A Case of Ambiguous Genitalia and Unaccustomed Sexual Behavior Depictedfrom the Margin Notes of a Byzantine Monk

A case of androgynism from Byzantine literature is presented. External genital ambiguity along with intense sexual behavior, both in the active and in the passive way is commented in the context of sexual ethics of Medieval Byzantine culture, compared to the ancient Greco-Roman approach. Male pseudohermaphroditism is excluded from the differential diagnosis, given that all male pseudohermaphroditisms are cases of insufficient masculinization due to insufficient androgen production and/or action. True hermaphroditism is also excluded from the differential diagnosis, due to gradual regression of testicular tissue. Consequently, female pseudohermaphroditism due to congenital adrenal hyperplasia is the most probable diagnosis. Differential diagnosis among the forms of congenital adrenal hyperplasia is further elucidated based on the features of sexual behavior. Insights in the variability of female sexual response emerge.