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Either a name compatible with either sex should be chosen or the naming of the infant should be delayed until the studies are completed. Although the diagnosis is not usually obvious on examination, there are some helpful distinguishing features (Fig. In normal boys, there is only a single midline frenulum on the ventral side of the phallus; in normal girls, there are two frenula lateral to the midline. A girl with clitoral enlargement still has two frenula, and a boy with hypospadias has a single midline frenulum or several irregular fibrous bands (chordee). The location or consistency of the gonad may be helpful in deducing its composition. A gonad located in the labial or inguinal regions almost always contains testicular tissue. A testis is generally softer than an ovary or a streak gonad and is more apt to be surrounded by blood vessels imparting a reddish cast. A gonad that varies in consistency may be an ovotestis or a testis or a streak gonad that underwent neoplastic transformation. If a well-differentiated fallopian tube is absent on only one side, the side without the tube probably contains a testis or ovotestis. Parents require reassurance that either a male or female gender will be assigned ultimately. Optimum clinical management should comprise of the following (67): Gender assignment must be avoided before expert evaluation of newborns. Evaluation and long-term management must be performed at a center with an experienced multidisciplinary team (pediatric endocrinologist, pediatric urologist, geneticist, clinical psychologist, and gynecologist). Open communication with patients and families is essential, and participation in decision making should be encouraged. Patient and family concerns should be respected and addressed in strict confidence. First-line testing in newborns includes: Karyotyping with X and Y-specific probe detection (even when prenatal karyotype is available) Measurement of serum 17-hydroprogesterone, testosterone, gonadotropins, antimullerian hormone, and electrolytes Abdominopelvic ultrasound (to assess anatomy of the vagina, uterus, or urogenital sinus, exclude renal anomalies, and locate any inguinal gonads) Urinalysis (to check for protein as a screen for any associated renal anomaly) the results of these investigations are generally available within 48 hours and sufficient to develop a working diagnosis. If needed, additional testing may include (102): Human chorionic gonadotropin and adrenocorticotropin-stimulation tests to assess testicular and adrenal steroid biosynthesis Urinary steroid analysis by gas chromatography mass spectroscopy Imaging studies Biopsies of gonadal material Genetic testing Although genital ambiguity is usually identified at birth, it may not be recognized for several years. It was believed that sex-of-rearing may be changed before 2 years of age without psychologically damaging the child, but experience with individuals with 5fi-reductase deficiency suggests that gender changes may be made after 2 years of age in certain instances (103). In any case, surgery for genital ambiguity to make the external genitalia (and development) as compatible with the sex-of-rearing of the child is warranted but was not always successful. Clitoral recession and clitorectomy are the most frequently performed surgical procedures. Excessive androgen exposure results in virilization to varying degrees, including clitoral enlargement, labial fold fusion, and rostral migration of the urethral/vaginal perineal orifice. Prader stage V defines virilization resulting in complete labioscrotal fusion, a penile phallus with the urethra opening on the glans.

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It is thus logically permissible for them to reject belieffiincongruent evidence and to accept with little scrutiny beliefficongruent evidence (Nisbett & Ross, 1980). In contrast, we argue that such biases issue from the motivation to maintain and protect identity (see also Munro & Ditto, 1997). According to our analysis, the need to protect a valued identity or selffi view is a major source of such biased processing and closed mindedness. Because longfiheld beliefs are often tied to important identities, they may be given up only with great reluctance, and they may be embraced even when they confiict with the demands of fact, logic, or material selffiinterest. Yet, people possess other important identities and values that they can draw on when they encounter belieffi threatening information. Providing them with an aYrmation of one of these alternative sources of selffiintegrity should enable them to evaluate the threatening information in a less biased and defensive manner. We tested this logic in a study of biased assimilation in the domain of capital punish ment (Cohen, Aronson, & Steele, 2000). Thus, proponents of capital punishment read an antificapital punishment report and opponents of capital punishment read a proficapital punishment report. Prior to reading the article on capital punishment, all participants com pleted a writing exercise that constituted our selffiaYrmation manipulation. Participants in the selffiaYrmation condition wrote an essay about a person al value that they had rated, during pretest, as personally important (such as their relationships with friends or sense of humor). Specifically, they were asked to describe three to four personal experiences where the value had been important to them and had made them feel good about themselves. By contrast, the responses of participants who aYrmed a valued selffiidentity proved more balanced. That is, selffiaYrmed participants were less critical of the reported research and suspected less bias on the part of the authors of the report. Participants even changed their global attitudes toward capital punishment in the direction of the report they read. That is, proponents of capital punishment supported the death penalty less, and opponents of capital punishment supported it more (Cohen et al. That both partisan groups showed the eVect attests to the power of the psychological mechanism. A third study examined how people evaluate others who either agree or disagree with their beliefs (Cohen et al. Profichoice and profilife parti sans were presented with a debate between two activists on opposite sides of the abortion dispute. Participants who did not receive a selffiaYrmation judged the activist who shared their convictions more favorably than the activist who did not (see also Hastorf & Cantril, 1954). In contrast, participants who were given a selffiaYrmation became more balanced in their evaluation of the two activists and asserted that they were relatively less confident of the validity of their abortion attitudes, relative to their nonaYrmed peers. The motivation to protect identity may prove especially consequential in the context of negotiation.

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