{"id":51,"date":"2019-07-23T09:39:34","date_gmt":"2019-07-23T08:39:34","guid":{"rendered":"https:\/\/mrkhvoice.nfshost.com\/?p=51"},"modified":"2019-08-01T03:01:13","modified_gmt":"2019-08-01T02:01:13","slug":"is-there-such-a-thing-as-intersex-genitalia","status":"publish","type":"post","link":"https:\/\/mrkhvoice.com\/index.php\/2019\/07\/23\/is-there-such-a-thing-as-intersex-genitalia\/","title":{"rendered":"Is there such a thing as &#8220;intersex genitalia&#8221;?"},"content":{"rendered":"\n<p>Okay, let&#8217;s talk about &#8220;intersex genitalia&#8221;, or using its proper term, ambiguous genitalia and how sex is determined. First of all, it is not some doctor, rubbing their chin, doing a sharp intake of breath and writing down a question mark, or a &#8220;best guess&#8221;, with a shrug. This really minimises the experience that parents of intersex babies go through and the <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16882788\">advances<\/a> we have made in identifying and treating DSDs.<\/p>\n\n\n\n<p>Before we begin, let\u2019s address what we mean by ambiguous genitalia. Many people think we mean genitalia that cannot be categorised as male or female at all. This is a common misconception. What we&#8217;re actually talking about is genitalia that cannot be easily classified as male or female upon initial observation. I\u2019ve written about ambiguous genitalia in genetic females and genetic males who are born with female genitalia <a href=\"https:\/\/mrkhvoice.nfshost.com\/index.php\/2019\/05\/12\/do-intersex-women-have-penises\/\">before<\/a>, but <a href=\"https:\/\/www.mayoclinic.org\/diseases-conditions\/ambiguous-genitalia\/symptoms-causes\/syc-20369273\">here\u2019s<\/a> a quick summary from an alternative source (I\u2019ll post the most relevant bits), with some additional information about other forms of male ambiguous genitalia:<\/p>\n\n\n\n<p>Babies who are genetically female (46 XX DSDs) may have:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>An enlarged clitoris, which may resemble a penis<\/li><li>Closed labia, or labia which include folds and resembles a scrotum<\/li><li>Lumps that feel like testes in the fused labia<\/li><\/ul>\n\n\n\n<p>Babies who are genetically male (46 XY DSD) may have:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Hypospadias &#8211; when the urethra doesn&#8217;t fully extend to the tip of the penis<\/li><li>An abnormally small penis with the urethral opening closer to the scrotum<\/li><li>The absence of one or both testicles in what appears to be the scrotum<\/li><li>Undescended testicles and an empty scrotum that has the appearance of a labia with or without a micropenis<\/li><\/ul>\n\n\n\n<p>One of the conditions that can cause ambiguous genitalia is <a href=\"https:\/\/www.nichd.nih.gov\/health\/topics\/cah\/conditioninfo\/symptoms\">congenital\nadrenal hyperplasia<\/a> (CAH). In the case of salt-wasting CAH (one of the two\nforms of classic CAH), this can be fatal for babies if left undiagnosed. This\nof course must be monitored. So, when a midwife sees ambiguous genitalia, a\nwhole raft of experts become involved. This includes, but is not limited to,\nspecialists from endocrinology (hormones), urology\/gynaecology (kidneys,\nbladders, genitals) and psychology. Other team members may include nurses,\ngeneticists, neonatologists, and people who work in the labs. Some smaller\nhospitals may not have these specialist teams, so the baby may need to be moved\nto a larger hospital that can offer the required services in one place.<\/p>\n\n\n\n<p>These specialists will carry out a number of investigations\nand tests. Doctors examine the baby and ask about their family\u2019s medical\nhistory. They also check the baby\u2019s chromosome pattern with a blood test. The\nchromosome pattern (aka karyotype) helps doctors understand the background to\nthe child\u2019s development and consider which direction to take the further tests.\nThe initial karyotype result usually takes 2-3 working days to come back.\nThat&#8217;s a long time for a new parent.<\/p>\n\n\n\n<p>Many babies are kept in hospital for the first few days so\nthat salt levels in the blood can be monitored. Doctors will also measure\nhormone levels in the blood, and possibly in the urine, to see how the adrenal\nglands and gonads are working. Ultrasound tests and scans can sometimes show\nthe internal sex organs (such as the womb\/uterus). Again, these are best\nperformed in specialist centres and can sometimes be difficult to interpret.\nDoctors take their time; they do not shrug and guess. Doctors might rarely look\nat the bladder and opening of the vagina with a special cystoscope and very\nrarely they might look at the gonads with a laparoscope and examine tissue\nsamples (biopsies) from them. All of this may be part of the diagnostic\nprocess.<\/p>\n\n\n\n<p>Once sex is determined, the doctors&#8217; involvement does not end there. If response to hormones has been flagged as an issue, medical interventions will also be necessary to help the child through puberty. It&#8217;s not a &#8220;fun talking point&#8221; or just some quirky variety in genitals that causes doctors to throw all medicine and science out of the window. The parent may have to make choices about surgical interventions etc. I&#8217;ve included a couple of tables at the end of this post that expand on some of the DSDs which may present with ambiguous genitalia and the possible interventions that may occur.<\/p>\n\n\n\n<p>All of this at a time when parents are normally celebrating their new arrival. <a href=\"https:\/\/www.dsdfamilies.org\/resources\">This<\/a> brilliant booklet from dsdfamilies really hammered home to me how much additional support parents of a new-born intersex baby needs and how different their experience is. I really would recommend reading the whole booklet if you would like to learn more. <\/p>\n\n\n\n<figure class=\"wp-block-image\"><img loading=\"lazy\" decoding=\"async\" width=\"924\" height=\"874\" src=\"https:\/\/mrkhvoice.nfshost.com\/wp-content\/uploads\/2019\/07\/20190722_1413398587347726434116998.jpg\" alt=\"\" class=\"wp-image-72\" srcset=\"https:\/\/mrkhvoice.com\/wp-content\/uploads\/2019\/07\/20190722_1413398587347726434116998.jpg 924w, https:\/\/mrkhvoice.com\/wp-content\/uploads\/2019\/07\/20190722_1413398587347726434116998-300x284.jpg 300w, https:\/\/mrkhvoice.com\/wp-content\/uploads\/2019\/07\/20190722_1413398587347726434116998-768x726.jpg 768w\" sizes=\"auto, (max-width: 924px) 100vw, 924px\" \/><figcaption>Extract from dsdfamilies: Our First Days DSD booklet<\/figcaption><\/figure>\n\n\n\n<p>You can also read more about the various DSDs that may result in ambiguous genitalia, the diagnostic process and any treatment that may be needed immediately after birth and throughout the persons lifetime in <a href=\"https:\/\/bestpractice.bmj.com\/topics\/en-gb\/868\">this clinical guide<\/a> from the BMJ.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"290\" src=\"https:\/\/mrkhvoice.nfshost.com\/wp-content\/uploads\/2019\/07\/image-1024x290.png\" alt=\"\" class=\"wp-image-62\" srcset=\"https:\/\/mrkhvoice.com\/wp-content\/uploads\/2019\/07\/image-1024x290.png 1024w, https:\/\/mrkhvoice.com\/wp-content\/uploads\/2019\/07\/image-300x85.png 300w, https:\/\/mrkhvoice.com\/wp-content\/uploads\/2019\/07\/image-768x218.png 768w, https:\/\/mrkhvoice.com\/wp-content\/uploads\/2019\/07\/image-1568x444.png 1568w, https:\/\/mrkhvoice.com\/wp-content\/uploads\/2019\/07\/image.png 2037w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><figcaption>Information from &#8216;Ambiguous genitalia in neonates&#8217;, BMJ Best Practice<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"601\" src=\"https:\/\/mrkhvoice.nfshost.com\/wp-content\/uploads\/2019\/07\/image-2-1024x601.png\" alt=\"\" class=\"wp-image-64\" srcset=\"https:\/\/mrkhvoice.com\/wp-content\/uploads\/2019\/07\/image-2-1024x601.png 1024w, https:\/\/mrkhvoice.com\/wp-content\/uploads\/2019\/07\/image-2-300x176.png 300w, https:\/\/mrkhvoice.com\/wp-content\/uploads\/2019\/07\/image-2-768x451.png 768w, https:\/\/mrkhvoice.com\/wp-content\/uploads\/2019\/07\/image-2-1568x921.png 1568w, https:\/\/mrkhvoice.com\/wp-content\/uploads\/2019\/07\/image-2.png 2045w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><figcaption>Information from &#8216;Ambiguous genitalia in neonates&#8217;, BMJ Best Practice<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"484\" src=\"https:\/\/mrkhvoice.nfshost.com\/wp-content\/uploads\/2019\/07\/image-3-1024x484.png\" alt=\"\" class=\"wp-image-65\" srcset=\"https:\/\/mrkhvoice.com\/wp-content\/uploads\/2019\/07\/image-3-1024x484.png 1024w, https:\/\/mrkhvoice.com\/wp-content\/uploads\/2019\/07\/image-3-300x142.png 300w, https:\/\/mrkhvoice.com\/wp-content\/uploads\/2019\/07\/image-3-768x363.png 768w, https:\/\/mrkhvoice.com\/wp-content\/uploads\/2019\/07\/image-3-1568x741.png 1568w, https:\/\/mrkhvoice.com\/wp-content\/uploads\/2019\/07\/image-3.png 2041w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><figcaption>Information from &#8216;Ambiguous genitalia in neonates&#8217;, BMJ Best Practice<\/figcaption><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>Okay, let&#8217;s talk about &#8220;intersex genitalia&#8221;, or using its proper term, ambiguous genitalia and how sex is determined. First of all, it is not some doctor, rubbing their chin, doing a sharp intake of breath and writing down a question mark, or a &#8220;best guess&#8221;, with a shrug. This really minimises the experience that parents [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":74,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[2,4],"tags":[34,29,36,26,32,21,14,20,9,33,6,13,35,22,24],"class_list":["post-51","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-46xy","category-intersex","tag-46xx","tag-46xy","tag-5-ard","tag-ambiguity","tag-ambiguous-genitalia","tag-biology","tag-cah","tag-development","tag-dsds","tag-health","tag-intersex","tag-mgd","tag-pais","tag-science","tag-sex","entry"],"jetpack_featured_media_url":"https:\/\/mrkhvoice.com\/wp-content\/uploads\/2019\/07\/20190722_141339.jpg","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/mrkhvoice.com\/index.php\/wp-json\/wp\/v2\/posts\/51","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mrkhvoice.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/mrkhvoice.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/mrkhvoice.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/mrkhvoice.com\/index.php\/wp-json\/wp\/v2\/comments?post=51"}],"version-history":[{"count":11,"href":"https:\/\/mrkhvoice.com\/index.php\/wp-json\/wp\/v2\/posts\/51\/revisions"}],"predecessor-version":[{"id":79,"href":"https:\/\/mrkhvoice.com\/index.php\/wp-json\/wp\/v2\/posts\/51\/revisions\/79"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/mrkhvoice.com\/index.php\/wp-json\/wp\/v2\/media\/74"}],"wp:attachment":[{"href":"https:\/\/mrkhvoice.com\/index.php\/wp-json\/wp\/v2\/media?parent=51"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/mrkhvoice.com\/index.php\/wp-json\/wp\/v2\/categories?post=51"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/mrkhvoice.com\/index.php\/wp-json\/wp\/v2\/tags?post=51"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}