Baby Boys With Micropenis Happier as Males

From the WebMD Archives

Jan. 25, 2002 -- Raising a child is a tough task for any parent. But imagine having to choose whether to raise your newborn as a male or female due to a rare birth defect. A new study may provide some insight for parents faced with that difficult decision.

The report suggests that genetically and physically male babies born with a condition called "micropenis" are more likely to achieve mental well-being and sexual satisfaction when they are raised as males. The study, the first to look at the long-term psychological and sexual effects for both men and women, is published in this month's Hormone Research.

Micropenis is a rare condition that occurs when the penis of a genetically male embryo develops normally during the first trimester but fails to grow normally during the second and third trimesters. At birth, a micropenis typically is no more than 0.75 inches long when stretched; that's about half the stretched size of the penis of a full-term male at birth.

Other problems associated with micropenis are small testes and hormone problems caused by low testosterone production, such as enlarged breasts and sparse body hair.

Due to the genitalia not looking like a normal male baby, infants born with micropenis are sometimes raised as females. This involves reconstructive surgery to form a vagina and hormone treatments.

Although all of the 13 men and 5 women born with micropenis who participated in the study identified closely with their gender, only 20% of the babies raised as females were satisfied with their genitalia, compared to 50% of the males.

"Patients reared male considered themselves to be masculine, and those raised female considered themselves to be feminine," said study author Amy Wisniewski, PhD, of the Johns Hopkins Children's Center, in a news release. "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."

In some cases, the birth defect can cause reduced male sexual function. That has prompted some parents to choose to raise their child as a female -- with the hope that genital reconstruction will lead to a more satisfying sex life and positive body image.

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But the study found that with testosterone treatment, half of the men were able to attain a normal penis length and most reported average or better libido. Only one of the five women in the study was satisfied with her genitalia, and two reported a lack of libido and inability to achieve orgasm.

The authors stress that they do not categorically recommend that parents raise a baby with micropenis as a male. But the study suggests that a child raised as a female would have to undergo extensive and complicated feminizing treatments to achieve a satisfactory cosmetic and functional result.

Overall, people raised as male or female were satisfied with their assigned gender, and no one was interested in changing sexes. Both groups also reported problems with social stigmas and teasing by others, and most patients received counseling for their medical condition.

"Raising the baby either male or female presents parents with challenges," says Wisniewski.

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