Sexual identity and sexual orientation in children with traumatized or ambiguous genitalia

It has long been proposed that the development of sexual orientation and sexual identity is due to an interaction of both constitutional and social forces (Diamond, 1965). A great deal of evidence has been accruing that nature sets a predisposition for these sexual developments and within such limits the environment works. Cases are presented in which individuals, because of trauma to their genitals or because their genitals are ambiguous, have been assigned to a gender they later come to reject. These cases provide evidence that one's sexual identity is not fixed by the gender of rearing. Further, they provide insight into a process that atypical as well as typical persons undergo in psychosexual development. Everyone undergoes self-analysis during which he or she evaluates being ''same'' or ''different'' from peers and other males or females and comes to terms with his or her sexual identity by such comparisons. These cases further illustrate that sexual orientation also develops independent of rearing. Significantly these cases and the attendant theory discussed reflect on contemporary postulates of sex assignment and reassignment. This leads to new recommendations for sex assignment in cases of genital trauma or hermaphroditic individuals with ambiguous genitalia.