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Editor's Note: Every Monday, Lori Gottlieb answers questions from readers about their problems, big and small. Have a question? Email her at dear. Months ago, on a business trip, a female co-worker and I attempted to meet up with others for drinks, but when everyone else bailed, we decided to still go out.SEE VIDEO BY TOPIC: 15 Things Women Look For in a Man
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Back to Health A to Z. Differences in sex development DSD is a group of rare conditions involving genes, hormones and reproductive organs, including genitals. It means a person's sex development is different to most other people's. Some adults and young people with DSD prefer to use the term intersex. You or your child may have sex chromosomes bundles of genes usually associated with being female XX chromosomes or usually associated with being male XY chromosomes , but reproductive organs and genitals that may look different from usual.
This happens because of a difference with your genes or how you respond to the sex hormones in your body, or both. It can be inherited, but there is often no clear reason why it happens. The most common times to find out that a person has a DSD are around the time of their birth or when they're a teenager.
Some people have XX usual female chromosomes with ovaries and a womb, but their genitals may not look the same as many females. The most common cause is congenital adrenal hyperplasia CAH. A person who has CAH lacks an enzyme chemical substance that their body needs to make the hormones cortisol and aldosterone. Without these hormones, their body produces more androgens sex hormones that are naturally higher in males.
If the child is female, the raised androgen levels before birth can cause their genitals to look different, such as a larger clitoris and a vagina that is not open in the usual place.
CAH can also cause serious health issues, such as life-threatening kidney problems that need to be treated as soon as possible. Find more information and advice from the CAH support group. Some people have XY male chromosomes, but their external genitals may develop in the usual way for girls or boys.
Sometimes it's difficult at first to know whether their genitals are more similar to girls' or boys'. A person may have a womb and may also have testicles inside their body. Sometimes the testicles might not work properly. Many people with 46,XY DSD are boys born with the opening to pass urine towards the bottom of their penis or below it. For some, the scrotum appears separated into two smaller sacs, one on either side.
Doctors call this peno-scrotal hypospadias and boys and men with this DSD can have either fully developed or partially developed testes. One possible cause is androgen insensitivity syndrome AIS , where the body "ignores" androgens or is insensitive to them. Complete insensitivity to androgens makes a person with XY chromosomes female. Partial insensitivity to androgens can mean that some people are male and others are female. Some people have a chromosome pattern other than the usual XY or XX.
Their internal and external sex organs can be either male or female, but they may not go through a full physical development at puberty. For example, a child with female sex organs may not start having periods.
This can mean they do not produce the usual level of testosterone, the sex hormone responsible for the development of male characteristics, such as the testes and body hair. Testosterone is also important for bone strength and fertility in men. Find more information and support about Klinefelter syndrome. Another example of this type of DSD is Turner syndrome , which is where a girl is born with a missing X chromosome.
Girls and women with Turner syndrome are often infertile and their height may be shorter than average. Some females are born with an underdeveloped womb or without a womb, cervix and upper vagina. The ovaries and external genitalia look the same as most girls and women and they develop breasts and pubic hair as they get older.
This is called Rokitansky syndrome. Often the first sign of Rokitansky syndrome is that a girl does not start having periods. Sex involving the vagina may also be difficult because the vagina may be shorter than most women's.
Not having a womb means that a woman cannot become pregnant, but it's sometimes possible to take eggs from their ovaries, fertilise them, and implant them in another woman's womb surrogacy. Some people with a very rare type of DSD have both ovarian and testicular tissue sometimes one ovary and one testis.
Their genitals may appear female or male or could look different from either. The cause is not usually clear, but some people with the condition have been found to have genetic material that's usually seen on the Y chromosome appearing on their X chromosome. Sometimes doctors check a baby for DSD soon after birth because of signs such as undescended testicles or if a baby's genitals look different.
Tests may be done to help get a clear diagnosis and find out whether any immediate treatment is needed. Your care team may advise you to delay registering your child's birth for a few days until the tests are complete, you have discussed the results with your child's care team and the sex of your baby is established or decided.
Many forms of DSD do not require any medical care other than understanding the baby's development and knowing what to expect as they grow older.
A specialist nurse in your care team can help you learn about DSD and a psychologist will help you address any concerns you have.
Sometimes a DSD may be diagnosed if an older child does not go through puberty properly. For example, your child may not start showing the changes linked with puberty, or they may start puberty but not have periods. Speak to a GP if you have any concerns about your child's development at puberty.
They can refer your child to a specialist. This will usually be a consultant paediatric endocrinologist, who specialises in hormones, or an adolescent gynaecologist. A team of specialist healthcare professionals will work with you to understand your child's condition and offer you and your child support and advice. A psychologist in the team can talk with you or your child about sexuality, relationships and body image among other subjects. Some people with DSD may need hormone therapy and psychological support.
Some may want to think about altering their existing genitals, for example by using vaginal stretch techniques. Speak to a GP, as they'll be able to refer you to a team of specialist healthcare professionals. They can answer your questions, help you stay healthy and put you in touch with others with DSD if that's something you're interested in. Most people with a DSD stay with the gender linked to their sex at birth, which is the sex on their birth certificate.
But if your legal sex does not represent who you are or how you identify, you may want to discuss your options with your care team. If you have a DSD and want to explore parenthood, you can also discuss this with your specialist care team. If you have a DSD or you're the parent of a child with a DSD, you may find it useful to contact a group involving others with the same or similar experiences. These groups can often offer more information and advice about living with a DSD, and may be able to put you in contact with others who've been in a similar situation to you.
Page last reviewed: 15 August Next review due: 15 August Differences in sex development. Why does DSD happen? Some examples are: Usual female pattern genes with genitals that look different to girls' genitals Some people have XX usual female chromosomes with ovaries and a womb, but their genitals may not look the same as many females.
For example, they may have a more developed clitoris and their vagina may be closed. Genes usually seen in males with genitals that look the same as most girls' and some internal male structures Some people have XY male chromosomes, but their external genitals may develop in the usual way for girls or boys.
Sometimes a person's body does not respond at all or only partly responds to androgens. Ordinary looking genitals but different sex development Some people have a chromosome pattern other than the usual XY or XX. Doctors call this sex chromosome DSD. Find support and more information about Turner Syndrome.
Female with usual external genitals, but without a womb Some females are born with an underdeveloped womb or without a womb, cervix and upper vagina. What happens after the birth of a baby Sometimes doctors check a baby for DSD soon after birth because of signs such as undescended testicles or if a baby's genitals look different. Tests may include: a further physical examination of your baby done by a specialist an ultrasound scan to examine their internal organs blood tests to check their genes and hormone levels Your care team may advise you to delay registering your child's birth for a few days until the tests are complete, you have discussed the results with your child's care team and the sex of your baby is established or decided.
Some people with DSD consider altering the appearance of their genitals by having surgery. Where to get support If you have a DSD or you're the parent of a child with a DSD, you may find it useful to contact a group involving others with the same or similar experiences.
Back to Health A to Z. Differences in sex development DSD is a group of rare conditions involving genes, hormones and reproductive organs, including genitals. It means a person's sex development is different to most other people's.
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