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Hermaphroditism (intersexuality): types, symptoms and treatment

Hermaphroditism (intersexuality): types, symptoms and treatment

July 22, 2022

The sexual differentiation of the human embryo is an extremely important stage during the development of pregnancy. It determines the biological sex of the person and the subsequent sexual development of this.

In the event that the pregnancy takes place without any alteration, the sex of the embryo will be feminine "by default", carrying out a series of chain reactions at the genetic and hormonal level for the embryo to develop as a male.

But there are a series of cases, in which certain causes, sometimes unknown, cause this process to be altered, leading to phenomena such as hermaphroditism or intersexuality .

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What is hermaphroditism?

At a general level, hermaphroditism is an expression used in biology to name those organisms that possess reproductive organs corresponding to both sexes . Specifically, except humans, those creatures or organisms listed as hermaphrodites are trained to produce sex cells, also called gametes, both male and female.

With regard to people, some cases similar to hermaphroditism have been described, which are determined as pseudohermaphroditism since there is no possibility of reproduction of both forms. Even so, from a gender perspective, the most appropriate term to describe people with these characteristics is intersexual.

An intersex person has a modification in their body, due to this modification that person has a divergence between your genitals and your sex ; being able to present genetic and phenotypical characteristics belonging to both sexes, in variable proportions.

A widespread myth is the belief that an intersex person possesses, simultaneously, sexual and reproductive organs, both male and female fully developed and functional. However, what characterizes intersexuality is that, unlike the hermaphroditism seen in other animals, an intersexual person has a genital indeterminacy that can occur in different degrees and that can manifest during any stage of his life.

  • Related article: "What is intersexuality? Definition, causes and types"

Categories of intersexuality

Human intersexuality can be divided into several categories according to the causes that originated it.

1. Intersexuality 46, XX

In this type of intersexuality the person is born with the Chromosomal characteristics of a woman and ovaries of the female sex , but its phenotype, or external appearance of the genitals, is masculine.

This phenomenon has as its most common cause Excessive exposure of the fetus to male hormones . In this way, during pregnancy the labia majora come together and the clitoris increases in size until it reaches the appearance of a penis. As regards the rest of the female reproductive organs, such as the uterus or the fallopian tubes, they usually develop correctly.

Some of the causes why the fetus is exposed to this amount hormones can be:

  • Congenital adrenal hyperplasia , this being the most probable cause.
  • Consumption, by the mother, of male hormones during pregnancy.
  • Ovarian tumors that produce an excess of male hormones.
  • Aromatase deficiency in the fetus , responsible for transforming male hormones into female hormones. The effects of this deficiency can begin to be noticed at puberty, during which it is possible that masculine characteristics begin to appear.

2. Intersexuality 46, XY

This alteration would be the opposite of the previous one. In these cases the person has male chromosomes , however the genitals are visibly feminine or imprecise in any case.

As for the formation of the internal reproductive system, the testes may have developed normally, but cases have been described in which they suffer some malformation or even fail to form .

For a correct development of the male genitalia, both internal and external, it is necessary a good stability of both types of sex hormones. Some of the reasons why this is sometimes not the case are:

  • Malformation of the testicles : if the testicles do not develop correctly, the production of male hormones can be reduced, leading to subvirilization.
  • Alterations in the formation of testosterone : lack or deficit in some of the enzymes responsible for producing this hormone properly.
  • Deficit of 5-alpha-reductase : this deficit is the main cause of intersexuality 46-XY, causing the well-known syndrome of androgen insensitivity (SIA).By which people with abnormal testicles, generate correct proportions of testosterone, however the recipients of these do not work properly.

3. True gonadal intersex

In these cases the person has the same way both ovarian tissue and testicular tissue . This phenomenon was known as true hermaphroditism, since the person can have this tissue in the same gonad, which is known as "ovotestículo", or have an ovary and a testicle at the same time.

At the chromosomal level, true gonadal intersexuality can be presented in both XX and XY , and the external genitals reveal themselves with masculine, feminine or ambiguous aspect. The causes of this type of intersexuality are still unknown in humans.

4. Complex intersex disorders or indeterminacy of sexual development

The latter category includes a series of disorders in which There is no difference between internal and external sex structures . Rather, alterations occur in sex hormone levels and in overall sexual development.

These cases include the 45-XO disorders, in which only one X chromosome exists; and the 47-XXY or 47-XXX, in which the person is born with extra sex chromosome.


The symptoms of intersexuality are variable in terms of degrees and assiduity, depending on the causes that underlie this.

The main symptoms are:

  • Clitoral enlargement or clitoromegaly
  • Micropene
  • Genital ambiguity
  • Joint of the lips
  • No descent of the testicles in male children, with the possibility that they are ovaries
  • Lip masses in girls that can be testicles.
  • Apparently unusual genitals
  • Hypospadias or abnormality whereby the hole in the penis is located in another place or the urethra has an opening in the vagina.
  • Lack or delay of puberty
  • Abrupt changes in puberty

Diagnostic tests and intervention

To carry out a good diagnosis of intersexuality, and possible subsequent treatment, it is necessary to carry out a series of tests by medical personnel. These are:

  • Analysis of hormone levels
  • Chromosome analysis
  • Hormone stimulation tests
  • Molecular tests
  • Genital endoscopy
  • Ultrasonography or magnetic resonance that allows to verify the existence of internal sexual structures

Medical and psychological intervention

Given the complexity of these alterations and the complexity of human sexual development, the performance of a multidisciplinary team is necessary that works, both with the person and with the family, both at the medical level and at the psychological level.

Traditionally, the procedure to be followed was the sex assignment according to external genitalia , instead of taking into account the chromosome configuration, leaving no room for ambiguity and recommending an early surgery in which the testicular or ovarian tissue was removed that did not suit.

However, with the passage of time, a large part of the medical community observed that this procedure caused great interference in the sexual development of the person , so that the point of view has now been modified as to how to intervene in cases of intersexuality.

Currently, both chromosomal and hormonal elements are taken into account, as well as psychological and behavioral aspects that mold sexual identity; taking time when performing any surgery and involving the person in the choice of their sex.

With the support, understanding and adequate professional intervention, the prognosis of intersex people is extremely positive, being able to develop their own sexuality, healthy and without complications.

What It's Like To Be Intersex (July 2022).

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