Van Howe and Cold are exactly correct when they say "the most important lesson to be learned from this tragedy [was that] consent was never given by the patient." We agree totally.
For our conclusions, however, we were limiting our advice for cases similar to the one presented. In cases of a penis loss, we advised that the child continue to be raised as a boy and refer the parents and child for appropriate and long-term counseling. Be honest as to what had occurred. This conservative management requires no statement of consent. We should have been clearer in our intimation that the long-term counselings extend until the child can cogently offer his input to surgery or sex reassignment. This should be at least until puberty has been reached and the patient has experienced conviction or doubt as to his sexual identity and has arrived at a sexual orientation (androphilic, gynecophilic,