Psychosocial and psychosexual outcome in DSD
The 2006 DSD consensus statement states that all newborns should receive a gender assignment. Gender assignment decisions are typically guided by a combination of diagnosis and long-term, adult follow-up studies that focus on gender identity stability and other psychosexual outcomes. One relevant question in gender assignment is whether, in newborns, gender identity can be predicted, and if so, whether adult gender identity is related to prenatal brain exposure to testosterone. Sexuality is another area that is closely related to quality of life. It may be hampered by psychological factors, such as uncertainties about ones sexual orientation, fertility, or appearance, but also to medical interventions such as early surgery. From various reviews is appears that gender identity is not closely related to prenatal brain exposure to testosterone. It also seems that adolescent girls with DSD reach psychological milestones somewhat later than their peers and that sexual problems are more common in women with DSD than in control women. Outcomes, however, differ largely between conditions, gender of rearing and treatment centers. This reflects the need for large scale multi-clinic collaboration.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.