Hermaphroditism or Third gender : neither man nor woman || Dr. Nasren Nipa

Hermaphroditism or Third gender : neither man nor woman

Hermaphroditism :

Hermaphroditism or intersex, is a condition in which there is 

a discrepancy between the internal sexual and external genital organs.

Hermaphrodite :

A hermaphrodite is a person that has both male and female 

sexual organs.This is an unusual word for an unusual condition: 

being a boy and a girl at the same time. This happens to a small 

number of people who have the reproductive organs of both men and women.

Causes of Hermaphroditism :

Hermaphroditism are caused by a variety of genetic conditions or 

the SRY gene, the gene responsible for testosterone and male genitals, being transferred to the X chromosome during meiosis, resulting in both male and female genitals.

Pseudohermaphroditism :

Pseudohermaphroditism, a condition in which the individual has a single chromosomal and gonadal sex but combines features of both sexes in the external genitalia, causing doubt as to the true sex. 

Pseudohermaphrodite:

A pseudohermaphrodite is a person whose gonads are consistent with the chromosomal sex but who has external genitalia of the opposite sex. 

Female Pseudohermaphroditism :

1.Female pseudohermaphrodites are genetic females (45,XX) who develop male configurations and identities. 

2.Female Pseudohermaphroditism is usually caused by the excessive exposure of the female fetus to male hormones in the womb. 

3.These individuals have ovaries, but their genital ducts and external genitalia are male.

4.There is fusion of the labia, and the clitoris becomes enlarged to resemble a penis. 

5.Internally, the female sexual organs such as the uterus and fallopian tubes have a normal structure. 

6.Secondary sex characteristics may never appear in some, whereas others may achieve a fully musculanized appearance.

Causes of Female pseudohermaphroditism :

1.Congenital adrenal hyperplasia (CAH), mostly 21-hydroxylase deficiency, is the most common cause. 

2.Maternal androgen excess due to maternal ovarian tumor or drug intake also causes female pseudohermaphroditism.

Male Pseudohermaphroditism :

1.Male pseudohermaphrodites are genetic males (45,XY) who develop female configurations and identities. 

2.These individuals have testes, but their genital ducts and external genitalia are female. 

3.Secondary sex characteristics may never appear in some, whereas others may achieve a fully feminized appearance.

4.This type usually occurs because of an imbalance of female and male hormones.

5.It may be caused by abnormal function of the testes, reduced ability to produce testosterone, or difficulty in utilizing the

testosterone produced in the body.

Causes of Male Pseudohermaphroditism :

Causes of male pseudohermaphroditism include 

1.cytogenetic abnormalities, 

2.teratogenic causes, 

3.defects in testosterone biosynthesis, and 

4.defects in androgen action.

How to differentiate True Hermaphroditism and PseudoHermaphroditism :

True Hermaphrodites have external genitalia and gonads of both genders, whereas 

pseudohermaphrodites have external phenotypes opposite the genotype but internal genitalia consistent with the genotype.

Presentation of A Hermaphrodite : 

The signs and symptoms of hermaphroditism depend on the type of condition.

They may include:

-Ambiguous genitalia.

-Micropenis.

-Clitoromegaly.

-Labial fusion.

-Undescended testes.

-Hypospadias.

-Electrolyte abnormalities.

-Delayed, absent or abnormal pubertal changes.

Investigation may need to diadnose A Hermaphrodite :

These may include:

-Analysis of chromosomes

-Blood tests to investigate hormone and electrolyte levels

-Hormone stimulation tests

-Molecular testing

-Endoscopic exam

-Ultrasound imaging

-Magnetic resonance imaging (MRI)

What are the Treatment Method for A Hermaphrodite :

1.A child with hermaphroditism will usually require care from a multidisciplinary healthcare team to address the various needs presented.

2.Surgery and Hormonal therapy was recommended. 

3.The female pseudohermaphrodites should be reared as girls and treated with cortisone.

If the clitoris is enlarged it should be removed before school age 

and the urogenital sinus corrected to form a separate vagina.

 

With cortisone therapy continued normal female development can be assured.

4.Male pseudohermaphrodites whose genitalia resemble the male or are ambiguous may either masculinize or feminize at puberty. 

If it is decided to raise such a child as a female because of the small size of the phallus, orchidectomy may be performed in infancy to avoid the risk of masculinization or it may be postponed until masculinization begins. 

At puberty estrogen should be given in doses adequate to develop female sex characteristics.

Hermaphroditism is a complex issue and the ideal treatment of the condition is not clear. 

It is important that affected individuals have access to adequate 

support to deal with any issues related to the condition. Their family and friends may also benefit from such support groups.

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