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Who are hermaphrodites? Hermaphrodite: the structure of the reproductive organs. True hermaphroditism and true hermaphrodites.

Hermaphroditism in Greek means bisexuality. There are two types of hermaphroditism - true and false (pseudohermaphroditism).

Hermaphroditism is due congenital anomalies both the gonads and the external genital organs of a person and is formed in the period up to the eighteenth week of embryo development.

In addition, among some North American indigenous communities, gender is seen more on a continuum than a category, with particular recognition of "two-air" people that span both male and female. feminine qualities and characteristics. Thus, it is obvious that different cultures apply different approaches to create gender differences with more or less recognition of the flexibility and complexity of the floor.

Genetically determined disorders of sexual differentiation

Typical sexual development is the result of numerous genes, and a mutation in any of these genes can lead to partial or complete failure of sex differentiation. However, these methods are flawed because they actually refer to biological sex, not gender. This discrepancy is underscored by the presence of intersex individuals whose psycho sexual development and sex sometimes does not match the biological sex assigned to them as infants. In this report, the term "sex" will be used where the practice refers to biological sex rather than the more social construction of "gender".

Epidemiology

In the structure of gynecological and urological diseases, hermaphroditism occurs in 2-6% of cases. It is possible that the frequency of hermaphroditism is much higher. There are currently no official geographical statistics for this disease. Patients suffering from true or false hermaphroditism undergo examination and treatment in family planning and reproduction centers, gynecological and urological hospitals and "hide" under the diagnoses of "adrenogenital syndrome", "testicular feminization", "gonadal dysgenesis", "ovotestis", "scrotal -perineal hypospadias with inguinal or "abdominal cryptorchidism".

Chromosomes are structures that carry genes, which in turn transmit hereditary characteristics from parents to offspring. Humans have 23 pairs of chromosomes, one half of each pair is inherited from each parent. In some cases of Turner syndrome, there is a slight mental retardation. Women with three X chromosomes experience normal development sexual qualities and fertile. Affected individuals are usually above average and have slender builds. The frequency of women receiving an extra X chromosome is approximately 1: women do not have a severe phenotype associated with three X chromosomes.

Moreover, patients suffering from hermaphroditism are often treated in psychiatric clinics, since the symptoms of true and false hermaphroditism in the form of transsexualism, homosexuality and bisexuality (intermittent sex) are mistakenly considered diseases of the "sex centers" of the brain. Therefore, the problem of diagnosing and treating true and false hermaphroditism is of a social nature and is of particular relevance in modern society.

These women may have slight learning difficulties. As a result of this hormone imbalance, affected males have not fully developed secondary male sex characteristics. Affected males are usually fertile and many do not know what they have. chromosomal abnormality. "True" hermaphroditism is a genetic condition in which affected individuals have both mature ovarian tissue and a testis. There are no published nationwide estimates of the frequency of true hermaphrodites. The autosomal inheritance of this condition suggests that the genes that control sexual development and differentiation are not limited to the sex chromosomes.

Forms

False male hermaphroditism

False hermaphroditism (pseudohermaphroditism) is a disease in which a person has gonads of the same sex, and the external genitalia, as a result of a malformation, resemble organs of the opposite sex. It is necessary to distinguish between male and female pseudohermaphroditism. A false male hermaphrodite is a male, but with female external genitalia and a female passport. A false female hermaphrodite is a woman, but with male external genitalia and a male passport.

Congenital adrenal hyperplasia

This familial heritage is thought to raise the possibility that, as with other inherited forms of sexual ambiguity, there may be pockets, perhaps even large geographical areas, with relatively high frequencies of true hermaphroditism. Congenital adrenal hyperplasia is an inherited autosomal recessive disorder that can affect both boys and girls. This disorder, also called adrenogenital syndrome, is the result of a genetically determined deficiency of cortisol, a steroid hormone produced by the adrenal cortex.


False male hermaphroditism is a condition when a man has anomalies of the external genitalia. The male external genitalia are similar to the female external genitalia. These anomalies have long been known and well studied, as they occur in one in 300-400 newborn boys. Usually this is a combination of two anomalies. One of them - not proper development male urethra, and the other wrong location testicles.

Androgen Insensitivity Syndrome

Androgen insensitivity syndrome is a recessive X-linked disorder in which affected individuals have external female genitalia and breast development despite being genetically male. The tissues of affected individuals do not respond to male hormones, but do respond to estrogens.

Assessed the physical and psychosexual status of 14 women with complete androgen insensitivity syndrome using a questionnaire, and medical examination to determine participants' "knowledge of their disorder as well as their opinions about medical and surgical treatment". Most of the women interviewed expressed satisfaction with their psychosexual development and sexual function.

The laying of the testicles in the embryo occurs in the lumbar region, and then descend down, pass through the inguinal canals and descend into the scrotum. As a result of impaired embryogenesis, the testicles may remain in abdominal cavity or in the inguinal canals and do not descend into the scrotum. This anomaly is called cryptorchidism. There are two forms of cryptorchidism: abdominal and inguinal. With this anomaly, the scrotum is empty or there is its complete aplasia.

All of the women in the study were satisfied with being raised as women, and none of the participants desired gender reassignment. Estimating the prevalence of interfamily at birth is difficult to make because there are no specific parameters to define intersex.

True hermaphroditism: where does nature fail?

An important consideration in regards to sexual assignment is the ethics of surgically reshaping the genitals of intersex children in order to "normalize" them. Subsequently, a standardized off-season management strategy was developed by psychologists at Johns Hopkins University based on the idea that babies are sex-neutral at birth. That the theory of psychosexual neutrality at birth has now been replaced by a model of the complex interplay between prenatal and postnatal factors that lead to the development of sex and then sexual identity.

Another anomaly in false male hermaphroditism is hypospadias. It is an underdevelopment of the peripheral sections of the male urethra with the replacement of the missing section of this channel with a dense cicatricial cord and deformation of the penis. There are several forms of this anomaly, depending on the location of the external opening of the urethra.

However, at present in the United States and in many Western European countries, the most likely clinical recommendation for parents of intersex newborns, their rise as females is often associated with surgery to feminize the appearance of the genitals. A study was conducted to evaluate the impact of the feminization of intersex surgery on adult sexual function in individuals with ambiguous genitalia.

As part of this study, they noted a number of ethical issues regarding this operation, including. There is no evidence that the feminization of genital surgery results in improved psychosocial outcomes; Feminizing genital surgery cannot guarantee that adults' gender identity will develop as a woman; So what sexual function an adult can be altered by removing clitoral or phallic tissue. Developmental biology suggests that the strict belief in absolute sexual dimorphism is incorrect.

Hypospadias of the glans penis

The external opening of the urethra opens at the base of the glans penis. The patients themselves do not notice this form of anomaly and believe that in all people the external opening of the urethra is located not at the pole of the glans penis, but at the base. This form of anomaly does not violate either the act of urination or sexual intercourse and does not require treatment.

An example of the consequences of legal definitions of sexuality

Two overlapping bell curves are proposed to conceptualize sex differences among populations. Qualitative change in the composition of chromosomes, the morphology of the genital organs and hormonal activity falls on the overlap area. This view calls into question the need medical intervention in cases of intersexuality. In addition to social implications, gender and gender categorization has important political and legal implications. Identifying a person as biologically male or female can have legal implications for marriage licenses, spousal support, and the right to parenthood.

The stem form of hypospadias is that the external opening of the urethra opens on the back surface of the shaft of the penis. From this opening to the head of the penis there is a short cicatricial strand, which pulls the head to the external opening of the urethra and thereby bends the penis in the form of a hook. This form of the disease causes trouble to the sick. When a child urinates, a stream of urine is sprayed. In adults, sexual intercourse is impossible because the penis, which is curved and fixed downwards, cannot be inserted into the vagina.

However, the question of sexual classification is complicated by factors such as chromosome addition, external genitalia, gender identification and surgical change. The United States, like most countries, lacks control legislation that specifies exactly how a person's gender is determined. The following example demonstrates some of the complications that may arise.

Although medical experts testified that the individual in question was psychologically and mentally female before and after the sexual intercourse transplant surgery, the court ruled that the addition of chromosomes, and not the sex transplant surgery, external gender characteristics, or psychosocial self-assessments, Determination, determination of the sex of a person. The court recognized invalid marriage on the basis that a transgender woman was legally a man.

Articular-scrotal form of hypospadias

The external opening of the urethra opens at the root of the penis, where the scrotum begins. The hypoplasia of the penis is noted, and it is also curved with a hook. The act of urination is carried out by female type squatting. Sexual intercourse is not possible.

Scrotal hypospadias

With this anomaly, the scrotum is split into two halves, which look like the labia majora in women. The external opening of the urethra opens between the halves of the split scrotum. The penis is underdeveloped and looks like a female clitoris. The act of urination according to the female type.

This case is one example of how the legal system in one country deals with the complexities of sex and sex determination and the consequences of sex and gender determination. It is clear that there are many other possible legal implications of such definitions, and many difficult questions they raise a lot.

How is the true sex of false hermaphrodites determined?

This term comes to us from the Greeks; they composed his name of the deity and goddess, to express in one word, according to custom, the mixture or combination of Mercury and Venus, which, they believed, presided over the birth of this unusual being. But whether this prejudice from the principles of Astrology or from Hermetic philosophy, the Greeks cleverly imagined that the hermaphrodite was the offspring of Mercury and Venus. The place of honor belongs to the child of the god and goddess, which is why the legend continues to respect Greek illusions.

perineal hypospadias

The urethra is short, like a woman's, and opens at the perineum. The scrotum is split or missing. The penis is pulled up to the external opening of the urethra and looks like a clitoris. As a rule, with scrotal and perineal hypospadias, cryptorchidism is also observed, that is, the testicles are located either in the abdominal cavity or in the inguinal canals.

The nymph Salmasis, desperately in love with the young hermaphrodite and unable to wake him up, prayed to the gods to make their two bodies in one; Salmasis got her wish, but the gods left marks of both sexes on the new creature. But are there true hermaphrodites? This question could be asked in times of ignorance; it should no longer be offered during enlightened ages. If nature sometimes wanders in the production of man, it does not go as far as metamorphoses, confusion of substances and perfect assemblies of the two sexes.

Hermaphrodite in mythology

Nature never forever confuses these true signs, nor her true estimates; nature ultimately shows the characteristics that distinguish sex; And if from time to time they are hidden in infancy, they finally appear during puberty.

Newborn boys suffering from scrotal and perineal hypospadias are often registered in maternity hospitals like girls. In such a girl, the external genitalia look like a female. There are labia (split scrotum), there is a clitoris (poorly developed and curved penis). Quite often at such patients the so-called genitourinary sinus remains. This is the cavity in which the embryo (in the period embryonic development) flows into urethra and the vagina opens. The opening of this urogenital sinus looks like the entrance to the vagina. Sometimes in such patients the urogenital sinus passes into the rudiment of the vagina. Such a girl urinates in a female pattern, squatting, and is brought up as a girl.

Complications and consequences of hermaphroditism in a child

Everything is equally true for both sexes: although nature can sometimes hide a woman in the appearance of a man, this appearance, this surface bark, this appearance, does not impress enlightened men and does not turn this woman into a man. If there were men who followed a woman, this is certainly due to ambivalent characteristics; but it is in an age that is a period of pleasure that the abundance of life, the source of strength and health, can no longer be contained within, and the search in this happy age, who will be seen from the outside, announces himself and finally succeeds. This is what happened to the alleged Italian girl, who in the time of Constantine became a man, as reported by one of the fathers of the Church.

When it comes puberty, there is a conflict between biological and social sex.

Female pseudohermaphroditism

Female pseudohermaphroditism lies in the fact that in a woman who has a female genetic (chromosomal) sex and a normal structure of the internal genital organs (uterus with tubes and ovaries), the external genitalia resemble the male genital organs. At birth, such patients are often mistakenly assigned a male passport sex. Upon reaching puberty, such a "man" behaves like a woman and becomes a passive homosexual.

In this invigorating state of humanity, the smallest effort can create parts that have never been perceived, witness Marie Germain, of whom Pare spoke, who, after jumping into the stream, appeared at the same moment and was never again seen as sex for which she was previously known.

Supposed hermaphrodites who have menstrual flow are just real girls; Columbus is said to have explored them internal organs without discovering anything fundamentally different than other women. Small round, empty, but sensitive body, which is located at the back of the vulva, has almost always been described as hermaphrodites, girls who, by a trick of nature, have had this part long enough to be abused. The same Columbus we were just talking about saw a bohemian woman who asked him to remove this body and enlarge the channel to her shame so that she could, she said, receive the arms of the man she loved.

There are five degrees of virilization (masculinization, i.e. male appearance) of the external genitalia in false female hermaphrodites.

  • I degree - an isolated increase in the clitoris.
  • II degree - the labia minora are underdeveloped. There is a narrowing of the entrance to the vagina and an increase in the clitoris.
  • III degree- Enlargement of the clitoris. The labia minora are absent. The labia majora are underdeveloped. The urogenital sinus was preserved. The opening of the preserved urogenital sinus is located at the base of the enlarged clitoris.
  • Grade IV - the clitoris is large and looks like a hypospadic penis. It has a head and foreskin. At the base of such a clitoris, the urogenital sinus opens, into which both the urethra and the vagina flow. Large labia take the form of a split scrotum. The labia minora are absent. Thus, the external genitalia with IV degree of false female hermaphroditism look exactly the same as the external genitalia of a false male hermaphrodite suffering from scrotal-perineal hypospadias. But a false female hermaphrodite has a uterus and ovaries, and a false male hermaphrodite has a prostate and testicles.
  • The fifth degree of masculinization of the external genital organs with false female hermaphroditism is expressed by the fact that there is a normally developed male penis with a male urethra. The vagina either opens at the root of the penis or opens into the posterior section of the male urethra. The male urethra is formed from the urogenital sinus. This explains the fact that the vagina can open in the posterior urethra. The scrotum may be split, or it may be normally developed, but without testicles. The act of urination in such patients is carried out standing, according to male type. With the V degree of false female hermaphroditism at birth, the male gender is always mistakenly established, and patients come to the attention of urologists.

Both female and male hermaphrodites have a "penis-clitoris", in which there are two cavernous bodies. This member is always bent downwards and, during erection, acquires an arcuate shape due to the cicatricial remnants of an underdeveloped urethra, which pull the head of the penis to the external opening of the urethra (in men) or to the opening of the urogenital sinus (in women).

The genitourinary sinus in false and true hermaphrodites is a cavity that opens at the root of the clitoris or penis, into which the urethra and vagina or vaginal rudiment flow. Sometimes the depth of the urogenital sinus reaches 10-14 cm. Thus, we emphasize once again that with false female and false male hermaphroditism, the external genitalia can look exactly the same. Patients suffering from pseudohermaphroditism need to undergo surgical correction of the genital organs and change the legal sex if it was incorrectly determined at birth. False hermaphroditism is clinically manifested by homosexuality and transvestism.

True hermaphroditism and true hermaphrodites

True hermaphroditism seems to be an amazing biological phenomenon. But after all, all life on earth came from hermaphroditism. Viruses, bacteria and protozoa have no sexes. For reproduction, one individual is enough. Hermaphroditism is observed not only in primitive animal organisms. It also occurs as a norm in highly organized animals. For example, worms have a complete set of both female and male genital organs, and one individual is enough for reproduction.

Hermaphroditism is widespread among insects and flora. Hermaphroditism as a norm exists in fish, leeches, shrimps and even lizards. Since man is in the process of embryonic, prenatal development in about 1-2 months, it repeats the entire process of the evolutionary development of the animal world on the planet "Earth", in humans, as an anomaly (deformity), there has always been, is and will be hermaphroditism in one form or another.

True hermaphrodites are people who have both male and female gonads in their bodies. female, and, therefore, in the blood there are sex hormones, both female and male. True hermaphroditism is anomalies of the gonads, either in the form of the presence of separate male and female gonads, or in the form of ovotestis.

It is necessary to distinguish between two variants of true hermaphroditism.

  • True hermaphrodites with anomalies of the external genital organs.
  • True hermaphrodites without anomalies of the external genital organs.

If there are abnormalities in the development of the external genital organs, true hermaphroditism can be diagnosed in childhood. If there are no abnormalities of the vulva, true hermaphroditism can only be diagnosed after puberty. In true hermaphrodites, such clinical symptoms as transvestism and homosexuality when the legal sex does not correspond to the hormonal sex, in cases where sex hormones opposite to the legal sex predominate in the blood.

In cases where in true hermaphrodites the external genitalia are correctly developed according to the male or female type and the secondary sexual characteristics correspond to the structure of the external genitalia, the diagnosis of true hermaphroditism is possible only after puberty by the presence of two symptoms that are observed only with true hermaphroditism. These are transsexualism and bisexualism (intermittent sex). Transsexualism is what's normal developed man considers himself a woman and turns to doctors with a request to change his gender, he cannot live in a male body.

Or ok developed woman(sometimes even having children) considers herself a man, and insists on a legal and surgical sex change. As a rule, transsexualism develops gradually, in the sense that the self-identification of the sex opposite to the person's physical status becomes deeper and deeper, and can even lead to suicide. This is explained by the fact that in the gonad opposite to the phenotypic status of the patient, a tumor (usually an adenoma) very often develops, which produces a huge amount of hormones of the sex opposite to the somatic status of this person.

Such a hermaphrodite in the form of a man may have children, but then he develops transvestism, then homosexuality, and, in the end, he becomes a transsexual. Or a true hermaphrodite in the form of a woman can also have children, but then she has transvestism, homosexuality and it comes to transsexualism. The second symptom, which is observed only in true hermaphroditism, is bisexuality or intermittent sex. Man in different periods life has the male, the female sexual behavior. Sexual behavior depends on the predominance of androgens or estrogens in the blood.

Thus, there is usually no clear distinction between transvestism, homosexuality, transsexualism and bisexualism, and all four of these symptoms can be combined with true hermaphroditism. Currently, attempts are being made to treat these sexual conditions by affecting the brain, up to and including surgical operations on the brain. The effect on the brain cannot cure the clinical symptoms of hermaphroditism. It is necessary to ensure that hormones of only one sex (male or female) enter the brain with blood.

From a clinical point of view, true hermaphroditism can be divided into two categories:

  • true hermaphroditism in combination with anomalies of the external genitalia;
  • true hermaphroditism without anomalies of the external genital organs and without secondary sexual characteristics of the contralateral sex.

True hermaphroditism in combination with anomalies of the external genital organs. Such anomalies usually include penoscrotal, scrotal, or perineal hypospadias. Quite often at the same time observe the preservation of the urogenital sinus in combination with cryptorchidism. Sometimes there are secondary sexual characteristics of the sex opposite to the passport one. There is a sharply enlarged clitoris in the form of a hypospadal penis.

Such people turn to urologists, andrologists and gynecologists for help, and sometimes they are diagnosed with true hermaphroditism. But usually the vulva is surgically reconstructed and adjusted to the legal sex, and hermaphroditism (true) is not diagnosed.

True hermaphrodites, who have no abnormalities of the vulva and no inversions of secondary sex characteristics, usually have a complete set of all male or female genital organs, and have a gonad or gonadal tissue of the contralateral sex. In such patients, hermaphroditism is almost never diagnosed, although they have vivid symptoms of hermaphroditism in the form of transvestism, homosexuality, transsexualism and bisexuality. If such people turn to a urologist, andrologist, gynecologist or endocrinologist, these doctors ascertain the correct development of the external genital organs and send them to a sexologist for psychotherapy. Sexologists can neither diagnose nor cure hermaphroditism.

Transvestites, homosexuals and bisexuals usually come to terms with their gender anomaly. And transsexuals by hook or by crook are trying to change their legal gender. The transsexualism syndrome occurs in such true hermaphrodites who have a complete set of all genital organs of the same sex, which allows them to be the mother or father of the child. But they have a gonad of the opposite sex. Transsexualism begins to grow as a hormone-forming tumor of the opposite sex in the form of an adenoma appears in the gonad of the opposite sex. And the radical treatment of transsexualism is to find and remove this gonad of the opposite sex with a tumor. There are three variants of anomalies of the gonads with true hermaphroditism:

  • a person has one or two testicular gonads, and he also has one or two ovaries;
  • in humans, one or two gonads are built according to the type of ovotestis;
  • in humans, one or two gonads are built in mosaic. In the gonad, the tissues of the testicle and ovary are intertwined in a mosaic pattern.

Sexologists believe that if the external genital organs (male or female) are developed normally and do not have any anomalies, then there can be no hermaphroditism. With true hermaphroditism, the external genitalia can be developed absolutely normally. True hermaphroditism is not anomalies of the external genital organs, but anomalies of the gonads.

There are three main morphological variants of true hermaphroditism:

  • The first option: a person has a complete set of genital organs of one sex (male or female) and also in the body there are one or two gonads of the opposite sex without any anomalies of the external genital organs.
  • The second option: a person has a complete set of genital organs of one sex (male or female), one or two gonads of the opposite sex, as well as other (except gonads) genital organs of the opposite sex. In "men" (according to the full set of genital organs) - the vagina or uterus, or mammary glands. In "women" (for a full set of genital organs) - the scrotum, penis, prostate.
  • The third variant of true hermaphroditism: a person has gonads of both sexes and incomplete sets of other genital organs in various combinations. This variant is characterized by various anomalies of the external genitalia and therefore urologists, andrologists and gynecologists diagnose it most often.

Undoubtedly, there is another, fourth, morphological version of true hermaphroditism, when a person has a complete set of genital organs. both men and women. Such hermaphrodites have a scrotum and testicles in the scrotum, there are epididymis, vas deferens, seminal vesicles, a prostate, and a penis with a male urethra. But in the same person, between the root of the penis and the beginning of the scrotum, there is an entrance to the vagina, vagina, cervix, uterus, fallopian tubes and ovaries. A variant of such true hermaphroditism in humans has not yet been described in the domestic medical literature.

Hermaphroditism can develop against the background of any genetic, chromosomal sex. In the male chromosome field 46XY, hermaphroditism is more often accompanied by scrotal-perineal hypospadias with cryptorchidism, and the presence of the urogenital sinus, or without it. In the female chromosome field 46XX, hermaphroditism is most often observed in the presence of clitoral hypertrophy and vaginal ectopia of the urethra with or without the presence of the urogenital sinus.

Much less often, hermaphroditism is observed with a mosaic structure of chromosomes: XX / XY; XX/XXYY; XX/XXY. Other variants of the set of sex chromosomes are also possible.

Based on clinical observations, a working classification of forms and variants of hermaphroditism has been developed.

Classification of forms and variants of hermaphroditism

  • False hermaphroditism
    • Male false hermaphroditism.
    • Female false hermaphroditism.
  • True hermaphroditism
    • The presence of gonads of both sexes.
    • Ovotestis.
    • Mosaic structure of the gonads.
  • True hermaphroditism without anomalies of the external genitalia
    • With male secondary sexual characteristics.
    • With female secondary sexual characteristics.
    • With secondary sexual characteristics of both sexes.
    • A complete set of genital organs of one sex (male or female) gonad (or gonadal tissue) of the opposite sex with a hormone-producing tumor in it, which is manifested by transsexualism.
  • True hermaphroditism with the presence of anomalies of the external bottom organs
    • A complete set of genital organs of one sex (male or female) and the presence of organs of the opposite sex.
    • Incomplete sets of genital organs of both sexes in various combinations.
    • Complete sets of genital organs of both male and female sexes.

Diagnosis of hermaphroditism

Gender - very important characteristic absolutely every person. In all documents that accompany a person from the moment of birth to death, the second column after the last name, first name and patronymic is the gender designation. Gender is indicated on the birth certificate, on all life forms, and on the death certificate.

The diagnosis of sex in hermaphroditism is based on the definition of six basic sex criteria. Therefore, sometimes they say and write that each person has not one, but as many as six sexes, and they may or may not coincide. Each person has a genetic sex, gonadal sex, hormonal sex, phenotypic sex, psychological (mental) sex and legal (passport) sex.

The genetic sex is laid at the time of fertilization. It is also called chromosomal sex.

The normal human chromosome set contains 22 pairs of chromosomes. In addition, there are two more sex chromosomes. There are 46 total chromosomes in humans. Sexual female chromosomes are indicated by the sign X. Women have two of them. The chromosomal genotype of a woman is designated 46XX. Sex cells (gametes) contain a half set of chromosomes, which includes only one sex chromosome. The eggs are produced in the female gonad (ovary) and contain 22 chromosomes (autosomes) and one sex X chromosome. Spermatozoa (sperm) are produced in the male gonad (testis), contain 22 autosomes and one sex chromosome (either the X chromosome or the Y chromosome). Y denotes the chromosome that determines the male sex. If, as a result of fertilization of the egg with sperm, a set of sex chromosomes XX is obtained, the embryo develops female genital organs. If you get a set of XY sex chromosomes, the male reproductive organs are formed in the embryo. So "conceived" by nature, but there are deviations. The male karyotype is designated 46XY. If, as a result of fertilization, the so-called mosaic set of sex chromosomes (XX / XY; XX / XXYY; XXX / XY; XX / XXY, etc.) is obtained, then both female and male genital organs will form in the embryo, that is, a bisexual organism will develop in the form false or true hermaphrodite. However, hermaphroditism can also form with a normal female karyotype (46XX) and with a normal male karyotype (46XY).

Diagnosis of chromosomal, genetic sex, genotype, karyotype is carried out by studying chromosomes, but this requires special equipment and qualifications. A widely used technique for diagnosing the genotype is the method of determining the sex chromatin of cell nuclei. To do this, perform a skin cut or scraping from the oral mucosa, or a blood smear. The drug is subjected to a special staining. The location of the staining parts in the nuclei of cells is different in men and women. The method of determining the genetic sex by sex chromatin is imperfect because the location of sex chromatin typical for the female sex is found in women only in 70-90% of all cells, however, such an arrangement of sex chromatin is found in 5-6% of the cells of the male body.


Chromosomal sex by itself (in isolation) is not an accurate determinant of a person's gender. With a normal male genotype (46XY), a person cannot be a woman, but he can be a hermaphrodite (bisexual) or a eunuch (sexless). So with anorchism (gonadal agenesis) of aplasia of both testicles, the karyotype can be male (46XY), the genitals develop either according to the female type or have a rudimentary structure. This is classic eunuchoidism with a male genotype.

The second sex (sex criterion), which every person has, is gonadal. This sex is also called the true sex or biological sex. Humans have four gonadal sexes:

  • female - there are ovaries in the body:
  • male - there are testicles in the body;
  • bisexuality (true hermaphroditism) - in the body there is both ovarian tissue and testicular tissue:
  • asexuality (eunuchoidism) - there are no sex glands (gonads) in the body.

The gonadal sex is determined by biopsy and histological examination. Pieces for histological examination are taken from both glands, since one of them may be a testicle and the other an ovary. It is necessary to examine the gonad from one and the other poles, since one half of the gland can be an ovary, and the other a testicle. This gonad is called an ovotestis. The gland can also have a mosaic structure (there are areas of testicular tissue in the ovarian tissue, or, conversely, there are areas of ovarian tissue in the testicular tissue). In order to take a piece of the gonad for research, it must be found and exposed. Gonads in humans are normally found in men in the scrotum, in women - in the abdominal cavity on the sides of the uterus. With hermaphroditism, the testicle may be in the abdominal cavity "and the ovary may be in the scrotum. By the way, the uterus may also be in the scrotum. Gonads can also be in the labia majora, in the inguinal canals, in the perineum and in inguinal hernias. Sex glands in the scrotum, in the inguinal canals and in the labia can be palpated. To determine the presence of gonads in the abdominal cavity, ultrasound and laparoscopy are performed, which can be combined with a biopsy. Normally, the genetic sex should match the gonadal sex, but they may not match, and then they observe different variants sex anomalies.

The third sex (sexual criterion) is hormonal. It is also called biological or true sex. It would seem that the gonadal sex should always coincide with the hormonal sex, because sex hormones are produced by the gonads. The ovary always produces estrogens, and the testicle must always produce androgens.

Hormonal sex is diagnosed by determining the level of androgens and estrogens in the blood. Hormonal sexes a person also has four:

  • male - in the blood normal level androgens;
  • female - a normal level of estrogen in the blood;
  • hermaphroditism in the blood high level and androgens and estrogens (the amount of male and female sex hormones in the blood varies widely);
  • asexuality - there are no or almost no female or male sex hormones in the blood.

Normally, the genetic, gonadal and hormonal sexes must match, that is, they must all be male or all must be female. If they do not match, then a gender anomaly occurs.

The fourth sex (sex criterion) of each person is the somatic or phenotype sex. This is the general appearance of a person, the structure of the external genitalia, secondary sexual characteristics, clothes and shoes, hairstyle and jewelry. All these signs depend on the influence of sex hormones and may vary depending on age and the occurrence of tumors in the tissue of the gonads. Changes in the phenotypic picture are always due to changes in the hormonal activity of the sex glands. Humans have four phenotypic sexes:

  • male - a person looks like a man;
  • female - a person looks like a woman;
  • bisexuality in the appearance of a person has both male and female features;
  • eunuchoidism - a person in appearance has neither male nor female features. He is childish and looks like a child.

Phenotypic sex always matches gonadal and hormonal sex, but may not match genetic sex. Phenotypic sex can only be diagnosed in sexually mature people by their appearance. Children do not have secondary sexual characteristics, and the somatic sex is diagnosed only by the structure of the external genital organs. And in its diagnosis, errors are not uncommon, since the structure of the external genitalia may not correspond to the gonadal and hormonal sex. Somatic sex can change under the influence hormonal treatment some diseases.

The fifth sex (sexual criterion) of a person is psychological or mental. This sex is completely determined by the presence or absence of sex hormones in the blood. Children have no sex hormones in their blood and no sexual behavior.

The mental gender in children is determined by the sexual psycho-orientation that the child receives from parents and people around him. In sexually mature people, psychological gender is determined by gender auto-identification: who a person feels like - a man or a woman. There are four mental sexes:

  • male - male sexual behavior;
  • female - female sexual behavior;
  • bisexuality is manifested by either male or female sexual behavior (alternating sex; bisexuality);
  • asexuality - there is no sexual behavior.

The sixth gender (gender criterion) of a person is a legal, passport, metric, civil, social, legal gender. This is the gender that is indicated in the personal documents of a person. There are only two legal genders: male and female. The passport sex may not coincide with either the genetic sex, or with the gonadal sex, or with the hormonal sex, or with the somatic sex, or with the psychological sex. Hermaphrodites and eunuchs have either male or female documents. In the first days after the birth of a child, the gender of male or female is officially registered. In this case, the gender may be determined incorrectly. Incorrect sex determination occurs not only in cases of anomalies of the external genital organs. With typically female or male external genitalia, the sex may be incorrectly determined, as the child may turn out to be a false or true hermaphrodite.

Thus, at present, urologists and gynecologists can, using surgery hermaphroditism, create male and female external genitalia. V male side: by straightening the deformed body of the penis and creating an artificial male urethra from the patient's own tissues, as well as surgically or hormonally (using chorionic gonadotropin) bringing the testicles down into the scrotum. The scrotum, in turn, is created from the skin of the perineum or "labia" of the patient.


Correction of the external genitalia to the female side consists in a surgical reduction in the size of the “clitoris-penis”, as well as in the creation of a vagina using tissues and the urogenital sinus cavity, or alloplastic materials, or a fragment of the peritoneum. Moreover, it is now possible to surgically create sex gonads by transplanting a male or female gonad on a vascular stalk into the body, which will provide an appropriate gonadal and hormonal sex. Hormonal sex can also be created by planting cultures of embryonic cells that produce sex hormones into the body. These methods save patients from the daily administration of synthetic sex hormones.

Children do not have clinical manifestations of true and false hermaphroditism in the form of transvestism, homosexuality, transsexualism and bisexualism, but the prevention of these phenomena depends entirely on pediatricians. They should understand the anomalies of the external genital organs and all such children should be referred to urological, gynecological or pediatric surgical clinics.

True hermaphroditism can be cured if the gonad (or gonadal tissue) of the opposite sex is found and removed from the body. You need to look for the gonad in the Douglas space, in the scrotum, in the inguinal canals and in the labia majora. If a separate gonad is not found, it is necessary to do a biopsy of the gonads and, in cases of ovotestis, resect the gonads, and in cases of a mosaic structure of the gonads, it is necessary to raise the question of castration followed by hormone therapy or donor gonad transplantation and correction of the external genitalia.

The treatment of hermaphroditism is very effective and consists in removing the gonads of one sex and leaving the gonads of the other sex. The direction of sex correction to the male or female side depends on the development and anomalies of other genital organs, except for the genital glands. Sexually mature patients usually choose the direction of sex correction themselves. They themselves feel either men or women. This sexual self-awareness depends only on which sex hormones (male or female) prevail in the body.

Dynamic monitoring of patients with false and true hermaphroditism consists in periodically determining the concentration of pituitary-gonadal hormones in the blood, in performing ultrasound of the genital organs and gonads. It is necessary to control the stability of the patient's sexual self-identification and his phenotypic secondary sexual characteristics.

Prevention

Prevention of hermaphroditism - minimization of the influence of factors causing dysembryogenesis, including correct application hormonal estrogen-containing contraceptives by women planning pregnancy. It has been proven that during the conception of a fetus that occurred against the background of prolonged hyperestrogenization female body, increases the risk of anomalies of the external genitalia and genital glands, in particular various forms hypospadias in male fetuses.

Forecast

The prognosis for the life of patients with hermaphroditism is generally favorable, but one should not forget about the possibility of malignancy of the abnormal gonad, including the ovotestis. In this case, the prognosis of the disease depends on the histological form of the neoplasm of the gonad. For the purpose of prevention and early warning disease, it is advisable to conduct an ultrasound of the structure of the tissues of the gonads approximately once every six months. If a neoplasm is found in without fail it is necessary to perform a biopsy and a histological examination of the formation to decide whether a radical operation is necessary.

Unfortunately, at present, patients with false and true hermaphroditism, especially those who do not have external anomalies of the external genital organs, do not always receive timely qualified assistance. This is due to two factors - insufficient coverage of this problem in the medical literature (the problem of hermaphroditism is not included in the curricula medical universities), and the unwillingness of the patients themselves to advertise their condition, given the specific clinical manifestations of this disease in the form of homosexuality, transsexualism, bisexualism and the attitude of society towards them.

Therefore, most of these patients are in the category of sexual minorities. Sounds absurd, but best position there are patients with hermaphroditism who have external anomalies of the external genital organs. They, as a rule, attract the attention of urologists or gynecologists, they are subjected to a special examination, as a result of which anomalies of the gonads are often detected.

We have all heard about hermaphrodites, but not everyone knows that there are several varieties of hermaphroditism.

This phenomenon deserves everyone to know more about it.

Sexual hermaphroditism

Sexual hermaphroditism refers to a situation where a person has a certain degree of developed genital organs of both sexes, both functionally and anatomically. Sexual generalized hermaphroditism distinguishes all bisexual persons into one group.

How is false hermaphroditism different from true hermaphroditism?

As mentioned above, bisexuality, or hermaphroditism, is expressed in the presence of the genital organs of two sexes in one person. There are such types of hermaphroditism as true hermaphroditism and false. How is true so different from false hermaphroditism?

False pseudo hermaphroditism is a disease in which a person has the gonads of one sex, but his external genitalia are similar in structure to those of the opposite sex. Pseudo hermaphroditism can be both female and male. In the case of a man, he has female external genitalia. There are two anomalies in this state of affairs. The first is hypospadias, in which the male urethra does not develop correctly, and the second is cryptorchidism, when the testicles are located abnormally, incorrectly.

True hermaphroditism is seen in people whose body contains the gonads of both sexes. With true hermaphroditism, more anomalies are distinguished than with false. These are ovotestis, and an anomaly of the gonads in the form of separately male, separately female genital organs, and hypospadias, and cryptorchidism.

Female hermaphroditism

A feature of female hermaphroditism is that a woman has a female chromosomal and genetic sex, the internal genital organs correspond to female ones, but the external genital organs are male. Often, at the birth of such a hermaphrodite, he is given a male passport gender. Then, reaching maturity, such a "man" in behavior completely resembles a woman, most often classifying himself as a passive homosexual.

Female ordinary hermaphroditism, as well as virtually all other forms of hermaphroditism, implies infertility in all individuals with similar developmental anomalies.