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(詳細はpediatric surgery, pediatric urology, and pediatric endocrinology, with our increasingly refined understanding of sexual differentiation, with the development of political advocacy groups united by a human qualified analysis, and in the last decade by doubts as to efficacy, and controversy over when and even whether some procedures should be performed. Ambiguous genitalia has been considered a birth defect throughout recorded history. Single cases were described by doctors sporadically over the centuries. Some of our modern ideas of birth defects can be traced to French anatomist Isidore Geoffroy Saint-Hilaire (1805–1861), who pioneered the field of teratology. Since the 1920s surgeons have attempted to correct an increasing variety of birth defects. Success has often been partial and surgery is often associated with minor or major, transient or permanent complications. Techniques in all fields of surgery are frequently revised in a quest for higher success rates and lower complication rates. Some surgeons, well aware of the immediate limitations and risks of surgery, feel that significant rates of imperfect outcomes are no scandal (especially for the more severe and disabling birth defects). Instead they see these negative outcomes as a challenge to be overcome by improving the techniques. Genital reconstruction evolved within this tradition, but in the last decade, nearly every aspect of this perspective has been called into question. == Surgical pioneering and constructed gender == Genital reconstructive surgery was pioneered between 1930 and 1960 by urologist Hugh Hampton Young and other surgeons at Johns Hopkins Hospital in Baltimore and other major university centers. Understanding of intersex conditions was relatively primitive, based on identifying the type of gonad(s) by palpation or by surgery. Since ability to determine even the type of gonads in infancy was limited, sex of assignment and rearing were determined mainly by the appearance of the external genitalia. Most of Young's intersex patients were adults seeking his help with physical problems of genital function. Demand for surgery increased dramatically with better understanding of the condition congenital adrenal hyperplasia (CAH) and availability of a new treatment (cortisone) by Lawson Wilkins, Frederick Bartter and others around 1950. For the first time, severely virilized infants with this disorder were surviving and could be operated upon. Hormone assays and karyotyping to ascertain sex chromosomes, and the availability of testosterone for treatment led to partial understanding of androgen insensitivity syndrome. Within a decade, most intersex cases could be accurately diagnosed and their future development predicted with some degree of confidence. As the number of children with intersex conditions referred to Lawson Wilkins' new pediatric endocrinology clinic at Hopkins increased, it was recognized that doctors "couldn't tell by looking" at the external genitalia, and many errors of diagnosis based on outward appearance had led to anomalous sex assignments. Although it seems obvious now that a doctor could not announce to an eight-year-old boy and his parents that "we have just discovered that you are 'really' a girl, with female chromosomes, and ovaries and uterus inside, and we recommend that you change your sex to match your chromosomes and internal organs," a few such events occurred around the world as doctors and parents tried to make use of new information. Genital reconstructive surgery at that time was primarily performed on older children and adults. In the early 1950s, it consisted primarily of the ability to remove an unwanted or nonfunctional gonad, to bring a testis into a scrotum, to repair a milder chordee or hypospadias, to widen a vaginal opening, and to remove a clitoris. John Money, a pediatric clinical psychologist in the new "Psychohormonal Research Unit" at Hopkins and his partners, John and Joan Hampson, analyzed these assignments and reassignments in an attempt to learn the timing and sources of gender identity. In most of these patients, gender identity seemed to follow the sex of assignment and sex of rearing more closely than it did genes or hormones. This apparent primacy of social learning over biology became part of the intellectual underpinning of the feminist movement of the 1960s. In its application to children with intersex conditions, this thesis that sex was a many-faceted social construction changed the management of ambiguous genitalia from ''determination of the baby's real sex'' (by checking gonads or chromosomes) to ''determination of what sex should be assigned''. The most common intersex surgery offered in childhood was amputation of the clitoris and widening of the vaginal opening to make a virilized girl with CAH appear less like a boy. However, by the late 1950s surgical techniques for transforming an adult man into a woman were being developed in response to requests for such surgery from transsexuals. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「History of intersex surgery」の詳細全文を読む スポンサード リンク
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