts may not be the ideal forum to resolve these issues.
Changing attitudes to sex assignment in intersex
The existence of people who are neither ‘all male’ nor ‘all female’ has long been recognized in many societies and, with the advent of scientific medicine in European societies in the 19th century,