BABIES
WITH MICRO PENIS DISORDER HAPPIER WHEN RAISED MALE
Genetically and physically male babies born with
a condition called "micropenis" are
more likely to achieve psychological and sexual well-being in adulthood
if raised male, according to a new study by researchers at Johns
Hopkins and three other centers. Their report in this month's Hormone
Research is the first comprehensive, long-term study examining
psychological and sexual outcomes for both men and women. People
born with a micropenis and raised as girls said they identified
solidly with their female gender, but only 20 percent of the women
said they were satisfied with their genitalia. In contrast, 50
percent of men, some of whom had attained normal penis length with
the help of testosterone replacement, said they were satisfied
with their genitalia. Like the women, men said they identified
with their male gender.
"Raising the baby either male or female presents parents
with challenges," says Johns Hopkins Children's Center psychologist
Amy Wisniewski, Ph.D., lead author of the study. "But we were
pleased with the successful outcome of some of the males. All men
who were compliant with their testosterone replacement attained
a final penile length within the normal range."
The research team collected birth and adult genitalia measurements
from 13 men and 5 women, all born with a micropenis. The researchers
surveyed the individuals, all adults between 21 and 54 years of
age at the time of the study, for self-assessments of gender identity,
sexual function and satisfaction with their genitalia. The researchers
also asked the participants questions regarding sexual orientation,
marriage and satisfaction with their sex of rearing.
Of the 12 men who responded, 10 reported a male heterosexual orientation,
six were married, and 11 said they were satisfied with their sex
of rearing. Among the women, three (of four responding) reported
a female heterosexual orientation, none was married, and all were
satisfied with the sex of their rearing, although men were more
often satisfied with the appearance of their genitalia.
While the researchers do not necessarily recommend that parents
raise a baby with a micropenis as male, their study suggests that
a child raised female would require extensive feminizing treatments
to achieve satisfactory cosmetic and functional outcome for her
genitalia.
"Patients reared male considered themselves to be masculine
and those raised female considered themselves to be feminine," Wisniewski
says. "Our recommendation that babies be raised male is based
not on problems with gender identity but on the difficulties associated
with the surgical construction of a vagina and subsequent hormone
treatment."
Micropenis occurs when the penis elongates properly during the
first trimester of a genetically male embryo's development but
fails to grow normally during the second and third trimesters.
Micropenises are typically 1.9 cm (0.75 inches) or less at birth
when stretched. Micropenis may also be accompanied by small testes
and lower testosterone production, which often leads to enlarged
breasts and sparse body hair as the child grows older.
Because the micropenis birth defect can, in some cases, result
in inadequate male sexual function later in life, some parents
have chosen to raise their child female with the hope that genital
reconstruction is more likely to result in a strong sexual identity,
positive body image and pleasurable sex life.
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