Intersex

　　1. Sexual chromosome abnormality

　　During the process of embryonic development, the sex organs differentiate into male or female, and the initial determinant is initially controlled by genetic factors. For example, the karyotype of a newborn individual is 46, XX, which means it develops into a female; if the karyotype is 46, XY, it will develop into a male. This is because the Y chromosome carries the genetic gene that determines the differentiation of the primordial germ cells into testes, while the X chromosome lacks such a gene. If the number and structure of the sex chromosomes are abnormal, it will inevitably lead to disordered sexual differentiation.

　　2. Abnormal secretion of androgens during the embryonic period.

　　When the primordial germ cells differentiate towards the testis under genetic factors, the cortex atrophies, but the medulla develops well, thus the stromal cells and adrenal cortex produce a considerable amount of androgens. Due to the effect of androgens, the primordial reproductive ducts and external genitalia buds differentiate towards the male direction. If the primordial germ cells differentiate into ovaries, the adrenal cortex produces few androgens, and the reproductive ducts and external genitalia buds differentiate towards the female direction. When the genetic sex is male and androgens are insufficient for some reason, or when the genetic sex is female and androgens are excessive, it will cause disordered differentiation of the reproductive ducts and external genitalia buds.

　　3. Other factors

　　A decrease in the number of embryonic primordial germ cells can also cause genetic feminization of male. A decrease in the number of primordial germ cells can lead to the obstruction of the development of the cortex of the primordial germ cells, the formation of testicular components in the deep medulla, and the stromal cells produce androgens, causing the differentiation of the primordial reproductive ducts and external genitalia buds towards the male direction.

　　Abnormal secretion of androgens during the embryonic period. When the primordial germ cells differentiate towards the testis under genetic factors, the cortex atrophies, but the medulla develops well, thus the stromal cells and adrenal cortex produce a considerable amount of androgens. Due to the effect of androgens, the primordial reproductive ducts and external genitalia buds differentiate towards the male direction. If the primordial germ cells differentiate into ovaries, the adrenal cortex produces few androgens, and the reproductive ducts and external genitalia buds differentiate towards the female direction. When the genetic sex is male and androgens are insufficient for some reason, or when the genetic sex is female and androgens are excessive, it will cause disordered differentiation of the reproductive ducts and external genitalia buds.

　　1. Observe the patient's physical appearance, somatometric development, and the development of secondary sexual characteristics such as beard, axillary hair, pubic hair, breasts, and voice. Understand the patient's menstrual condition.

　　1. The external reproductive organs of hermaphroditism are artificially divided into 5 types: Type I external reproductive organs have an enlarged clitoris; Type II has an enlarged clitoris and a wider funnel-shaped urogenital sinus, with a common opening for the vagina and urethra; Type III has a narrower urogenital sinus, but still funnel-shaped; Type IV has a small urogenital sinus opening at the base of the penis; Type V has the urogenital sinus opening at the tip of the penis, as in a normal male.

　　1. True hermaphroditism:If the external reproductive organs are close to the female, the male features should be removed. If the female internal reproductive organs are well-developed, there may not be a pressure for reproduction. For others, it should be dealt with according to the circumstances.

　　2. Male pseudohermaphroditism:The patient's reproductive glands and karyotype are both male, the testes secrete androgens, but the body is insensitive to androgens. The internal reproductive organs are underdeveloped or undeveloped, and the external reproductive organs are female-type. The testes are retracted in the labia, inguinal canal, or abdominal cavity. This testis is prone to become exposed and malignant after youth, and it should be removed early and treated in the female direction.

　　First, observe the patient's appearance

　　Development of physical development and secondary sexual characteristics such as mustache, axillary hair, pubic hair, breasts, and voice. Understand the patient's menstrual situation.

　　Second, examination of the external genitalia

　　The external genitalia of hermaphroditism are artificially divided into 5 types: Type I external genitalia only have an enlarged clitoris; Type II has an enlarged clitoris and a wider funnel-shaped urogenital sinus, with a common opening for the vagina and urethra; Type III urogenital sinus is narrower but still funnel-shaped; Type IV the base of the penis has a small opening of the urogenital sinus; Type V the opening of the urogenital sinus is at the tip of the penis, like a normal male.

　　Third, laboratory examination

　　1. Sex chromatin examination and karyotype analysis.

　　2. Determine plasma testosterone, 5α-dihydrotestosterone, serum estradiol, progesterone, and luteinizing hormone. 24-hour urine 17-ketosteroids and pregnatriol. H-Y antigen serological examination.

　　Fourth, X-ray examination.

　　Fifth, wrist X-ray film, urogenital sinus造影, retroperitoneal air contrast, CT examination of adrenal gland size changes.

　　Sixth, surgical exploration and sex gland biopsy.

　　The diet of hermaphroditism patients should be light, easy to digest, with more fruits and vegetables, a reasonable diet, and attention to adequate nutrition. In addition, patients should avoid spicy, greasy, cold foods. Patients should eat high-protein foods, high-vitamin foods, and high-calorie foods.

　　True hermaphroditism, if the external genitalia are close to females, the male outline is removed. If the female internal genitalia develop well, there may not be pressure to bear children. Others are dealt with according to circumstances. Male pseudohermaphroditism, the patient's reproductive glands and karyotype are both male, the testes secrete androgens, but the body is insensitive to androgens. The internal genitalia are underdeveloped or not fully developed, and the external genitalia are female. The testes are hidden in the labia, inguinal canal, or abdominal cavity. This testicle is prone to head and neck malignant transformation after youth, and should be removed early and treated in the female direction.