Disorders of sexual differentiation (DSD) encompass a variety of malformations related to sexual function. These disorders may affect the genitalia primarily, but often impact the patient in a more systemic manner. Complex factors of embryonic formation, genetics, hormonal function and even brain anatomy are involved in the development of sexual identity and orientation for individuals affected by DSD. Traditionally, surgical reconstruction has been performed in early childhood for these patients. This approach was based on three basic assumptions: 1) children under the age of two years old would not have a conscious memory of genital surgery and would be less traumatized. 2) Early reconstruction would aid in the child’s formation of sexual identity as well as the parents’ ability to rear the child in a ‘normal’ gender role. 3) Both surgeons and parents were anticipating a hetero-normative sexual identity as a treatment goal for these patients. Published reports of successful surgical reconstruction in patients with these disorders increased dramatically in the 1960s with the advent of better surgical and anesthetic techniques for children. At this same time, psychologists postulated that environment was the most crucial factor in sexual identity development and counseled parents to raise children with DSD in strict gender roles without reference to reconstructive surgery. This approach led many DSD patients to feel distrustful of medical care when they became adults and questioned issues of sexual identity for themselves. From this backlash of distrust over misinformation, several DSD advocacy groups have called for a moratorium on genital reconstructive surgery until the patient is of the age of consent. They contend that sexuality does not need to be hetero-normative and successful childrearing no longer has clear-cut gender roles. These groups would also place DSD in the spectrum of gender identity and orientation issues along with gender dysphoria, transvestitism and homosexuality. The purpose of this paper is to define the aspects of DSD that make it distinct from other issues of gender identity/orientation and to discuss a new paradigm in treatment that accounts for a postmodern analysis of sexual identity.