Sexual Identity and Sexual Orientation in Children with Traumatized or Ambiguous Genitalia
Journal article by Milton Diamond; The Journal of Sex Research, Vol. 34, 1997
Journal Article Excerpt
Sexual identity and sexual orientation in children with traumatized or ambiguous genitalia. by Milton Diamond Despite older theories to the contrary (Diamond, 1996a, b; Zucker, 1996), an individual is born with prenatal biases with which he or she will interact with the world. In the current article I describe the lives of three unique individuals to support a model for how these prenatal biases mesh with environmental influences to mold one's sexual identity and sexual orientation. A broad outline had been proposed (Diamond, 1979). I now go further, however. On the basis of this analysis, new recommendations are offered for dealing with cases of potential sex reassignment. The three cases presented offer insight to the development of sexual identity and orientation. Case I has been discussed elsewhere and will only briefly be described here. It involves an XY individual who had his penis accidentally burned by ablation and was then raised as a girl (Diamond, 1982, 1993, 1994; Diamond & Sigmundson, 1997; Money, 1975; Money & Ehrhardt, 1972; Money & Tucker, 1975). Cases 2 and 3 are hermaphroditic 46, XX individuals. They have not previously been discussed in the scientific literature. These presentations are the result of my lengthy personal interviews over repeated sessions. Singular and unique personalities, these cases are, nevertheless, believed to illustrate typical developmental strategies of psychosexual development. The strategy reflected in the model holds that all individuals consciously or unconsciously compare themselves with others while growing up. People, unless otherwise restrained or coerced, then drift toward identifying with those with whom they feel an affiliation and feel "similar to" and drift away from identifying with those they feel "different from" or incompatible with. In this manner, even though contrary to social pressures and upbringing, those of different sexual minorities can find a niche acceptable to themselves. Allowed an abundance of choices in partners and activities, few problems are anticipated. Restrictions in partner choices or activity choices, however, are interpreted negatively. This "similar-different" theory is not new for normal development and has been proposed for gay and lesbian identity formation (Troiden, 1988). It is extended here to apply as well to all individuals regardless of sexual identity, orientation, or intersex condition. It thus broadens the model to a universal one for psychosexual development. The lives of these persons also call into question the standard beliefs used in sex assignment that dictated the way these individuals were raised. These beliefs are strongly enough held by pediatricians that they might be considered medical postulates: (a) Individuals are psychosexually neutral at birth; (b) healthy psychosexual development is dependent upon the appearance of one's genitals; (c) doubt should not be allowed as to sex of assignment; (d) do not change sex after two years of age (see, e.g., Behrman & Kliegman, 1994; Blethen & Weldon, 1985; Burg, Merrill, Winter, & Schaible, 1990; Diamond, 1996a, b; Diamond & Sigmundson, 1997; Kessler, 1990; Zucker, 1996). New postulates and recommendations for sex assignment or reassignment are offered to replace these. Case Presentations Case 1. A Normal Male: Penis Ablated and Raised as a Girl John (pseudonym) is an XY individual born an identical twin in the suburb of a large metropolitan city. During a phimosis repair by cautery at eight months of age, his penis was accidentally burned beyond repair. On the advice of consultants, considering the beliefs of the time--that individuals are psychosexually neutral at birth--the child was from then on treated as a girl and, at the age of 17 months, surgically reassigned to be unambiguously raised as a female. Orchiectomy and "vulva" reconstruction were started with further surgery to wait until Joan (pseudonym) was older. All professionals associated with Joan's treatment, as did the parents and family, reinforced her feminine identity. Basically they treated Joan as a girl, preparing her for future vaginal reconstructive surgery and life as a woman. The broad history of this case has been reported (Diamond, 1982, 1993, 1994; Money, 1975; Money & Ehrhardt, 1972; Money & Tucker, 1975). Details too are available (Diamond & Sigmundson, 1997).Despite Joan's rearing, from early on, she did not feel to be a girl, preferred association with boys, and pursued typical boys' activities and interests. Joan shunned female-typical activities and interests. Male predilections persisted until the age of 14, when Joan dramatically rebelled at living as a girl. This was despite orchiectomy and estrogen therapy, which led to breast development and rounded hips. To be forced to continue as a girl prompted Joan seriously to contemplate suicide. Without knowing her ... |
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