Thursday, January 28, 2010

Intersexuality, Part One

WARNING: As this blog deals with genitalia, there are graphic pictures (of a medical nature) involved.

As a general rule, children are either born male or female. The classification of males and females is simple. Females have two X chromosomes, a vagina leading to a uterus, fallopian tubes, ovaries, breasts, a separate outlet for urine labia minora and majora, etc, while males have testicles, a prostrate, and a penis through which the urethra passes, etc. (Dreger 3). However, in about 1/500 births there is some confusion as to whether a fetus is male or female, due to the external genitalia (Dreger 42). In the past people of an unsure sex were referred to as hermaphrodites, but when extensive research revealed that it is impossible for a human to be a true hermaphrodite (with functioning male and female organs), the medical terminology was changed in the late nineteenth century to the more politically correct 'intersexual' (Dreger 31).

Causes of Intersexuality:

The conditions causing intersexuality can be divided into three sections. Chromosomal causes are caused by a change in the X or Y chromosomes, Hormonal are caused by a body's inability to absorb or produce hormones, and environmental are caused by outside factors that affect a fetus in the womb.

Chromosomal:

Two chromosomal syndromes are the main causes of intersexuality, Turner Syndrome, and Klinefelter's Syndrome.

Turner's syndrome:

Turner's syndrome is caused when a female fetus only receives one X chromosome. This happens in approximately 0.0369/100 births (Ojeda). While the genitalia of the person will be that of a normal female, they will not menstruate and will be infertile due to an underdeveloped uterus. They may also have a short neck, short fingers, puffy hands and feet (Haeberle). Children born with Turner's syndrome may face other health problems, such as “heart problems, high blood pressure, ear and hearing problems, shortsightedness, learning difficulties, thyroid problems, kidney problems, diabetes, and osteoporosis” (Haeberle).


Klinefelter's Syndrome:

Klinefelter's Syndrome is cause when a male fetus receives two X chromosomes, instead of one, making them XXY. While the person is physically male, and can often live a normal life, they can be subject to absent body hair, breasts, wide hips, and no frontal baldness, traits normally associated with females (Haeberle). There are no other health problems associated with Klinefelters, and it occurs in about 0.0992/100 births (Ojeda).

Hormonal:

There are three basic disorders that can lead to intersexuality cause by hormonal problems. These are Congenital Adrenal Hyperplasia (CAH), 5-Alpha-Reductase (5AR), and Androgen Insensitivity Syndrome (AIS).

Congenital Adrenal Hyperplasia:

CAH is caused by a malfunction of the adrenal gland, and happens in XX individuals (Haeberle). In CAH, large amounts of hormones from the adrenal gland affect the genitalia (Dreger 38). This can lead to masculinity in females in womb, making the genitalia androgynous (Ojeda). Approximately .00799/100 children are born with CAH (Ojeda).

5-Alpha-Reductase:

5AR is a rare but dramatic disorder that affects XY individuals (Haeberle). While the child is born female, at puberty the voice drops, hair grows, testicles descend into what was previously thought was labia, and the clitoris grows into a penis ( Dreger 39). This makes it particularly noticeable, and it was one of the first causes of intersexuality to be studied extensively. Individuals with 5AR are often infertile (Haeberle).

Androgen Insensitivity Syndrome:

AIS is caused when an XY person has “no physiological receptors to read and respond to testosterone in the body” (Dreger 7). Even women have these receptors, as they also have testosterone int heir bodies, though in smaller amounts then men. People with AIS can still have male genitalia in causes of partial AIS, or have entirely female bodies, in cases of complete AIS. They can also be anywhere between the two, depending on their body's ability to absorb testosterone (Haeberle). Partial AIS occurs in .00076/100 births, and complete AIS occurs in .0076/100 (Ojeda).

Environmental:

Intersexuality due to environment can be cause by radiation, certain chemicals, and certain medications.

Radiation:

Radiation can affect the way cells join together, and can therefore affect sexual organs during development. In Chernobyl, Ukraine, where a nuclear blowout of a power plant caused the land to become contaminated with radioactive waste, there have been many reported incidents of individuals born with ambiguous genitalia, and reproductive problems.

Chemicals:

The industrial age has released many pollutants into air and water that can harm the sex of fetuses, such as DDT (pesticide) and PCBs (coolant). A mother's exposure to these chemicals, whether before or during pregnancy, can leads to mutations in the fetus, including mutations of the genitalia (Haeberle).

Medications:

Many medications are now marked with warnings to consult a doctor if the patient is pregnant, or planning to become pregnant. Part of this is because some medications have been found to affect the genitalia of a fetus. Two particularly ironic examples are Progestin and Diethylstilbestrol (DES). Progestin was used in the 50's and 60's to prevent miscarriages, and while it didn't work, it caused masculinity in female fetuses (Haeberle). DES was also used to prevent miscarriages from the 40's to the 70's, and it often resulted in abnormal genitalia in males (Haeberle).


All these causes, some preventable, some not, can lead to varying degrees of sex confusion in fetuses. Often in cases of abnormal genitalia, doctors will operate, and researchers are always in search of cures for and ways to prevent these syndromes. Is this the best way to deal with intersexuality? For more, see Intersexuality, Part Two.


Works Cited

Dreger, Alice. Hermaphrodites and the Medical Invention of Sex. London, England: Harvard University Press, 1998. Print.

Haeberle, Erwin . "Causes of Intersexuality." Manus Hirschfeld Archive For Sexology. 2005. Web. 28 Jan 2010. .

Ojeda, Auriana . Male/Female Roles. 2nd. New York: Greenhaven Press, 2004. Print.

Pictures:

Klinefelter's: https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUhruje63ZCGF_V5d0V2yHPPyBUtnhX4Gou4nSiKm62R9q4hIKgQbRyblLYh2jiiD9PRDzcZ2GREjr0uA0Ff88oMShoKQVYbGOwg_RedVS9Heb9AA7sN81qARFLTqxNdmiL5XV6PXsarg/s400/Klinefelter+syndrome.jpg

Turner's: http://www.nature.com/nrendo/journal/v4/n3/images/ncpendmet0747-f1.jpg

CAH: http://www2.hu-berlin.de/sexology/ECE3/assets/images/adglands.gif

AIS: http://www2.hu-berlin.de/sexology/ECE3/assets/images/aisscale.gif