Sexual Development Problem/Difference

What is the problem or difference in sexual development?

It is a genital appearance that is different from the appearance of a girl or a boy. The definitions of "Hermaphrodite" and "Dual Sex" used in the past do not reflect reality. Because most of these patients are not actually "hermaphrodite". There are varying degrees of difference in the development of external genital organs for some reasons. It is seen in roughly one in 2000 children.

What are the causes of sexual development problems/differences?

Genetics, some drugs used during pregnancy, deficiency or excess of some hormones secreted after birth and during adolescence, development of genital organs. It may cause problems and differences.

What causes sexual development problems/differences?

Gender identity and sexual function problems or differences, sexual orientation differences, anxiety about inadequacy regarding sexuality, difficulty in getting close to the opposite sex Important situations such as postponement and avoidance of marriage may arise. It may lead to social adaptation and psychological problems, depression, insecurity, feeling alone, self-confidence and behavioral problems, self-harm (suicide). Realizing that the person looks different from the gender he or she feels may lead to traumatic consequences.

In the long run, genital organ damage may occur. Effect on the child

There are many reasons for concern, such as the size of the penis in boys, amenorrhoea in girls, failure of breasts to grow and the absence of a uterus, hormone treatments applied for years and whether there will be a chance of fertility. Depending on the type of developmental difference, 'gender dysphoria/dissatisfaction' may be observed at a varying rate (5-50%).

A girl-looking boy may be a boy-looking girl.

Girl-type sexual development difference or The problem is the most common. Although the genetics and internal genital organ development of children in this group are girls, their external genital appearance is like boys. Male type sexual development difference or problem is the opposite; In other words, although the genetic and internal organ development is male-like, its external genital appearance is girl-like. There may also be a problem of sexual differentiation due to a sex chromosome disorder or, rarely, true bisexuality.

Sexual development problem/difference� � how to notice? What symptoms should be paid attention to?

In what cases should families be suspicious?

It is an important symptom that the baby's external genitalia shape is different from the typical girl or boy appearance. Families' baby;

A developmental problem or difference should be suspected.

It can be detected early with a detailed examination in infancy

Detailed genital examination must be performed in babies. Thus, it can be detected early in the neonatal period. The chromosome structure of babies with different external genital appearance should be investigated and their gonads (ovaries/testicles) should be examined.

To avoid delay in diagnosis, a detailed and meticulous "genital area examination" should be performed in all children who go to the doctor for any disease. .

Absence of menstruation during adolescence, failure to develop breasts or penis remaining small is an important symptom.

Early diagnosis may not be possible in some people because the external genitalia in infancy have a typical male or female appearance. However, during adolescence, their differences with their peers become evident. In this period, amenorrhea, lack of breast development, and small penis size are important symptoms.

Not being able to have children in adulthood is an important symptom.

The person may have a male appearance but feel like a female. Or she may feel like a male, even though she is seen as a typical girl from the outside. As a result of research conducted due to the inability to have children after marriage, sexual development problems or differences in adulthood may occur.

When does gender take shape in children?

Behavioral symptoms related to gender in children are more evident between the ages of 2-6. During this period, children largely recognize their sexual organs and acquire their sexual identity. To avoid significant concerns and confusion, approach the child correctly during this age period. This is important.

What are the important factors in sexual identity development?

The child exhibits more behaviors appropriate to the gender he/she identifies himself/herself as. Gender, genetic structure and hormones play an important role in the development of sexual identity. However, gender; It may not be compatible with the chromosome structure and sexual organs.

 

How should gender be approached in children?

A multidisciplinary approach is essential

A multidisciplinary approach is essential to children with sexual development problems or differences. It should be evaluated by a multidisciplinary committee that may consist of many physicians, especially a pediatric endocrinologist, a child psychiatrist, and a pediatric surgeon or pediatric urologist. This commission evaluates the individuals' future sexual life, psychology, expectations, fertility, social environment, and the family and the child, if older, by taking into account the possible benefits and harms of the treatments or approaches to be applied.

The family and the child should also be included in the approach to the current situation. ; Anxiety and expectations should be taken into consideration

When evaluating these children, close communication with the family and the child who has reached the age of understanding and perception is necessary. The family and the child should participate in the process, and their concerns and expectations should be taken into account. Except for some urgent and vital special situations, the child should always make the final decision regarding his or her future, if possible.

What should be the follow-up and treatment approach in sexual development problems/differences?

The type of approach may vary depending on the age at which the condition is noticed. It is very important to recognize the condition early for the healthiest approach.

The external genitalia of children with a definitive diagnosis and no suspicion of gender difference can be corrected in accordance with the gender they will be raised in. However, in children whose future situation is uncertain or hesitant regarding sexual identity, non-urgent treatments should be postponed to later ages and the individual should be allowed to determine his own future.

In addition, considering possible gender unhappiness and possible gender change request in the future, no surgery should be performed that is not reversible. The procedure should not be performed.

What kind of surgeries are performed in practice in those who are considered for surgical intervention? Is it done?

In male gender; Healthy, undeveloped, damaged female type internal genital organ residues can be removed. The small and malformed sexual organ can be shaped into a penis. An egg bag can be created just under the penis and the testicle, if any, can be placed in this bag. If there is no testicle, a prosthesis can be placed in the bag.

For female gender; The genital organ, which has grown in the shape of a penis, can be transformed into a clitoris by simply hiding it without cutting it off. The vagina, which opens into the urinary tube, can be separated from here and put out into the genital area. Genital lips can be made from the foreskin. If a real vagina is not available, an artificial vagina can be created from tissues such as skin or intestine.

The experience of the expert team is very important

Due to the future sexual life, fertility and serious psychosocial problems of these children, a group of experts who have received the necessary training and experience in this regard must examine, follow up and, if necessary, treat them.

What kind of treatments can be done?

Just creating organs anatomically is not a solution. Hormonal and psychological treatment and follow-up, which will last for many years, are very important.

How should these children be approached? How should one act?

There must be a multidisciplinary team approach at every stage of these individuals' lives and lifelong support must be provided.

The physician, the family and the environment have a great responsibility. Judging children can lead to suicide!

These children have a high potential to become a normally functioning individual in society. The child's privacy must be respected. Serious problems may occur, such as frequent genital examinations, taking photographs, and feeling like a "creature" as a result.

Adults with sexual development problems or differences are not due to their condition; In fact, they experience serious problems due to the behavior and perception of the family, doctor and society.

Basic points to consider:

 

SLOGANS

Genital examination of babies should be performed in detail from the moment of birth and in suspicious or different babies, The situation should be recognized early and a correct and impartial approach should be taken.

As a result of the right approach, these individuals can make improvements that increase their quality of life, such as establishing close friendships, falling in love, sexual functionality, marriage opportunities and having children.

 

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