Prenatal predisposition and the clinical management of some pediatric conditions

Theoretical understanding of psychosexual development, particularly in regard to sexual identity, has undergone several historical changes. Most notable has been the transition away from a learning paradigm, which held that individuals are psychosexually neutral at birth and that they develop their sexual identity due to rearing. This has shifted to contemporary acceptance that an interaction of both nature and nurture is responsible for psychosexual development. That there probably exists an inherent predisposition or bias toward a male or female identity, which is inferred by prenatal influences, is also current theory. However, while this shift has occurred in the theoretical understanding of the phenomenon, a comparable shift has not occurred in the clinical management of individuals where sex assignment or reassignment is a real issue. The theoretical change and real case management should be concordant.