Mavuto otukuka amtundu wamwamuna wamkazi

Zovuta zakukula kwa njira yoberekera yaikazi ndizovuta m'ziwalo zoberekera za mwana wamkazi. Zimachitika pamene akukula m'mimba mwa amayi ake.

Ziwalo zoberekera zazimayi zimaphatikizapo nyini, thumba losunga mazira, chiberekero, ndi khomo pachibelekeropo.

Mwana amayamba kupanga ziwalo zake zoberekera pakati pa milungu 4 ndi 5 ya mimba. Izi zikupitilira mpaka sabata la 20 la mimba.

Kukula ndi njira yovuta. Zinthu zambiri zingakhudze njirayi. Kukula kwa vuto la mwana wanu kumatengera nthawi yomwe kusokonekera kunachitika. Mwambiri, ngati mavuto amachitika koyambirira m'mimba, zotulukapo zake zimafalikira kwambiri.Mavuto pakukula kwa ziwalo zoberekera za atsikana atha kuyambitsidwa ndi:

• Chibadwa chosweka kapena chosowa (chibadwa cholakwika)
• Kugwiritsa ntchito mankhwala ena ali ndi pakati

Ana ena amatha kukhala ndi vuto m'matenda awo omwe amalepheretsa thupi lawo kupanga enzyme yotchedwa 21-hydroxylase. Matenda a adrenal amafunikira enzyme iyi kuti apange mahomoni monga cortisol ndi aldosterone. Matendawa amatchedwa kobadwa nako adrenal hyperplasia. Ngati mwana wakhanda akusowa mavitaminiwa, amabadwa ali ndi chiberekero, thumba losunga mazira, ndi machubu. Komabe, maliseche ake akunja adzawoneka ngati omwe amapezeka pa anyamata.

Mankhwala ena omwe mayi amatenga amatha kulowa m'magazi a mwana ndikusokoneza kukula kwa ziwalo. Mankhwala omwe amadziwika kuti amachita izi ndi diethylstilbestrol (DES). Opereka chithandizo chamankhwala nthawi ina amapatsa amayi apakati mankhwalawa kuti apewe padera komanso kubereka msanga. Komabe, asayansi adazindikira kuti ana atsikana obadwa kwa amayi omwe adamwa mankhwalawa anali ndi chiberekero chopangidwa modabwitsa. Mankhwalawa adakulitsanso mwayi kwa ana akazi kuti atenge khansa yapakhungu yosowa.

Nthawi zina, vuto lokula limatha kuwonekera mwana akangobadwa. Zitha kupangitsa kuti mwana wakhanda awonongeke. Nthawi zina, matendawa samapezeka mpaka mtsikanayo atakula.

Njira yoberekera imayamba pafupi ndi thirakiti ndi impso. Amakula nthawi imodzi ndi ziwalo zina zingapo. Zotsatira zake, zovuta zakukula munjira yoberekera ya amayi nthawi zina zimachitika ndimavuto ena. Maderawa atha kuphatikizira kwamikodzo, impso, matumbo, ndi msana.

Zovuta zakukula kwa njira yoberekera ya amayi ndi awa:

• Kuyanjana
• Maliseche osadziwika

Zovuta zina zakukula kwa njira yoberekera yaikazi ndi monga:

• Zovuta zamphepo: Cloaca ndi mawonekedwe onga chubu. Kumayambiriro koyambirira kwa chitukuko, thirakiti, mkodzo, ndi nyini zonse zilibe kanthu mu chubu chimodzi. Pambuyo pake, madera atatuwa amasiyana ndipo ali ndi mipata yawo. Ngati chovalacho chikupitilira pamene mwana wamkazi amakula m'mimba, mipata yonse siyimapangika ndikulekana. Mwachitsanzo, mwana akhoza kubadwa atangotsegula kamodzi kokha pansi pa thupi pafupi ndi malo ozungulira. Mkodzo ndi ndowe sizingatuluke mthupi. Izi zitha kupangitsa kutupa m'mimba. Zovuta zina zobisika zimatha kupangitsa kuti mwana wamkazi azioneka ngati ali ndi mbolo. Ziphuphu zobadwa nazozi ndizochepa.
• Mavuto ndi ziwalo zoberekera zakunja: Mavuto akutukuko atha kubweretsa khungu lotupa kapena labia wosakanikirana. Ma labia ophatikizidwa ndi mkhalidwe pomwe matumba a minofu kuzungulira kutseguka kwa nyini amalumikizidwa pamodzi. Mavuto ena ambiri kumaliseche akunja amakhudzana ndi ma intersex ndi maliseche osamveka bwino.
• Hymen yopanda tanthauzo: Nyengoyi ndi minyewa yopyapyala yomwe imakuta kutseguka kumaliseche. Nyimbo yosavomerezeka imatseketsa kutseguka kwa amayi. Izi nthawi zambiri zimabweretsa kutupa kowawa kwa nyini. Nthawi zina, nyengoyi imakhala ndi kabowo kakang'ono kwambiri kapena timabowo ting'onoting'ono. Vutoli silimatha kupezeka mpaka kutha msinkhu. Ana ena atsikana amabadwa opanda nyimbo. Izi sizikuwoneka ngati zachilendo.
• Mavuto a ovari: Mtsikana amatha kukhala ndi ovary owonjezera, minofu yowonjezera yolumikizidwa ndi ovary, kapena nyumba zotchedwa ovotestes zomwe zimakhala ndi minofu yamwamuna ndi wamkazi.
• Mavuto a chiberekero ndi chiberekero: Mwana wamkazi akhoza kubadwa ndi chiberekero chowonjezera ndi chiberekero, chiberekero chopangidwa ndi theka, kapena kutseka kwa chiberekero. Nthawi zambiri, atsikana obadwa ndi theka la chiberekero ndi theka lina nyini amasowa impso mbali yomweyo ya thupi. Nthawi zambiri, chiberekero chimatha kupanga "khoma" chapakati kapena septum kumtunda kwa chiberekero. Vutoli limachitika wodwalayo akabadwa ndi khomo lachiberekero koma chiberekero chiwiri. Chiberekero chapamwamba nthawi zina sichimayankhulana ndi chiberekero. Izi zimabweretsa kutupa ndi kupweteka. Zovuta zonse za chiberekero zimatha kuphatikizidwa ndi zovuta za chonde.
• Mavuto a nyini: Mwana wamkazi akhoza kubadwa opanda nyini kapena kutsegula kwa nyini kutsekeka ndi ma cell omwe ali okwera kwambiri kumaliseche kuposa komwe kuli khomo lanyimbo. Nyini yomwe imasowa nthawi zambiri imachitika chifukwa cha matenda a Mayer-Rokitansky-Kuster-Hauser. Munthawi imeneyi, mwana amasowa gawo kapena ziwalo zonse zoberekera (chiberekero, khomo pachibelekeropo, ndi machubu ofunikira). Zovuta zina zimaphatikizira kukhala ndi nyini ziwiri kapena nyini yomwe imayamba kulowa mumikodzo. Atsikana ena atha kukhala ndi chiberekero chokhala ngati mtima kapena chiberekero chokhala ndi khoma pakati penipeni.

Zizindikiro zimasiyanasiyana kutengera vuto linalake. Zitha kuphatikiza:

• Mabere samakula
• Sangathe kutulutsa chikhodzodzo
• Chotupa m'mimba, nthawi zambiri chifukwa cha magazi kapena ntchofu zomwe sizingatuluke
• Kutha msambo komwe kumachitika ngakhale mutagwiritsa ntchito tampon (chizindikiro cha nyini yachiwiri)
• Kupunduka kapena kupweteka kwa mwezi uliwonse, osasamba
• Osasamba (amenorrhea)
• Zowawa zogonana
• Kuperewera kwapadera kapena kubadwa msanga (mwina chifukwa cha chiberekero chachilendo)

Wothandizirayo atha kuwona zizindikilo za matenda otukuka nthawi yomweyo. Zizindikiro izi zitha kuphatikiza:

• Nyini yachilendo
• Chiberekero chachilendo kapena chosowa
• Chikhodzodzo kunja kwa thupi
• Ziwalo zoberekera zomwe ndizovuta kuzizindikira ngati msungwana kapena mnyamata (maliseche osadziwika)
• Ma Labia omwe amamatira limodzi kapena kukula kwakukulu
• Palibe zotseguka kumaliseche kapena kotseguka kamodzi kokha
• Kutupa clitoris

Malo am'mimba amatha kutupa kapena chotupa m'mimbamo kapena pamimba chimamveka. Woperekayo atha kuwona kuti chiberekero sichimakhala chabwinobwino.

Mayeso atha kuphatikiza:

• Endoscopy pamimba
• Karyotyping (kuyesa majini)
• Mahomoni a Hormone, makamaka testosterone ndi cortisol
• Ultrasound kapena MRI ya m'chiuno
• Mkodzo ndi seramu electrolytes

Madokotala nthawi zambiri amati opareshoni ya atsikana omwe ali ndi vuto la kakulidwe ka ziwalo zoberekera zamkati. Mwachitsanzo, nyini yotsekedwa nthawi zambiri imakonzedwa ndikuchitidwa opaleshoni.

Ngati mtsikanayo akusowa kumaliseche, woperekayo amatha kupereka mankhwala osungunulira mwanayo atakula. Dilator ndi chida chomwe chimathandiza kutambasula kapena kukulitsa malo omwe nyini amayenera kukhala. Izi zimatenga miyezi 4 mpaka 6. Kuchita opaleshoni kumathandizanso kuti apange nyini yatsopano. Opaleshoni iyenera kuchitidwa pamene mtsikanayo amatha kugwiritsa ntchito chopukutira kuti nyini yatsopano ikhale yotseguka.

Zotsatira zabwino zafotokozedwa pogwiritsa ntchito njira zamankhwala komanso zopanda opaleshoni.

Chithandizo cha zovuta zapachimbudzi nthawi zambiri chimakhudza maopaleshoni angapo ovuta. Opaleshoniyi amathetsa mavuto ndi rectum, nyini, ndi kwamikodzo.

Ngati vuto la kubadwa limayambitsa zovuta zakufa, opaleshoni yoyamba imachitika atangobadwa kumene. Kuchita maopaleshoni azovuta zina zakubala zitha kuchitidwanso mwana ali khanda. Maopaleshoni ena amatha kuchedwa mpaka mwanayo atakula.

Kuzindikira msanga ndikofunikira, makamaka pakagwa maliseche osamveka bwino. Wosamalayo akuyenera kuyang'anitsitsa asanasankhe kuti mwana ndi wamwamuna kapena wamkazi. Izi zimatchedwanso kugawa jenda. Chithandizo chiyenera kuphatikiza upangiri kwa makolo. Mwanayo adzafunikiranso uphungu akamakula.

Zida zotsatirazi zitha kupereka zambiri pazovuta zosiyanasiyana zakukula:

• CARES Foundation - www.caresfoundation.org
• DES Action USA - www.desaction.org
• Intersex Society yaku North America - www.isna.org

Zovuta zamtundu zimatha kubweretsa zovuta zakubadwa pobadwa.

Zovuta zomwe zingachitike zingayambike ngati matendawa achedwa mochedwa kapena ndikulakwitsa. Ana okhala ndi ziwalo zoberekera zodziwika bwino omwe amapatsidwa amuna kapena akazi anzawo amatha kupezeka kuti ali ndi ziwalo zamkati zokhudzana ndi kugonana komwe adakulira. Izi zitha kupangitsa mavuto amisala.

Mavuto osadziwika mu njira yoberekera ya atsikana angayambitse kusabereka komanso mavuto azakugonana.

Zovuta zina zomwe zimachitika pambuyo pake m'moyo ndi izi:

• Endometriosis
• Kupita kuntchito molawirira kwambiri (kutumiza asanakwane)
• Zotupa zam'mimba zopweteka zomwe zimafunika kuchitidwa opaleshoni
• Kupita padera mobwerezabwereza

Itanani yemwe akukuthandizani ngati mwana wanu ali:

• Ziwalo zoberekera zachilendo
• Makhalidwe achimuna
• Kupweteka kwa m'chiuno ndi kuphwanya kwa mwezi uliwonse, koma sakusamba
• Osayamba kusamba pofika zaka 16
• Palibe kukula kwa mawere msinkhu
• Palibe tsitsi lakubala mukatha msinkhu
• Zotuluka zachilendo pamimba kapena m'mabako

Amayi oyembekezera sayenera kumwa chilichonse chomwe chili ndi mahomoni achimuna. Ayenera kukaonana ndi opereka chithandizo asanamwe mankhwala amtundu uliwonse kapena zowonjezera.

Ngakhale mayi atayesetsa kuti akhale ndi pakati, mavuto amakulidwe a mwana atha kuchitika.

Kobadwa nako chilema - nyini, thumba losunga mazira, chiberekero, ndi khomo pachibelekeropo; Chibadwa chobadwira - nyini, thumba losunga mazira, chiberekero, ndi khomo pachibelekeropo; Kukula kwamatenda amtundu woberekera wamkazi

• Zovuta zakukula kwa nyini ndi kumaliseche
• Zobadwa mwachibadwa zolakwika

Daimondi DA, Yu RN. Zovuta zakukula kwakugonana: etiology, kuwunika, ndi kasamalidwe ka zamankhwala. Mu: Wein AJ, Kavoussi LR, Partin AW, Peters CA, olemba. Urology wa Campbell-Walsh. 11th ed. Philadelphia, PA: Elsevier; 2016: chap 150.

Eskew AM, Merritt DF. Zovuta za Vulvovaginal ndi mullerian. Mu: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, olemba. Nelson Textbook of Pediatrics. Wolemba 21. Philadelphia, PA: Elsevier; 2020: chap 569.

Kaefer M. Kuwongolera zovuta za maliseche mwa atsikana. Mu: Wein AJ, Kavoussi LR, Partin AW, Peters CA, olemba. Urology wa Campbell-Walsh. 11th ed. Philadelphia, PA: Elsevier; 2016: chap 149.

Rackow BW, Lobo RA, Lentz GM. Matenda obadwa nawo oberekera achikazi: zovuta za nyini, khomo pachibelekeropo, chiberekero, ndi adnexa. Mu: Lobo RA, Gershenson DM, Lentz GM, Valea FA, olemba. Gynecology Yambiri. Wachisanu ndi chiwiri. Philadelphia, PA: Elsevier; 2017: mutu 11.