1. Disorders of Sexual Differentiation Pediatric GU Review UCSD Pediatric Urology George Chiang MD Sara Marietti MD Outlined from The Kelalis-King-Belman Textbook of Clinical Pediatric Urology 2007 (not for reproduction, distribution, or sale without consent)

4. Chromosomal sex Gonadal sex Phenotypic sex Sexual Differentiation

6. “ Development” TDF SRY Testis Testosterone Müllerian Inhibiting Substance Penis Vas Deferns Prostate Uterus Fallopian Tubes Upper Vagina

16. Tanner Stages

19. HWA Protests Intersex Genital Mutilation [Washington, DC: 21 Apr 98] A dozen members of Hermaphrodites With Attitude and Transexual Menace picketed outside the George Washington University Hospital, protesting GWU's cutting of intersexed infants' genitals to make them resemble 'normal' male and female genitals . Hermactivists call this medical intervention Intersex Genital Mutilation (IGM). " Not only are American doctors cutting into 7 intersexed infants every working day, but people like GWU's Dr. Barry Belman are telling parents they have to do it for the good of the infant ," said Cheryl Chase, founder of HWA. "Mutilating my genitals wasn't for my good; it was to make the doctors and my parents more comfortable with my body." After the demo, several protestors visited GWU Hospital departments that take part in IGM--OB/GYN, Endocrinology, Pediatrics and Plastic Surgery--to discuss their concerns with caregivers and, as one hermactivist put it, to speak for the infants who cannot speak for themselves. From In Your Face on-line news, April 1998

20. First and foremost, we recommend avoidance of harmful or unnecessary genital surgery on infants and children. No surgery should be performed unless it is absolutely necessary for the physical health and comfort of the intersexual child . We believe any surgery that does not meet these criteria to be essentially elective cosmetic surgery which should be deferred until the intersexual child is able to understand the risks and benefits of the proposed surgery and is able to provide appropriately informed consent.

23. Wide range of phenotypes

35. 21-Hydroxylase deficiency Testosterone

36. FEMALE CAH

37. Female CAH

38. Female CAH

50. Case #1

53. Workup?

55. Voiding Cystourethrogram

61. Case 3

62. QUESTIONS