Hermaphroditism is an androgynous syndrome named after the gods and goddesses of Greek mythology, Hermes and Aphrodite. This condition, also called intersex, means that a person has both male and female characteristics in varying proportions. Individuals who have hermaphroditism caused by genetic disorders are called hermaphrodites. This condition is quite rare in the population and can be defined as a genetic variation rather than a disease.
In hermaphrodite individuals, it is not mandatory to have any disorders related to physiological health, except for the negative effects of fertility and reproductive health. Except for the loss of reproductive ability, it is possible for many hermaphrodite individuals to continue their lives in a healthy way. In some cases, with the help of various surgical operations, individuals can be treated in a way that they have the gender they choose and their body structure allows.
What is Hermaphrodite?
Hermaphrodites can be defined as individuals who do not exactly match any of the distinctively male or female sex characteristics. In other words, the sexual organs, hormonal structures and external appearances of hermaphrodite individuals contain male and female characteristics together. Hermaphroditism cannot be defined in a single way, but it can also occur congenitally in many different ways. Therefore, it is studied under different subspecies. Although it varies according to the type of hermaphroditism, it can be noticed at birth in some cases. In cases detected in this way, if two different sexual organs are detected from the outside, surgical treatment can be applied with the decision of the family.
In some cases, hermaphroditism may not be noticed until puberty or at any time throughout life. In most intersex individuals, the external appearance is typically male or female, with a single genitalia. However, unlike the external appearance of these people, there are also differences in the internal structure of the body. In such cases, hermaphroditism can only be noticed during medical examinations due to the symptoms it causes or during diagnostic medical imaging performed for a different reason.
What Causes Hermaphroditism?
Hermaphroditism, which is characterized by the presence of an inconsistency between the internal and external genital organs, usually occurs as a result of genetic differences that lead to sexual developmental disorders. The chromosome structure that determines the sex in a hermaphrodite individual can be 45+XX or 45+XY. Apart from these individuals with 46 chromosomes, in individuals related to chromosome separation, hermaphroditism may also occur when trisomy (having three chromosomes numbered 21) occurs in the sex chromosome, just as in Down Syndrome.
Intersex condition may develop in genetic variations such as 45+X0, 46+XXY, 46+XXX. Apart from genetic disorders, other risk factors thought to cause hermaphroditism include:
- Excessive exposure of the unborn baby to male sex hormones
- Imbalance between female and male sex hormones
- Insufficient secretion of sex hormones from the ovaries or testicles
- Medical problems that reduce the availability of testosterone produced in the body
- Exposure to agricultural pesticides, chemical agents, or radiation
- Presence of ovarian cysts or tumors that produce the hormone testosterone in the mother
- Congenital adrenal hyperplasia
- Deficiency or excess of the aromatase enzyme, which converts male hormones to female hormones
Most of the above conditions are risk factors that are thought to be effective on the formation of hermaphroditism. However, the only factor that has been proven to be effective in the development of this condition is chromosomal disorders. Apart from these, the reason that is effective in other types of hermaphroditism is not known exactly.
What Are Hermaphrodite Symptoms?
Symptoms seen in hermaphrodite individuals vary depending on the type of hermaphroditism. Possible symptoms include:
- Small penis size (micropenis)
- The clitoris is larger than normal or has a penis-like appearance (clitoromegaly)
- Indeterminate genitalia
- Urinary canal shortness and opening in another part of the penis (Hypospadias)
- Labia adhesion (labial fusion)
- undescended testicles
- Absence, delay, or abnormal occurrence of sexual characteristics that occur during puberty
What Are the Types of Hermaphroditism?
Hermaphroditism is generally studied under 4 different types. These are as follows:
- 45+XX: Individuals with this type of hermaphroditism have normal female chromosomes and ovaries, while the external appearance is male type and male genitalia. In general, in hermaphrodite individuals with this chromosome structure, the female fetus is heavily exposed to male hormones. Depending on the labial adhesion (labial fusion) and the size of the clitoris, which is also called clitoromegaly, the genitals take on a similar appearance to the male genitalia. Most individuals have womb (uterus) and fallopian tubes.
- 45+XY: Individuals with this type of hermaphroditism have normal male chromosomes, but their external reproductive organs are formally missing or uncertain. Testes may exist normally in the body, may have structural defects or may not be present at all. This situation, also known as 45+XY with insufficient circulation, is caused by the imbalance between male and female hormones. Insufficient production of the testosterone hormone by the testicles, the absence of testes, or problems with the use of the testosterone hormone in the body reveal this type of hermaphroditism.
- True (Gonadal) Hermaphroditism: It is a type of complete and true hermaphroditism in which both testicular and ovarian structures are present. Individuals can have XX, XY, or both of these chromosomes. The external genitalia can be female, male or indeterminate. Among the factors that are thought to underlie this situation, the cause of which cannot be determined exactly, problems such as exposure to agricultural pesticides and disorders that occur during the formation of the embryo are emphasized.
- Complex or Undetermined Sexual Development Disorders: Hermaphrodite cases seen in the presence of chromosome structures other than the usual 46 chromosome structures (45+XX or 45+XY) are included in this group. Chromosome structure in the individual may be in the form of 46+XXY, 46+XXX or 45+X0 (Turner syndrome). The structure of the external and internal genital organs differs according to the type of chromosomal disorder.
How Is Hermaphrodite Diagnosed?
Depending on the type of hermaphroditism, the diagnosis may be made immediately after birth, may be delayed until puberty, or rarely, this problem may not be detected at all. In order to diagnose hermaphroditism in the newborn baby, one or more of the anatomical disorders such as labial adhesion, absence of vaginal opening, small penis, large clitoris should be detected. If such a physical problem cannot be detected, the diagnosis may be delayed until adolescence, when hormonal changes begin and gender characteristics become evident. In some cases, a hermaphroditism picture that could not be detected until adulthood can be diagnosed in patients who apply to health institutions with problems such as inability to conceive and infertility. Among the methods that can be used for diagnosis,
- Chromosome analysis,
- Tests to measure hormone and electrolyte levels,
- ultrasound imaging,
- endoscopic examinations,
- molecular tests,
- Magnetic resonance imaging (MRI),
- Medical examinations such as hormone stimulation tests are included.
How Is Hermaphroditism Treated?
The family usually decides what path to follow in babies born as a hermaphrodite. Although this situation varies from country to country, the baby is usually assigned the dominant gender based on the anatomical structure. By performing some surgical operations on the genitals of the baby, the external appearance characteristics of the determined gender can be gained to a large extent. A second method is to wait until puberty and to apply hormone treatments according to the current health status in this period.
There are different approaches to what kind of approach should be followed for true hermaphrodite babies around the world. One of them is that no surgical treatment should be applied for hermaphroditism, which is not exactly a disease, and the individual should decide for himself in adulthood. Another view is to establish gender identity through surgical operation after birth so that the baby can lead a healthier life socially and psychologically. Any of these approaches can be preferred according to the family’s preference, the type of hermaphroditism and the approach of the health institutions.
If you have detected a difference in your own or your baby’s sexual identity or the appearance of the external genitalia, it would be beneficial to apply to a health institution for examination.
See more information please visit https://en.wikipedia.org/wiki/Hermaphrodite
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