Archives of Sexual Behavior

, Volume 34, Issue 4, pp 423-438

First online:

Gender Identity Outcome in Female-Raised 46,XY Persons with Penile Agenesis, Cloacal Exstrophy of the Bladder, or Penile Ablation

  • Heino F. L. Meyer-BahlburgAffiliated withNew York State Psychiatric InstituteDepartment of Psychiatry, Columbia UniversityDepartment of Psychiatry, New York State Psychiatric Institute, Columbia University Email author 

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This review addresses the long-term gender outcome of gender assignment of persons with intersexuality and related conditions. The gender assignment to female of 46,XY newborns with severe genital abnormalities despite a presumably normal-male prenatal sex-hormone milieu is highly controversial because of variations in assumptions about the role of biological factors in gender identity formation. This article presents a literature review of gender outcome in three pertinent conditions (penile agenesis, cloacal exstrophy of the bladder, and penile ablation) in infancy or early childhood. The findings clearly indicate an increased risk of later patient-initiated gender re-assignment to male after female assignment in infancy or early childhood, but are nevertheless incompatible with the notion of a full determination of core gender identity by prenatal androgens.

Key Words

gender dysphoria gender identity penile agenesis cloacal bladder exstrophy penile ablation