For questions about the sex marker in U.S. passports, please visit https://travel.state.gov/content/travel/en/passports/passport-help/sex-marker.html .

If you still have questions, please contact the U.S. Embassy or Consulate in Italy:

https://docs.google.com/forms/d/e/1FAIpQLSd-LdNVWSQ58Vcq5fTSH6nMDVsJ8sw7ih5mqevDrzLxuPMqgw/viewform