THE MANAGEMENT OF AGENESIS OF THE PHALLUS

Abstract

Personal experience with four cases of complete agenesis of the phallus are recorded. The principal question is whether to raise the newborn infant as a boy or a girl. The answer was deduced from the major psychological and social problems encountered in raising two of these patients as boys. In one of these cases multiple, previous attempts at plastic construction of a phallus had been complete cosmetic failures, and the patient suffered from extreme psychological trauma. A cosmetic and psychological improvement was obtained by covering the existing pedicle flap with scrotal skin.

Both the psychological and surgical considerations have led us to raise two newborn infants with agenesis of the phallus as girls. The testicles were placed in the inguinal region so that the endocrine relationships of childhood were not disturbed. The scrotum was preserved for later use in construction of a vagina. From an unusual case of transexualism, we found that it is possible to obtain a completely normal female appearance by giving estrogens to a normal male at puberty. Feminization will be achieved in a similar manner in these patients with agenesis of the phallus. Following construction of a vagina, these children will be completely normal, female sexual partners, except that they will not be able to reproduce. Furthermore, these children will go through childhood and adolescence with a more acceptable appearance as a girl than they could as a boy.

We place great emphasis on a rapid decision on sex assignment within a day or so after the child's birth. After that the legal problems of sex change and the social problems of ambiguity among relatives and friends are compounded.