Moving toward an international standard in informed consent: the impact of intersexuality and the Internet on the standard of care.

What determines sexual identity? David Reimer’s revelation that he was raised as a girl beside his twin brother, and his rejection of the sex assignment made for him at the age of twenty-two months provides additional data for the age-old debate. No longer would Reimer be the “puppet” of Dr. John Money, psychologist and sexologist, who proclaimed nurture over nature in the determination of sexual identity. The painful story of David is related in the book, As Nature Made Him, where author John Colapinto relates how David, through an accident of electricity and bad medicine, suffered through years of gender misidentity, psychological abuse, child molestation, counseling, teasing and confusion. The publication of Reimer’s story (using his real name) and the scientific papers that preceded this revelation brought the issue of intersexuality into the public eye. Basic assumptions about human gender, sexual identity and sexual re-assignment, and what makes a person male or female, or man or woman, are being re-evaluated in light of David Reimer’s experience and subsequent revelations from intersexed individuals, concomitant with new medical procedures, theories and standards.