SEX REASSIGNMENT OF A TWIN WITH ABLATIO PENIS

One of the most famous cases in the literature on sexual development is that of a male identical twin whose penis was accidentally destroyed – a disorder termed Ablatio Penis – during circumcision at the age of 7 months. Because there was no satisfactory way of surgically replacing the lost penis, a widely respected expert in such matters, John Money, recommended that the boy be castrated, that an artificial vagina be created, that the boy be raised as a girl, and that estrogen be administered at puberty to feminize the body. After a great deal of consideration and anguish, the parents followed Money’s advice.

Money's (1975) report of this case has had a great influence on current thinking about sexaul development. It has been seen by some as the ultimate test of the nature-nurture controversy with regard to the development of sexual identity and behavior. It pitted the masculinizing effects of male genes and male hormones against the effects of being reared as a female. And the availability of a genetically identical control subject, the twin brother, make the case all more interesting.

According to Money, the outcome of this bizarre case comes down strongly on the side of the social-learning theory of sexual identity. Money reported in 1975, when the patient was 12, that "she" had developed as a normal female, thus confirming this prediction that being raised as a girl would override the masculinizing effects of male genes and early androgens. Because it is such an interesting case, Money's description of it has been featured in many textbooks of psychology, medicine, sociology, and women's studies, as well as in many television, magazine, and newspaper stories, each time carrying with the message that the sexual identity and behaviour of men and women is largely a matter of upbringing. However,there is a reason to question the rosy picture painted by Money.

In 1980, a British news team preparing a report on the case discovered that several psychiatrists had examined the patient in 1976 when she was 13 and had reached a conclusion that conflicted with that of Money. Their conclusion was that the patient was having significant psychological problems, including considerable ambivalence toward the female role. She refused to draw pictures of females, she aspired to occupations that are commonly regarded as masculine (e.g, auto mechanic), and her masculine gait was the object of scorn from the classmates who referred her as "cave woman". Clearly, things were not as a cut-and-dried as Money's report, published the year before, had made them out to be.

Current theories of hormones and sexual development greatly increase the understanding of the case mentioned above, and they provide the basis of prescribing treatment. However, it is important to recognize that the current theories do better with respect to gonads, reproductive organs, and secondary sex characteristics than they do with respect to brain and behavior.