In micropenis, the penile corpora are underdeveloped. They may be so small that the penis looks like a clitoris. Unlike a clitoris, however, the micropenis has a median raphe, a covered urethra, a foreskin, and a glans in which the urethral meatus is normally placed. It may or may not be erectile, dependent upon the amount of corpora cavernosa and corpus spongiosum present. The scrotum is present and fused. The testes may be descended or either unilaterally or bilaterally cryptorchid. The etiology of micropenis is unknown.
In the two cases of micropenis compared here, the sex of assignment, rearing, and rehabilitation (surgical and hormonal, as required) was male and female respectively. In the male case, the boy differentiated a masculine gender identity/role, but not without difficulty. As a child, he did not join in rough-and-tumble play. He played more with girls than he did with boys. At the age of ten, he revealed to an interviewer that he had often thought about changing his sex. He already had made up his mind, however, that he would not bother with a change of sex unless he could be guaranteed to have children by his own pregnancies. Despite application in childhood of testosterone cream to his penis and, in adolescence, injections of androgen (given primarily to induce a masculinizing puberty since his testes were vestigial and defective) the micropenis remained excessively minute. Consequently, its use in both heterosexual and homosexual relationships was grossly impaired. Maintenance of intromission was, in fact, impossible.
At the present time, despite surgical and/or hormonal treatments for micropenis, there is no evidence that such treatments produce a fully functioning penis of adult size.
The other micropenis infant was surgically rehabilitated as a girl during the fourth month after birth. This consisted of bilateral gonadectomy and feminization of the external genitalia. At age twelve, feminizing puberty was exogenously induced by means of oral estrogen. Vaginoplasty was performed at age seventeen.
In childhood, this girl played with boys and girls. Although she did prefer outdoor activities, it was not to an intense or one-sided degree. With adolescence, she began to be interested in boys and had experiences with necking and petting at age thirteen, even though girls in her family were not officially permitted to date. At age eighteen and a half, she had intercourse for the first time with her steady boyfriend.
Three years later they married. Her gender identity/role is unquestionably female.
The fact that the testes of the infant assigned and reared male were defective and did not produce pubertal androgen, and that the testes of the infant assigned and reared female were removed before the age of six months, might eventually prove important in relationship to the differentiation of their erotic gender identity/role. In normal XY infants there is an increase in plasma testosterone from birth until the second or third month of life, followed by a gradual decrease. By the seventh month, the level of plasma testosterone diminishes and stays at the low, pre-pubertal level of boyhood. Perhaps the high postnatal level of plasma testosterone is needed to complete the job, initiated prenatally, of setting in the brain thresholds for the release of certain types of sexually dimorphic behavior later in life. This hypothesis is currently only speculative. In any event, the lesson of the matched pair of micropenis individuals teaches the same lesson taught by individuals matched for various diagnoses of hermaphroditism. It is that, in the differentiation of an individual’s gender identity/role, the determinants are prenatal as well as postnatal. It is possible for postnatal determinants to override prenatal ones, just as it is possible for prenatal determinants to intrude on postnatal ones. The various possible permutations and combinations still need to be clarified.
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