Abstract
We have chosen to emphasize our experience with the management of patients with cloacal exstrophy, because this is the primary patient population in which gender reassignment has been utilized at this center over a 30 year span. These 11 reassigned patients comprise a cohort with similar medical and surgical issues, and their progress may be contrasted with 4 males who were not gender reassigned as well as 7 genetic females. By gender reassignment, we are specifically referring to the assignment of a female gender for a neonate with an absent phallus who has a normal XY karyotype and functional testes in the absence of any endocrine disorder. Other reasons for gender reassignment within this department have included aphalia, ablatio penis, and one case of classic exstrophy. In addition to these extremely rare cases, the division has accumulated a substantial experience in gender assignment in intersex cases with the most common diagnosis being congenital adrenal hyperplasia. It has always been the philosophy of this division to assign a gender consistent with the chromosomal and gonadal sex whenever possible.
Keywords
- Gender Identity
- Congenital Adrenal Hyperplasia
- Spina Bifida
- Hypothalamic Pituitary Adrenal Axis
- Androgen Insensitivity Syndrome
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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References
Austin PF, Homsy YL, Gearhart JP, Porter K, Madsen K, Maizels M. The prenatal diagnosis of cloacal exstrophy.J Uro!160:1179–1181, 1998.
Bradley SJ, Oliver GD, Chernick AB, Zucker KJ. Experiment of nurture: ablatio penis at 2 months, sex reassignment at 7 months, and a psychosexual followup in young adulthood.Pediatrics102:e9, 1998.
Carr MC, Mitchell ME. Continent gastric pouch.World J Uro!14:112–116, 1996.
Colapinto J. The true story of John loan.Rolling Stonepp. 54–97, Dec II, 1997.
Diamond M, Sigmundson I-1K. Sex reassignment at birth: long term outcome review and clinical implications.Arch Ped Adol Med151:298–304, 1997.
Diamond M, Sigmundson HK. Management of intersexuality: guidelines for dealing with persons with ambiguous genitalia.Arch Ped Adol Med151:1046–1050, 1997.
Diamond M. Pediatric management of ambiguous and traumatized genitalia.J Urol162:1021–1028, 1999.
Dodson RE, Gorski RA. Pre and postnatal influence of testosterone propionate and DES on differentiation of the sexually dimorphic nucleus of the preoptic area in male and female rats.Brain Res302:291–295, 1984.
Gorski RA, Gordon JH, Shyrne JE, Southam, M. Evidence for a morphologic sex difference in the medial preoptic area of the rat brain.Brain Res148:333–346, 1978.
Grady RW, Mitchell ME. Complete primary repair of exstrophy.J Uro!162:1415–1420, 1999.
Harrison MR, Bressack MA, Churg AM, de Lorimier AA. Correction of congenital diaphragmatic hernia in utero. II. Simulated correction permits fetal lung growth with survival at birth.Surgery88(2):260–268,1980.
Holzbeirelein J, Pope IC, Adams MC, Bruner J, Tulipan N, Brock JW. The urodynamic profile of myelodysplasia with spinal closure during gestation.J Urol164:1336–1339, 2000.
Howell C, Caldamone A, Snyder HM, Ziegler M, DuckettJW.Optimal management of cloacal exstrophy.J Ped Surg18:365–369, 1983.
Husmann DA, McLorie GA, Churchill BM. Management of the hindgut in cloacal exstrophy: terminal ileostomy versus colostomy.J Ped Surg23:1107–1113, 1988.
Hussman DA, McLorie GA, Churchill BM. Phallic reconstruction in cloacal exstrophy.J Uro!142:563–564, 1989.
Hussman DA, Vandersteen DR, McLorie GA, Churchill BM. Urinary continence after staged bladder reconstruction for cloacal exstrophy: the effect of coexisting neurological abnormalities on urinary continence.J Urol 161:1598–16021999.
Jordan GH, Schlossberg SM, Devine CJ. Surgery of the penis and urethra, in:Campbell’s Urology 7th Ed., PC Walsh, AB Teick, D Vaughan, AJ Wein, eds., WB Saunders, Philadlephia, pp. 3386–3392, 1998.
Jordan GH. Total phallic reconstruction, option to gender reassignment,in:Pediatric Gender Assignment A Critical Reappraisal Chapter 17SA Zderic, DA Canning, MC Carr, HM Snyder, eds.,Kluwer-Plenum, New York, 2002
Lahr G, Maxson SC, Mayer A, Just W, Pilgrim C, Resisert L. Transcription of the Y chromosomal gene SRY in the adult mouse brain.Mol Brain Res33:179–182, 1995.
LeVay S.The Sexual BrainMIT Press, Cambridge, MA, 1994.
LeVay S. A difference in hypothalamic structure between heterosexual and homosexual men.Science253:1034–1037, 1991.
Matthews R l, Perlman E, Marsh DW, Gearhart JP. Gonadal morphology in cloaca] exstrophy: implications in gender reassignment.Brit J Urol lilt84:99–100, 1999.
Mayer A, Lahr G, Swaab DF, Pilgrim C, Resiert I. The Y-chromosomal genes SRY and ZFY are transcribed in adult human brain.Neurogenetics1:281–288, 1998.
Mitchell ME, Bagli DJ. Complete penile disassembly for epispadias repair: The Mitchell technique.J Urol155:300, 1996.
Montagnino B, Czyzewski DI, Runyan RD, Berkman S, Roth DR, Gonzales ET. Long term adjustment issues in patients with exstrophy.J Ural160:1471–1474, 1998.
McCullough L, in:Pediatric Gender Assignment A Critical Reappraisal Chapter 10SA Zderic, DA Canning, MC Carr, HM Snyder, eds., Kluwer-Plenum, New York, 2002.
McFadden D. Sex differences in the auditory system.Dev Neuropsych14:261–298, 1998.
McRoberts JW, Sadove RC. Penile reconstruction with a free sensate osteocutaneous fibula flap in the surgical management of the intersex patient, in:Pediatric Gender Assignment: A Critical Reappraisal Chapter 18SA Zderic, DA Canning, MC Can.HM Snyder, eds., Kluwer-Plenum, New York, 2002
Meyer-Bahlberg HFL. Gender assignment and reassignment in intersexuality: controversies, data, and guidelines for research, in:Pediatric Gender Assignment: A Critical Reappraisal Chapter /2SA Zderic, DA Canning, MC Carr, HM Snyder, eds., Kluwer-Plenum, New York, 2002.
Money J. Normal male infant sex-reassinged as a girl.Arch Sex Behav4:65,1975.
Olutoye 00, Adzick NS. Fetal surgery for myelomeningocele.Seminars in Perinatology23(6)462–73 1999
Reilly JR, Woodhouse CJ. Small penis and the male sexual role.J Urol142:569–571, 1989.
Reiner WG. To be male or female — that is the question.Arch Ped Adol Med151:224–225, 1997.
Reiner WG. Gender identity and sex reassignment: a reappraisal for the 21’ century, in:Pediatric Gender Assignment: A Critical Reappraisal, SA Zderic, DA Canning, MC Carr, HM Snyder, eds., Kluwer-Plenum, New York, 2002
Sadove RC, Sengezer M, McRoberts JW. One stage penile reconstruction with a free sensate osteocutaneous fibula flap.Plast Reconstructive Surg92:1314–1323, 1993.
Shapiro E, Santiago IC, Crane JP. Prenatal fetal adrenal suppression following in utero diagnosis of congenital adrenal hyperplasia.J Urol 141:663–6661989.
Swaab, DF, Fliers, E. A sexually dimorphic nucleus within the human brain. Science228 1112–1115 1985
Rickham PP. Vesico-intestinal fissure.Arch Dis Child35:97, 1960.
Tank ES, Lindenauer SM. Principles of management of exstrophy of the cloaca.Am J Surg119:142–147, 1970.
Woodson JC, Gorski RA. Structural sex differences in the mammalian brain: reconsidering the male female dichotomy, in:Sexual Differentiation of the BrainA Matsuomoto, ed., CRC Press, Boca Raton, 1999.
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Zderic, S.A., Canning, D.A., Carr, M.C., Kodman-Jones, C., Snyder, HM. (2002). The Chop Experience with Cloacal Exstrophy and Gender Reassignment. In: Zderic, S.A., Canning, D.A., Carr, M.C., Snyder, H.M. (eds) Pediatric Gender Assignment. Advances in Experimental Medicine and Biology, vol 511. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-0621-8_9
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