The way of treatment of Ambiguous Genitalia And its Understanding

Amibigous genitalia or problems of intercourse development (DSD) is a disorder of s*xual development that rarely happen, where the s*x of the baby becomes unclear, i.e. whether he is male or female. In infants that experience this condition, the genitals are not formed perfectly so that the baby can have a sign of the genitals of men and women. In addition, the genitals of the outside possibility does not fit with the organs of the genital parts in or with the chromosomes of s*xual baby.

Amibigous genitalia in infants can be caused by a variety of things, whether caused by chromosomal abnormalities or abnormalities in the h0rm0nes. Abnormalities of s*xual development due to the number of chromosomes usually occur if a baby is experiencing a lack or excess of chromosomes in the cell, such as Turner's syndrome and Klinefelter's syndrome. Abnormalities of s*xual development due to a h0rm0ne usually associated with abnormalities in the production of h0rm0nes or the sensitivity of the s*xual organs during in utero to h0rm0nes.

Often amibigous genitalia does not endanger the lives of infants who suffer from abnormalities of the. However, keep in mind that a s*xual disorder that can lead to social problems, both for the baby at the time grew large and for the family.

The Causes Of Ambiguous Genitalia

The cause of the occurrence of amibigous genitalia are different for baby boys and girls. Please note that the main factor in determining the gender of a baby is the presence of the Y chromosome that determines male gender. If the fetal cells contained a Y chromosome, then the s*x of the fetus is male. Whereas if there is no Y chromosome, then the fetus will be female.

Normally, the male will have 22 pairs of chromosomes of the body (autosomes) and 1 pair of chromosomes intercourse or genitals i.e. XY. While the women will have 22 pairs of autosomes and 1 pair of chromosome is s*x i.e. XX. Klinefelter syndrome occurs when a male is having an excess of X-chromosome so that it becomes XXY. While Turner syndrome occurs when women lack the X-chromosome so that it becomes the XO.

In addition, the s*x of the baby can also be affected by the response of the fetus to the male s*xual h0rm0ne, i.e. testosterone. Therefore, the development of the person's s*x can also be affected, although the mapping to the chromosome correctly, i.e. 46 XY for a male and forty six, XX for women. Below is the cause of the occurrence of ambiguous genitalia or disorders of intercourse improvement (DSD) that occurs in the mapping of chromosomal s*x, in men, and women.

The cause of the occurrence of amibigous of the genitalia in the male, among which are:

•  Impaired development of the testes. The development of the testes in the male fetus may be disturbed by certain factors, such as genetic abnormalities or other unknown causes.
• Deficiency of the enzyme 5A-Reductase. The enzyme 5A-reductase plays a role in the formation of androgen h0rm0nes which encourages the development of male genital organs. Deficiency of these enzymes can cause the production of male s*xual h0rm0ne become interrupted and cause male genital organs do not develop properly.
•  The syndrome of insensitivity to androgens. This condition is caused by the response of the genital organs of the male fetus which is not sensitive to the h0rm0ne androgen. Although the production of the h0rm0ne androgen in the testes is not impaired, but due to insensitivity to androgen, the development of the organs of s*x can be disrupted.
• Abnormalities in the testes and testosterone. Testes and male genital organs other can be disturbed by various factors, either in the form of disruption of the structure of organs, disorders of h0rm0ne production, and disruption of h0rm0ne receptors.

The cause of the occurrence of amibigous of the genitalia in women, among which are:

1. Consumption of drugs containing the h0rm0ne androgen by the expectant mother. Some drugs exist that contain androgen h0rm0ne so if consumed by pregnant women can cause a female fetus that was conceived exposure to the h0rm0ne androgen. This condition causes the female genital organs of the developing fetus will contain the traits of the male gender. In addition, h0rm0nal imbalance expectant mothers can also cause a female fetus is exposed to h0rm0nes that trigger the occurrence of amibigous genitalia.
2.  Tumors. Tumors in pregnant women who produce the male s*xual h0rm0ne may influence the development of the female genital organs.
3. Congenital adrenal hyperplasia. Congenital adrenal hyperplasia is a genetic condition congenital that appears in pregnant women. Adrenal hyperplasia cause the mother produces the h0rm0ne androgen excess causing abnormalities of the developments of s*xual in the female fetus.

Until now, the things that increase the risk of a fetus having amibigous genitalia are still being studied. Suspected family history play a role in increasing the risk of emergence of abnormalities of s*xual development in the fetus. Some history of the disease in a family under this allegedly can increase the risk of the fetus having amibigous genitalia or DSD, among other things:

• The death of a child who is not clearly the cause.
• Abnormalities of the genital organs.
• Congenital adrenal hyperplasia.
• Infertility or sterility, absence of menstruation, or the growth of excess hair on the face in women.
•  Experience abnormalities of physical development during puberty.

Symptoms Of Ambiguous Genitalia

Amibigous of the genitalia in baby can sometimes be unknown at the time of a baby still in the womb, or newly known then by the time the baby is born. The severity of the amibigous genitalia in babies depend on the cause and time of occurrence of the abnormalities of the s*xual.

Generally, amibigous of the genitalia in baby genetically is female (has 22 autosomes and chromosome intercourse XX) can be recognized from the following signs:

• Labia closed and swells so it feels like a scrotum with testicles.
• Enlargement of the clitoris so that it looks like a small penis size.
• The hole of the urinary tract can be located on top of the clitoris, under the clitoral, or in the area of her clitoris itself.
• Often babies of women with these conditions is suspected as a baby boy with kriptokismus.

Amibigous the genitalia on baby is a genetic male (has 22 autosomes and gonosom XY) can be recognized from the following signs:

1. Hypospadias.
2. A Penis that is not ordinary and small-sized, and the hole of the urinary tract located close to the scrotum.
3. The loss of one or both testes from the scrotum or a part suspected as the scrotum.
4. The scrotum looks like labia with cryptorchidism, with or without a small penis.

Analysis Ambiguous Genitalia

Doctors and health care workers who help childbirth be able to recognize a baby who is experiencing amibigous genitalia immediately after the baby is born. After knowing the baby is experiencing amibigous genitalia, the doctor will consult with the parents of the baby to diagnose the cause of abnormalities of s*xual development in the baby. To determine the cause of the amibigous genitalia for certain, some things will be done by a doctor, such as:

• Ask the medical history of both parents and the family.
•  Perform a physical examination on the baby to check the structure of the genital organs of the baby.
• Do the examination of the baby's blood to measure h0rm0nes and other substances that affect the s*xual development of the baby, such as:

1. h0rm0nes of the endocrine glands.
2. The androgen receptor.
3. The enzyme 5A reductase.
4. The condition of the electrolyte of the baby.

• Checking the chromosome to determine the genetic s*x of the baby. Checking the chromosomes is performed by analyzing a blood sample taken from the baby.
•  Perform inspection of the genital organs of the baby using ULTRASOUND, x-rays (genitografi), a CT test, or
• Analyze tissue samples genital organs of the baby inside. The tissue sample can be taken through the procedure of this Method can determine whether there is ovarian tissue, testicular tissue, or both (ovotestis).

After the prognosis is established, the doctor will tell the parents about the s*x of the baby for genetic, anatomical abnormalities of the reproductive organs that occurs in infants and its causes, as well as the potential for reproduction at the time of the baby becomes an adult. If gender is hard to determine, then the doctor will ask the family to determine it. But be wary of that when the child grows big, he can choose a different gender. To determine the gender, the family was advised to wait until the results of the tests performed doctor done.

The Treatment Of Ambiguous Genitalia

After the doctor or baby's parents decide the gender for the baby, the doctor can start treating the baby. The purpose of the treatment of the baby is to:

1. Facilitate s*xual function and maintaining fertility s*xual the child at the time he was an adult.
2. Keep the social interaction of the child in society at the time he grew up.
3. Maintain the condition of the child psychology.

Surgery of the genital organs of the baby is generally carried out as methods of treatment of infants suffering from amibigous genitalia. Due to abnormalities of s*xual development is quite rare, often the surgery is performed with the involvement of physicians from various fields of specialization. Surgery is performed with the aim to keep the s*xual function of the child, as well as forming the external genital organs to be more normal looking.

In girls, often the function of the organs of reproduction section in a still regular, though the reproductive organs the outer part looks ambiguous. If the vagina the baby is covered by the skin, surgery can be done to help maintain his s*xual function later. In boys, the surgery is performed to improve the structure of the penis so it can keep the erectile function of the penis at the time the child becomes an adult.

If amibigous genitalia in infants is caused by h0rm0nal imbalance and remains ongoing at the time of the baby grows, the baby may be given h0rm0ne therapy to balance the reproductive h0rm0nes. The sample in girls with congenital adrenal hyperplasia who experience enlargement of the clitoris, can be given h0rm0nes to shrink the size of the clitoris. Administering the h0rm0ne can also be performed at puberty.

So that the condition of psychic and mental development of children with abnormalities of s*xual development is maintained, is preferably carried out consultation in child psychology. In addition, it is recommended that parents do not direct children as male or female, until the s*x of the child can be determined with certainty.

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