Kuyanjana

Intersex ndi gulu lazikhalidwe pomwe pamakhala kusiyana pakati pa ziwalo zoberekera zakunja ndi ziwalo zoberekera zamkati (machende ndi thumba losunga mazira).

Nthawi yayitali pachikhalidwe ichi ndi hermaphroditism. Ngakhale mawu akale akuphatikizidwabe m'nkhaniyi kuti awone, asinthidwa ndi akatswiri ambiri, odwala komanso mabanja. Mowonjezereka, gulu ili lazikhalidwe limatchedwa zovuta zakukula kwa kugonana (DSDs).

Intersex itha kugawidwa m'magulu anayi:

• 46, XX yolumikizirana
• 46, kulumikizana kwa XY
• Intersex yeniyeni ya gonadal
• Ma intersex ovuta kapena osadziwika

Iliyonse yafotokozedwa mwatsatanetsatane pansipa.

Chidziwitso: Kwa ana ambiri, zomwe zimayambitsa ma intersex zitha kukhalabe zosadziwika, ngakhale atakhala ndi njira zamakono zodziwira.

46, XX INTERSEX

Munthuyo ali ndi ma chromosomes a mkazi, thumba losunga mazira a mkazi, koma maliseche akunja (akunja) omwe amawoneka achimuna. Izi nthawi zambiri zimakhala chifukwa cha mwana wamkazi yemwe amakhala ndi vuto la mahomoni amphongo asanabadwe. Labia ("milomo" kapena mapiko a khungu la maliseche akunja) amaphatikizira, ndipo clitoris imakulitsa kuti iwoneke ngati mbolo. Nthawi zambiri, munthuyu amakhala ndi chiberekero komanso machubu abwinobwino. Matendawa amatchedwanso 46, XX ndi virilization. Poyamba ankatchedwa wamkazi pseudohermaphroditism. Pali zifukwa zingapo zomwe zingayambitse:

• Kobadwa nako adrenal hyperplasia (chifukwa ambiri).
• Mahomoni achimuna (monga testosterone) omwe amatengedwa kapena kukumana ndi mayi nthawi yapakati.
• Zotupa zamwamuna zomwe zimatulutsa amayi: Izi nthawi zambiri zimakhala zotupa m'mimba. Amayi omwe ali ndi ana omwe ali ndi zaka 46, XX intersex ayenera kuyang'aniridwa pokhapokha ngati pali chifukwa china chomveka.
• Kuperewera kwa Aromatase: Izi mwina sizimawoneka mpaka kutha msinkhu. Aromatase ndi enzyme yomwe nthawi zambiri imasintha mahomoni amphongo kukhala mahomoni achikazi. Ntchito zambiri za aromatase zimatha kubweretsa kuchuluka kwa estrogen (mahomoni achikazi); Zochepa kwambiri mpaka 46, XX intersex. Atatha msinkhu, ana XX awa, omwe adaleredwa ngati atsikana, atha kuyamba kutenga mawonekedwe amphongo.

46, XY ZOTHANDIZA

Munthuyo ali ndi ma chromosomes amwamuna, koma maliseche akunja sanapangidwe bwino, osamvetsetsa, kapena owoneka bwino achikazi. Mkati, ma testes atha kukhala achilengedwe, opunduka, kapena osapezeka. Matendawa amatchedwanso 46, XY osavomerezeka. Poyamba ankatchedwa kuti pseudohermaphroditism. Kapangidwe ka ziwalo zoberekera zabwinobwino zamwamuna zimadalira mulingo woyenera pakati pa mahomoni achimuna ndi achikazi. Chifukwa chake, zimafunikira kupanga kokwanira ndi magwiridwe antchito a mahomoni achimuna. 46, XY intersex ili ndi zifukwa zambiri zomwe zingayambitse:

• Mavuto ndi ma testes: Mayesowa nthawi zambiri amatulutsa mahomoni amphongo. Ngati mayesowa sanapangidwe bwino, amadzetsa mavuto. Pali zifukwa zingapo zomwe zingayambitse izi, kuphatikiza XY yoyera gonadal dysgenesis.
• Mavuto pakupanga kwa testosterone: Testosterone imapangidwa kudzera munthawi zingapo. Iliyonse ya njira izi imafunikira ma enzyme osiyana. Zofooka zilizonse zamtunduwu zimatha kubweretsa testosterone yosakwanira ndikupanga matenda ena a 46, XY intersex. Mitundu yosiyanasiyana yobadwa nayo adrenal hyperplasia ikhoza kugwera mgululi.
• Mavuto ogwiritsa ntchito testosterone: Anthu ena amakhala ndi mayeso oyenera ndipo amapanga testosterone yokwanira, komabe amakhala ndi 46, XY intersex chifukwa cha zovuta monga 5-alpha-reductase defence kapena androgen insensitivity syndrome (AIS).
• Anthu omwe ali ndi vuto la 5-alpha-reductase alibe ma enzyme omwe amafunikira kuti asinthe testosterone kukhala dihydrotestosterone (DHT). Pali mitundu isanu yosiyana ya 5-alpha-reductase. Ana ena amakhala ndi maliseche achimuna abwinobwino, ena amakhala ndi maliseche achikazi, ndipo ambiri amakhala ndi china pakati. Ambiri amasintha kumaliseche achimuna akunja nthawi yakutha msinkhu.
• AIS ndiye chifukwa chofala kwambiri cha 46, XY intersex. Amatchedwanso testicular feminization. Apa, mahomoni onse ndi abwinobwino, koma zolandilira ku mahomoni amphongo sizigwira bwino ntchito. Pali zolakwika zoposa 150 zomwe zadziwika pakadali pano, ndipo chilichonse chimayambitsa mtundu wina wa AIS.

ZOONA ZA GONADAL INTERSEX

Munthuyo ayenera kukhala ndi minofu yamchiberekero ndi testicular. Izi zikhoza kukhala mu gonad (ovotestis) yemweyo, kapena munthuyo akhoza kukhala ndi ovary 1 ndi testis 1. Munthuyo atha kukhala ndi ma chromosomes XX, ma chromosomes a XY, kapena onse awiri. Ziwalo zoberekera zakunja zitha kukhala zosamveka bwino kapena zitha kuwoneka zachikazi kapena zachimuna. Vutoli limadziwika kuti hermaphroditism yoona. Mwa anthu ambiri omwe ali ndi gonadal intersex weniweni, chomwe chimayambitsa sichidziwika, ngakhale m'maphunziro ena anyama adalumikizidwa ndi kukhudzana ndi mankhwala ophera tizilombo wamba.

ZOTHANDIZA ZOTHANDIZA KAPENA KUSINTHA KWAMBIRI KWA ZOCHITIKA ZOKHUDZA KWAMBIRI

Makonda ambiri a chromosome kupatula 46 yosavuta, XX kapena 46, XY imatha kubweretsa zovuta pakukula kwa kugonana. Izi zikuphatikiza 45, XO (X chromosome imodzi yokha), ndi 47, XXY, 47, XXX - onsewa ali ndi chromosome yowonjezerapo yogonana, mwina X kapena Y. Matendawa samapangitsa kuti pakhale kusiyana pakati pa mkati ndi maliseche akunja. Komabe, pakhoza kukhala mavuto ndi kuchuluka kwa mahomoni ogonana, kukula kwakugonana, komanso kusintha ma chromosomes ogonana.

Zizindikiro zokhudzana ndi intersex zimadalira pazomwe zimayambitsa. Zitha kuphatikiza:

• Maliseche osadziwika pakubadwa
• Micropenis
• Clitoromegaly (clitoris wokulitsa)
• Kusakanikirana pang'ono kwa labial
• Ma testes osavomerezeka (omwe atha kukhala ovaries) mwa anyamata
• Mayi a Labani kapena inguinal (kubuula) (omwe atha kukhala mayeso) mwa atsikana
• Hypospadias (kutsegula kwa mbolo kuli kwinakwake kupatula kunsonga; mwa akazi, mtsempha [mkodzo] umatsegukira kumaliseche)
• Kupanda kutero ziwalo zoberekera zachilendo pobadwa
• Zovuta zamagetsi
• Kuchedwa kapena kutha msinkhu
• Zosintha mosayembekezereka munthu akatha msinkhu

Mayeso ndi mayeso otsatirawa atha kuchitika:

• Kusanthula kwa Chromosome
• Mulingo wa mahomoni (mwachitsanzo, mulingo wa testosterone)
• Kuyesedwa kwa mahomoni
• Mayeso a Electrolyte
• Mayeso apadera a maselo
• Endoscopic test (kutsimikizira kupezeka kapena kupezeka kwa nyini kapena khomo pachibelekeropo)
• Ultrasound kapena MRI kuti muwone ngati ziwalo zogonana zamkati zilipo (mwachitsanzo, chiberekero)

Mwachidziwikire, gulu la akatswiri azaumoyo omwe ali ndi ukadaulo pakati pa ma intersex ayenera kugwira ntchito limodzi kuti amvetsetse komanso amuthandize mwanayo ma intersex ndikuthandizira banja.

Makolo akuyenera kumvetsetsa zotsutsana komanso zosintha pakuthandizira ma intersex m'zaka zaposachedwa.M'mbuyomu, malingaliro omwe anali paliponse anali akuti zinali zabwino kwambiri kugawana jenda mwachangu momwe zingathere. Izi nthawi zambiri zimadalira ziwalo zoberekera zakunja osati jenda ya chromosomal. Makolo adauzidwa kuti asakhale ndi chinsinsi m'malingaliro awo pankhani ya jenda la mwanayo. Nthawi zambiri ankalimbikitsidwa kuchitidwa opaleshoni mofulumira. Matenda a ovari kapena testicular ochokera ku jenda linalo amachotsedwa. Mwambiri, zimawerengedwa kuti ndizosavuta kumanganso maliseche achikazi kuposa magwiridwe antchito a amuna, ndiye ngati kusankha "kolondola" sikunamveka, mwanayo nthawi zambiri amapatsidwa mwayi wokhala msungwana.

Posachedwa, malingaliro a akatswiri ambiri asintha. Kulemekeza kwambiri zovuta zakugwirira ntchito kwazimayi kwawatsogolera kuti aganizire kuti maliseche azimayi ocheperako mwina sangakhale abwinobwino kuposa maliseche amphongo, ngakhale kumangidwanso kuli "kosavuta." Kuphatikiza apo, zinthu zina zitha kukhala zofunikira kwambiri pakukhutira jenda kuposa magwiridwe antchito akumaliseche. Chromosomal, neural, mahomoni, malingaliro, ndi machitidwe amatha kukopa kudziwika kuti ndi amuna kapena akazi.

Akatswiri ambiri tsopano akulimbikitsa kuchedwetsa kuchitidwa opaleshoni kwa nthawi yayitali malinga ndi momwe angakhalire athanzi, ndikuphatikizanso mwana posankha jenda.

Zachidziwikire, ma intersex ndi nkhani yovuta, ndipo chithandizo chake chimakhala ndi zotulukapo zazifupi komanso zazitali. Yankho labwino kwambiri limadalira pazinthu zambiri, kuphatikiza zomwe zimayambitsa ma intersex. Ndi bwino kutenga nthawi kuti mumvetsetse mavuto musanapange chisankho. Gulu lothandizana ndi ma intersex lingathandize mabanja kuwadziwa bwino kafukufuku waposachedwa, ndipo lingapereke gulu la mabanja ena, ana, ndi achikulire omwe akumanapo ndi zotere.

Magulu othandizira ndi ofunikira kwambiri mabanja omwe ali ndi ma intersex.

Magulu osiyanasiyana othandizira atha kukhala amalingaliro osiyanasiyana pamutu wovuta kwambiriwu. Fufuzani chimodzi chothandizira malingaliro anu ndi malingaliro anu pamutuwu.

Mabungwe otsatirawa amapereka zambiri:

• Msonkhano wa X ndi Y kusiyana kwa chromosome - genetic.org
• CARES Foundation - www.caresfoundation.org/
• Intersex Society yaku North America - isna.org
• Turner Syndrome Society ku United States - www.turnersyndrome.org/
• 48, XXYY - XXYY Project - genetic.org/variations/about-xxyy/

Chonde onani zambiri pazomwe mungachite. Kulosera kumatengera chifukwa chenicheni cha ma intersex. Ndikumvetsetsa, kuthandizira, ndi chithandizo choyenera, malingaliro onse ndiabwino.

Mukawona kuti mwana wanu ali ndi maliseche achilendo kapena chitukuko chakugonana, kambiranani izi ndi omwe amakuthandizani.

Zovuta zakukula kwakugonana; Ma DSD; Zachinyengo; Chidziwitso; Hermaphrodite

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.

Donohoue PA. Zovuta zakukula kwakugonana. 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 606.

Wherrett DK. Yandikirani kwa khanda ali ndi vuto loti akuganiza zakukula kwakugonana. Chipatala cha Odwala North Am. 2015; 62 (4): 983-999. PMID: 26210628 www.ncbi.nlm.nih.gov/pubmed/26210628. (Adasankhidwa)