الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Summary and Conclusion
he term DSD was proposed for congenital conditions in
which chromosomal, gonadal or anatomical sex is
atypical. In general, factors influencing sex determination are
transcriptional regulators, whereas factors important for sex
differentiation are secreted hormones and their receptors.
At each stage of the life of the DSD patient and his
family, new symptoms and malfunctions arise, affecting the
balance of the system. Although the psychological outcome of
DSD is often satisfactory, many medical and psychosocial
factors may put the development of children with DSD in many
ways at risk. Clinical decisions, the timing of interventions and
the way medical information is communicated have farreaching
consequences for one’s quality of life.
Also newborns with ambiguous genitalia pose a difficult
emotional situation for parents in deciding their future sexual
orientation. Moreover, these parents also face a social nightmare
explaining to their relatives and friends, the gender reassignment.
The current intense debate on the management of
patients with intersexuality and related conditions focus on four
major issues:
1) Etiological diagnosis.
2) Assignment of gender.
3) Indication for and timing of genital surgery.
4) The disclosure of medical information to the patient and
his/her parents.
The goals of therapy include a surgical outcome with a
good cosmetic appearance and functionality with potential for
sexual intercourse with sufficient sensitivity for satisfactory
responsiveness. Psychological care should be provided from
birth with gradual transition primarily to the patient.
Optimal care for children with DSD requires an experienced
multidisciplinary team which is generally found in tertiary care
centers. Ideally, the team includes pediatric subspecialists in
endocrinology, surgery or urology or both, psychology,
gynecology, genetics, neonatology, and, if available, social work,
nursing, and medical ethics.
The physicians involved in intersex clinical management
have a responsibility to respect patient autonomy, patient
disclosure, and informed consent. They also have an ethical
obligation to pursue the patient’s best interests while promoting
universal human rights.
In addition, the physician managing families of DSD
patients could minimize the trauma of having a child of
unidentified sex by providing appropriate genetic counseling so
that the parents can make an early decision. Prenatal DNA
testing in at-risk families should be considered, and appropriate
therapy offered to minimize or prevent genital ambiguity.
Currently available outcome studies of patients with
DSDs have limitations because of multiple factors, including
lack of representative patient sampling, and lack of adequate
information concerning both medical and surgical care, as well
as psychological, social and family support.
The discussion on respect and tolerance towards
individuals with DSDs must continue around the globe. In
discussing the issues on a global scale; biological, psychological,
sociological, anthropological, legal, and cultural factors must be
considered. The medical profession must regularly provide up-todate
information and findings on biological and medical issues for
individuals to make responsible decisions in their personal lives.
Finally, Individuals within various social institutions and
cultures need to be more accepting of individual differences;
the laws, both nationally and internationally, need to provide
greater protections to all human as a matter of preserving
human integrity and dignity.