A perspective on the approach to the intersex child born with genital ambiguity

Factors that have led to reassessment of the care of intersex patients are discussed with specific attention to the following issues: 1) role of the parents in medical decisions, 2) full disclosure to patients and parents of details of results of diagnostic tests, possible therapies, and outcome date, 3) excessive exposure during medical examinations, 4) the impact of in utero androgen upon the central nervous system, and 5) the challenge to defer surgery until the child is 'old enough' to give consent. An overview of the approach to intersex patients is included with particular emphasis upon the 'optimal gender' approach developed about 50 years ago. It is clear that care of the child with genital ambiguity must be individualized, with parents and patients regularly receiving updated information concerning the etiology, treatment and outcome among children with similar diagnoses. A medical team approach is advocated, with the goal of striking the best balance between outcome data and differing opinions.