Milton Diamond

Sex Reassignment at Birth: Long-term Review and Clinical Implications

This article is a long-term follow-up to a classic case reported in pediatric, psychiatric, and sexological literature. The penis of an XY individual was accidentally ablated and he was subsequently raised as a female. Initially this individual was described as developing into a normally functioning female. The individual, however, was later found to reject this sex of rearing, switched at puberty to living as a male, and has successfully lived as such from that time to the present. The standard in instances of extensive penile damage to infants is to recommend rearing the male as a female. Subsequent cases should, however, be managed in light of this new evidence.

Homosexuality and bisexuality in different populations.

The general public as well as the scientific community have use for accurate data on the size(s) of the heterosexual, homosexual, and bisexual populations. Uses include political, legal, medical, and social. The data upon which the typically used figures are dependent have come under scrutiny. This review of studies from the U.S. and elsewhere indicate that it is unreasonable to consider the often-used figure of 10% of the male population as more or less regularly engaging in same-sex activities. The figure is closer to half that. And the figure for the lesbian population is even smaller. Further, routinely exclusive or predominantly exclusive homosexual activities are more common than bisexual activities.

Intromission Pattern and Species Vaginal Code in Relation to Induction of Pseudopregnancy

Mechanical stimulation was used to mimic normal vaginal stimuli during copulation in the mouse; the number and rate of intromissions were crucial influences on reproductive success. The best combinations for the mechanical induction of pseudopregnancy were comparable to those male behaviors normally seen during mating. The behavior of the male coincides with a species-related vaginal code, increasing chances for reproductive success between cospecifics.

Sex Change in a Coral-Reef Fish: Dependence of Stimulation and Inhibition on Relative Size

The removal of a single dominant individual has been shown to trigger a sex change in some coral-reeffish. In the saddleback wrasse (Thalassoma duperrey), however, female-to-male sex change requires visual stimulation from smaller conspecifics. This change is not dependent on the sex or color of the stimulus fish and can be inhibited by larger conspecifics. On the reef, a female probably changes sex when the relative numbers of larger and smaller conspecifics change within her home range.

PEDIATRIC MANAGEMENT OF AMBIGUOUS AND TRAUMATIZED GENITALIA

PURPOSE The present standard of practice in the management of ambiguous and traumatized genitalia was evaluated. MATERIALS AND METHODS Published cases of intersexuality and protocols for the management of traumatized genitalia were reviewed with consideration of the input of intersexual individuals. Independent research on different types of intersexuality is also presented. RESULTS The present standard pediatric recommendations and precepts for the management of ambiguous or traumatized genitalia are wanting. Followup studies on which to base treatment decisions are needed. Evidence based principles of medical management are proposed. CONCLUSIONS A moratorium on sex reassignment cosmetic surgery is recommended. Also recommended are that followup studies should be instituted on past cases, and honesty and counseling should be the core of initial and subsequent treatment.

Transgender people: health at the margins of society

In this paper we examine the social and legal conditions in which many transgender people (often called trans people) live, and the medical perspectives that frame the provision of health care for transgender people across much of the world. Modern research shows much higher numbers of transgender people than were apparent in earlier clinic-based studies, as well as biological factors associated with gender incongruence. We examine research showing that many transgender people live on the margins of society, facing stigma, discrimination, exclusion, violence, and poor health. They often experience difficulties accessing appropriate health care, whether specific to their gender needs or more general in nature. Some governments are taking steps to address human rights issues and provide better legal protection for transgender people, but this action is by no means universal. The mental illness perspective that currently frames health-care provision for transgender people across much of the world is under scrutiny. The WHO diagnostic manual may soon abandon its current classification of transgender people as mentally disordered. Debate exists as to whether there should be a diagnosis of any sort for transgender children below the age of puberty.

Homosexual orientation in twins: A report on 61 pairs and three triplet sets

Twin pairs in which at least one twin is homosexual were solicited through announcements in the gay press and personal referrals from 1980 to the present. An 18-page questionnaire on the “sexuality of twins” was filled out by one or both twins. Thirty-eight pairs of monozygotic twins (34 male pairs and 4 female pairs) were found to have a concordance rate of 65.8% for homosexual orientation. Twenty-three pairs of dizygotic twins were found to have a concordance rate of 30.4% for homosexual orientation. In addition, three sets of triplets were obtained. Two sets contained a pair of monozygotic twins concordant for sexual orientation with the third triplet dizygotic and discordant for homosexual orientation. A third triplet set was monozygotic with all three concordant for homosexual orientation. These findings are interpreted as supporting the argument for a biological basis in sexual orientation.

Sex and Gender are Different: Sexual Identity and Gender Identity are Different

This article attempts to enhance understanding and communication about different sexual issues. It starts by offering definitions to common terms such as sex, gender, gender identity and sexual identity. Alternate ways to discuss one’s sexual attractions are also presented. Terms are defined or redefined and examples given of their preferred use in different clinical situations, including those associated with children. Adherence to the usage advocated here is proposed as helpful in theory formulation and discussion as well as in clinical practice. When reference is made to individuals of various sexual-minority groups such as transsexual or intersexual persons, the distinctions offered are particularly advocated.

Visual sensitivity and sexual arousal levels during the menstrual cycle.

The possibility of a relationship between visual acuity and phases of the menstrual cycle was investigated in women at different stages of their cycles. Visual sensitivity, as measured by the ability to detect a test light, was found to be great at midcycle (approximately the time of ovulation), to stay high until menses, and then to decline abruptly at the onset of menstruation. Following menstruation visual sensitivity again begins to increase. Significant visual threshold changes were not found in women taking nonsequential oral contraceptives or in men tested at the same time intervals. The results suggest an effect of cyclic hormonal changes on visual functions. This is considered along with other sensory changes as increasing the probability that coitus would occur at the time of ovulation, increasing the chance for conception.

Sex behavior after neonatal progesterone, testosterone, estrogen, or antiandrogens

Abstract The effect on adult sexual behavior of high doses of progesterone and testosterone given to neonatal male rats were tested and compared with the effects of administered estrogen, cyproterone, and cyproterone acetate. Results indicated that high doses of all the test substances affect male sexual performance; the direction of change, however, is dependent upon the parameter measured. It is asserted that not only must a critical period be considered in evaluating developmental influences on sexual performance but so too must the steroidal environment in terms of type and dosage. High dosages used in the study are seen as possible experimental models of the abnormal hormonal milieu associated with certain clinical situations.