The phenotypic expression of selective disorders of male sexual differentiation

46,XY intersex individuals: phenotypic and etiologic classification, knowledge of condition, and satisfaction with knowledge in adulthood

OBJECTIVES

The objective of this study was to identify and study adults who have a 46,XY karyotype and presented as infants or children with variable degrees of undermasculinization of their genitalia (female genitalia, ambiguous genitalia, or micropenis). Participants' knowledge of their condition, satisfaction with their knowledge, and desire for additional education about their intersex condition were assessed.

METHODS

Participants were classified according to the cause underlying their intersex condition based on review of medical and surgical records. Knowledge of medical condition, satisfaction with that knowledge, and desire for additional education were assessed with a written questionnaire and a semistructured interview.

RESULTS

Patients were ineligible for recruitment because of death (9%), because of developmental delay (12%), or because they were not located (27%). Among the 96 eligible patients, 78% participated. Approximately half of the men (53%) and women (54%) exhibited a good understanding of their history. Fewer women who have a 46,XY chromosome complement and were born with female genitalia were informed about their intersex condition (36% with complete androgen insensitivity syndrome) than were women who were born with masculinized genitalia such as micropenis (80%) or ambiguous genitalia (72%). More women (66%) than men (38%) were satisfied with their knowledge of their medical and surgical history.

CONCLUSIONS

Almost half of the patients, reared male or female, were neither well informed about their medical and surgical history nor satisfied with their knowledge.

Persistent müllerian duct syndrome

Persistent müllerian duct syndrome is a rare form of pseudohermaphroditism, in which well developed müllerian structures are present in an otherwise normal male, possibly resulting from absence of müllerian duct inhibiting factor. Two cases of the syndrome are presented. The diagnosis, as in most cases, was confirmed at herniorrhaphy or exploration for undescended testis.

Benign prostatic hyperplasia and uterine leiomyomas in a female pseudohermaphrodite: a case report

A 60-year old female pseudohermaphrodite with congenital adrenal hyperplasia presented with acute retention of urine and a lower abdominal mass. At laparotomy a large uterus with multiple leiomyomas was removed. Transurethral resection of the obstructing bladder neck revealed benign prostatic hyperplasia. This patient demonstrates that benign prostatic hyperplasia may develop in the presence of androgens from an extratesticular source.

Transverse testicular ectopia

A case of transverse testicular ectopia is reported, and the Japanese literature is reviewed. The value of intraoperative vasovesiculography is also reviewed.