Disorders of sex development arise in parts of the world with different socio-economic and cultural characteristics. We wished to determine the regional variations in the management of these conditions. A questionnaire was e-mailed to the 650 members of the European Society for Paediatric Endocrinology (ESPE), an international society with a mainly European membership but which also includes professionals from other continents. Results were subjected to statistical analysis. A total of 62 answers were received, a satisfactory rate given that not all members are involved in this issue. Results show statistically significant regional differences for available diagnostic resources, age of the patient at gender assignment, parameters considered important for gender assignment, and timing of discussion of various issues with parents and patient. The regional variations exist not only between different continents, as already demonstrated by others, but also between Northern, Latin and Eastern European countries. This suggests that ‘one-fits-all’ guidelines for management are not appropriate.

Ahmed SF, Achermann JC, Arlt W, Balen A, Conway G, et al: UK guidance on the initial evaluation of an infant or an adolescent with a suspected disorder of sex development. Clin Endocrinol (Oxf) 2011, in press.
Bashamboo A, Ledig S, Wieacker P, Achermann J, McElreavey K: New technologies for the identification of novel genetic markers of disorders of sex development (DSD). Sex Dev 4:213–224 (2010).
Davies JH, Knight EJ, Savage A, Brown J, Malone PS: Evaluation of terminology used to describe disorders of sex development. J Pediatr Urol 7:412–415 (2011).
Hughes IA, Houk C, Ahmed SF, Lee PA; LWPES Consensus Group; ESPE Consensus Group: Consensus statement on management of intersex disorders. Arch Dis Child 91:554–563 (2006).
Hughes IA, Nihoul-Fékété C, Thomas B, Cohen-Kettenis PT: Consequences of the ESPE/LWPES guidelines for diagnosis and treatment of disorders of sex development. Best Pract Res Clin Endocrinol Metab 21:351–365 (2007).
Julka S, Bhatia V, Singh U, Northam E, Dabadghao P, et al: Quality of life and gender role behavior in disorders of sexual differentiation in India. J Pediatr Endocrinol Metab 19:879–888 (2006).
Lang C, Kuhnle U: Intersexuality and alternative gender categories in non-Western cultures. Horm Res 69:240–250 (2008).
Migeon CJ, Wisniewski AB, Brown TR, Rock JA, Meyer-Bahlburg HFL, et al: 46,XY intersex individuals: phenotypic and etiologic classification, knowledge of condition, and satisfaction with knowledge in adulthood. Pediatrics 110:e32 (2002).
Morel Y, Rey R, Teinturier C, Nicolino M, Calemard-Michel L, et al: Aetiological diagnosis of male sex ambiguity: a collaborative study. Eur J Pediatr 161:49–59 (2002).
Nihoul-Fékété C, Thibaud E, Lortat-Jacob S, Josso N: Long-term surgical results and patient satisfaction with male pseudohermaphroditism or true hermaphroditism: a cohort of 63 patients. J Urol 175:1878–1884 (2006).
Reiner WG: Gender identity and sex-of-rearing in children with disorders of sexual differentiation. J Pediatr Endocrinol Metab 18:549–553 (2005).
Sowande OA, Adejuyigbe O: Management of ambiguous genitalia in Ile Ife, Nigeria: challenges and outcome. Afr J Paediatr Surg 6:14–18 (2009).
Thyen U, Lanz K, Holterhus PM, Hiort O: Epidemiology and initial management of ambiguous genitalia at birth in Germany. Horm Res 66:195–203 (2006).
Warne G, Grover S, Hutson J, Sinclair A, Metcalfe S, et al: A long-term outcome study of intersex conditions. J Pediatr Endocrinol Metab 18:555–567 (2005).
Warne GL: Long-term outcome of disorders of sex development. Sex Dev 2:268–277 (2008).
Warne GL, Raza J: Disorders of sex development (DSDs), their presentation and management in different cultures. Rev Endocr Metab Disord 9:227–236 (2008).
Wiesemann C: Is there a right not to know one’s sex? The ethics of ‘gender verification’ in women’s sports competition. J Med Ethics 37:216–220 (2011).
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.