In a newborn who presents a problem of correct sex assignment, it is better to delay than to reverse the sex assignment at a later date. Generally, the decision can be made within a several days, at most a several weeks. In dealing with the parents, terms with unfortunate connotations, such as hermaphrodite, should be avoided. An easy way to explain ambiguous genital development to parents is to indicate that the genitals are unfinished, rather than abnormal from a sexual point of view. Chromosome discrepancies are probably best left unmentioned.
When all the information is in place, gender assignment will rest on:

1. Future fertility,
2. The projected appearance of genitalia after puberty,
3. Penile adequacy for coital function.

The future fertility in all masculinized females is unaffected. With proper treatment, reproduction is possible, since the internal genitalia and gonads are those of a normal female. Therefore, all masculinized females should be reared as females.physician must be convinced that a functional penis is possible.

All decisions regarding sex of rearing and the overall treatment program should be made early in life. If a case has been neglected, sex reassignments must be made according to the gender identity in which a child has developed. Reassignment of sex can probably be made safely up to age 18 months.

Socialization and hormone therapy are important for gender identity and sexual function. Future gender role and identity can be in accord with assigned sex if 4 conditions are met:

1. The parents are comfortable in their ability to raise their child and their resolution of any doubts or uncertainty about the sex of the child. In this acceptance and adaptation, the parents must have participated in and agreed to the sex reassignment decision. Ambiguous names should be discouraged to assure normal gender identity.
2. Genital reconstruction should take place as early as possible, certainly well before 18 months. Thereafter, sex reassignment is difficult and adjustment impaired.
3. Properly timed hormonal and/or additional surgical interventions must be provided at puberty.
4. The patient should be informed about his or her condition as deemed age-appropriate.

The only other category of patients with ambiguous genitalia with reproductive capability consists of males with 1) isolated hypospadias, 2) the male with repaired isolated cryptorchidism, and 3) the male with the uterine hernia syndrome.

All other patients with ambiguous genitalia will be sterile. Except for salt-wasting adrenal hyperplasia, the physician's prime concern is not with physical survival, but to enable the patient to grow into a psychologically normal, healthy, and well-adjusted adult. The sex of assignment depends upon only one judgment: can the phallus ultimately develop into a penis adequate for intercourse. The success of a penis is dependent upon erectile tissue, and the genitalia should not only be serviceable but also erotically sensitive. Technically, the construction of female genitalia is easier, and therefore.