Disorders of Sexual Differentiation: Cosmetic Genital Surgery
Disorders of Sexual Differentiation: Cosmetic Genital Surgery
During infancy and toddlerhood, children not only experience rapid physical growth and development, but it is also believed to be when most individuals establish gender identity. Gender identity describes something more complicated than physical characteristics and outward behaviors. It is not sexual identity or sexual orientation. Rather, gender identity refers to one's personal self-identification, which may be the same or different than the sex assigned at birth and evolves through childhood and adolescence. The differentiation between sex and gender is important in recognizing that biology is not destiny. Gender identity is the interrelationship between those traits and one's personal sense of self and self-identification/self-representation as male, female, both, or neither; it does not always fit within gender stereotypes. Most individuals develop gender identity that coincides with their genotype. During the second year of life, most children gravitate to gender-specific toys and games, and by 3 years of age, demonstrate gender awareness that classifies them as either a "boy" or "girl" (Berenbaum, 2006; Meyer-Bahlburg, 2011).
Western culture and its social constructs view gender as a binary concept with two gender identity options: male or female. But gender extends beyond biology (anatomic or genetic sex), and it is becoming clearer that gender is a spectrum with no clear dividing line. If gender identity can vary among individuals with "typical" genotype and phenotype, it can have potentially devastating effects for individuals with DSD. Some children and adolescents may present with markedly gender-atypical behavior that may call into question the gender to which they belong. It can lead to confusion and even gender dysphoria with a desire to change gender. It cannot be overemphasized that gender identity is not determined by any single factor. The best predictors of gender identity are sex of rearing combined with prenatal (and perhaps postnatal) androgen exposure. In addition, there appears to be some flexibility of gender identity later in life as demonstrated by individuals who are transsexual. Although gender identity develops early, it is not solidified until adulthood. When considering gender identity among individuals with DSD, there is considerable unexplained variability (Berenbaum, 2006).
"Typical" Gender Identity Development
During infancy and toddlerhood, children not only experience rapid physical growth and development, but it is also believed to be when most individuals establish gender identity. Gender identity describes something more complicated than physical characteristics and outward behaviors. It is not sexual identity or sexual orientation. Rather, gender identity refers to one's personal self-identification, which may be the same or different than the sex assigned at birth and evolves through childhood and adolescence. The differentiation between sex and gender is important in recognizing that biology is not destiny. Gender identity is the interrelationship between those traits and one's personal sense of self and self-identification/self-representation as male, female, both, or neither; it does not always fit within gender stereotypes. Most individuals develop gender identity that coincides with their genotype. During the second year of life, most children gravitate to gender-specific toys and games, and by 3 years of age, demonstrate gender awareness that classifies them as either a "boy" or "girl" (Berenbaum, 2006; Meyer-Bahlburg, 2011).
Western culture and its social constructs view gender as a binary concept with two gender identity options: male or female. But gender extends beyond biology (anatomic or genetic sex), and it is becoming clearer that gender is a spectrum with no clear dividing line. If gender identity can vary among individuals with "typical" genotype and phenotype, it can have potentially devastating effects for individuals with DSD. Some children and adolescents may present with markedly gender-atypical behavior that may call into question the gender to which they belong. It can lead to confusion and even gender dysphoria with a desire to change gender. It cannot be overemphasized that gender identity is not determined by any single factor. The best predictors of gender identity are sex of rearing combined with prenatal (and perhaps postnatal) androgen exposure. In addition, there appears to be some flexibility of gender identity later in life as demonstrated by individuals who are transsexual. Although gender identity develops early, it is not solidified until adulthood. When considering gender identity among individuals with DSD, there is considerable unexplained variability (Berenbaum, 2006).
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