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Johns Hopkins Researcher Challenges Conventional Wisdom on Gender Reassignment Surgery

Johns Hopkins Medicine
Office of Communications and Public Affairs
Media Contact: Staci Vernick Goldberg
[email protected]
January 21, 2004


Cloacal exstrophy is a severe birth defect that occurs in approximately 1 in 400,000 live births. One of the most pronounced characteristics is severe phallic inadequacy, or the complete absence of a penis in genetic males.  Historically, doctors have treated cloacal exstrophy by surgically altering, or "reassigning" these babies as female.

John Gearhart, M.D., director of pediatric urology at Johns Hopkins Children's Center and an expert on exstrophy complexes, and colleagues challenge this standard treatment in this week's New England Journal of Medicine.  The authors studied 16 genetic males from 5 to 16 years of age, 14 of whom underwent surgical conversion to female sex. They found that more than half of them identified themselves as male; six individuals were so unhappy with their female sex of rearing as to pursue gender reassignment back to male. All 16 had interests and attitudes that were considered typical of males.

"We are challenging the conventional wisdom and urging doctors who see patients with cloacal exstrophy not to routinely perform conversion surgery," Gearhart says. "Rather, we suggest they strongly consider counseling families to raise the children as males, and recommend penile reconstruction at a later age."

To interview John Gearhart, please call Staci Vernick Goldberg at 410-516-4958 or Jessica Collins at 410-516-4570.