MALE PSEUDOHERMAPHRODITISM - FACTORS DETERMINING THE GENDER OF REARING IN SAUDI-ARABIA

Objective. Experience with male pseudohermaphrodites at King Fahd Hosp ital of King Faisal University, Al-Khobar, Saudi Arabia from 1981 to 1 991 was reviewed to ascertain the factors determining the gender of re aring. Methods. The records of 14 patients consisting of 6 prepubertal and 8 postpubertal patients were studied. None of the patients had an y prior evaluation or treatment, since their gender assignment at birt h was carried out by midwives in rural communities. The males presente d to our hospital with ambiguous genitalia: small phallus, bifid scrot um, perineoscrotal hypospadias, and undescended testes (UDT). Most of those raised as females presented in the postpubertal period seeking r emedy for deep voice, excessive musculature, facial hair, erection of the phallus, ejaculation, inappropriate attraction to the female sex, and primary amenorrhea. As their male genotype became determined, all the patients and/or their parents, with the exception of one, insisted on appropriate reconstructive surgery to the male gender. This report focuses primarily on 11 patients assigned a female gender at birth, 1 0 of whom insisted on a gender change. Results. Most adolescents and a dults still complained of small penises after reconstructive surgery, but cherished their male role. Conclusions. The male genotype is a mor e important factor than phallic adequacy in determining the gender of rearing in the Kingdom of Saudi Arabia, an observation attributable to the financial, social, and cultural benefits that the male gender con fers in Saudi society.