Variations in genital development, gender identities and consent to care

Genital development Variations (GDV) refers to situations where the chromosomal, gonadal or anatomical sex is atypical. It is difficult to estimate the incidence of GVD on the basis of solid data. For these situations, ethical and societal questions remain present in terms of early surgical intervention. In this text, after a brief overview of gender identity development and the evolution of practices in the management of GDV, we will discuss three main issues. The first medical issue is the need to distinguish between interventions of immediate medical necessity and those that are not medically urgent. The second concerns the developmental dissociation between the temporality of the child, that of his physicians and his parents in terms of decision-making and maturity. The third is the legal constraint in France of having to decide quickly on a gender mention in the civil status. In order to provide appropriate support for GDV, it is necessary to provide access to competent centers capable of organizing multidisciplinary concertation meetings as well as individualized local support. We believe that the objectives of psychological care are to adjust to the individual situation of the child and his socio-familial environment and to provide clear information, without glossing over the complexity. It warrants making understanding accessible to children according to their age and maturity, as well as to parents, and exposing the different points of views.