The series also includes a close-up of the subject's genitalia, with the legs open.
In The Journal of Sexual Medicine, Dirk Schultheiss, Thomas R. Herrmann, and Udo Jonas suggest that the photographs are "probably the first medical photo-illustrations of a patient with intersex genitalia" and describe them as a "milestone in the history of sexual medicine".
In older individuals the accepted gender may be reinforced by the appropriate surgical procedures and by hormonal therapy.
In these groups, hermaphroditism is a normal condition, enabling a form of sexual reproduction in which either partner can act as the "female" or "male".
Later in life, for example, the person may not be satisfied with the results of surgery and may not identify with the assigned .