Not many people are aware of the fact that a child can be born with genitals that are neither male nor female, known as ambiguous genitals. When awareness of this fact does eventually set in, most parents go into shock. However, there is nothing to worry about as surgery can easily rectify this irregularity. Quite a number of children with such genitals are pseudohermaphrodites, i.e., only their external organs are unclear; they have either testes or ovaries, but not both. Pseudohermaphrodites are genetically male or female.
You might wonder just how in the world this can happen. Well, abnormal levels of sex hormones in the fetus, prior to birth, can lead to defects of the external organs (penis, testes, or clitoris). A metabolic disorder or a chromosomal anomaly can cause these genital defects. When the male and female sex organs develop, they do so from similar tissues in the embryo.
When high levels of testosterone act on them before birth, these tissues become the penis, scrotum, and penile urethra. If the testosterone levels are low or absent, it can lead to the development of a clitoris and labia majora along with separate vaginal and urethral canals. The genitals in both sexes look pretty much the same.
Pseudohermaphroditism in the male results in a genetic male whose external genitals look like those of a female but whose testicles have not descended. On development, the testes produce most of the male body's androgens (male sex hormones). Androgen deficiency is caused by underdeveloped or absent testes.
The absence of androgens in a boy can give him a high pitched voice and also result in poor muscle development. Growth of pubic and underarm hair is thin and the arms and legs are unusually long. The penis, testes, and scrotum do not develop fully. To treat androgen deficiency, testosterone, which stimulates sexual development, growth, and fertility, may be given either by injection or through a skin patch.
In the case of females, when the body is exposed to high levels of male hormones, the result is female pseudohermaphroditism. The most common cause being enlarged adrenal glands that produce extra male hormones due to a missing enzyme. Although a female pseudohermaphrodite has organs that are totally female, the clitoris looks like a small penis. If the child is to be allotted a female gender, surgery is done to give it female genitals, which can involve reducing the clitoris, forming or repairing a vagina, and repairing the urethra.
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