Male pseudohermaphroditism: factors determining the gender of rearing in Saudi Arabia

Abstract

Objective: Experience with male pseudohermaphrodites at King Fahd Hospital of King Faisal University, Al-Khobar, Saudi Arabia from 1981 to 1991 was reviewed to ascertain the factors determining the gender of rearing.

Methods: The records of 14 patients consisting of 6 prepubertal and 8 postpubertal patients were studied. None of the patients had any prior evaluation or treatment, since their gender assignment at birth was carried out by midwives in rural communities. The males presented to our hospital with ambiguous genitalia: small phallus, bifid scrotum, perineoscrotal hypospadias, and undescended testes (UDT). Most of those raised as females presented in the postpubertal period seeking remedy for deep voice, excessive musculature, facial hair, erection of the phallus, ejaculation, inappropriate attraction to the female sex, and primary amenorrhea. As their male genotype became determined, all the patients and/or their parents, with the exception of one, insisted on appropriate reconstructive surgery to the male gender. This report focuses primarily on 11 patients assigned a female gender at birth, 10 of whom insisted on a gender change.

Results: Most adolescents and adults still complained of small penises after reconstructive surgery, but cherished their male role.

Conclusions: The male genotype is a more important factor than phallic adequacy in determining the gender of rearing in the Kingdom of Saudi Arabia, an observation attributable to the financial, social, and cultural benefits that the male gender confers in Saudi society.