Psychologic Approach to Psychosexual Misidentity with Elective Mutism

Two cases of hyperadrenocortical fe male hermaphroditism illustrate that psy chosexual identity may differentiate inde pendently of genetic, gonadal, hormonal and morphologic sex, and also of assigned sex. One child, assigned as a boy, elected by age 12 to be reassigned as a girl. The other child, assigned as a girl, elected by age 11 to be reassigned as a boy. It was possible to overcome the psychologic handicap of their elective mutism, espe cially by the use, initially, of drawing, writing and modeling. These cases illustrate the general rule that proper weighting must be given to psychosexual differentiation and the sense of gender identity before a decision for or against sex reassignment can be valid. A sex reassignment can be success fully undertaken if it resolves incongruity between gender identity and assigned sex, or if the gender identity is ambivalently noncommittal. Otherwise sex reassign ment is contraindicated.