large. In this context, enhancing the ability of people born with abnormalities of the genitalia to engage in "normal" heterosexual intercourse as adults assumed increasing importance as a goal of medical management. Many felt that a child could not become a happy adult if his penis was too small to insert in a vagina, or if her vagina was too small to receive a penis. By 1970, surgeons still considered it easier to "dig a hole" than "build a pole", but had abandoned "barbaric" clitorectomies in favor of "nerve sparing" clitoral recession and promised orgasms when the girls grew up. Pediatric endocrinology, surgery, child psychology, and sexuality textbooks recommended sex reassignment for a male whose penis was irreparably malformed or "too small to stand to urinate or penetrate a vagina," because the surgeons claimed to be able to construct vaginas where none existed. The majority of these genetic males who were reassigned and surgically converted had cloacal exstrophy-type malformations or extreme micropenis (typically less than 1.5 cm). In 1972 John Money published his influential text on the development of gender identity, and reported successful reassignment at age 22 months of a boy (David Reimer) who had lost his penis to a surgical accident. This experiment proved not to be as successful as Money claimed. David Reimer grew up as a girl, but never identified as one. Academic sexologist Milton Diamond later reported that Reimer failed to identify as female since the age of 9 to 11, making the transition to living as a male at age 15. Reimer later went public with his story to discourage similar medical practices. He later died by suicide, owing to suffering years of severe depression, financial instability, and a troubled marriage. Complications arise Throughout the 1980s pediatric surgery textbooks recommended female assignment and feminizing reconstructive surgery for XY infants with a severely inadequate phallus. Nevertheless, in the 1980s several factors began to induce a decline in the frequency of certain types of genital surgery. Pediatric endocrinologists had realized that some boys with micropenis had deficiency of growth hormone which could be improved with hormones rather than surgery, and over the next decade a couple of reports suggested adult outcome as males was not as bad as expected for the boys with micropenis who had not had surgery. Although textbooks were slower to reflect the change, few reassignment surgeries for isolated micropenis were carried out