The Diagnosis and Treatment of Hermaphroditism*

Until recently the determination of the sex of an individual was mainly based upon the gonadal structure, and the sexual individuality identified with this finding. Accordingly a person having testes was a man and one having ovaries a woman. In the hermaphrodites certain anomalies inside the genital tract were considered more or less as anatomical variations from the normal without more profound changes in the sexual structure of the organism. Clinical investigations into the various problems of hermaphroditism have, however, changed this picture completely and have shown how much more complicated these things are and how many different factors are working together to build up the harmonious sexual individuality of a human being. Today, in cases where the sex of the child is dubious, thorough investigations must be performed before any determinations as to the sex are made or any treatment can be instituted. The investigations should determine five different aspects of the organisms: (1) the genetic sex, (2) the gonadal sex, (3) the somatic sex-including the external and internal genitalia and the secondary sexual character, (4) the hormonal status, and (5) the psychic structure, including the rearing and gender role of the patient. Only then can a satisfactory decision be made. The present paper is intended as a short introduction to some of the clinical aspects of hermaphroditism based on a personally known group of human hermaphrodites.