Hermaphroditism is a condition in which the sexual organs of an individual have the appearance of both sexes. It occurs because of abnormalities in sex chromosomes and abnormalities in androgen secretion that lead to abnormal development of sexual organs during embryonic life. If there are both testes and ovaries in the same body, the external genitalia and secondary sexual characteristics are between the two sexes, which is called true hermaphroditism. If the gonads and external genitalia do not coincide, it is called pseudohermaphroditism, e.g., external genitalia resembling female and internal genitalia being testes is called male pseudohermaphroditism. On the contrary, if the external genitalia are similar to male and the internal genitalia are ovaries, it is called female pseudohermaphroditism. 1, female pseudohermaphroditism This is a more common hermaphroditism, the patient’s gonads are ovaries, the internal genital tract is normal female, but the external genitalia have different degrees of masculine features, such as clitoral hypertrophy, the shape of the male urethral cleft, the labia are often combined in the midline, similar to the male scrotum, but there are no testicles, the vaginal opening is small. The sex chromosome histotype is XX and the sex chromatin is positive. The cause is mostly due to congenital hyperadrenocorticism and excessive androgen secretion. 2, male pseudohermaphroditism male pseudohermaphroditism patient’s gonads only testes, their external genitalia change greatly, can be shown as male appearance, can also be shown as female appearance, or gender difficult to identify. The sex chromosome histotype is XY and the sex chromatin is negative. Clinical manifestations The vulva is indistinguishable between male and female at birth but is more female oriented, and about 3/4 of the children are raised as girls. Most of the gonads can be felt in the groin or in the scrotum. Patients generally develop female secondary sexual characteristics during development, such as enlarged breasts and a female-like distribution of pubic hair and menstruation. This is because any karyotype of true hermaphroditism has ovarian tissue, and the ovaries are relatively well-structured, so most true hermaphroditic ovaries can secrete estrogen during development, and also secrete progesterone when there is ovulation, so female secondary sexual characteristics can appear firecan.com, but breast development is later most patients have uterus and vagina vaginal opening in the urogenital sinus, common uterine developmental disorders are dysplasia and cervical agenesis. If the gonad is the ovary, it is generally normal microscopically, and the testes are all sperm-producing microscopically, so patients can have normal ovarian function, and very few patients can even become pregnant The oviduct is the most common gonadal abnormality, with about half of the oviduct displaced upward in the normal ovarian location and the remaining half either in the groin or in the scrotum. The location of the oviduct is related to its composition, the greater the percentage of testicular tissue the more likely it is to enter the groin or scrotum firecans.com. The genital ducts on the ovarian side are always the oviducts, and the genital ducts on the testicular side are both the vas deferens fire canal network. As for the genital ducts on the oviductal side, they can be both the oviducts and the vas deferens, depending on the composition of the ovarian and testicular tissues, and the presence of the oviducts is usually the most common. Diagnosis If an abnormality of the external genitalia is found after birth, a specialist should be consulted immediately to make a diagnosis as soon as possible, and the wrong diagnosis of simple hypospadias combined with cryptorchidism or scrotal division should not be made. If this test does not match the normal male, karyotype analysis of tissue cells is more helpful than karyotype analysis of blood cells to detect chimerism. For those with XX karyotype, the source of the female masculine phenotype should be carefully searched for firecan.com, and various adrenal hormones, 17-keto steroids, progesterone, and 17-dehydroprogesterone should be measured to exclude common types of congenital adrenal hyperplasia. Histological examination reveals both ovarian and testicular tissue to make a clear diagnosis of health search, but sometimes diagnostic difficulties are caused by abnormal gonadal development. Differential diagnosis: 1, female pseudohermaphroditism from the external genitalia alone is difficult to determine the sex, the karyotype is also 46XX health search, and true hermaphroditism performance is similar but 24h urinary 17-ketosteroids and progesterone triol increased, ultrasound, CT examination often see bilateral adrenal gland enlargement or have occupancy. 2, male pseudohermaphroditism from the external genitalia alone is difficult to determine the gender and true hermaphroditism performance is similar. However, 5α-dihydrotestosterone is low, and gonadal biopsy only has testicular tissue, no ovarian tissue. 3. It is difficult to determine the sex from the external genitalia only, and the presentation is similar to that of true hermaphroditism. However, the karyotype is 47XXY, and the gonadal biopsy only has testicular tissue without ovarian tissue.