Disorders of Sexual Differentiation: Ethical Considerations Surrounding Early Cosmetic Genital Surgery

Disorders of sexual differentiation (DSD) describe a number of genetically influenced congenital anomalies of the genitalia for which the previous standard of care has included emergent sex assignment and early genitoplasty and gonadectomy. This article provides a brief summary of the most common DSD and their genotypic and phenotypic variations. It presents an overview of the history of and treatment recommendations for individuals with DSD beginning in the 1950s. It provides a historical basis upon which evolving treatment guidelines are beginning to call into question the status quo. The discussion applies the moral principles of autonomy, beneficence, and nonmaleficence for the care of individuals with DSD. In the process, the advantages of early as well as delayed cosmetic genital surgery will be discussed when contemplating the ethical question: Do parents have the moral right to provide informed consent to surgically alter the ambiguous genitalia of their infants born with DSD?