The problems of sex differentiation: hermaphrodites and eunuchs
In the normal condition of the reproductive system the reproductive organs are developed from the intermediate mesoderm. The permanent organs of the adult are preceded by a set of structures which are purely embryonic. The gonad is developed in the place, of the structural elements of the mesonephros; with which the Wolffian duct remains as the duct in males, and the MQllerian as that of the female. The male and female reproductive systems follow a similar pattern of development, sexual distinction comes as a result of the influence of hormones.
During the sex development there could be several pathologies that result in the problems of gender differentia¬tion. An examples of such conditions are: hermaphroditism and eunuchoidism.
Hermaphroditism. The term comes from a ancient Greek legend. There are two types: true hermaphroditism and false, or pseudo.
True hermaphroditism is a rare disease that can be subdivided into bilateral, unilateral and lateral types. It is the only condition in which the testicular tissue is found with the absence of Y - chromosome karyotype. It has the following characteristics: on the side where there is the ovary, the uterus, or one of its horn or the tube is usually preserved as well. At the side, where an egg is located, the epididymis and the duct are found. Hormonal studies show estrogens and androgens at a level of an average between men and women.
The diagnosis can be made only based on the histological proof of the presence of both ovarian and testicular tissue in an individual. Therapeutic measures include the operative sex change. For females the removal of all testicular tissue is necessary followed by a hormonal treatment with estrogens. For male- the removal of all ovarian tissue, and the treatment with testosterone is necessary.
False hermaphrodites can be characterized by the difference in genital structure and the structure of the gonads. It can be divided into male and female hermaphroditism.
Eunuchoidism is a clinical syndrome that is characterized by underdevelopment of gender characteristics, not proportionate physical appearance, relatively shortened body, long limbs, and obesity. There are two types of Eunuchoidism: hereditary and acquired.
The disease is due to the deficiency of hormones that regulate the development of the genitalia and ensure the formation of secondary sexual characteristics, as well as a normal functioning of many organs and systems.
It can be caused by primary testicular pathology of hormone-producing elements of testis and ovaries, as well as a damage to gonadotrophic function of the hypothalamic pituitary system.
Eunuchoidism has the following characteristics: testicles take the wrong localization in the abdomen, seminiferous tubule cells are small, the spermatogenesis does not occurs. The epididymis is usually the same. The ovary is small, dense, sclerotic, the protein shell is thickened. As to the visual appearances: the skin is wrinkled of yellowish color, skeletal muscles are poorly developed.
The disorders of sex differentiation have a lot of different sides, not only from the point of view of medicine, but also from the psychological, social and others. Therefore the patient with this condition should be treated not only medically but also have a psychological treatment.
M. Rossinskaya, A. Yudina
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