Anatomical Studies of the Fetal Genitalia: Surgical Reconstructive Implications

Abstract

Under the influence of the SRY gene, testes determining factor, and androgens fetal differentiation precedes to form the normal male genitalia. Genetic and environmental abnormalities can disrupt normal development leading to an ambiguous state of the genitalia. In most societies it is the accepted norm; that the genitalia either look male, or female, with an ambiguous state not being socially acceptable. Based on societal norms, the previous standard of care was to surgically recreate either the male or the female physical appearance. Long-term data validating this approach, however, is lacking and recently there has been an effort to document the optimal treatment for patients who do not fit into either a classic male or female category. The new concept that is gradually being embraced is that sex assignment is not an irrevocable phenomena. In other words, it is not a social or medical emergency to assign a sex immediately after birth, and in fact, the sex of the patient may actually change during life depending on genotypic, phenotypic and environmental conditions. This awareness has been initiated by both physicians as well as advocate groups with the hope that difficult but correct decisions can be made for patients with ambiguous states in the future.