Intersexual

Alternative names

Pseudo-hermaphroditism; Hermaphrodite; Hermaphroditism

Definition

Hermaphroditism is a term referring to being of both sexes (intersexual).

Causes, incidence, and risk factors

True hermaphroditism requires the presence of both ovarian (female) and testicular (male) reproductive tissue and is relatively rare and poorly understood. Pseudo-hermaphroditism is more common. From a medical standpoint, hermaphroditism suggests two factors:

• ambiguous external genitalia
  
• genitalia that do not match the genetic make-up of the person (example: female genitalia in a genetically male individual)
  

The following conditions can produce ambiguous genitalia and hermaphroditism:

• congenital adrenal hyperplasia
  
• fetal exposure to sex hormones
  
• testicular feminization syndrome
  
• XY gonadal dysgenesis
  
• XY gonadal agenesis
  
• chromosomal abnormalities
  o cryptophthalmos
  o Smith-Lemli-Opitz
  o 4p syndrome
  o 13q syndrome
  

Symptoms

• ambiguous genitalia at birth
  
• unusual appearing genitalia at birth
  

Signs and tests

• chromosome analysis
  
• hormone levels (for example, testosterone level)
  
• endoscopic examination (to verify the absence or presence of a vagina or cervix)
  
• ultrasound to evaluate whether internal sex organs are present (for example, a uterus)
  

Treatment

The family of the infant needs to be informed of the child's condition as early as possible. It is a very sensitive time, requiring compassion and guidance to avoid feelings of guilt, shame, or discomfort.

Early assignment of the sex is important for the emotional well being of the person. In large part, the decision is based on the corrective potential of the ambiguous genitalia, rather than on chromosomal determinants. The initial care should include a team of professionals that include neonatologists and pediatric specialists, endocrinologists, radiologists, urologists, psychologists, and geneticists.