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(Gilbert 2006)
This surgical intervention has proven controversial in modern times as many physicians and surgeons have begun to stress that gender assignment by surgical means is not warranted as an emergent condition and should therefore be delayed until such time that the individual involved can participate in the decision, or until such time as gender assignment takes place naturally, i.e. By individual socialization, and self-determination of gender assignment. In other words there are simply to many variations of the condition to warrant permanent decision making based on outward appearance, regardless of parental or medical opinions and emotions on the subject. Teaching is the key and gauging the need for such teaching and reassurance often falls on the nurse as a period of heightened emotions will most certainly follow the birth of such a child. Developing a reasonable take on the situation and offering support to the family is essential as the individual nurse may find him or herself embroiled in a vast variety of reactions and possibly even demands associated with the condition. (Johnstone, 1999, p. 245) The family may feel strongly that gender assignment surgery needs to take place if it is not offered or the opposite, may be true if it is. The variations are endless and the need for the nurse and other support staff to be consummately aware of the support and education of the family and the sensitivity of the issue is intense.
More frequently found in the many variations of hermaphrodites there is a condition known as pseudohermaphrodite, where the individual may present as one or the other gender/sex but have an enlarged or true to size version of the other gender's gonads. Yet, as clear cut as this might seem the variations are many and surgical assignment may not be warranted or desired in later life.
Our current classification scheme of male and female pseudohermaphrodites reflects this gonadal (and later, chromosomal) assignment of sex. A male pseudohermaphrodite (usually caused by androgen receptor mutations) has a female phenotype but male gonads, while a female pseudohermaphrodite (usually caused by congenital adrenal hyperplasia where the adrenal gland secretes testosterone) has a male phenotype but has ovaries. (Gilbert, 2006)
References
Dreger, A.D. (1998). Hermaphrodites and the Medical Invention of Sex. Cambridge, MA: Harvard University Press. Retrieved June 4, 2009.
Gilbert, S.F. (2006) Developmental Biology Eighth Edition: Online Companion Chapter 17 Hermaphrodites article: Human Hermaphrodite Retrieved June 4, 2009 http://8e.devbio.com/article.php?id=266&search=hermaphrodite
Johnstone, M. (Ed.). (1999). Bioethics: A Nursing Perspective. Sydney, N.S.W.: Harcourt Saunders.
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