Ambiguous genitalia in rural Africa and the complexities of management: Which way forward?

Intersex disorders are amongst the most controversial conditions managed by doctors today. Although the diversity of their presentations demands broad classifications to help standardize management guidelines, each patient remains unique, requiring individualized care. The authors review the prevailing schools of thought on gender determination, assignment and re-assignment of intersex patients. The "liberal" views on sexuality, as espoused in current Western literature, vis-a-vis the "traditional" views of the average rural African community on sexuality are noted. The case histories of four patients highlight the diversity of presentations as well as the challenges in their management in a rural Kenyan hospital.