Should we change our approach to ambiguous genitalia?

Care of infants with intersex must consider the changing understanding of determination of sex and gender. Although most intersex infants are either females with relatively mild virilization (clitoromegaly with some posterior labial fusion) or males with incomplete virilization (varying degrees of hypospadias), a small portion of intersex patients have genital ambiguity to the extent that the sex of rearing is not obvious on initial assessment. Guidelines for the traditional approach have compared anatomic potential for fertility, sexual function, and endogenous gonadal hormone production. Inherent in the care is disclosure to the parents, and later, progressively to the patients. Counseling should include available information concerning diagnosis, medical and surgical therapy, as well as updated information regarding determinants of sexual and gender roles and behavior. Because these guidelines have not been fully used or because adequate outcome information is unavailable, some intersex patients have expressed dissatisfaction with their care. This, plus increasing understanding of gender and sexual roles, has demanded a reassessment of the approach to the child with intersex. More outcome information is needed to recommend the best guidelines and to formalize the best approach.