True hermaphroditism karyotype. Hermaphroditism in humans: causes, symptoms, treatment

– a congenital disorder of sexual differentiation, characterized by the presence in an individual of two types of gonads (ovary and testis) or gonads of a mixed structure (ovotestis). Clinical manifestations of true hermaphroditism can be different and depend on the predominance of the functional activity of the male or female gonad. Patients with true hermaphroditism may experience a disturbance in the structure of the external genitalia (small penis, hypospadias, cryptorchidism, clitoral hypertrophy), gynecomastia, bisexual body type; menstruation, ovulation and spermatogenesis are possible. The diagnosis of true hermaphroditism is established on the basis of examination of the genital organs, ultrasound of the gonads, examination of the level of sex hormones, determination of the karyotype and biopsy of the gonads. Therapeutic tactics are determined by the psychosexual orientation of patients and consist of removing the gonads of the opposite sex and conducting hormonal therapy.

On the side of the testicle, the epididymis and vas deferens are usually formed; on the opposite side, a unicornuate uterus and fallopian tube develop. The vagina may be well developed and open into the perineum, along the midline of the scrotum, or into the posterior urethra. As a rule, the ovaries are positioned correctly; ovulation occurs in 25% of patients with true hermaphroditism.

During puberty, signs of virilization or feminization may be observed; secondary sexual characteristics of both sexes are often present (bisexual body type, gynecomastia, low timbre of voice, male-pattern hair growth). Half of patients experience menstruation; in the male phenotype, monthly bleeding is manifested by cyclic hematuria. Patients with true hermaphroditism may have problems with gender identity and social adaptation; tendency towards bisexuality, homosexuality, transsexuality, transvestism.

Diagnosis of true hermaphroditism

In order to confirm or exclude the diagnosis of true hermaphroditism, patients should be consulted by an endocrinologist, urologist, gynecologist, or geneticist. During a physical examination, the development of the external genitalia and the severity of secondary sexual characteristics are assessed. Palpation of the scrotum area, vaginal or rectal examination, ultrasound of the pelvic organs and adrenal glands are performed.

True hermaphroditism must be differentiated from false hermaphroditism, gonadal dysgenesis (Klinefelter syndrome). For this purpose, determination of sex chromatin, karyotyping, study of hormone levels (testosterone, estrogens, FSH, 17-ketosteroids in daily urine), other tests and samples are carried out. A definitive diagnosis of true hermaphroditism can only be made after exploratory laparotomy, gonadal biopsy and histological confirmation of the presence of both ovarian and testicular tissue.

Treatment of true hermaphroditism

The issue of assigning a passport gender and the nature of gender education of persons with true hermaphroditism is complex; requires taking into account the karyotype, hormonal status, psychosexual orientation of the patient’s personality and is resolved with the involvement of medical specialists. In most cases, newborns with true hermaphroditism are classified as female and raised as girls, since the activity of the ovarian part of the gonad usually prevails over the testicular part.

Subsequently, taking into account the anatomical, psychological and functional aspects, surgical correction of true hermaphroditism is carried out, including gonadectomy and plastic surgery on the external genitalia. In persons with a passport female gender, all testicular tissue is removed or ovotestis, resection of the clitoris, and vaginal plastic surgery. The problem of excess hair growth is solved using hair removal methods. Subsequently, throughout the entire reproductive age, cyclic administration of estrogen-gestagen drugs is prescribed. When choosing a male passport gender, patients with true hermaphroditism undergo complete removal of ovarian tissue and female genital organs, correction of gynecomastia, formation of the scrotum, and plastic surgery of the penis. From puberty, androgen replacement (maintenance, stimulating) therapy is carried out.

Prognosis of true hermaphroditism

Normal psychosexual development and adaptation of patients with true hermaphroditism in society depends on the correct choice of sex, the correspondence of the phenotype of the chosen gender and self-identification. Typically, patients with true hermaphroditism are infertile, but isolated cases have been described in which individuals with a female and male phenotype, after removal of the ovotestis or gonads of the opposite sex, were able to acquire offspring.

Patients with true hermaphroditism, even after gonadectomy, should remain under close supervision of an endocrinologist to monitor the correctness of hormone therapy. In some cases, such patients need the help of a psychologist, psychotherapist, or sexologist.

Differences between the sexes of people at all times determined the structure of society and influenced literally all aspects of life, including culture and art. Even today, when men and women have almost achieved complete equality, gender is still one of the defining characteristics of a person.

All the more surprising is the possibility of combining the sexes. This phenomenon - hermaphroditism - has always been covered in a flair of mysticism. Even the very name of this deviation comes from ancient Greek mythology - it is a combination of the names Hermes and Aphrodite. In different societies, the appearance of a hermaphrodite child was considered the result of a blessing from above, a curse, degradation, degeneration of the human race... In fact, everything is much more prosaic.

What is the floor made of?

First, let’s figure out what the concept of “gender” is based on. Sex cells (gametes) are involved in the process of reproduction. They differ from all other cells in that they contain only half the chromosome set. In order for a new organism to begin to develop, two such cells need to be united - this is how a new combination of hereditary characteristics is obtained.

Among the germ cells, a distinction is made between female and male. The first ones are larger, immobile, and contain a supply of nutrients to start the development of a new organism. The second are smaller, more mobile, capable of penetrating the female gamete in order to combine their hereditary material with hers.

The pattern in which a new organism will be built also depends on genes. In female or male individuals, various genital organs develop preferentially. In boys, testicles and penis are formed, in girls - ovaries, uterus, vagina, and so on. So, even newborn children of different sexes are already different from each other.

Over time, these differences become stronger. In adolescence, secondary sexual characteristics appear - differences in body structure, hair, skin type, muscle development corset in men and women. These changes occur under the influence of hormones secreted by the sex glands.

And all these complex transformations serve a single purpose - to raise heterosexual individuals who can give birth to offspring. Breaking away from cynical biological definitions, we can say that not only the differences in physiology, but also the difference in the psychology of men and women allows them, when united, to conceive, give birth and raise children.

Hermaphroditism in nature

But if higher vertebrates, which include humans, are characterized by a clear division into two sexes, then for other living beings this law may not be so strict. There are many organisms that simultaneously produce both male and female reproductive cells. These gametes are found right there in the parent’s body, and the conception and development of new creatures occurs.

There are even species (some fish, for example) in which one individual goes through the stages of a “female” and a “male” organism.

Moreover, even in some mammals, clear sex shifts can be observed. For example, female hyenas have a large false penis, through which they mate and even (!) give birth.

In old age, people's hormonal levels are disrupted, and you can notice that women acquire some “masculine” traits, and men acquire “feminine” ones.

So hermaphroditism in its true form or some kind of “sex shift” are not so uncommon.

Hermaphroditism - causes of pathology

Hermaphroditism can occur at the genetic level, when the “wrong” set of chromosomes is formed during conception. Various influences - toxins, infections, radiation, and so on - can lead to pathological formation of organs.

In addition, various diseases that change the functioning of the hormonal system can lead to the pathological formation of secondary sexual characteristics in humans.

When we're talking about Regarding hermaphroditism in humans, there are two types:

True - internal characteristics of both sexes are present, externally - various options are possible;
False - external signs of gender do not correspond to internal ones (hypertrophied clitoris in a woman, mammary glands in a man, and so on);

In any case, this is a disease that causes suffering to a person - physical and psychological.

True hermaphroditism

An extremely rare disease. Such people have a set of male and female sex glands (gonads). In other words, they can have two reproductive systems. Sometimes the ovaries and testicles are combined into one system.

At the cellular level, with true hermaphroditism, a “female” set of chromosomes is most often found. Mosaicism becomes a rare phenomenon - some cells turn out to be “female”, while others are “male”.

However, external signs may not “give away” a true hermaphrodite. That is, the following options are possible:

The presence of a full set of genital organs and characteristics of one sex (dominant);
The presence of a full set of genital organs and characteristics of one sex, but also some organs belonging to the opposite sex;
The presence of a mixed set of genital organs and secondary characteristics of both sexes;

That is, the main sign of true hermaphroditism is the presence in the body of a sex gland belonging to the opposite sex. And it may remain undiagnosed for many years. But this “secret” gland produces hormones that are unnecessary for the body of a given sex. Often a tumor develops in this organ, which leads to the production of huge amounts of hormones.

This is what affects the human psyche and leads to abnormal sexual behavior. For example, such a person becomes bisexual - experiencing attraction to both men and women. It is possible to change the vector of sexual desire - from heterosexual to homosexual and back. Transsexuals who psychologically feel “not in their body” and sensually belong to the opposite sex suffer the most.

It should not be assumed that anyone who is bi, trans or homosexual is a true hermaphrodite. But if this deviation becomes a problem, it is worth examining the patient’s body for the presence of “secret” gonads.

If a person has external sexual characteristics of both sexes, then diagnosing hermaphroditism is simple. However, treating this condition is very difficult.

False hermaphroditism

As we have already noted, with this form of the defect, the gonads of only one sex are present, but in the development of the external genital organs and characteristics, traits of both sexes appear.

With false male hermaphroditism, the male genitals are similar to female ones. This is caused by their improper development in the prenatal period. Thus, various pathologies of the development of the testicles, urethra, and penis can lead to the fact that a man’s genitals are more reminiscent of a woman’s genitals.

In some cases, such a child is mistaken for a girl and the appropriate documents are issued. The parents are trying to raise their daughter, but sooner or later, this fatal mistake makes itself felt, causing the patient a lot of psychological suffering.

With false female hermaphroditism, everything happens exactly the opposite. When the clitoris develops excessively, it resembles a penis. At the same time, other parts of the female genitalia may be underdeveloped. As in the case of male pseudohermaphroditism, such girls may be considered boys.

Diagnosis and treatment of hermaphroditism in humans

Obviously, if a person has deformed or “extra” genital organs, it is not difficult to diagnose hermaphroditism in one form or another. However, in this case, a number of studies are required to determine which gender the patient belongs to.

To do this, you need to determine what the chromosomal sex is, what sex glands are present in the body, what the person’s hormonal background is, who he considers himself to be. These issues affect not only health, the medical aspect of life, but also social, family, and psychological aspects. And this makes finding answers extremely difficult. In any case, such a patient will experience enormous psychological pressure.

If there are no pathologies of the external genitalia, then identifying hermaphroditism is a difficult task. The doctor should generally assume that the patient has this deviation and prescribe the appropriate tests. Often another diagnosis is made that describes the problem that results in hermaphroditism. For example, “ovotestis” is the presence in the gonad of tissues that produce hormones of “different sexes”. This is also due to the fact that the word “hermaphrodite” has an unpleasant social connotation.

If a form of hermaphroditism is identified, treatment may include hormonal therapy, surgical interventions, psychological and legal assistance.

Sex hormone medications are used for a variety of conditions. For example, for contraception. In the medical correction of hermaphroditism, hormones specific to the sex that is dominant (and desired) for the patient can be used.

Surgical interventions will help to form genitals that will not be in dissonance with the patient’s self-identification. Also, additional glands that are not typical for a given gender can be removed.

The most important aspect of the treatment of hermaphroditism in humans is psychological assistance. Often the problem of “confusion” between the sexes, which arises in such a patient in early childhood, worsens over the years. It is important not only to help a person understand who he really is, but also to relieve him of feelings of guilt and inferiority. It is also necessary to work with the patient’s relatives and friends, who also find it very difficult to understand and accept the true state of affairs.

Along this path, the question of changing legal gender often arises. This has enormous psychological significance, as a symbol of recognition from society and the state. And although the patient’s life may become more difficult or may not improve dramatically, many literally fight to the death for the right to register a new gender.

Lack of understanding and treatment often leads people with hermaphroditism to severe psychological and even mental pathologies. Cases of suicide are not uncommon among them. Moreover, these are precisely suicides, and not attempts that only imitate suicide, but are aimed at attracting the attention of others.

(Greek Hermaphroditos - Hermaphrodite - the son of the ancient Greek gods Hermes and Aphrodite, who combined the characteristics of male and female; synonyms - androgyny, bisexuality), a congenital disorder of sexual development, in which the external genitalia have characteristics of female and male.
Hermaphroditism causes difficulty in classifying an individual as a particular gender. It is a form of intersexism. Occurs on average in one in 2,000 newborns. There are true and false hermaphroditism. With true hermaphroditism, or bisexual gonad syndrome, along with the structure of the external genital organs characteristic of hermaphrodites, there are both male and female gonads; if false, the gonads are formed correctly according to the male or female type, but the external genitalia have signs of bisexuality. True hermaphroditism is much less common than false hermaphroditism (about 150 cases are described in the entire world literature). In true hermaphroditism, the testicles and ovaries can either be combined into one mixed sex gland or located separately. The chromosome set (karyotype) in such patients usually corresponds to a female karyotype, less often there are cells containing a female chromosome set and cells containing a male chromosome set (the phenomenon of so-called mosaicism); when determining sex chromatin, the result is positive; mammary glands are noted, the appearance of spontaneous menstruation is possible, female-type hair growth, less often with masculine features, the figure is bisexual.

,

Signs of male false hermaphroditism are present in gonadal dysgenvia syndrome and incomplete masculinization syndrome; in false female hermaphroditism, congenital adrenogenital syndrome is most often diagnosed. Patients with these syndromes have functionally and morphologically defective internal genital organs - depending on the form of the disease, either male and female, or only male, and the external genitalia have characteristics of both sexes. A special form of false male hermaphroditism is testicular feminization syndrome.
A direct relationship between mental makeup and the type of gonads in hermaphroditism has not been noted. There are cases where the mental makeup and sexual orientation changed during the life of the same patient. Educational conditions play an important and sometimes decisive role in the formation of mental makeup. Suspicion of hermaphroditism should arise at the birth of a child with hypospadias in combination with cryptorchidism, in the presence of an underdeveloped penis resembling a clitoris, a bifurcated scrotum similar to the labia. In order to clarify or exclude the diagnosis, children are examined by an endocrinologist, gynecologist, urologist, and geneticist. Treatment of hermaphroditism is strictly individual. When choosing sex, the functional predominance (female or male part) of the gonad is taken into account. During surgical treatment, plastic surgery is performed on the external genitalia; in some cases, surgical removal of the malformed gonad is necessary. The prognosis for hermaphroditism, with the exception of some forms, is favorable for life, but constant monitoring by specialists is necessary. Childbearing is impossible.

(Source: Sexological Encyclopedia)

Bisexuality, intersexuality; congenital duality of the reproductive organs, when the sex of an individual cannot be unambiguously determined as either male or female. There are true hermaphroditism (in the presence of male and female gonads) and false, or pseudohermaphroditism (the presence in the body of only female or only male gonads).

(Source: Sexological Dictionary)

the presence of a male in one organism. and wives genitals. In humans, a distinction is made between true G. (ovotestis) and false, which manifests itself only in malformations of the genitals or secondary sexual characteristics.

(Source: Dictionary of Sexual Terms)

bisexuality, intersexuality; congenital duality of the reproductive organs, when the sex of an individual cannot be unambiguously determined as either male or female

(Source: Concise Dictionary of Sexopathological Terms)

Synonyms:

See what “Hermaphroditism” is in other dictionaries:

Hermaphroditism... Spelling dictionary-reference book

HERMAPHRODITISM- HERMAPHRODITISM. (from the Greek Hermes and Aphrodite), bisexuality, bisexuality, bisexual development, the presence of signs of both sexes in an individual. Classification of hermaphroditism. There are two main types of G.: G. and s t i n n y (her maphroditismus... ... Great Medical Encyclopedia

- (from the Greek Hermaphrodites, son of Hermes and Aphrodite, mythical bisexual creature), the presence of male organs. and wives sex in the same individual. Natural G. is widespread in the animal kingdom and is characteristic of oligochaetes and leeches, barnacles... Biological encyclopedic dictionary

Bisexuality. Dictionary of foreign words included in the Russian language. Pavlenkov F., 1907. HERMAPHRODITISM is a combination of two sexes, a mixture of male and female genital organs in one individual. A complete dictionary of foreign words that came into use in ... Dictionary of foreign words of the Russian language

HERMAPHRODITISM, the presence of male and female genital organs in one organism. A distinction is made between natural hermaphroditism, which is characteristic mainly of invertebrates, and abnormal hermaphroditism (developmental defect), which also occurs in humans... Modern encyclopedia

The presence of male and female genital organs in one organism. A distinction is made between natural hermaphroditism, which is characteristic mainly of invertebrates, and abnormal hermaphroditism (developmental defect), which also occurs in humans... Big Encyclopedic Dictionary

hermaphroditism- a, m. hermaphrodisme m. The presence of male and female characteristics in one organism (animal or human); bisexuality. ALS 2. Hermaphroditism is a common phenomenon for lower animals. It occurs as a rare deformity in the higher classes. B. Sergeev Occupied... ... Historical Dictionary of Gallicisms of the Russian Language

hermaphroditism- Bisexuality, intersexuality; congenital duality of the reproductive organs, when the sex of an individual cannot be unambiguously determined as either male or female. A distinction is made between true hermaphroditism (in the presence of male and female gonads) and... ... Technical Translator's Guide

Hermaphroditism- HERMAPHRODITISM, the presence of male and female genital organs in one organism. There are natural hermaphroditism, characteristic mainly of invertebrates, and abnormal (developmental defect), which also occurs in humans. ... Illustrated Encyclopedic Dictionary

HERMAPHRODITISM, hermaphroditism, pl. no, husband (scientific). The presence of characteristics of both sexes in one person or one individual of the animal world. Ushakov's explanatory dictionary. D.N. Ushakov. 1935 1940 ... Ushakov's Explanatory Dictionary

HERMAPHRODITISM, huh, husband. The presence of male and female characteristics in one individual (human, animal). | adj. hermaphrodite, oh, oh. Ozhegov's explanatory dictionary. S.I. Ozhegov, N.Yu. Shvedova. 1949 1992 … Ozhegov's Explanatory Dictionary

The definition of “hermaphroditism” means “bisexuality”; the specificity lies in the presence of characteristics of both sexes in one organism. In the animal world, the phenomenon of hermaphroditism is considered one of the natural processes of reproduction. In botany, in plants, the predominant part of which are hermaphroditic, the definition of “dioecy” is used, when both male and female flowers are present on the same plant. The ability to self-fertilize is common in a significant part of worms and some species of fish. Mollusks, algae, mushrooms, crustaceans are just a few representatives of natural hermaphroditism on the planet.

What is hermaphroditism in humans

Human hermaphroditism is considered an abnormal phenomenon, since it is a defect in the development of the genital area at the genetic and hormonal stage, in which signs of both sexes are present in the body (who are hermaphrodites, see photo of human organs above).

Often this disease is congenital. Less often, deviations towards the opposite affiliation are detected at the stage of premature sexual development. In adulthood, hermaphroditism can occur as a result of hormonal therapy during sex reassignment.

There are no statistics on the number of people with such deviations due to reluctance to advertise the diagnosis. Hermaphroditism is always accompanied by concomitant diseases and developmental anomalies not only of the genital organs. The following disorders are often diagnosed in parallel:

of cardio-vascular system;
anomalies of skeletal structure.

Accompanied by pronounced, to varying degrees:

mental and mental disorders;
disorders in the sexual and psycho-emotional sphere;
problems with social adaptation.

Causes of hermaphroditism

The root cause of defectiveness inherent in hermaphroditism is the influence of hereditary factors. Second place belongs to damaging factors from the outside. Hereditary include pathology in the number and quality of sex chromosomes, genetic mutations in non-sex chromosomes.

Factors of external influence on the developing fetus include:

radioactive radiation;
use of toxic substances;
alcohol consumption;
taking hormonal drugs that manifest.

The most dangerous influence of these factors is at the beginning of the third trimester of pregnancy.

Also, female or male hermaphroditism, while still in the body of a pregnant woman, can be provoked by the following factors:

hormonal disorders in the body of a pregnant woman, occurring due to diseases of the hypothalamus and pituitary gland, which are responsible for the production of sex hormones;
excessive levels of hormones of the opposite sex in the fetus;
intrauterine infection of the fetus;
tumors and diseases of the adrenal glands and ovaries.

Symptoms of hermaphroditism

True hermaphroditism
Male pattern hair growth in women
Hermaphroditism due to congenital 21-hydroxylase deficiency

Below are the symptoms common for all types of this pathology (what does hermaphroditism look like in humans, see photo above):

early puberty;
defect in the formation of the genital organs:
- the penis is underdeveloped, deformed:
- There are different options for placing the urethra in the perineum, apart from the head of the penis:
  - the testicles are absent in the scrotum, located either in the abdominal cavity, or in folds of skin, replicating the labia majora, or in the inguinal canal;
  - hypertrophy, to the size of the penis, clitoris;
unformed mammary glands in individuals with a female set of chromosomes and breast development in individuals with a male set;
standards of figure, hair, and larynx that do not correspond to the passport gender;
failure of sexual life;
inability to have offspring.

Classification

There are true and false hermaphroditism:

True hermaphroditism a purely episodic phenomenon. It is manifested by the formation in the human body of glands of both sexes (testicle and ovary).

The chromosomal component, with true hermaphroditism, is often female, less often male. There are cases of mosaicism in chromosomes.

The glands are capable of developing independently, or, in the case of mutational fusion, forming into a single one (ovotestis), partially containing the tissues of both glands. There is a subtype of true hermaphroditism - cross. It is manifested by the formation in the human body, simultaneously, of a male (testicular) gland on one side, and a female (ovary) gland on the other.

In 10% it is possible to identify gender. In 90% of cases, the structure of the genital organs is combined. Found in various variations:

female characteristics predominate:
- vagina present;
- the clitoris is significantly enlarged;
predominant male characteristics:
- there is a small size of the penis, scrotum;
- unicornuate uterus and vagina;
the clitoris, vagina and urethra enlarged to the size of a penis are located separately;
the urethra opens into the vagina, the penis is small, sometimes there is a prostate gland;
There are variants with normally formed genitals, but with the presence of gonads of the opposite sex.

The symptoms of true hermaphroditism are variable and are determined by the activity of the gonad tissue. A quarter of patients with this pathology ovulate, and in some cases spermatogenesis is preserved. Individuals whose genital structure is close to the female type experience menstruation, while those with the male type experience blood in the urine during the menstrual period.

Patients are likely to have difficulties with self-identification and adaptation in society.

False hermaphroditism divided into male and female.

The frequency of episodes is higher than that of the true one. It is determined by the formation in a person of sex glands opposite, according to gender, to the genitals formed in him.

Female false hermaphroditism

With this type of pathology, the ovaries are identified in the body, but the genitals, which are characterized by masculinizing characteristics:

the clitoris is significantly enlarged, there is a possibility of overgrowth of the labia majora;
mammary glands are not developed;
there is growth of hair on the face and chest;
low timbre of voice;
skeleton and musculature typical of men;
mental self-perception corresponds to that of a man.

Male false hermaphroditism.

The external organs are visually similar to those of women. The testicles are not descended into the scrotum; their probable location is the abdominal cavity. They develop slowly and pathologically. The penis is underdeveloped and curved. The opening of the urethra is greatly displaced, making urination difficult. The shape of the mammary glands is enlarged, reminiscent of female ones. The structure of the vocal cords and hair growth characterize the female type. The structure of the figure and mental self-perception are female.

Diagnostics

Immediately after the birth of a child with a set of bisexual external genitalia, measures are taken to establish gender: karyotyping - determination of sex by chromosomes and pelvic ultrasound to determine the correspondence of the gonads. After this, the civil gender is officially registered in the documents.

According to indications, on the 3-4th day of life, a blood test is taken from the newborn to identify genetic abnormalities, including.

To confirm the diagnosis, patients are examined by a geneticist, endocrinologist, gynecologist, and urologist.

Older patients, with developmental pathology, begin examination:

from a general examination;
collecting life history, complaints;
the condition of the genital organs is assessed, as well as the presence and degree of development of secondary sexual characteristics (hair and physique, development of muscles and mammary glands);
attention is paid to the general state of health, since there is a high probability of concomitant diseases;
A vaginal examination and palpation of the scrotum is performed.

Also carried out:

karyotyping– one of the methods for early diagnosis of pathologies, even during the period of intrauterine development of the fetus. Studies the composition and quality of chromosomes. Determines the gender of the fetus;
sex chromatin analysis;
ultrasound examination of the pelvic organs, adrenal glands and abdominal cavity. Allows you to determine the condition of internal organs, deficiencies in their development, the presence of gonads;
magnetic resonance imaging (MRI) provides highly accurate visual information about the condition and location of internal organs;
Laboratory tests of blood and urine. Conducted with the purpose determining hormonal levels. The nature of the tests is specified by the attending physician. Usually this:
- testosterone;
- luteinizing and follicle-stimulating hormones;
- estradiol;
- glucocorticoids;
endoscopic examination internal genital organs;
diagnostic laparotomy. It is carried out to take gonadal tissue for histological analysis.

Treatment of hermaphroditism

The main goal is the choice of the patient or his legal representatives of the civil gender, on the basis of which complex treatment is prescribed: surgical reconstruction and hormonal replacement therapy.

Drug treatment with sex hormones lasts the entire reproductive period of life:

To enhance feminization, estradiol dipropionate is used (“ Proginova"), microfollin; combined oral contraceptives – “Mersilon”, “Logest”, “Novinet”, “Yarina”, “Zhanine” and others;
means for hormone replacement therapy for disorders that arise after menopause ( "Climodien", "Femoston");
persons whose disease is caused by congenital defects in the production of steroids in the adrenal cortex are prescribed synthetic analogues Glucocorticoid and mineralocorticoid hormones.
for masculinization – Testosterone propionate, "Testenate", "Sustanon-250", "Omnadren".
To stimulate the patient's growth, individuals with Turner syndrome are prescribed somatotropic hormone preparations ( "Norditropin" or analogues);

Surgery

One of the most important factors in the treatment of hermaphroditism is to carry out surgical measures as early as possible, preferably before the age of two, before the end of the period of sexual identity. As a last resort, before the onset of puberty, in order to raise a full-fledged organism corresponding to the established gender.

In all cases of female false hermaphroditism, it is necessary to choose the female version of education.

Successful surgical (feminizing) plastic surgery and hormonal therapy provide every chance for successful adaptation to womanhood. If there are two rudimentary testicles in the body, their removal, feminizing plastic surgery and education according to the female type, with support from hormonal therapy, are indicated.

The issue of false hermaphroditism is more difficult to resolve. The case when at least one testicle functions in the body and the structure of the genitals is similar to that of a man allows the patient to be raised as male. Subject to plastic correction and hormone therapy.

In older patients, gender correction is carried out taking into account the psychosexual direction and the anatomical and functional capabilities of the genital area.

If the penis is poorly developed, then they resort to its removal. The testicles are also removed, as there is a possibility of their malignant degeneration. With a successful operation and complex hormone therapy, the chance of developing a female body is quite high.

For average penis sizes, plastic correction is performed:

straightening the penis;
removal of the urethra into it;
the scrotum is formed from the tissue of one’s own body;
lower the testicles into it;
If present, female organs are removed.

For women, the hypertrophied clitoris is removed and labiaplasty is performed. The vagina is formed from peritoneal tissue. All organs containing testicular tissue are removed. Glucocorticoids, adrenal hormones that inhibit the production of androgens, and estrogens are prescribed to form female characteristics.

Patients, after undergoing surgery, are observed by an endocrinologist. If indicated, consultation with a psychotherapist, sexologist or psychologist is necessary.

Possible complications

Inability to bear children.
Unconventional sexual behavior:
- Transvestism, homosexuality, transsexualism, bisexuality.
Disadaptation in society.
Pathology of urination due to improper location of the urethra.
Malignant tumors of the testicles and ovaries.

Unfortunately, it is not possible to completely cure hermaphroditism, but with adequate correction, the prognosis for life is favorable. An integral component of therapy is psychological and psychotherapeutic assistance to the patient. Constant supervision by an endocrinologist. Malignancy, that is, degeneration into malignant, of abnormally developed gonads, can worsen the prognosis.

Videos on the topic

Hermaphroditism is a pathology of the genital area when an individual has both male and female functionally developed genital organs. However, false hermaphroditism should be distinguished from true one. In the article we will consider the issue of true and false female and male hermaphroditism. How to diagnose pathology, can the disease be cured?

Nature has clearly divided humanity into male and female halves. A man differs sharply from a woman externally and internally. This difference is facilitated by the production of sex hormones and the structure of the reproductive organs. As a result of the presence of a certain level of hormones in the body, the external characteristics of a person clearly correspond to their gender.

Men are characterized by a rougher voice, an abundance of body hair, highly developed muscle tissue and a special body structure (narrow hips, broad shoulders). Women have a different body structure (wide hips, narrow shoulders, developed mammary glands), and they are characterized by a more pronounced fat pad. Based on these (external) gender characteristics, we can say with confidence that this is a man or a woman.

Note! In the body of men, there is also a certain proportion of female sex hormones, but it is the male ones that are predominant.

True hermaphroditism

Bisexual gonadal syndrome is the presence of functional ovaries and testes in an individual at the same time. This is called bisexuality. With true hermaphroditism, the glands produce both male and female sex hormones in equal quantities.

Note! 25% of hermaphrodites ovulate with menstruation and produce sperm at the same time.

In bisexual syndrome, the ovaries and testes can be localized separately, or they can form a single sex gland: it is called ovotestis. Individuals with bisexual pathology can look like anything:

secondary gender characteristics of masculinity are clearly expressed;
secondary gender characteristics of femininity are clearly expressed;
mixed bisexual type - a combination of gender characteristics;
transsexuals - a combination of male genital organs with female glands.

The causes of deviations in sexual development of this type have not yet been determined by science. According to statistics, among hermaphrodites, 60% of the female karyotype and 10% of the male karyotype predominate, 30% belong to the mixed type.

At birth, almost all infants with bisexual gonadal syndrome have a mixed genital structure. Approximately 10% of infants have differentiated sexual characteristics. There are no other anomalies in the structure of body organs in hermaphrodites.

Note! With this disease, self-identification is impaired. The patient may exhibit predilections for transsexualism, homosexuality, transvestism or bisexuality.

False hermaphroditism

However, false hermaphroditism can be found more often. This disease is defined as follows: a person has an anatomically expressed belonging to one gender type, but his gonads (sex glands) correspond to another type. Representatives of both sexes are susceptible to the disease.

Symptoms:

anatomical pathology of the reproductive organs;
developed mammary glands in men;
mustache and beard for women;
presence of a male penis in women;
the presence of testicles in a woman’s labia;
body type inconsistency with gender type;
change in voice sound;
inability to conceive;
untimely puberty.

In men, an external manifestation of the deviation may be underdevelopment or curvature of the penis, the absence of testicles in the scrotum (they are located inside the peritoneum).

Causes of pathology

The deviation can be either congenital or acquired. Congenital depends on the developmental characteristics of the fetus during the formation of the pelvic organs. Acquired hermaphroditism is formed due to pathology of the pituitary gland and adrenal cortex - organs that produce hormones.

A congenital malformation is determined in the third week of the fetus’s life, when the child’s reproductive system begins to form. The genitals of boys and girls are formed from the paramesonephric and mesonephric ducts. If a malfunction occurs at this stage, the fetus will begin to develop male and female genitalia. This pathology is caused by a change in the composition of the chromosomes (karyotype) or a change in the genome (as part of the chromosomes).

Also, the cause of improper development of the fetal reproductive system can be a mutation due to irradiation of the embryo or poisoning by poisons (alcohol, drugs, taking illegal drugs by the mother). Infection of the mother with Toxoplasma or other viruses also makes a significant contribution to the mutation of the embryo's genome.

Another reason for the pathological development of the fetal reproductive system is hormonal disorders in the mother or embryo. This leads to excessive production of male sex hormones in girls and female sex hormones in boys. Disruption of the pituitary gland, which is responsible for the production of hormones, provokes pathology in the structure of the reproductive organs of the fetus.

The abnormal structure of the reproductive system of the embryo can be facilitated by the localization of a tumor in the mother, due to which the production of androgens becomes uncontrollable, or by taking hormonal drugs during pregnancy. Congenital pathology of the adrenal cortex in the fetus also disrupts the process of hormone production.

False female hermaphroditism

The female half of the population is less susceptible to the disease than the male half. False hermaphroditism is considered a pathology (disease) in which the body produces an excess amount of androgens. As a result, a woman’s internal reproductive organs develop in accordance with her sex (ovaries), and appearance resembles male reproductive organs.

In addition to pathology, many women have a pronounced masculine body structure:

developed muscles;
abundant hair;
low timbre of voice;
behavioral features.

Often women with this deviation perceive themselves as men and act in accordance with this perception.

False male hermaphroditism

With this pathology, the individual has well-developed masculine glands (testicles) with weakly expressed external sexual characteristics - they are more reminiscent of a woman’s constitution. The body shape with this disease resembles the female type:

poorly developed hairline;
voice timbre is high;
the muscles are poorly expressed;
female type of behavior.

A man with this deviation identifies himself as a woman.

The visual severity of the anomaly depends on the degree of manifestation of the chromosome mutation - from a slight enlargement of the clitoris to its transformation into a male penis. There are known cases of erroneous determination of the sex of a newborn due to the abnormal structure of the reproductive system. Later it turned out that the boy had female ovaries inside. Often this type of man identifies himself as homosexual (passive).

There is another form of pathology: a man has external reproductive organs of the feminine type and masculine sex glands (gonads). This is facilitated by abnormal development of the urinary duct or cryptorchidism (testicles in the abdominal cavity).

A man can have a feminine type of appearance, however, he will lack internal female reproductive organs. In this case, the patient has pronounced secondary feminine sexual characteristics - the absence of masculine-type hair and the presence of developed mammary glands. The degree of feminization of a man depends on the level of production of female hormones.

Doctors distinguish three degrees of male feminization:

the patient has a feminine body type;
the patient’s appearance fully corresponds to the masculine type;
eunuch type - high timbre of voice with undeveloped mammary glands and absence of hair on the chest and legs.

Treatment of hermaphroditism is addressed not only in case of illness (testicular tumors in the peritoneum and the inability to have normal sexual intercourse), but also to achieve a sense of inner harmony. Most patients experience discomfort from the discrepancy between the inner world and the outer appearance.

Several methods are used to treat the disease:

surgery;
surgical correction - for minor deviations from the norm.

In addition to surgical intervention, the patient is prescribed a course of hormone therapy and drugs to stimulate the pituitary gland. In any case, treatment methods depend on the individual characteristics of the disease. Methods of psychotherapeutic influence play an important role in overcoming the social isolation of the patient.

Diagnostics

To identify the cause of an intrauterine anomaly in the development of the child’s reproductive system, the doctor asks the woman in detail about the course of pregnancy and collects data:

were there any complications during pregnancy;
whether the woman took medications dangerous to the fetus;
what infectious diseases did the woman suffer during pregnancy?
how the anomaly in the structure of the genital organs manifested itself in a newborn after birth;
features of child puberty.

In an adult with hermaphroditism, the characteristics of sexual behavior are determined:

is libido present?
are there any problems with intimate contacts;
whether infertility has been identified.

Next, the doctor conducts a visual examination - muscle development, hair growth, the structure of the external reproductive organs, the degree of swelling of the mammary glands. The doctor also records the patient’s height, body weight, blood pressure in the medical history and examines the skin.

Laboratory diagnostics include the study of chromosomes—informants of heredity. This is necessary to establish the genetic sex of the patient. The patient’s blood and urine are also examined for the presence of hormones of one type or another.

Important! The diagnosis of true hermaphroditism is confirmed by diagnostic laparotomy.

Men are also examined by a urologist. At the appointment, the doctor records data on the condition of the external and internal reproductive organs. The scrotum and prostate are subject to examination (palpation).

Ultrasound diagnostics examines the patient's pelvis and abdominal cavity. During the diagnosis, you can see the localization of the ovaries in a man, notice undescended testicles, and determine the pathology of the internal systems. All this is necessary to collect data on the causes of the disease. However, the most detailed picture of internal pathology can be obtained by MRI and laparoscopy.

Therapy

Is it possible to treat false hermaphroditism? Patients are offered hormone therapy, since the main cause of the pathology is hormonal disorders. After receiving the results of laboratory and hardware diagnostics, therapy is prescribed. In accordance with the disturbance in the production of hormones by a certain gland, medications are prescribed for:

correction of sex hormones;
thyroid functionality;
adrenal gland functionality;
correction of the pituitary gland.

To correct the abnormal shape of the external reproductive organs, surgery is used - straightening/enlarging the penis, correcting the anatomical pathology of the female reproductive organs. Men can undergo surgery to lower the testicles into the scrotum, correct an abnormality of the urinary duct, and form the missing scrotum from body biomaterial.

If a man's testicles have undergone malignant changes, they are removed. Patients are also given a course of mental correction to normalize the perception of sexual behavior that corresponds to their gender type.

True hermaphroditism is treated by eliminating one type of gonad - muscular or feminine. Before the operation, the patient’s psychosexual orientation is determined. Next, plastic surgery of the external reproductive organs is performed. To maintain hormonal status, an individual takes medications during the reproductive period of life: women take estrogen-progestogen medications, men take androgens. In addition to drug therapy, patients must be constantly under the supervision of a psychologist and sexologist for successful socialization.

Complications

If a patient with hermaphroditism does not agree to treatment, what might such a decision result in? Consequences of this pathology:

inability to conceive a child;
inability to have normal sexual intercourse;
perversions and pathologies of sexual behavior;
antisocial behavior, difficulty socializing;
tumors of the testicles located in the peritoneum;
the inability to urinate normally due to an abnormal structure or location of the urinary canal.

Bottom line

Modern medicine has the necessary equipment and methods for correcting hermaphroditism. Most often, a false form of this disease is treated when it is impossible to have normal sexual intercourse or conceive a child. Another reason for visiting a doctor is pain in the peritoneum due to the development of a tumor of the testicles located inside the body. However, the disease may also be accompanied by severe mental or mental underdevelopment, perverted sexual behavior or increased libido. Timely contact with specialists (urologist, psychologist) will help identify pathology and restore reproductive function.