性别歧义与性别分配中的挑战

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摘要

这是一个病例报告,涉及来自邻国的两名年龄分别为4岁和6岁的女性性别认同的兄弟姐妹,患有46,xy DSD,以及来自埃塞俄比亚西北部的一名20岁的年轻人,据称性别为男性,但患有46,xx DSD;但肯定三个都有明显模糊的外生殖器。46XX,患有先天性肾上腺增生症(CAH)的DSD与被诊断患有完全雄激素不敏感综合征(CAIS)的兄弟姐妹相比产生了更多的挑战。病例介绍是独特的,因为他们被医生推荐用于性别鉴定,而不像通常的晚期主诉患者原发性闭经或月经初潮,未能达到阴道性交或原发性不孕症。显然,父母、祖父母、亲属和保健专业人员的作用对客户的性别分配有很大影响,尽管最终的优先性别选择是由个人自己做出的。非典型外生殖器,与迄今为止饲养的性别相反,是异常的标志,也是调查对象困惑的根源。早期和彻底的新生儿体格检查和儿科年龄组的随机检查强调了随后的多学科方法对性别分配的复杂问题。这些情况突出了所涉人员的性心理和身体发展,并对他们各自的家庭、亲属和各自的社会造成不良后果,在这些社会中,信仰、宗教和文化在个人的社会教育中起着重要作用。介绍的主要目的是提高保健专业人员对社区中存在的这种先天性异常的认识程度,并旨在为国家和世界文献作出贡献。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Genital Ambiguity and Challenges in Gender Assignment
This is a case presentation involving two siblings of four and six years of age with female gender identity from a neighboring country with 46,XY DSD and a 20 years old youngster from Northwest Ethiopia with an alleged male sex but with a 46,XX DSD; but definitely all the three with obvious ambiguous external genitalia. The 46XX, DSD with Congenital Adrenal Hyperplasia (CAH) generated more challenges as opposed to the siblings who were diagnosed to have Complete Androgen Insensitivity Syndrome (CAIS). The case presentations are unique as they were referred for sex identification by physicians unlike the usual late complaints of patients with primary amenorrhea or absence of menarche, failure to attain penetrative vaginal sexual intercourse or primary infertility. It was evident that the role of the parents, grandparents, relatives and the healthcare professionals is very much impacting in the sex assignment of the clients, although the final preferential gender choice is made by the individual himself. The atypical external genitalia, contrary to the sex of rearing so far, are the hallmark of the abnormality and source of confusion of the clients under investigations. An early and thorough neonatal physical examination and random checkups of pediatric age groups underscores the complex issues of the subsequent multidisciplinary approach towards the sex assignment. The situations glare the psychosexual and physical development of those involved and the undesirable consequences in their respective families, relatives and their respective societies where beliefs, religion and culture play significant role in the social upbringing of the individual. The main objective of the presentation is to increase the degree of awareness among healthcare professionals of the existence of such congenital anomalies in the communities and is also intended to contribute to the national and world literature.
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