Discordant Sexual Identity in Some Genetic Males with Cloacal Exstrophy Assigned to Female Sex at Birth

Sparse outcome data exist for genetic males who are assigned female sex at birth to overcome severe phallic inadequacy occurring in cloacal exstrophy, a rare, complex pelvic defect. This article reports the subsequent sexual identity of 16 genetic males, 14 of whom were assigned to female sex soon after birth. Eight of 14 subjects assigned to female sex declared themselves male over time; the 2 raised as males remained so. The practice of reassigning sex because of phallic inadequacy should be reconsidered. The concept of sexual identity in persons with genital malformations has intrigued the medical world since Money and colleagues' pioneering studies of intersex in the 1950s. 1 , 2 They later reasoned that an infant's sex could be assigned if corresponding genitalia were constructed during infancy and the child's upbringing corresponded to that sex. 3 This concept of sex assignment was especially important for clinicians who were caring for aphallic genetic males, in whom the construction of a functional penis was not feasible. 1 , 4 – 10 Androgens have long been thought to influence prenatal brain development as well as postpubertal activity, interests, and libido. . . .