For masculinized 46XX CAH, virtually all respondents favored female sex assignment. The most important factor was potential fertility. For 46XY cloacal exstrophy, two thirds favored the male sex. The most important factor was potential androgen brain imprinting, whereas in selecting female assignment, it was difficulty creating a functional phallus. Respondent characteristics associated with assigning female sex were longer duration in practice (>15 years) and affiliation with training programs. Most respondents advocated a team approach to decision making with parental involvement and early surgery (<18 months).

From this paper, the group concluded that pediatric urologists are in strong consensus about sex assignment for newborns with ambiguous genitalia from CAH. It is prudent that there be a team approach with parental involvement, and early reconstruction. The consensus was positive for female rearing. In regards to cloacal exstrophy, there was a remarkable difference in sex assignment centering on the reconstruction and functionality of the penis with cautions of imprinting. Overall, one can only stress that the true approach is via a knowledgeable team effort including the parents. Unfortunately, this decision should include the patient but it is not practical. Socially it is difficult, and almost impossible, to assign a "third sex".

The Journal of Pediatrics 148(4):445-449, April 2006

Written by Pasquale Casale, MD, a Contributing Editor with UroToday.

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