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The challenges in diagnosis and gender assignment in disorders of sex development presenting to a pediatric surgical unit in a developing country: The role of laparoscopy and simple tests for gender identity.
[congenital adrenal hyperplasia]
We
aimed
to
assess
how
the
diagnosis
and
determination
of
gender
identity
of
disorders
of
sex
development
(
DSD
)
is
different
in
a
developing
country
from
Western
medicine
,
and
whether
a
pediatric
surgery
department
can
determine
the
underlying
diagnosis
and
use
simple
tools
to
determine
the
likely
gender
identity
(
GI
)
.
We
reviewed
the
records
of
DSD
patients
admitted
to
the
Department
of
Pediatric
Surgery
,
Chittagong
Medical
College
&
Hospital
(
CMCH
)
,
Chittagong
,
Bangladesh
,
from
January
2006
to
December
2012
and
performed
a
cross-sectional
study
on
GI
and
gender-related
behavior
in
these
patients
during
the
year
2012
.
DSD
boys
and
girls
answered
a
GI
interview
and
had
their
gender
role
behavior
assessed
by
observations
of
structural
toy
play
and
analyzed
for
differences
in
scores
.
This
cohort
of
DSD
patients
presented
in
mid-childhood
(
6
months
-
16
years
,
mean
6
.
9
years
)
rather
than
infancy
,
and
30
%
came
from
consanguineous
unions
.
Congenital
adrenal
hyperplasia
(
CAH
)
constituted
only
11
of
50
(
22
%
)
of
the
DSD
cohort
,
and
not
all
families
had
access
to
steroid
hormone
replacement
.
A
simple
assessment
of
GI
and
gender-related
behavior
allowed
effective
gender
assignment
,
as
there
was
significant
difference
between
DSD
boys
and
girls
in
GI
and
gender-related
behavior
score
.
DSD
management
in
Bangladesh
provides
some
unique
challenges
because
of
limited
resources
.
A
national
reference
laboratory
for
biochemical
and
genetic
testing
and
development
of
a
quaternary
referral
center
for
DSD
patients
will
be
helpful
.
Continued
use
of
the
GI
interview
and
gender-related
behavior
study
will
enable
effective
interim
decisions
about
diagnosis
and
management
.