Fróðskaparrit - 01.01.1965, Page 94

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True Hermaphroditism
An early diagnosis is important in order to decide upon
the sex of rearing to be adopted. Sex determination depends
on the appearance of the external genitalia and on the nature
of the gonads. Any external genital malformations must be
corrected surgically as early as possible, and if it is equally
easy to change the genitalia surgically into either sex, attempts
must be made at determining which of the two types of gona-
dal tissue is best developed, whereupon the tissue which shows
the poorest degree of development is removed21. In most cases
the surgical correction must be supported by hormone treat-
ment during the period of puberty. If the disorder is diag-
nosed at a later time of life, the appearance of the external
genitalia and the sex of rearing must be decisive of the treat-
ment to be adopted, considering the severe psychical problems
which may be present. In some cases a combination of surgical
and hormonal therapy will help the patients to lead fairly
normal lives, but in other cases where the condition is not
diagnosed till after the time of puberty, it will most often be
better to abstain from interfering.
It has been stated that many cases of true hermaphrodi-
tism are disclosed m connexion with operations because of
inguinal hernia. Apart from the risk of incarceration of ingui-
nal hernia, which occurred in our two cases, other compli-
cations of hermaphroditism may arise. Several cases of malig-
nant neoplastic changes in undescended testes have been des-
cribed and cystic degeneration of ovaries has been reported19.
Furthermore, Hanley22 described one patient with normal mas-
culine external genitalia, but with uterus, vagina and uterine
tubes and salpingitis developing because of prostatic hyper-
trophy. Finally, on several occasions endometriosis following
surgery in hermaphrodites has been reported, as was the case
in our second patient23.
Case 1. Our first case is a 70 years old person, registered as a male,
who had regarded himself as a male his whole life and lived
accordingly. He was the only child of normal parents who died
from natural causes. In the family there were no known cases
of malformations of any kind.