Hermaphroditism

Abstract

It is the custom to recognize sex in two forms, the typical male and the typical female, but irrespective of the initial determination in the fertilized egg, variants of sex development remain possible. This has been demonstrated with sexual polymorphisms in the laboratory and in clinical practice, resulting from experimental or accidental use of radiation, medicine, chemicals, and hormones. Assignment of sex to a newborn infant merely by glimpsing at the external genitalia may be erroneous. Correct interpretation of gender early in childhood is imperative for therapeutic management of the various mosaics of sex syndromes. The configuration of an infant's external genitalia is only one factor in a complex of symptoms to consider for correct sex assignment. In addition to the external gonadal sex pattern, other factors demanding attention are the internal gonadal sex pattern, the chromosomal sex pattern, and the hormonal sex pattern. Final sex assignment is not based on any one of these sex factors but on a thorough investigation of all of them. Chromosomal mosaics are surprisingly common, occurring in nealy 1 per cent of all newborn infants. Thousands of cases of hermaphroditism that have already been identified by cytogeneticists remain to be recognized by clinicians. Sexual ambiguities may be hereditary or may occur in twinning. Such ambiguities are common in brothers and sisters and happen spontaneously in lower vertebrates and invertebrates, in which they are not abnormal. Among the natural hermaphrodites are frogs, swordfish, chickens, butterflies, snails, worms, mussels, corals, protozoa, and algae.