By Prof. Dr. Waldemar Ch. Hecker (auth.)
This booklet is the made of lengthy years of shut collaboration among physicians, a pediatric endocrinologist and a pediatric healthcare professional, who're drawn to the complicated box of human malformations. Their efforts have set a brand new average within the therapy of kids with intersexual or mal shaped girl genitalia. it really is most unlikely to express the main points of complicated surgeries with no the aid of meticulous illustrations. it really is lucky that occurred to satisfy an academically knowledgeable artist, Mrs. Siri generators, M.A., whereas vacationing within the usa. Her very good wisdom of anatomy, her amazing abilities as an artist and technical illustrator, and her readiness to incorporate all info of curiosity to the medical professional have chanced on their fruitful expression within the illustrations of this ebook. We convey our due to Springer-Verlag and particularly to Prof. nutrition wealthy Goetze, at whose recommendation this ebook was once written, for his or her amiable compliance with all our needs, and especially for his or her willingness to maintain Mrs. turbines as our illustrator. Munich, may possibly 1985 WALDEMAR HECKER Contents In trod ucti on 1 half 1 : Endocrinologic prognosis in Pediatric sufferers with Genital Anomalies basic ideas . . . . . . . . . . . four Endocrinology of Antenatal intercourse Differentiation 6 Male Differentiation 6 lady Differentiation 7 particular Endocrinologic prognosis and remedy eight Virilization of the feminine exterior Genitalia eight Congenital Adrenogenital Syndrome with a illness of 21-Hydr- ylase . . . . . . . . . . . . . . . . . . . . . . . . . . eight Intersexual Genitals because of poor Androgenization of the Male eleven Defects of Testosterone Biosynthesis eleven Androgen Receptor Defects . . .
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Additional info for Surgical Correction of Intersexual Genitalia and Female Genital Malformation: With a Section on Pediatric Endocrinology
First, nonabsorbable sutures are run from each crus to the middle of the shaft and tied. Then additional plicating sutures are placed from the proximal third of 30 Urogenital Sinus and Clitoral Hypertrophy the shaft to within a short distance of the glans. These sutures (3-0 or 4-0 Ethiflex) are also tied. The ends are left long, and they are passed through the periosteum of the symphysis with a small periosteal needle and tied. The effect of this procedure is two-fold: The clitoral shaft is shortened by the plication, and the clitoris is recessed behind the symphysis.
The goal of all therapeutic efforts is to enable the intersexual patient to live a normal life both physically and psychologically. From the standpoint of personality development, it is essential that the child acquire a sexual identity at an early age. According to Hassenstein (quoted in Hemminger 1982), there are five main forces which shape the acquistion of sexual identity (Fig. 8). These are the chromosomal sex, the morphological sex, the sex of rearing, biologically based sex-specific behav- Morphology of extemal genitalia Chromosomal sex '" Assigned sex ~ .
This is stated only to aid the parents in making their decision. From a medical standpoint, the most appropriate solution would be a surgical correction that conforms to the child's chromosomal sex. However, a complete change of sex always represents a serious social problem for the patient and the family. We have seen children with adrenogenital syndrome and external genitalia of Prader type V who were reared as males for several years before their true chromosomal sex was discovered and whose parents did not desire a sex reversal.