Stories about: Ambiguous genitalia

Challenges cases: Disorders of sexual differentiation and the ethics of gender assignment

Urology-gender assignmentBoston Children’s Urologist-in-Chief and Associate Clinical Ethicist, David A. Diamond, MDshares three complex cases of ambiguous genitalia in which optimal gender assignment was unclear. These case studies discuss patient history, the process of investigation, subsequent dialogue with each family and decisions made in each case.


Children with disorders of sexual differentiation can present complicated management problems. The most challenging aspect of these cases occurs when optimal gender assignment is unclear. For some conditions, outcomes with regard to gender assignment along a male or female pathway are well established. For other conditions the outcomes are far less clear. Over the past two years, we have encountered three complex cases of ambiguous genitalia in which optimal gender assignment was unclear and a complex process of investigation of these children and a lengthy dialogue with each family was undertaken. Subsequently, a pathway was elected for each case that represented a balance between parental preference and patient self-determination. …Read More