Psychosexual development in individuals who have female pseudohermaphroditism

This article describes psychosexual outcomes and issues in syndromes of female pseudohermaphroditism, broadly defined. Congenital adrenal hyperplasia, the most common cause of intersex genitalia at birth, is covered as are Turner Syndrome and syndromes in which XY infants who are born with undervirilized genitalia are assigned and reared as girls (androgen insensitivity syndrome; cloacal exstrophy). The same hormonal abnormalities that cause most physical intersex conditions also influence brain development and behavior; individuals who have intersex conditions can show behavior that is in between that of the typical boy/man and the typical girl/woman. Changes in sex-typical play behavior in childhood are larger than in sexual orientation or core gender identity in adulthood. Most female pseudohermaphrodites, whether XX or XY, who are assigned and reared as girls evolve a feminine core gender identity and primarily are heterosexual. Implications for current debate about the treatment of infants who have ambiguous genitalia are discussed, as is the need for additional research and for consideration of psychologic counseling as part of the treatment program.