Ambigious Genitale

One of the first things that families and relatives wonder about when the baby is first born is the gender of the baby. When babies with ambiguous genitalia are first born, it may not be possible to determine their gender by looking at their external genital organs. It occurs once in 4500 births. Gender and causative disease can be determined by performing various tests. These babies are generally physically healthy. Göztepe Pediatric Surgery Clinic successfully follows up patients with sexual development disorders together with pediatric endocrinology.
In the female gender; The clitoris looks like a small penis that is larger than normal
There is no separate vaginal and urethra (urinary tract) opening. The two come together and open out as one.
In severe cases, a sac-like appearance containing male eggs may occur.
In the male gender; The penis is smaller than normal and curved forward.
The urinary tract is not at the tip of the penis.
The urinary hole may be between the ovarian sacs.
Bilateral eggs may not be palpable.
In severe cases, they may have a completely female-like appearance.

Male and female genital organs develop from the same fetal tissues. Female gender develops when X chromosomes are taken from the Mother and the Father. Male genital organs develop in the presence of X chromosome from the mother and Y chromosome from the father and, accordingly, the male sex hormone (testosterone). If Testosterone is low or ineffective even though there is an XY chromosome, female-like external sex characters develop. In females with XX chromosomes, male-like external gender characters develop due to exposure to testosterone.
-Congenital Adrenal Hyperplasia (CAH): Some substances accumulate as a result of a disorder in the functioning of the adrenal gland. One of these is testosterone. Depending on the amount of testosterone, varying degrees of male-like external genitalia appear. What to pay attention to are the salt-losing types of this disease. Urgent intervention may be required for salt-losing types.
-Using drugs that have male hormone activity during pregnancy (e.g. progesterone)
-Tumors of the mother or baby that produce male hormones

-Disruption of testicular development due to genetic disorders or unknown reasons
-Impairment of testosterone production due to the absence of Leydig cells in the testicle that secrete testosterone
-Absence of the substance (5-Alpha reductase) that enables it to convert to ethyl form even though the testosterone level is sufficient
-Absence of binding sites of male sex hormones in the affected organs
-Taking substances with female hormone activity during pregnancy (For example, estrogen)
A team including a pediatric surgeon, pediatric endocrinologist, child psychiatrist and social development specialist decides what kind of treatment will be given to the child and when. Surgery is required for corrections. At Göztepe Pediatric Surgery Clinic, follow-up of patients with sexual development disorders is carried out successfully with teamwork.
For female patients: The clitoris is reduced, the combined urethra and vagina are separated from each other and sewn separately to the skin.

For male patients: First of all, hormonal treatment is applied to enlarge the penis. Surgery is performed after sufficient growth is achieved. During the surgery, the urinary tract is moved to its proper place, the tip of the penis. The curvature of the penis is corrected. The eggs are lowered into the scrotal sac where they should be.
The mentioned surgeries are successfully performed by Göztepe pediatric surgery team.
Patients leave the surgery with a catheter in the external urinary tract. After the surgery, the patient is followed up in the Pediatric Surgery service. The catheters are removed within 5-10 days depending on the patient's condition. If there is no additional problem after the catheters are removed, the patient is called to Göztepe pediatric surgery and pediatric endocrinology outpatient clinic controls and discharged.
- Bleeding, hematoma, swelling (edema) may occur at the surgery site
- Infection may develop.
- Stenosis may occur in the created urethra and vagina.
-Urethra and/or vagina may leak in
-Reoperation. may be required.
In boys:
- Bleeding, hematoma, edema may occur.
-Infection may develop.

-Stenosis, fistula (small hole that causes urine leakage) may develop in the transported urethra.
-The newly created urinary tract may completely rot.
-If the eggs have been lowered, they may leak up again.
-The eggs may shrink.
-Re-operation may be required.

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