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Pseudohermaphroditism is a condition in which an infant is born with one chromosomal and gonadal sex, but has or develops some of the secondary sexual characteristics of the other sex. It can be distinguished from 'true' hermaphroditism by the presence of only one sex's gonads, either ovaries or testes, whereas in true hermaphrodites both ovarian and testicular tissues are present. The two types of hermaphroditism and other disorders of ambiguous genitalia are now referred to by the umbrella term intersex. This acknowledges that these conditions are more complex than merely being born with the 'wrong' genitals, and that there is wide variability in the physical and psychological presentation of the condition. There is great debate over the management of intersex infants and what treatment, if any, should be performed.
It is particularly important to distinguish between sex and gender when discussing intersexuality. Sex is biologically determined in the chromosomes and genotype of an individual. Gender is much more socially and psychologically determined, and someone's gender may not match the person's sex. People who are intersex may think of themselves as male, as female, or as neither, both, or something in between.
There are two varieties of pseudohermaphroditism: female pseudohermaphroditism, known now as XX intersex, and male pseudohermaphroditism, or XY intersex. People with XX intersex have the chromosomes and ovaries of a female but external genitalia that appear male, such as an enlarged clitoris and fused labia that resemble a scrotum. People with XY intersex have the chromosomes and testes of a male, but external genitalia that appear female, such as a small penis that resembles a clitoris, internal testes and lack of scrotal sac.
People with pseudohermaphroditism can vary widely in physical appearance. Some may reach puberty looking like one sex but then develop the secondary sexual characteristics for the opposite sex, such as breasts or facial hair. Others may have external genitalia that is not clearly male or female. Some individuals may only discover their intersexuality when they are unable to conceive children of their own.
Pseudohermaphroditism may have a variety of causes, and the cause for a particular person may never be determined. An overexposure to the hormones of the opposite chromosomal sex while in utero may cause the genitals to develop abnormally. Some people are insensitive to the hormones of their chromosomal sex, and so can only incorporate the hormones of the opposite sex. Random mutations or damaged or abnormal chromosomes can also cause intersex.
Many individuals born with ambiguous genitalia have had gender assignment surgery as infants or children. In the past and by some doctors currently, gender assignment surgery was recommended very soon after birth for intersex people. Since surgically creating female genitalia is considered to be easier, the majority of intersex infants would be given female genitalia through surgery if the genitals did not look clearly and functionally male. This has caused a lot of problems for people who were assigned a gender that they felt was wrong. Even besides the psychological issues, genital surgery can have serious consequences, such as the inability to experience sexual pleasure.
Intersex children who have not had surgery may also struggle with gender identity and can experience serious social problems, such as bullying and exclusion. Medical professionals vary widely in their surgical recommendations for infants born intersex, but counseling and support is often recommended for families dealing with intersexuality. Deciding whether to have corrective surgery performed or not, and which gender a child should be raised as, is a very difficult decision and should be made by the family with the support of compassionate and capable professionals.
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