Problems Of Sex Determination

Sex and sexual function are, therefore, the outcome of a finely balanced hormonal control system. Imbalances in the levels of hormones, often caused by chromosomal anomalies, can result in a number of bizarre syndromes. Turner’s syndrome (XO), where there is an absent X-chromosome, results in a sexually immature female; whereas the presence of an extra X-chromosome in males (XXY or Klinefelter’s syndrome) results in a sexually immature male. Both types of aberrant genetic constitution will render it virtually impossible for either sex to have children. True hermaphrodites (organisms with both sets of male and female sex organs) in the human species are exceptionally rare, but an imbalance of hormones during development in the uterus, and subsequent hormonal errors being repeated at puberty, can result in so-called pseudo-hermaphroditism*, when the genetic gender and the biological gender do not match. Such cases are luckily very rare, but the results can be tragic.

In the condition known as male intersex, the child is born with a normal complement of an X-chromosome and a Y-chromosome, but the genitalia are described as ‘ambiguous’.

The penis resembles an enlarged clitoris, and the scrotum is split. There are no internal female sex organs, however. At puberty the body takes on a female form and, sadly, does not respond to injections of male hormones which are sometimes given in the hope that they will stimulate the body to become more masculine.

The condition known as female intersex is mostly the result of an excess of androgens in the foetus. One of the causes is a malfunctioning adrenal cortex. The genetic sex is female, but at birth male-type genitalia are present. Treatment of the adrenal disorder often helps to change the male characteristics into female. There are other errors in the configuration of sex hormones that occur in meiosis (sex cell formation). These are known as translocations and deletions, and come about when the chromosome complement is being reduced from the full number found in all body cells to the half-complement found in sex cells. Many of these deletions, which result in the loss of a piece of chromosome and consequently the loss of important genetic information, are lethal; this kind of genetic defect accounts for a high proportion of spontaneous abortions, or miscarriages.

In normal females, although there are two X-chromosomes present, it appears that at a certain stage in a body cell’s development only one remains activated. The other takes on a reduced form. This shrunken and presumably non-functional X-chromosome is known as sex chromatin, or Barr body, and it can be identified by a particular type of biological staining technique. It thus provides a useful marker for cytologists (those who study cells) as to the sex of a newborn child when there are doubts. This same test is also used, when necessary, for testing the sex of athletes in, for example, international competitions. A light scraping of cells is taken from the roof of the mouth and stained. The presence of Barr bodies can be seen under the microscope and this provides positive proof of the female sex. Their absence indicates that the sex is male.

Delayed puberty

Probably the commonest cause of concern is not the rarer conditions mentioned above, but delayed puberty in boys and girls. Puberty in the vast majority of cases starts in the early part of the second decade of life. The adolescent growth spurt is a particularly characteristic sign that puberty has commenced, even though breast development (in girls) and pubic hair growth may be sparse or slow.

If a child has reached his or her early teens and is of small stature and with no outward signs of pubescent development, then medical advice should be sought. Most of the time there is a family history of delayed puberty and – when nothing serious has been found – it is perhaps best to refrain from hormonal treatment. More rarely, there may be other causes such as a derangement of the pituitary gland or hypothalamus, leading to damage to the whole of the endocrinological system that controls the process of development. It could also be that the child is suffering from either Turner’s or Klinefelter’s syndrome because these would prevent adolescent development.

Children who experience delayed puberty are often shunned by their peers at school, and this can further aggravate the problem.

Psychological changes

It is at the time of puberty that a child has a growing awareness of his or her sexuality. It is important that children are informed, in terms they can understand, of the changes that are occurring within their bodies and of the significance of these changes. If they are kept ignorant of the facts, the start of menstruation can be an alarming experience for girls, and the first nocturnal emission (‘wet dream’) can be equally disturbing for boys.

Both sexes are likely to notice the disparity in sexual The term ‘sexuality’ refers to the many and varied psychological aspects of the sex act and of interest in sex. This includes attitudes and feelings about intercourse itself, about one’s identity as a man or woman, and about the choice of sexual partner and/or ‘sex object’. In this context, ‘sex object’ does not only mean a socially accepted, sexually desirable individual in the mould of Bardot or Valentino. It also means any person – or any object (in fetishism*, for example) – to which sexual drive has become directed. It is helpful to discuss first the development of ‘normal’ sexuality, going on to give examples of ways that diverge from such an accepted pattern.

‘Normal’ sexuality

In looking at the ‘norm’ we must examine the standard, statistically-based psycho-social context in which sex takes place between humans. Most adult sexuality takes place between a man and a woman who have already entered into a ‘loving’ relationship and are considering, or have already become, a recognised ‘pair’ in the eyes of their peers. This usually means they are, or plan to become, married according to the ceremonies of their own culture. It is important to stress that most variations on this theme, such as homosexual partnerships or sex groups, should incur no value judgments. They should be treated just like any other relationship because, viewed objectively, such variations are simply different, and less common. There is much speculation about the psychological basis of sexual behaviour and, as a result, there are fewer facts than theories. This is because of the complexity of the subject and of its still slightly taboo nature. Some theories, such as Sigmund Freud’s (1856-1939) exposition on psychosexual development, place sexuality in a central position in all social interactions. Western thinking on sexuality has been widely influenced by this view. Other theories see sexuality as only one aspect of human interaction. This constitutes a more balanced viewpoint, because there is a need to collect together in groups for a far greater number of purposes, than those connected with sex.

Freud’s views on psychosexual development

According to Freud, normal adult sexuality does not suddenly appear at puberty – although the sex drive, or libido, does change gear during adolescence and tends to go into overdrive for a while. Although the very young child does not show full-blown sexuality he or she shows evidence of sensuality. Freud called pre-pubertal children polymorphously perverse’,

meaning that they derive sexual sensations from different sources such as the mouth, anus or genitals. Young children show an uninhibited interest in their own bodies, which are after all very different in structure and shape from their grown-up parents. They gain pleasure from many different stimuli, without associating any pleasure with what adults term ‘sex’. With this in mind, we turn to Freud’s theories of ‘infantile sexuality’. When Freud first put forward his theories of the development of sexuality in children, there was outrage. This was partly due to confusion over his meaning of the word sexuality.

The baby begins life with his or her experiences centered around the mouth. At first the breast is the most important object, because it is the source of nutrition. During infancy objects are manipulated and invariably put straight into the mouth because this is the most sensual, or sensitive, part of the body. In Freud’s scheme this first stage is the oral stage of sexuality. Before the child can pass to the next stage he or she must resolve the developmental conflicts of the oral stage – basically, by learning to trust the parents. The focus then shifts to the anus. This takes place around the time of toilet training, when the developmental issue is the child’s autonomy and the ability to control things in the immediate surroundings, such as bowel movements. At this second or anal stage, the child experiments with and takes pleasure in retaining or expelling faeces.

Towards the end of the anal stage the child becomes interested in the parents’ bodies and genitals, and classically becomes attached to the parent of the opposite sex. This is a crucial time for the development of adult sexuality. The attachment is called the Oedipus complex*, and Freud gave it a central position in his theories. The attachment has a rebound effect because it brings the child into conflict (in fantasy or reality) with the parent of the same sex – the father in the case of a boy. This causes fear, which Freud rather picturesquely called ‘castration anxiety’. Eventually the child relinquishes his or her attachments, the conflict is neutralized, and he or she can develop into a mature adult. If the attachments are not relinquished or resolved but are instead buried, or ‘repressed’ to use the technical term, they may return sometime during adult life to cause neurosis and psychosexual problems.

Freud also proposed that special problems at any stage could arrest (or fixate) development, which would have a lasting effect on an individual’s development of sexuality. The libido would remain attached to the activities appropriate for that age. For example, an individual who was weaned very early and did not have enough sucking pleasure, might become fixated in the oral stage. As an adult, this person might become overly fond of oral pleasures such as drinking, smoking and eating, express sexuality verbally, or indulge in oral sex to the exclusion of genital sex. On the other hand someone who fixated in the anal stage might, according to Freud, become obsessional in later life – punctilious, tidy, clean and mean with money. Such people are emotionally closed and cannot open up enough to make a mature sexual relationship. This simplified view of Freud’s theories of sexuality cannot really do justice to their intricacies or their importance in modern schema. Although most people today (especially doctors and psychiatrists) would prefer not to take them too seriously they have, for better or worse, become a part of most Western cultures.