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ISSN 0973 - 0958
Genital Problems in
Children
Absence of Testis from
Scrotum
Circumcision in Children
Acute Swelling and Pain
in Scrotal Region
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ABNORMAL GENITALIA IN NEWBORNS
Continued...
This is a very complicated subject and without going into too many details, suffice it to say that numerous investigations are necessary. The investigations vary from combinations of blood tests, radiological tests, and operative procedures with microscopic examination to come to a final diagnosis. The art and science of this subject is firstly to determine the actual sex of the child and then reconstruct the
This is a very complicated subject and without going into too many details, suffice it to say that numerous investigations are necessary. The investigations vary from combinations of blood tests, radiological tests, and operative procedures with microscopic examination to come to a final diagnosis. The art and science of this subject is firstly to determine the actual sex of the child and then reconstruct the
external genitals to match the sex. This may not always be possible and the confusion recurs. Hence, to make it simple, the decision has to be made on what this child should be brought up as "a male or a female" This will depend on a number of factors some of which I shall try to explain in the next few lines.
The first important aspect of this condition is knowing what is the chromosomal sex of the child. Normal females have a XX sex Chromosome, and normal males have a XY sex Chromosome. There are a few such children who have abnormal sex chromosome like a XO or a XXY and others. This complicates matter and hence this test by itself cannot be fully relied on.
Another factor is the type and quality of external genitals the child is born with. A normal boy must have a penis, scrotum, testes within the scrotum. In a girl, there is a clitoris, a urethral opening and a vaginal opening surrounded by two pairs of labia or lips on each side. No gonad is felt on the outside. In children with intersex there may be a penis like structure but the urethral opening may be like a girl, there may be structures that are midway between a scrotum and labia, male looking child with the testes not seen or felt in the scrotal or labial folds. In short, a quick look gives the impression of a boy but detailed examination belies the truth, and in others it may be vice versa.
A third factor is the internal genitals of the child. In a boy, there will be prostate gland surrounding the initial part of the urethra after the bladder; seminal vesicles behind the prostate and the vas deferens on each side opening into the urethra ( tubes bringing the sperms from the testis to the urethra). In contrast, a female will have a uterus just behind the bladder, with a Fallopian tube on each side of the uterus and an ovary at the end of the tube. In children with intersex, externally though appears like boy, this child may have a uterus inside or the other way around - looking like a girl externally, but will have no uterus or ovaries inside.
There are other factors to be considered before deciding on a course of therapy - like age at which the child is brought to the doctor first, and also the psychology of the family and the individual. A final decision is taken after a thorough discussion between the doctor and the parents of the child as to what should be the sex of rearing. In an older child the wishes of the parents and the child are to be taken into consideration.
The first important aspect of this condition is knowing what is the chromosomal sex of the child. Normal females have a XX sex Chromosome, and normal males have a XY sex Chromosome. There are a few such children who have abnormal sex chromosome like a XO or a XXY and others. This complicates matter and hence this test by itself cannot be fully relied on.
Another factor is the type and quality of external genitals the child is born with. A normal boy must have a penis, scrotum, testes within the scrotum. In a girl, there is a clitoris, a urethral opening and a vaginal opening surrounded by two pairs of labia or lips on each side. No gonad is felt on the outside. In children with intersex there may be a penis like structure but the urethral opening may be like a girl, there may be structures that are midway between a scrotum and labia, male looking child with the testes not seen or felt in the scrotal or labial folds. In short, a quick look gives the impression of a boy but detailed examination belies the truth, and in others it may be vice versa.
A third factor is the internal genitals of the child. In a boy, there will be prostate gland surrounding the initial part of the urethra after the bladder; seminal vesicles behind the prostate and the vas deferens on each side opening into the urethra ( tubes bringing the sperms from the testis to the urethra). In contrast, a female will have a uterus just behind the bladder, with a Fallopian tube on each side of the uterus and an ovary at the end of the tube. In children with intersex, externally though appears like boy, this child may have a uterus inside or the other way around - looking like a girl externally, but will have no uterus or ovaries inside.
There are other factors to be considered before deciding on a course of therapy - like age at which the child is brought to the doctor first, and also the psychology of the family and the individual. A final decision is taken after a thorough discussion between the doctor and the parents of the child as to what should be the sex of rearing. In an older child the wishes of the parents and the child are to be taken into consideration.
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