Ngaba kunzima ukufumanisa ukuba amalungu esini omntwana wakho ngawamadoda okanye ngawabafazi? Oku kusenokuba 'yi-Atypical Genitalia'.

Ubungaziva njani ukuba ububambe umntwana wakho osandul’ ukuzalwa ezandleni zakho kwaye ungakwazi ukubona kwangoko ukuba yinkwenkwe okanye intombazana? Kunzima ukuyicinga, kwaye kunokuba yinto edidayo kakhulu, exhalabisayo, kwaye ide ibe lusizi. Kukho imibuzo emininzi efika engqondweni ngexesha elinje. "Yintoni engalunganga ngomntwana wam?" "Ingaba oku kuqhelekile?" "Ndenze ntoni ngoku?" Izinto ezinjalo zisenokuba zihamba engqondweni yakho. Oku kubizwa ngokuba yi-'Atypical Genitalia' ngokwezonyango. Ngaphambili, yayibizwa ngokuba yi-'Ambiguous Genitalia'. Ngamafutshane, le yimeko apho amalungu esini angaphandle omntwana engengowamadoda okanye amabhinqa ngokucacileyo. Amalungu esini omntwana asenokungakhuli ngokupheleleyo, okanye anokuba nomxube wesini sobabini. Oku kwaziwa ngokuba yiDifference of Sexual Development (DSD).

Ixhaphake kangakanani le meko ibizwa ngokuba yi-'Atypical Genitalia'?

Le yimeko engaqhelekanga kakhulu . Ngokwezibalo, ngumntwana omnye kuphela kwi-1,000 ukuya kwi-4,500 osandul’ ukuzalwa ochaphazeleka yile meko. Ngoko ke, nangona ingaqhelekanga, kubalulekile ukuyiqonda le meko.

Izakhi zofuzo zomntwana zihlala zikhula njani?

Ukuze uqonde oku, kufuneka wazi kancinci malunga nendlela amalungu esini omntwana akhula ngayo esibelekweni. Khawuthelekelele, le yinkqubo enzima kakhulu nemangalisayo. Oku kwenzeka ngamanyathelo amathathu aphambili: 1. Ukuchonga isini semfuza: Into yokuqala eyenzekayo kukuba isini semfuza somntwana sichongiwe. Oku kwenzeka xa isidoda esivela kuyise sidibana neqanda elivela kumama. Umama uhlala efumana i-chromosome X. Utata angafumana i-chromosome X okanye i-Y. Ngoko ke, ukuba i-X evela kumama kunye ne-X evela kutata ziyadibana (XX), kuzalwa intombazana. Ukuba i-X evela kumama kunye ne-Y evela kutata ziyadibana (XY), kuzalwa inkwenkwe. 2. Ukwakheka kwe-gonad: Okulandelayo, ii-gonad zomntwana ziyakhula ngokwesi sini semfuza. Kumntwana obhinqileyo, ii-ovari ziyakhula, kwaye kumntwana oyindoda, ii-testes ziyakhula. 3. Ukuphuhliswa kwezitho zangasese zangaphakathi nezangaphandle: Okokugqibela, iihomoni eziveliswa zezi gonad zinoxanduva lokuphuhliswa kwezitho zangasese zangaphakathi zomntwana kunye nezitho zangasese zangaphandle. Ngoko ke, ukuba kukho utshintsho nakweyiphi na inxalenye yale nkqubo, imeko ebizwa ngokuba yiDissociative Developmental Disorder (DSD), okanye 'Atypical Genitalia', inokwenzeka. Ngokuqhelekileyo, oku kungenxa yeengxaki zehomoni. Ezi mpembelelo zehomoni zinokudluliselwa ngeejini ezivela kubazali, okanye zinokwenzeka ngaphandle kwesizathu esicacileyo.

Zithini izizathu ze-'Atypical Genitalia'?

Izihlandlo ezininzi, esona sizathu siphambili soku kukungasebenzi kakuhle kwamahomoni okwenzeka emzimbeni womntwana ngexesha lokukhulelwa.Ezi homoni zilawula uphuhliso lwamalungu esini omntwana. Ngoko ke, ukuba kukho ukungalingani kwezi homoni, kuya kuchaphazela indlela amalungu esini omntwana akhula ngayo. Ezi zizathu zinokwahluka ngokuxhomekeke kwiikhromosomu zesini zomntwana.

46 XX DSD (i-DSD enepateni yechromosome yabasetyhini)

Kule meko, ukwakheka kwemfuza yomntwana kukwabasetyhini (XX). Oku kuthetha ukuba umntwana une-ovaries kunye nesibeleko ngaphakathi. Nangona kunjalo, i-genitalia yangaphandle inokubonakala njengendoda, enepenis kunye namasende. Oku kwenzeka ukuba i-genitalia yangaphandle yomntwana ivezwa kumanqanaba aphezulu ee-hormone zamadoda (androgens) ngexesha lokukhula kwe-genitalia yangaphandle yomntwana. Eyona nto ixhaphakileyo yile meko ebizwa ngokuba yi-'Congenital Adrenal Hyperplasia' (CAH). Oku kwenzeka xa ii-adrenal glands zomntwana zivelisa ii-hormone zamadoda ezininzi kakhulu .

46 XY DSD (i-DSD enepateni yechromosome yamadoda)

Kwimeko enjalo, ukwakheka kwemfuza yomntwana yindoda (XY). Oku kuthetha ukuba umntwana kufuneka abe namasende (amasende) ngaphakathi. Nangona kunjalo, amalungu esini angaphandle awabonisi ngokucacileyo iimpawu zobudoda, kwaye asenokufana neempawu zobufazi. Kukho izizathu ezininzi eziphambili zoku:

• Amasende omntwana awakhuli kakuhle.
• Amasende ayasilela ukuvelisa i-testosterone eyaneleyo yehomoni yamadoda.
• Nangona i-testosterone iveliswa, umzimba womntwana awukwazi ukuyisebenzisa ngokufanelekileyo.

Iingxaki zokwahluka kweGonadal

Okwenzekayo kule meko kukuba ii-gonads zomntwana azikhuli ngokupheleleyo zibe ngamasende okanye ama-ovari.

• Ukwahlukana kweGonadal Dysgenesis: Kule meko, iigonads (amasende okanye ama-ovari ) azikhuli ngokupheleleyo.
• Ukuphazamiseka kwe-Partial Gonadal: Kule meko, nangona ezinye izicwili zamasende zakheke kwii-gonads zomntwana, ezo zicwili azisebenzi kakuhle.
• Ukuphazamiseka kweGonadal: Kule meko, zombini iigonad zingaphambi kwexesha, oko kuthetha ukuba azikhuli zibe ngamasende okanye ama-ovari.

I-Ovotesticular DSD (i-ovum-testicular DSD)

Le yimeko engaqhelekanga kakhulu. Kwimeko enjalo, ii-gonads zomntwana zinokuba nezicubu ze-ovarian kunye nezicubu ze-testicular. Okanye, kusenokuba ne-ovary kwelinye icala kunye ne-testicle kwelinye.

Injani imeko 'ye-Atypical Genitalia' ngaphandle?

Imbonakalo yale meko iyahluka ngokuxhomekeke kwiichromosomes ezichaphazelekayo kunye nesimo sehomoni. Izitho zangasese ezingaqhelekanga kumntwana ozelwe ngokwemfuza (iichromosomes zeXX) unokuba nezi mpawu zilandelayo:

• I-clitoris iyakhula ize ibonakale ngathi yipenis encinci.
• Umnyango we-urethra ungaphantsi kwe-scrotum okanye ngaphakathi kwilungu lobufazi endaweni yendawo eqhelekileyo.
• Iilebhiya zinamathelene, zibukeka njengescrotum.
• Kusenokubakho iqhuma lezicubu phakathi kwelabia, elinokubonakala njengengxowa equlethe amasende.

Izitho zangasese ezingaqhelekanga kumntwana ozelwe ngokwemfuza (ii-chromosomes ze-XY) zingabandakanya:

• Ipenisi ayikho kwaphela okanye incinci kakhulu, ibukeka njengepenisi ekhulisiweyo (micropenis).
• Umnyango we-urethra ufumaneka ezantsi kwepenis okanye phakathi kwe-scrotum endaweni yokuba usencamini (le meko ikwabizwa ngokuba yi-'Hypospadias').
• I-scrotum inciphile, yahlulwe kubini, kwaye ifana ne-labia.
• Amasende ehle esuka kwisisu kwaye awasekho kwi-scrotum ( amasende angaphakamanga ).

Ziziphi ezinye iimpawu ze-'Atypical Genitalia'?

Inkangeleko yamalungu esini angaphandle yeyona nto iphambili. Ukongeza, ungabona izinto ezifana nezi:

• Ukungalingani kwamahomoni .
• Kwimeko yentombazana, ukuya exesheni kungaqala kwangethuba kakhulu, kubuye kade, okanye kungenzeki konke konke.
• I-Hypospadias kuxa umngxuma we-urethra ungekho kwincam yepenis.

Oogqirha bayixilonga njani le meko?

Oogqirha badla ngokuxilonga le meko kwangoko nje ukuba umntwana uzelwe . Okanye, ngexesha lovavanyo lokuqala lomntwana ophilileyo. Ukuba akucaci ukuba umntwana yinkwenkwe okanye yintombazana, ugqirha womntwana uya kuyalela ezinye iimvavanyo.

Yintoni onokuyilindela ngexesha lokuhlolwa kwempilo yomntwana wakho?

Ugqirha uza kuqala akubuze ngembali yempilo yosapho lwakho. Emva koko, uza kuhlola ngononophelo amalungu esini angaphandle omntwana. Ezi mvavanyo zilandelayo zinokwenziwa ukuze kufunyanwe isifo esichanekileyo:

• Uvavanyo lwegazi: Ukujonga amanqanaba eehomoni zomntwana kunye neekhromosomu.
• Uvavanyo lwemifanekiso: Olu vavanyo lunokujonga amalungu angaphakathi omntwana, njenge-ultrasound, i-X-ray, okanye i-MRI (Magnetic Resonance Imaging).
• I-Biopsy okanye i-Laparoscopy: Ukuthatha iqhekeza elincinci lesicwili kwi-gonads yomntwana ukuze lihlolwe.

Ngamanye amaxesha ukuxilongwa kungenziwa ngokukhawuleza. Kodwa ngamanye amaxesha kungathatha ixesha. Ukufumana ukuxilongwa ngokuchanekileyo kubaluleke kakhulu. Yiyo loo ndlela onokumisela ngayo isabelo somntwana sesondo kwaye ucebe unyango olufanelekileyo.

Iphathwa njani 'i-Atypical Genitalia'?

Ngaphambi kokuba uqale unyango, inyathelo lokuqala kukufumanisa unobangela ochanekileyo wale meko. Emva koko, ngokusekelwe kwiziphumo zovavanyo lweehomoni kunye nezinye iimvavanyo, iqela lezonyango liya kugqiba ngesicwangciso sonyango kunye nokunikezelwa kwesondo okufanelekileyo komntwana. Ekubeni le yingxaki enzima kakhulu kwaye inobuzaza, iqela lezifundo ezahlukeneyo liya kuba lapho ukukunceda. Kubaluleke kakhulu ukufumana abantu abanolwazi kwezi ntlobo zeemeko. Ngabo banokukunika icebiso elingcono. Eli qela linokubandakanya iingcali ezifana nezi:

• Ingcali yeentsana ezisanda kuzalwa
• Ingcali yemfuza
• Ingcali ye-Endocrinologist
• Ugqirha wotyando
• Ingcali yoMchamo
• Ingcali yezengqondo

Kunye, wena kunye neqela lezonyango niya kwenza izigqibo ezilungileyo malunga nempilo-ntle yomntwana wakho yexesha elide, ukusebenza ngokwesondo kwixesha elizayo, kunye nokuzala. Unyango luya kuxhomekeka kwizinto ezininzi, kuquka:

• Isizathu semeko yomntwana.
• Inkangeleko yezitho zangasese zomntwana.
• Iminqweno yosapho lwakho kunye neenkolelo zenkcubeko.

Iindlela zonyango zingabandakanya:

• Unyango Lokutshintshwa KweeHormone (HRT): Ukuba kukho ukungalingani kweehomoni, le meko inokulawulwa ngonyango lweehomoni kuphela.
• Utyando lokuvuselela: Ngamanye amaxesha, iqela lezonyango linokuxoxa nawe lize licebise utyando ngelixa umntwana wakho esemncinci. Nangona kunjalo, kukho izimvo ezahlukeneyo malunga nolu tyando lokuvuselela 'i-Atypical Genitalia'. Ngamanye amaxesha, umzekelo, ukuba umntwana akanayo indawo yokuphuma komchamo, utyando luyimfuneko ngokwezonyango. Nangona kunjalo, ukuba utyando lujolise ekuphuculeni inkangeleko, abanye abazali bakhetha ukulinda de umntwana abe mdala kwaye banokwenza izigqibo malunga nomzimba wabo. Esi sisigqibo esibaluleke kakhulu nesicingisiswe kakuhle.

Khumbula: Esi sigqibo sotyando sinokuba nefuthe elikhulu kubomi bomntwana wakho kwixesha elizayo, ngoko ke kungcono ukuthetha nomcebisi onamava kweli candelo.

Ukuba umntwana wam une-'Atypical Genitalia', yintoni endimele ndiyilindele?

Imeko ethi 'Atypical Genitalia' inefuthe elikhulu kumntwana kungekuphela nje ngokwasemzimbeni, kodwa nakwezentlalo nangokwengqondo.Ingabangelwa yindlela ezimile ngayo izitho zangasese, nto leyo enokuchaphazela indlela umntwana azijonga ngayo. Isigqibo sokwenza utyando sinokuchaphazela umgangatho wobomi bomntwana. Yingakho kubalulekile ukufuna iingcebiso zeengcali ngale nto. Nangona ukuxilongwa kwe-'Atypical Genitalia' kunokuba yinto ebangela uxinezeleko olukhulu, iqela lakho lezonyango liya kukunceda ukhethe eyona ndlela ilungileyo yonyango.

Ndingalufuna nini uncedo lwezonyango malunga nemeko yomntwana wam 'ye-Atypical Genitalia'?

Ugqirha udla ngokuxilonga esi sifo xa umntwana ezalwa okanye ngexesha lovavanyo lokuqala lonyango lomntwana. Emva koko ugqirha uya kuxoxa nawe ngokuxilongwa kunye neendlela zonyango.

Yeyiphi imibuzo endifanele ndiyibuze ugqirha womntwana wam?

Ngexesha elinje, usenokuba nemibuzo emininzi engqondweni yakho. Le mibuzo inokukunceda:

• Ngaba umntwana wam ufuna unyango ngoko nangoko, okanye singalinda ixesha elide size senze isigqibo kamva?
• Zeziphi iingcali umntwana wam afanele azibone?
• Ngaba kufuneka siye kumcebisi wezemfuza?
• Liza kuba njani ikamva lomntwana wam?
• Ngaba kukho amaqela enkxaso kubantu nakwiintsapho ezine-'Atypical Genitalia'?

Ngaba umntwana wam uza kukwazi ukuba nabantwana kwixesha elizayo?

Ukuzala kwexesha elizayo kunye nokusebenza ngokwesondo kuxhomekeke kwisizathu sale meko, i-Atypical Genitalia. Ezinye izifundo zifumanise ukuba:

• Amantombazana ane-Congenital Adrenal Hyperplasia (CAH) angakhulelwa emva kokufumana unyango lwe-hormone.
• Abafana abanesende elinye elisebenza kakuhle banokukwazi ukuba nabantwana.
• Abantu abane-Ovotesticular DSD abane-ovary esebenza kakuhle banokukwazi ukuba nabantwana.
• Nokuba kukho i-dysgenesis yama-testicular, abo bane-uterus ephuhlileyo banokukwazi ukuxhasa i-embryo efakwe kwi-embryo.

Okokugqibela, yintoni ekufuneka uyikhumbule (Umyalezo Wokuya Ekhaya)

Siyaqonda ukuba ukufumanisa ukuba umntwana wakho osandul’ ukuzalwa une-'Atypical Genitalia' kunokuba ngamava anzima kakhulu, aphazamisayo kwaye adidekayo kuwe nakusapho lwakho. Kuya kufuneka uxoxe ngemiba emininzi yezonyango, yokuziphatha neyengqondo nosapho lwakho kunye neqela lezonyango.

Kodwa nceda ukhumbule, awuwedwa kolu hambo. Iqela lakho lezonyango liza kukunika ulwazi, inkxaso, kunye neengcebiso ozifunayo. Ngoncedo lwabo, ungenza izigqibo ezilungileyo malunga nesini somntwana wakho kunye nonyango, unike umntwana wakho ubomi obungcono kangangoko, kwaye ufumane iziphumo ezilungileyo kangangoko. Musa ukuphelelwa lisibindi. Ngolwazi olufanelekileyo kunye nenkxaso, uya kuba namandla okujongana nalo mceli mngeni.

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"Ii-genitalia ezingaqhelekanga, ii-genitalia ezingacacanga, i-DSD, ii-genitals, iiHormones, iiChromosomes, impilo yomntwana, iimeko zemfuza, i-Congenital Adrenal Hyperplasia, uphuhliso lwesondo