The sexual differentiation of the human embryo is a very important stage in the development of pregnancy. It determines the biological sex of the person and his subsequent sexual development.
In the event that the pregnancy proceeds without any alteration, the sex of the embryo will be female “by default”, carrying out a series of chain reactions at the genetic and hormonal level so that the said embryo develops like a male.
But there are a number of cases in which certain, sometimes unknown, causes cause this process to be altered, leading to phenomena such as hermaphroditism or intersexuality.
What is hermaphroditism?
At a general level, hermaphroditism is a term used in biology to refer to organisms that possess reproductive organs corresponding to both sexes. Specifically, with the exception of humans, creatures or organisms classified as hermaphrodites are able to produce sex cells, also known as gametes, both male and female.
As for people, some cases similar to hermaphroditism have been described, which are determined as pseudohermaphroditism since there is no possibility of reproduction of both forms. However, from a gender perspective, the most appropriate word to describe people with these characteristics is intersex.
An intersex person has a change in their body, because of this change this person has one. discrepancy between her genitals and her sex; be able to present / display genetic and phenotypic characteristics belonging to both sexes, in varying proportions.
A common myth is the belief that an intersex person simultaneously possesses male and female sexual and reproductive organs fully developed and functional. However, what characterizes intersexuality is that, unlike hermaphroditism seen in other animals, an intersex person has genital indeterminacy which can occur to varying degrees and manifest at any stage of their life.
Human intersexuality can be divided into several categories according to the causes that have generated it.
1. Intersexuality 46, XX
In this type of intersex, the person is born with the chromosomal characteristics of a woman and female ovariesBut its phenotype, or outward appearance of the genitals, is male.
The most frequent cause of this phenomenon is excessive exposure of the fetus to male hormones. In this way, during pregnancy, the labia majora come together and the clitoris increases in size until it reaches the appearance of a penis. As for other female reproductive organs, such as the uterus or fallopian tubes, they are usually developing well.
Some of the causes that the fetus is exposed to this amount of hormones can be:
- Congenital adrenal hyperplasia, Being the most likely cause.
- Consumption by the mother of male hormones during pregnancy.
- ovarian tumors which produce excess male hormones.
- Aromatase deficiency in the fetus, Responsible for transforming male hormones into females. The effects of this deficiency may begin to be felt at puberty, during which masculine characteristics may begin to appear.
2. Intersexuality 46, XY
This modification would be the opposite of the previous one. In these cases, the person it has male chromosomesBut the genitals are noticeably feminine or imprecise in any case.
As for the formation of the internal reproductive system, the testes may have developed normally, but cases have been described in which they suffer. any malformation or even not forming.
For the proper development of male genitalia, both internal and external, good stability of both types of sex hormones is necessary. Some of the reasons that sometimes this is not the case are:
- Malformation of the testicles: If the testes do not develop properly, the production of male hormones may be reduced, resulting in understeer.
- Alterations in testosterone formation: Lack or deficiency of some of the enzymes responsible for the correct production of this hormone.
- 5-alpha-reductase deficiency: This deficiency is the main cause of intersex 46-XY, causing the well-known androgen insensitivity syndrome (AIS). Whereby people with abnormal testes generate the correct proportions of testosterone, but their receptors are not functioning properly.
3. True gonadal intersexuality
In these cases, the person similarly possesses ovarian tissue and testicular tissue. This phenomenon was known as true hermaphroditism, because the person can have this tissue in the same gonad, called “ovotestículo”, or have an ovary and a testis at the same time.
At the chromosomal level, true gonadal intersexuality this can happen in both XX and XY, And the external genitalia reveal themselves with a masculine, feminine or ambiguous appearance. The causes of this type of intersexuality are still unknown in humans.
4. Disorders of complex intersexuality or indeterminacy of sexual development
The latter category includes a number of disorders in which there is no difference between internal and external sexual structures. On the contrary, the alterations occur in the levels of sex hormones and in the overall sexual development.
These cases include 45-XO disorders, in which there is only one X chromosome; and 47-XXY or 47-XXX, in which the person is born with an extra sex chromosome.
The symptoms of intersexuality vary in degree and regularity, depending on the underlying causes.
The main symptoms are:
- Increase in the size of the clitoris or clitoromegaly
- genital ambiguity
- Union of lips
- No descent of the testes in male children, with the possibility that they are ovaries
- Lumps of the lips in girls which may be testicles.
- Seemingly unusual genitals
- Hypospadias or an abnormality where the opening of the penis is located elsewhere or the urethra has an opening in the vagina.
- Absence or delay of puberty
- Sudden changes in puberty
Diagnostic tests and intervention
For a correct diagnosis of intersexuality, and possible subsequent treatment, it is necessary to carry out a series of tests by the medical staff. These are:
- Analysis of hormone levels
- chromosome analysis
- Hormonal stimulation tests
- molecular tests
- genital endoscopy
- Ultrasound or magnetic resonance imaging to check for the existence of internal sexual structures
Medical and psychological intervention
Given the complexity of these alterations and the complexity of human sexual development, the action of a multidisciplinary team is necessary to work, both with the person and with the family, both medically and psychologically.
Traditionally, the procedure to be followed has been sex assignment based on the external genitaliaRather than taking chromosome configuration into account, leave no room for ambiguity and recommend early surgery in which inappropriate testicular or ovarian tissue has been removed.
However, over time, much of the medical community has observed that this procedure causes major interferences in the sexual development of the nobodySo, at the moment, the point of view has been changed on how to intervene in cases of intersex.
Currently, chromosomal and hormonal elements are taken into account, as well as psychological and behavioral aspects that shape gender identity; take the time to perform any surgery and involve the person in choosing their gender.
With the right support, understanding and professional intervention, the prognosis for intersex people is extremely positive, being able to develop their own sexuality, in good health and without complications.