The Dilemma of Sex of Rearing: A Case of a 45,X/46,XY Neonate with Hydrocolpos

J Pediatr Adolesc Gynecol. 2019 Feb;32(1):70-73. doi: 10.1016/j.jpag.2018.09.001. Epub 2018 Sep 8.


Background: A rare disorder of sex development is 45,X/46,XY mosaicism, which is phenotypically very heterogenous, ranging from normal male (or female) to that of genital ambiguity of varying degrees.

Case: We report a case of a neonate with 45,X/46,XY mosaicism and hydrocolpos, and we point out the dilemma and the difficulty in gender assignment.

Summary and conclusion: Gender assignment of cases with frank genital ambiguity is often difficult to be determined, because several factors have to be taken into consideration, such as genital appearance, anticipated urological and sexual function, capacity for future fertility, gonadal malignancy risk, and psychosocial factors. A multidisciplinary approach is definitely needed in the management of such cases.

Keywords: 45,X/46,XY mosaicism; Ambiguous genitalia; Hydrocolpos.

Publication types

  • Case Reports

MeSH terms

  • Female
  • Gender Identity
  • Genitalia
  • Gonadal Dysgenesis, Mixed / complications
  • Gonadal Dysgenesis, Mixed / diagnosis*
  • Gonadal Dysgenesis, Mixed / therapy
  • Gonads
  • Humans
  • Hydrocolpos / etiology*
  • Infant, Newborn
  • Male
  • Mosaicism
  • Sexual Development
  • Ultrasonography / methods