This case report highlights the dilemma faced by staff with regard to the timing of surgery on a child with a disorder of sex development living in a large, lower socio-economic class, South African, urban township. In this community, children with disorders of sex development can sometimes become an object of interest and ridicule or are thought to be bewitched. Many parents of children with such disorders find it difficult to protect their offspring from the marginalization and rejection that is the consequence of such curiosity and transparency. Current research and theory pertaining to the biological and social bases of gender identity and behaviour are reviewed and their capacity to guide decisions is explored. The absence of a support group to assist these children and their parents, and the paucity of information available in the public domain, compounds an already challenging problem.
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