Sex assignment, gender identity and gender roles in patients with ambiguous genitalia at King Chulalongkorn Memorial Hospital

Abstract

Background : Patients with ambiguous genitalia often face difficulty in sex assignment. They were reported to have deviant gender roles and gender identity. However, the studies on these areas of the patients are yet lacking both
in Thailand and other countries.

Objective : Our study aims to determine gender identity and gender roles in patients with ambiguous genitalia together with collection of data on their sex assignment.

Method : Patients, aged 3 - 18, along with their parents who visited our pediatric endocrinology outpatient department at King Chulalongkorn Memorial Hospital between January to May 2016 were selected. In-depth interview guided by literature review consisted of questions about gender identity and gender roles was conducted. Information about sex assignment and their treatment were gathered from medical records. Data were analyzed with qualitative method using Colaizzi’s strategy and content analysis.

Results : Patients included twenty-one patients with 46XX, disorders of sexual developments (DSD), eight with 46XY, DSD and one with 45X, 46XY, DSD. Only nine patients were evaluated by child psychiatrists. Twelve
patients did not start their treatment at birth. Five patients were reassigned by clinician and two asked for reassignment themselves. In this group of patients with 46XX, DSD, gender roles in the domains of activities and plays showed male trends while hair, dress and playmates showed female trends. Patients with 46XY, DSD mostly showed male gender roles. Seventeen patients had female gender identity, nine had male. Moreover, four 46XX, DSD patients had wished to be male.

Conclusions : Most of gender roles correlates with patients’ chromosome except the activity and plays that showed male trends. Almost half of all patients had not started their treatment at birth and most patients had never
seen the child psychiatrist. This implies the need for improvements in management of patients with ambiguous genitalia.