title: Long-term psychosocial adjustments, satisfaction related to gender and the family equations in disorders of sexual differentiation with male sex assignment.
abstract: OBJECTIVE
  The varied management and counseling in disorders of sexual differentiation (DSD) depends a lot on the socioeconomic structure. A follow-up study was designed to evaluate the outcome in terms of patient satisfaction with strong socio-cultural issues.
  
  
  METHODS
  Of the 1,134 DSD patients being followed up in pediatric intersex clinic, 60 adolescents and adults assigned male sex in childhood were called for follow-up. They were interviewed for psychosocial and family adjustments including level of acceptance of gender, social relationships and future expectations.
  
  
  RESULTS
  The ages ranged from 15 to 25 years (mean, 19.3 ± 3.7 years). The disorders were male pseudo hermaphrodite (MPH)-43, mixed gonadal dysgenesis (MGD)-3, true hermaphrodite (TH)-7 and congenital adrenal hyperplasia (CAH)-7. Of all patients, 85% (51/60) felt satisfied with their gender assignment; 76.9% (46/60) did not feel comfortable with the opposite sex. Penile erections; ejaculation and masculine voice were present in 53, 44 and 47 patients. Facial hair was normal; sparse and absent in 16, 26 and 18 patients, respectively. Stretched penile length was 2.5-9 cm (median, 5.5 cm) and 16/60 patients were satisfied with their penile length; 28 patients required redo surgeries for scrotum diverticulum (1), proximal penile diverticulum (1), stricture urethra (2), hair in the urethra (3), vaginal pouch dilatation (1), orchiopexy (2), residual chordee correction (3), distal urethroplasty (4), urethral fistula repair (21), mastectomy (6) and testicular prosthesis (4). Family support was available to all 85% (51/60) of the patients who had good family relationships. However, only 15% (9/60) felt that they fitted into society. Peer relationships were considered 'good' by 43/60 and poor by 17/60. Two patients had got married and 44.8% (26/58) patients would consider marriage in future. Most patients (42/60) were worried about the smaller size of the phallus and lack of adequate semen, leading to apprehension before marriage. As much as 15 patients had jobs, 15 attended school, 3 attended colleges and 17 illiterate patients were dependent on their families.
  
  
  CONCLUSIONS
  Despite moral, social and economic support provided by the parents, children with DSD continue to have apprehensions in social adjustments.
authors.affiliation: Department of Pediatric Surgery, Psychology and Endocrinology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Deepika
authors.initials: D
authors.lastname: Gupta
authors.forename: Madhu
authors.initials: M
authors.lastname: Bhardwaj
authors.forename: Shilpa
authors.initials: S
authors.lastname: Sharma
authors.forename: A C
authors.initials: AC
authors.lastname: Ammini
authors.forename: Devendra K
authors.initials: DK
authors.lastname: Gupta
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000175:diagnosis / Q000523:psychology*; D000328:Adult; D003937:Diagnosis, Differential; D005190:Family / Q000523:psychology*; D005500:Follow-Up Studies; D005837:Genitalia, Male / Q000002:abnormalities* / Q000254:growth & development; D006060:Gonadal Dysgenesis, Mixed / Q000175:diagnosis / Q000523:psychology*; D006801:Humans; D008297:Male; D050090:Ovotesticular Disorders of Sex Development / Q000175:diagnosis / Q000523:psychology*; D017060:Patient Satisfaction; D012732:Sex Determination Analysis; D012733:Sex Differentiation; D013997:Time Factors; D055815:Young Adult