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The most complex clinical manifestation of DSD is genital ambiguity.It occurs primarily in the neonatal period and requires unhesitating recognition to enable planning an adequate approach.Although the UNDP’s gender indices go some way to reflecting broader aspects of gendered poverty, particularly in respect of capabilities and opportunities, there is scope for improvement.
In this period, knowledge has increased, such as the first description of 5α-reductase deficiency by Imperato-Mc Guinley et al.
(9), and the discovery of the SRY gene by Sinclair et al. Those publications have transformed DSD management in recent years.
Developmental psychology theories back this hypothesis. They state that anatomic differences between sexes initiate the very important process of identification with the parent of the same sex.
Sex-related endocrinological issues also demand early care.
There is evidence that the definition of the sex of creation and acceptance of sexuality differs significantly among various societies.
Therefore, when discussing sex-related issues with the family, one should not overlook social, cultural, ethnic, and religious aspects of the family or the society (3).
The third is to propose directions for the kinds of data and indicators which might be incorporated within the GDI or GEM, or used in the creation of a Gendered Poverty Index (GPI).
Appropriate management of disorders of sex development (DSD) has been a matter of discussion since the first guidelines were published in the 1950s.
Another important issue is that most data concerning long-time outcomes, such as gender dysphoria in DSD (11), evaluated individuals based on old recommendations and surgical techniques, which does not necessarily reflect current contexts. In Brazil, most parents demand prompt sex assignment and surgical treatment.
Although our approach does not follow the current European trends, it shows very good results. showed a very low sex reassignment rate in a single-center study of Brazilian patients (12).