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This is no longer recommended by most experts in the field because of the publicity surrounding similar failed reassignments which became public in the s, such as that of David Reimer. Raise nearly all XX infants with functional ovaries as female. Not having the choice to choose their own gender can lead to depression and anxiety due to confusion and possible isolation. Any reassignment after the first month or two is no longer considered an "early reassignment". The resulting medical model was termed the "Optimal gender model. There have been cases where a male infant has been reassigned to female at several days, weeks, or months of age because of an irreparable birth defect of the genitalia or loss of the penis to trauma or other accident. However, intersex and human rights organizations have criticized medical models as they are not based on the consent of the individuals on whom such irreversible medical treatments are conducted, and outcomes may be inappropriate or poor. History[ edit ] Nothing currently appears to be known about sex discernment prior to the medicalization of intersex. Raise as male any XY infant with unambiguous micropenis.
Although physicians recognized that there were conditions in which the apparent secondary sexual characteristics could develop contrary to the person's sex, and conditions in which the gonadal sex did not match that of the external genitalia, their ability to understand and diagnose such conditions in infancy was too poor to attempt to predict future development in most cases. At age 15, Reimer reverted to living as a male. If it was too small or atypically formed e. Clinical recommendations in the s for assignment changed as a result: The most common example of this is when a newborn is assumed to be a boy and assigned as such despite absent testes. This is no longer recommended by most experts in the field because of the publicity surrounding similar failed reassignments which became public in the s, such as that of David Reimer. Although John Money had described the reassignment as a success in the s, Reimer went public with his account of continuing to have a male gender identity despite the reassignment to a female sex of rearing. From the s, pediatric surgeons attempted and claimed success with reconstruction of infant genitalia, especially enlargement or construction of vaginas. This may occur in several types of circumstances. Approximately 1 in 20,[ citation needed ] infants is born with enough ambiguity that assignment becomes a more drawn-out process of multiple tests and intensive education of the parents about sexual differentiation. In approximately 1 in 2, infants, there is enough variation in the appearance of the external genitalia to merit hesitation about appropriate assignment by the physician involved. The recommended rules of assignment and surgery from the late s until the s were roughly: Examples of this have occurred in adolescents with several forms of CAH and 5-alpha-reductase deficiency. The subject, David Reimer , later identified as a man. Any XX infant, no matter how virilized, should be raised as a girl to preserve the chance of future fertility. In a much smaller proportion of cases, the process of assignment is more complex, and involves both determining what the biological aspects of sex may be and choosing the best sex assignment for the purposes of rearing the child. Intersex medical interventions and History of intersex surgery Observation or recognition of an infant's sex may be complicated in the case of intersex infants and children, and in cases of early trauma. Any undervirilized XY infant should be raised as a boy if the penis could be expected to be large enough to stand to urinate and to insert into a vagina for coitus. These recommendations do not explicitly necessitate surgical or hormonal interventions to reinforce sex assignments, but such medical management persists worldwide , utilizing rationales such as the mitigation of parental distress and trauma, reducing the likelihood of stigma, making a child feel more "normal", and improving marriage prospects. However, in European societies, Roman law , post-classical Canon law , and later Common law , referred to a person's sex as male, female or hermaphrodite, with legal rights as male or female depending on the characteristics that appeared most dominant. When the external genitalia appear to be in between, they are described as ambiguous. A large, protruding clitoris should be reduced in size with a nerve-sparing recession or reduction rather than simple amputation. The primary goal of assignment was to choose the sex that would lead to the least inconsistency between external anatomy and assigned psyche gender identity. The Act was widely welcomed by civil society organizations. This led to the recommendation that any child without a penis or with a penis too small to penetrate a vagina could be raised as a girl, taught to be a girl, and would develop a female gender identity, and that this would be the best way to minimize future discrepancy between psyche and external anatomy in those infants determined to be biologically male but without a penis that meets medical norms e. People who seek these processes often form a subset identity among transgender people known as transsexual, albeit not all may identify as such. Raise infants with mixed gonadal tissue, true hermaphroditism, or other chromosome anomalies as the sex most consistent with external genitalia, since gonads are usually nonfunctional.
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