Problems of sex differentiation - surgical correction

The aims of surgery in patients with disorders of sex differentiation are to remove structures, especially gonads, which function in a manner contradictory to the sex of rearing, and to provide genitalia which are cosmetically acceptable and functionally useful to the assigned sex. This discussion will be limited to patients seen by the gynecologist who, in the normal course of responsibilities, accepts for care those who are reared as females. If consideration be given only to those who by classic definition can be considered as examples of female or male pseudohermaphroditism, or true hermaphroditism, it follows that the gynecologist is concerned with essentially all patients with female pseudohermaphroditism, about 80% of all patients with male pseudohermaphroditism, as only about 20% of male pseudohermaphrodites have genitalia which lend themselves to functional male surgical augmentation, and at least 50% of the uncommon true hermaphrodites, this being the approximate percentage of those who have a uterus and vagina, and therefore the potential for reproduction as a female. The remarks to be made stem from 20-odd years of experience with well over 400 patients with problems of sex differentiation, of which 240 comprise the female and male pseudohermaphrodites, and the true hermaphrodites.