Le contrôle de genre lors de compétitions de très haut niveau est un sujet qui reste mal connu. Nous situons cette question de médecine du sport à partir de deux éléments principaux : son objectif et son éthique. Son objectif est bien de vérifier qu'il n'y a pas d'homme inscrit dans la catégorie Dames. Son éthique : après avoir rappelé que l'inscription des athlètes dans la catégorie de leur choix est libre, le rôle de protection des individus que joue ce contrôle est une réalité forte depuis qu'une évolution méthodologique majeure lui a redonné un maximum de crédibilité. Les alternatives sont discutées. En screening, le passage en 1992 du test de Barr à la mise en évidence du gène SRY par la méthode PCR est explicité. Cela correspond à un gain de fiabilité exceptionnel. Un arbre décisionnel est proposé qui aidera les médecins du sport, en charge de ce contrôle, à le gérer avec tout le soin et toute la compétence requise. Les niveaux de responsabilité sont bien précisés. L'avancée technologique moderne de l'outil de screening donne à ce contrôle les caractéristiques essentielles, souhaitées entre autres pour le contrôle antidopage : une crédibilité excellente, une dissuasion quasi totale, une éthique forte.
In 1967, it was shown that a control on gender was vital to end a series of incidents which were proven cases of shameful exploitation of persons with non-well defined sexual identity. At that time controls were already based on genotype, on the analysis of the chromosomes according to the Barr method. This relatively simple test matches the requirements fixed by the organizers of international competitions (IOC, IAAF, SIF): results obtained within 24 hours moderate cost very high decency for young female athletes whatever their cultural background. However, the Barr test, credited with 20% of uncertainty, has resulted in very strong pressure to stop the control. Various alternatives are proposed and their advantages and disadvantages discussed. There is only one process which meets all the desired conditions: reliability, ethics, productivity, cost and decency. Since 1967, the study of genotype has been made from the oral cells. So since 1992, always from the oral cells, the control relies on identifying the SRY gene by using PCR method. This gives almost 100% accuracy for a healthy population. The method described here was used for the first time at the Albertville Olympic games. It was put into practice at Barcelona, Lillehammer, Paris and Atlanta and will be used for the games at Nagano. The question whether to maintain this test is discussed though positive aspects overwhelm the unique problem of accidentaly discovering a male pseudohermaphrodism, particularly unusual with athletes in the age range of international competitions. This discovery of an abnormal biological system can be judged unfair. However as it can lead to an early removal of the pseudo-gonadique tissue which is often cancerous, this discovery will be greatly beneficial to the individual. The control occurs after the free registration of the athletes in the category of their choice. The control has become much more a tool against fraud: it is now a vital element in the protection of an individual's privacy by stopping the media spreading doubts about the sex of some athletes. This will be enough to justify and maintain the control of gender. This test is done only once during the career of an athlete. It has fulfilled the aims of the anti-doping control: total dissuasion of fraud. The authors would like to remind that whatever the reliability of the test, none of the athletes should be excluded from competition following only a biological test result. Suggestions to test all athletes at the beginning of their international career are made.
