Aleke gbegbee woyɔa nɔnɔme sia be ‘Atypical Genitalia’?
Esia nye nɔnɔme si mebɔ kura o . Akɔntabubuwo ɖee fia be vidzĩ yeye 1,000 va ɖo 4,500 ɖesiaɖe dometɔ ɖeka koe dɔléle sia gblẽa nu le. Eyata togbɔ be womese nya sia kura o hã la, ele vevie be nànya esia.Aleke vidzĩ ƒe vidzinuwo tsina le dzɔdzɔme nu?
Be nàse esia gɔme la, ele be nànya nu vi aɖe tso ale si vidzĩ ƒe gbɔdɔdɔ ƒe ŋutinuwo tsina le vidzidɔ me ŋu. Bu eŋu kpɔ, esia nye nuwɔna si sesẽ ŋutɔ eye wòwɔ nuku ŋutɔ. Esia dzɔna le afɔɖeɖe vevi etɔ̃ me: 1. Domenyiŋusẽfianu ƒe gbɔdɔdɔ ƒe nyametsotso: Nu gbãtɔ si dzɔna enye be wokpɔa vidzĩa ƒe domenyiŋusẽfianu ƒe gbɔdɔdɔ. Esia dzɔna ne vifofoa ƒe tsinyenye wɔ ɖeka kple azi si tso dadaa gbɔ. Vidadaa xɔa X domenyiŋusẽfianu ɣesiaɣi. Vifofoa ate ŋu axɔ X alo Y domenyiŋusẽfianu. Eyata ne X si tso dadaa gbɔ kple X si tso fofoa gbɔ ƒo ƒu (XX) la, wodzia nyɔnuvi. Ne X si tso dadaa gbɔ kple Y si tso fofoa gbɔ ƒo ƒu (XY) la, wodzia ŋutsuvi. 2. Gonad wɔwɔ: Eyome vidzĩa ƒe vidzidɔa tsina le domenyiŋusẽfianu sia nu. Le vidzĩ nyɔnu gome la, azigolowo tsina, eye le vidzĩ ŋutsu gome la, vidzidɔa tsina. 3. Vidzinu ememetɔwo kple egodo ƒe tsitsi: Mlɔeba la, lãmetsi siwo dona siawo wɔna lae naa vidzidɔa ƒe vidzinu ememetɔwo kple gotagome vidzinuwo ƒe tsitsi. Eyata, ne tɔtrɔ aɖe va le ɖoɖo sia ƒe akpa aɖe me la, ekema nɔnɔme aɖe si woyɔna be Dissociative Developmental Disorder (DSD), alo ‘Atypical Genitalia’ ate ŋu adzɔ. Zi geɖe la, lãmetsiŋusẽ ƒe kuxiwo gbɔe esia tsona. Lãmetsiŋusẽ ƒe ŋusẽkpɔɖeamedzi siawo ate ŋu ato domenyiŋusẽfianu siwo tso dzilawo gbɔ dzi, alo woate ŋu adzɔ le susu aɖeke manɔmee.Nukawoe hea ‘Atypical Genitalia’ vɛ?
Zi geɖe la, nusi koŋ gbɔ esia tsonae nye lãmetsiŋusẽ ƒe dɔmawɔmawɔ nyuie si dzɔna le vidzĩa ƒe ŋutilã me le fufɔɣi.Lãmetsiŋusẽ siawo kpɔa ŋusẽ ɖe vidzĩa ƒe gbɔdɔdɔ ƒe ŋutinuwo ƒe tsitsi dzi. Eyata ne lãmetsi siawo meda sɔ o la, akpɔ ŋusẽ ɖe alesi vidzĩa ƒe gbɔdɔdɔ ƒe ŋutinuwo tsinae dzi. Susu siawo ate ŋu ato vovo le vidzĩa ƒe gbɔdɔdɔ ƒe domenyiŋusẽfianuwo nu.46 XX DSD (DSD si me nyɔnu ƒe domenyiŋusẽfianu ƒe nɔnɔme le) .
Le nɔnɔme sia me la, vidzĩa ƒe domenyiŋusẽfianu nye nyɔnu (XX). Esia fia be azigolowo kple vidzidɔ le vidzĩa me. Gake gotagome vidzinuwo ate ŋu adze abe ŋutsu ene, eye ŋutsu ƒe vidzinu kple vidzidɔ le eŋu. Esia dzɔna ne ŋutsu ƒe lãmetsiŋusẽ (androgens) ƒe agbɔsɔsɔ si dzi ɖe edzi le vidzĩa ƒe gotagome vidzinuwo me le vidzĩa ƒe gotagome vidzinuwo ƒe tsitsi me. Nusi gbɔ esia tsona wue nye nɔnɔme aɖe si woyɔna be ‘Congenital Adrenal Hyperplasia’ (CAH). Esiae nye esime vidzĩa ƒe adrenal glandwo wɔa ŋutsu ƒe lãmetsiŋusẽ geɖe akpa .46 XY DSD (DSD si me ŋutsu ƒe domenyiŋusẽfianu ƒe nɔnɔme le) .
Le go sia me la, vidzĩa ƒe domenyiŋusẽfianu nye ŋutsu (XY). Esia fia be ele be vidzidɔ (vidzidɔ) nanɔ vidzĩa me. Gake gotagome vidzinuwo meɖea ŋutsu ƒe nɔnɔme fiana nyuie o, eye ate ŋu aɖi nyɔnu ƒe nɔnɔme gɔ̃ hã. Susu vevi geɖewo tae wòle alea ɖo:- Vidzĩa ƒe vidzinuwo mele tsitsim nyuie o.
- Vidzidɔawo mete ŋu wɔa ŋutsu ƒe lãmetsi si nye testosterone wòde edeƒe o.
- Togbɔ be wowɔa testosterone hã la, vidzĩa ƒe ŋutilã mete ŋu zãnɛ nyuie o.
Gonadal Vovototodedeameme ƒe Dɔlélewo
Nusi dzɔna le nɔnɔme sia mee nye be vidzĩa ƒe vidzidɔ metsina bliboe zua vidzidɔ alo azigolo o.- Mixed Gonadal Dysgenesis: Le esia me la, gonads (testes alo ovaries ) metsi bliboe o.
- Gonadal Dysgenesis ƒe Akpa aɖe: Le esia me la, togbɔ be vidzidɔ ƒe lãkusi aɖewo va le vidzĩa ƒe vidzidɔ me hã la, vidzidɔ mawo mewɔa dɔ nyuie o.
- Gonadal Dysgenesis: Le esia me la, gonads eveawo siaa tsi kaba, si fia be wometsina zua vidzidɔ alo azigolo o.
Ovotesticular DSD (azigolo kple aɖuɖɔtoe ƒe DSD) .
Esia nye nɔnɔme si mebɔ kura o. Le go sia me la, ate ŋu anye be azigolo kple vidzidɔ siaa nanɔ vidzĩa ƒe lãkusiwo me. Alo, ate ŋu anye be azigolo nanɔ akpa ɖeka eye vidzidɔ nanɔ akpa kemɛ.Aleke nɔnɔme si nye ‘Atypical Genitalia’ le le gotagome?
Nɔnɔme sia ƒe dzedzeme toa vovo le domenyiŋusẽfianu siwo ŋu wògblẽ nu le kple lãmetsiŋusẽ ƒe nɔnɔme nu. Vidzinu siwo mebɔ o le vidzĩ si ƒe domenyiŋusẽfianu nye nyɔnu (XX chromosomes) me ate ŋu anye nɔnɔme siwo gbɔna:- Vidzidɔa lolona eye wòdzena abe ŋutsu ƒe vidzinu sue aɖe ene.
- Aɖuɖɔtoea ƒe ʋuƒoa le aɖuɖɔtoea te alo le nyɔnu ƒe vidzidɔa me tsɔ wu be wòanɔ teƒe si wòle be wòanɔ.
- Aɖuɖɔtoeawo lé ɖe wo nɔewo ŋu, eye wodzena abe aɖuɖɔtoe ene.
- Ate ŋu anye be lãkusi aɖe nanɔ lãkusiawo dome, si ate ŋu adze abe kotoku si me vidzidɔa le ene.
- Ŋutsu ƒe vidzinu meli kura o alo le sue ŋutɔ, edzena abe ŋutsu ƒe vidzinu si lolo ene (micropenis).
- Aɖuɖɔtoe ƒe ʋuʋu le ŋutsu ƒe vidzinu ƒe gɔme alo le akɔta dome tsɔ wu be wòanɔ eƒe nugbɔ (woyɔa nɔnɔme sia hã be ‘Hypospadias’).
- Aɖuɖɔtoea le sue, mã ɖe eve, eye wòdze abe akɔtaƒu ene.
- Vidzidɔawo ɖiɖi tso ƒodoa me eye womegale vidzidɔa ( undescended testicles ) me o.
Nukae nye ‘Atypical Genitalia’ ƒe dzesi bubuwo?
Vidzinu ƒe gotagome ƒe dzedzemee nye nusi koŋ ɖenɛ fiana. Tsɔ kpe ɖe eŋu la, àte ŋu akpɔ nanewo abe:- Lãmetsiŋusẽ ƒe masɔmasɔ.
- Le nyɔnuvi gome la, dzinukpɔkpɔ ate ŋu adze egɔme kaba ŋutɔ, atsi megbe, alo madzɔ kura o.
- Hypospadias nye ne tsinyegoe ƒe ʋuƒoa mele ŋutsu ƒe vidzinu ƒe nugbɔ o.
Aleke ɖɔktawo wɔa dea dzesi dɔléle siae?
Zi geɖe la , ne wonya dzi vidzĩ ko la , ɖɔktawo kpɔa dɔléle sia dzea sii . Alo, le vidzĩa ƒe vidzidzi dodokpɔ gbãtɔ me. Ne womenya ne vidzĩa nye ŋutsuvi alo nyɔnuvi o la, vidzĩa ƒe ɖɔkta aɖe gbe be woagawɔ dodokpɔ geɖe.Nukae nàkpɔ mɔ na le viwòa ƒe atikewɔƒe ƒe dodokpɔɣi?
Ðɔktaa abia wò ƒomea ƒe atikewɔwɔ ŋutinya gbã. Emegbe, alé ŋku ɖe vidzĩa ƒe gotagome vidzinuwo ŋu nyuie. Woate ŋu awɔ dodokpɔ siwo gbɔna be woakpɔ dɔlélea nyuie:- Ʋudodokpɔ: Be woalé ŋku ɖe vidzĩa ƒe lãmetsiŋusẽ kple domenyiŋusẽfianu ƒe agbɔsɔsɔ ŋu.
- Nɔnɔmetatawo dodokpɔ: Esiawo ate ŋu alé ŋku ɖe vidzĩa ƒe vidzinuwo ŋu, abe ultrasound, X-ray, alo MRI (Magnetic Resonance Imaging) scan ene.
- Biopsy alo Laparoscopy: Be woaɖe lãkusi sue aɖe tso vidzĩa ƒe vidzidɔ me be woadoe kpɔ.
Aleke wowɔa nu ɖe ‘Atypical Genitalia’ ŋui?
Hafi woadze atikewɔwɔ gɔme la, afɔɖeɖe gbãtɔe nye be nànya nusi tututu gbɔ nɔnɔme sia tso. Emegbe atikewɔlawo ƒe ƒuƒoƒoa anɔ te ɖe lãmetsiŋusẽ dodokpɔ kple dodokpɔ bubuwo me tsonu dzi atso nya me le atikewɔwɔ ƒe ɖoɖo kple gbɔdɔdɔ ƒe dɔdasi si sɔ na vidzĩa ŋu. Esi wònye nya si sesẽ ŋutɔ eye wòsesẽ ŋutɔ ta la, ƒuƒoƒo aɖe si me tɔwo nye dɔwɔla vovovowo anɔ afima akpe ɖe ŋuwò. Ele vevie ŋutɔ be nàdi amesiwo bi ɖe nɔnɔme siawo ƒomevi me. Woawoe anye amesiwo ate ŋu aɖo aɖaŋu nyuitɔ kekeake na wò. Ƒuƒoƒo sia ate ŋu anye eŋutinunyala bibiwo abe:- Vidzĩ yeyewo ŋuti nunyala
- Domenyiŋusẽfianuŋutinunyala
- Dɔlékuiwutikeŋutinunyala
- Amekola
- Aɖuɖɔtoedɔdala
- Susuŋutinunyala
- Nusita vidzĩa ƒe nɔnɔmea tso.
- Vidzĩa ƒe vidzinuwo ƒe dzedzeme.
- Wò ƒomea ƒe didiwo kple dekɔnu dzixɔsewo.
- Lãmetsiŋusẽ ƒe Atikewɔwɔ (HRT): Ne lãmetsiŋusẽ ƒe dɔmawɔmawɔ nyuie aɖe li la, woate ŋu atsɔ lãmetsiŋusẽtike ɖeɖeko aɖu nɔnɔme sia dzi.
- Amekoko si ana viwòa nagbugbɔ atu ame: Ɣeaɖewoɣi la, atikewɔlawo ƒe ƒuƒoƒoa ate ŋu adzro eme kpli wò ahaɖo aɖaŋu be woawɔ dɔ na viwòa esime viwòa gakpɔtɔ le sue. Ke hã, nukpɔsusu vovovowo li ku ɖe amekoko sia si wotsɔ gbugbɔa ‘Atypical Genitalia’ tutu ŋu. Le kpɔɖeŋu me, ɣeaɖewoɣi ne ʋuƒo aɖeke mele vidzĩa si be aɖuɖɔ nato eme o la, ehiã be woawɔ dɔ nɛ le atikewɔwɔ me. Gake ne amekokoa koŋue nye be yeana yeƒe dzedzeme nanyo ɖe edzi la, dzila aɖewo tiae be yewoalala vaseɖe esime vidzĩa natsi eye yewoate ŋu atso nya me le yewo ŋutɔ yewoƒe ŋutilã ŋu. Esia nye nyametsotso vevi aɖe ŋutɔ si ŋu wobu nyuie.
Ðo ŋku edzi be: Amekoko ŋuti nyametsotso sia ate ŋu akpɔ ŋusẽ gã aɖe ɖe viwòa ƒe etsɔme agbenɔnɔ dzi, eyata anyo be nàƒo nu kple aɖaŋuɖola si bi ɖe dɔ sia me.
Ne ‘Atypical Genitalia’ le vinye ŋu la, nukae wòle be makpɔ mɔ na?
Nɔnɔme si nye ‘Atypical Genitalia’ kpɔa ŋusẽ gã aɖe ɖe ɖevia dzi menye le ŋutilã me ɖeɖeko o, ke le hadome kple susu hã gome.Ate ŋu atso vidzinuwo ƒe nɔnɔme gbɔ, si ate ŋu akpɔ ŋusẽ ɖe ɖevi ƒe ɖokuiŋudzedze dzi. Nyametsotso be woawɔ dɔ na ɖevi ate ŋu akpɔ ŋusẽ ɖe ɖevi ƒe agbenɔnɔ dzi. Esia tae wòle vevie be nàdi eŋutinunyalawo ƒe aɖaŋuɖoɖo tso esia ŋu ɖo. Togbɔ be ‘Atypical Genitalia’ ƒe dɔléle si wokpɔ ate ŋu aɖe fu na wò ŋutɔ hã la, wò atikewɔlawo akpe ɖe ŋuwò nàtso nya me le atikewɔwɔmɔnu nyuitɔ ŋu.Ɣekaɣie wòle be madi atikewɔlawo ƒe aɖaŋuɖoɖo tso vinye ƒe ‘Atypical Genitalia’ nɔnɔmea ŋu?
Zi geɖe la, ɖɔktaa kpɔa nɔnɔme sia le vidzĩa dziɣi alo le eƒe atikewɔwɔ me dodokpɔ gbãtɔ me. Emegbe ɖɔktaa adzro dɔlélea didi kple atikewɔmɔnu siwo woate ŋu azã me kpli wò.Nya kawoe wòle be mabia vinye ƒe ɖɔkta?
Le ɣeyiɣi sia tɔgbe me la, ɖewohĩ nyabiase geɖe anɔ susu me na wò. Nyabiase siawo ate ŋu akpe ɖe ŋuwò:- Ðe vinyea hiã atikewɔwɔ enumakea, alo ɖe míate ŋu alala vie atso nya me emegbea?
- Eŋutinunyala bibi kawoe wòle be vinyea nakpɔ?
- Ðe wòle be míayi domenyiŋusẽfianu ŋuti aɖaŋuɖola aɖe gbɔa?
- Aleke vinye ƒe etsɔme anɔ?
- Ðe kpekpeɖeŋunahawo li na amewo kple ƒome siwo ŋu ‘Atypical Genitalia’ lea?
Ðe vinye ate ŋu adzi vi le etsɔmea?
Vidzidzi kple gbɔdɔdɔ ƒe dɔwɔwɔ le etsɔme nɔ te ɖe nusi gbɔ nɔnɔmea tso, Atypical Genitalia, dzi. Numekuku aɖewo ɖee fia be:- Nyɔnuvi siwo ŋu Congenital Adrenal Hyperplasia (CAH) le ate ŋu afɔ fu ne wodo lãmetsiŋusẽtike na wo vɔ.
- Anɔ eme be ŋutsuvi siwo ƒe vidzidɔ ɖeka ya teti wɔa dɔ nyuie la ate ŋu adzi vi.
- Ame siwo ŋu Ovotesticular DSD le siwo ƒe azigolo wɔa dɔ nyuie ate ŋu adzi vi.
- Ne vidzidɔ ƒe dɔmawɔmawɔ nyuie li gɔ̃ hã la, amesiwo ƒe vidzidɔ tsi nyuie ate ŋu alé fugboe si wotsɔ de eme la ɖe te.
Mlɔeba la, nusi dzi nàɖo ŋkui (Take-Home Message) .
Míese egɔme be ne ènya be ‘Atypical Genitalia’ le viwò si wodzi yeyee ŋu la, ate ŋu anye nuteɖeamedzi, dzikudodo kple tɔtɔ si mexɔ se o na wò kple wò ƒomea. Ele be nàdzro atikewɔwɔ, agbenɔnɔ kple susuŋutinunya me nya geɖewo me kple wò ƒomea kple atikewɔlawo ƒe ƒuƒoƒo.Gake taflatse ɖo ŋku edzi be menye wò ɖeka koe le mɔzɔzɔ sia me o. Wò atikewɔlawo ƒe ƒuƒoƒoa ana nyatakaka, kpekpeɖeŋu, kple aɖaŋuɖoɖo siwo nèhiã la wò. Le woƒe kpekpeɖeŋu me la, àte ŋu awɔ nyametsotso nyuitɔwo kekeake le viwòa ƒe gbɔdɔdɔ kple atikewɔwɔ ŋu, ana viwòa nanɔ agbe nyuitɔ kekeake, eye nàkpɔ nu nyuitɔ kekeake. Dzi megaɖe le ƒowò o. Ne sidzedze nyuitɔ kple kpekpeɖeŋu le asiwò la, ŋusẽ asu asiwò be nàdze ŋgɔ kuxi sia.
`Vidzinu Siwo Mebɔ O, Vidzinu Siwo Me Mekɔ O, DSD, Vidzinuwo, Lãmetsiŋusẽwo, Dzɔdzɔmeŋusẽŋununya, Ðeviwo ƒe Lãmesẽ, Domenyiŋusẽfianu ƒe Nɔnɔmewo, Vidzidzi ƒe Adrenal Hyperplasia, Gbɔdɔdɔ ƒe Tsitsi
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