Sex deformities at birth or at any other time

Sometimes, a boy may be born with small pennies (micropenis) or they may have the penis missing at all. My people have continuously referred to the sex organ to determine the sex of the child and therefore boy without penies may mistakably be taken as a girl. However, research has proved that there are may other factors that should be considered in determining the sex of a child.

A boy may be born with micropennis or without a penies due to a number of defects including cloacal exstrophy which affects the bladder.  It may also b due to an accident at birth like a mishandled circumcision, which is normally referred to as ablation penis. The issue of concern around such cases is whether these children should be taken as a boy or a girl.

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The theory underlying ablation penies is that when a boy is born without a penies or loses penis as a result of circumcision, the child can be brought up as a girl and by the time they reach puberty, oestrogen can be introduced in her body to induce development of female characteristics.  In this paper we are going to review one of study on ablation penis which was research by John Money in 1975.

John/Joan case

The 1975 study has been considered as a study of opportunity since the set involve twin brothers with one brother acting as control for the study.  The study was about John who penis had been distorted in a botched circumcision and was later reassigned as a female while his brother acted as the control for the study.

In his work Money had encountered the two twins who had been born in 1960s. When they reached the age of 7months, the boys were recommended to undergo circumcision since they were developing phimosis, a condition which leads to narrowing of the opening of the foreskin. While undergoing circumcision, one of the boys, John was severely burned by an electrocautery knife in his pennies which was completely destroyed. (Money, 1975)

This incident would affect the life of the boy in severe way. One of the psychiatrist postulated that the boy would no be able to consummate marriage since he would be incapacitated to have a heterosexual relationship. This would severely affect his relationship with other people especially the fellow boys and therefore he will be forced to live apart from others. Something had to be done to change his course of life.

When Money learned about the plight of the boy, he suggested to the parents that the boy to be reassigned as a grail. Money recommended that the boy should undergo a surgical process to create a female genitalia organ by removing the male penis and should be raise as a girl.  When the boy reached 17 months, surgeons removed his testes reshaping the scrotum like a vulva. Henceforth, John became Joan and was raised like a girl by his parents. John/Joan did not experience any trauma or suspicion. (Money, 1975)

John Money, who had done extensive research on the hermaphroditic children, based his argument on that at birth infants are sexually neutral and malleable for a window period which last from birth to about 18-24 months. It is during the window period that sexual identity is formed and fixed.  According to Money social imprinting and learning are the most important factors that affect psychosexual development. This assertion was inconsistent with many researches that had been done on acquisition of language.

Therefore in this case John/Joan was the subject of study while his brother was the control. The twins were evaluated on regular bases at Hopkins. At puberty, Money reevaluated their psychosexual development and confirmed in his 1975 publication that John/Joan behavior confirmed her as a girls and no one would conjecture that Joan had been born as boy.  Joan behaviors were like that of a little girl and were remarkably different from that of her/his brother. (Money, 1975)

Money publication was important in the field as is confirmed that plasticity could be used in gender as well.  This confirmed that an infant who had been born as an unambiguous male could be successfully reassigned as a female and henceforth grows as a normal girl. Money’s publication formed the basic practice for pediatricians taking care of infants with ambiguous genitalia. The study showed that genetic make and prenatal endocrinology does not have an effect in assignment of sex.

However, a follow up of the study revealed that Joan had exhibited male behaviors contrary to Money’s publication. For example it was revealed that Joan stood up when urinating and she was rejecting by her girlfriends. She was alienated by other girls.

Later exploration of the case or what had happened to Joan/John revealed the failure of the process. His twin brother revealed that John had never shown any feminine characteristics.

When Joan reached fourteen years, psychiatrist advised his father to reveal the childhood ordeal when John told his mother that he would kill himself if he was taken to Hopkins to be administered with hormones. John request for mastectomy which was performed and he became a male again.  He has since then lived as a husband, father and a breadwinner for the family.

Conclusion

The case of John/Joan reveals important factor that should be considered when refashioning infants with ambiguous genitalia.  Although this case had shown initial success, the later results which contradict the earlier findings assert that there must be a thorough assessment of sex reassignment before considering their success.

These results show that contrary to what has been assumed, children usually observe the pattern of their sexes. Though Joan was supposed to live as a girl, her behaviors never changed and she exhibited male behaviors.

References

Money, J. (1975): Ablatio penis: Normal male infant sex-reassignment as a girl. Archives of Sexual Behaviors, vol. 4: 65-71

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