Kunzima yini ukusho ngqo ukuthi izitho zangasese zomntwana wakho zingezabesilisa noma abesifazane? Lokhu kungaba 'yi-Atypical Genitalia'.

Ubungazizwa kanjani uma ubambe ingane yakho esanda kuzalwa ezandleni zakho futhi ungakwazi ukubona ngokushesha ukuthi ingumfana noma intombazane? Kunzima ukuyicabanga, futhi kungaba yinto edidayo kakhulu, ekhathazayo, futhi edabukisa. Kunemibuzo eminingi efika engqondweni ngesikhathi esinjengalesi. "Yini engalungile ngomntanami?" "Ingabe lokhu kujwayelekile?" "Ngenzenjani manje?" Izinto ezinjengalezo zingase zidlule engqondweni yakho. Lokhu yilokho esikubiza ngokuthi 'i-Atypical Genitalia' ngokwezokwelapha. Ngaphambilini, yayibizwa nangokuthi 'i-Ambiguous Genitalia'. Kalula nje, lesi yisimo lapho izitho zangasese zomntwana zingabonakali njengowesilisa noma owesifazane. Izitho zangasese zomntwana zingase zingakhuli ngokugcwele, noma zingase zibe nengxube yazo zombili izini. Lokhu kwaziwa nangokuthi i-Difference of Sexual Development (DSD).

Sivame kangakanani lesi simo esibizwa ngokuthi 'i-Atypical Genitalia'?

Lesi yisimo esingavamile kakhulu . Ngokwezibalo, yinye kuphela kwezinsana ezisanda kuzalwa eziyi-1,000 kuya kweziyi-4,500 ethinteka yilesi simo. Ngakho-ke, nakuba singavamile, kubalulekile ukuqaphela lokhu.

Izitho zangasese zomntwana zivame ukukhula kanjani?

Ukuze uqonde lokhu, udinga ukwazi okuncane ngendlela izitho zobulili zengane ezikhula ngayo esibelethweni. Cabanga nje, lena inqubo eyinkimbinkimbi kakhulu futhi emangalisayo. Lokhu kwenzeka ngezinyathelo ezintathu eziyinhloko: 1. Ukunqunywa kobulili bezakhi zofuzo: Into yokuqala eyenzekayo ukuthi ubulili bezakhi zofuzo bomntwana bunqunywa. Lokhu kwenzeka lapho isidoda esivela kuyise sihlangana neqanda elivela kumama. Umama uhlala ethola i-chromosome X. Ubaba angathola i-chromosome X noma i-Y. Ngakho-ke, uma i-X evela kumama kanye ne-X evela kubaba kuhlangana (XX), kuzalwa intombazane. Uma i-X evela kumama kanye ne-Y evela kubaba kuhlangana (XY), kuzalwa umfana. 2. Ukwakheka kwe-gonad: Okulandelayo, i-gonad yengane ikhula ngokwalobu bulili bezakhi zofuzo. Enganeni yowesifazane, ama-ovari ayakhula, kanti enganeni yowesilisa, ama-testes ayakhula. 3. Ukuthuthukiswa kwezitho zobulili zangaphakathi nezangaphandle: Okokugcina, ama-hormone akhiqizwa yizitho zobulili ze-gonad anesibopho sokuthuthukiswa kwezitho zobulili zangaphakathi zengane kanye nezitho zobulili zangaphandle. Ngakho-ke, uma kukhona ushintsho kunoma iyiphi ingxenye yale nqubo, khona-ke isimo esibizwa ngokuthi i-Dissociative Developmental Disorder (DSD), noma 'i-Atypical Genitalia', singavela. Ngokuvamile, lokhu kungenxa yezinkinga zama-hormone. La mathonya ama-hormone angadluliselwa ngofuzo oluvela kubazali, noma angavela ngaphandle kwesizathu esibonakalayo.

Yiziphi izimbangela 'ze-Atypical Genitalia'?

Esikhathini esiningi, isizathu esiyinhloko salokhu ukungasebenzi kahle kwamahomoni okwenzeka emzimbeni wengane ngesikhathi sokukhulelwa.Lawa ma-hormone alawula ukukhula kwezitho zobulili zengane. Ngakho-ke, uma kukhona ukungalingani kula ma-hormone, kuzothinta indlela izitho zobulili zengane ezikhula ngayo. Lezi zizathu zingase zihluke kuye ngama-chromosome obulili engane.

46 XX DSD (i-DSD enephethini ye-chromosome yabesifazane)

Kulesi simo, ukwakheka kofuzo komntwana kungowesifazane (XX). Lokhu kusho ukuthi umntwana unezibeletho kanye nesibeletho ngaphakathi. Kodwa-ke, izitho zangasese zangaphandle zingase zibukeke njengezowesilisa, zinepenis namasende. Lokhu kwenzeka uma izitho zangasese zangaphandle zomntwana zivezwa emazingeni aphezulu amahomoni wesilisa (androgens) ngesikhathi sokuthuthukiswa kwezitho zangasese zangaphandle zomntwana. Imbangela evame kakhulu yalokhu yisimo esibizwa ngokuthi 'Congenital Adrenal Hyperplasia' (CAH). Lokhu kwenzeka lapho izindlala ze-adrenal zomntwana zikhiqiza amahomoni wesilisa amaningi kakhulu .

46 XY DSD (i-DSD enephethini ye-chromosome yesilisa)

Kulesi simo, ukwakheka kofuzo komntwana kungowesilisa (XY). Lokhu kusho ukuthi umntwana kufanele abe namasende (amasende) ngaphakathi. Kodwa-ke, izitho zangasese zangaphandle azibonisi ngokucacile izici zowesilisa, futhi zingase zifane nezici zowesifazane. Kunezizathu eziningana eziyinhloko zalokhu:

• Amasende engane awakhuli kahle.
• Amasende awakwazi ukukhiqiza i-testosterone eyanele ye-hormone yesilisa.
• Ngisho noma kukhiqizwa i-testosterone, umzimba womntwana awukwazi ukuyisebenzisa kahle.

Izinkinga Zokwehluka Kwe-Gonadal

Okwenzekayo kulokhu ukuthi i-gonad yomntwana ayikhuli ngokugcwele ibe amasende noma ama-ovari.

• I-Mixed Gonadal Dysgenesis: Kulokhu, ama-gonad (ama-testes noma ama-ovari ) awakhuli ngokugcwele.
• Ukuphazamiseka Kwe-Gonadal Okuyingxenye: Kulokhu, nakuba ezinye izicubu zamasende zakheke kuma-gonad omntwana, lawo masende awasebenzi kahle.
• Ukuphazamiseka Kwe-Gonadal: Kulokhu, womabili ama-gonad asheshe abe yi-testicles noma ama-ovari.

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

Lesi yisimo esingavamile kakhulu. Kulesi simo, ama-gonad omntwana angase abe nezicubu zesibeletho kanye nezicubu zesibeletho. Noma, kungase kube ne-ovary kolunye uhlangothi kanye ne-testicle kolunye.

Sibukeka kanjani isimo 'se-Atypical Genitalia' ngaphandle?

Ukubonakala kwalesi simo kuyahlukahluka kuye ngama-chromosome athintekile kanye nesimo sama-hormone. Izitho zangasese ezingavamile enganeni yowesifazane onofuzo (ama-chromosomes angu-XX) zingase zibe nezici ezilandelayo:

• I-clitoris iyakhula futhi ibukeke njengepenis encane.
• Imbobo ye-urethral itholakala ngaphansi kwe-scrotum noma ngaphakathi kwesitho sangasese sowesifazane esikhundleni sendawo yayo evamile.
• Ama-labia anamathele ndawonye futhi abukeka njenge-scrotum.
• Kungase kube nesigaxa sezicubu phakathi kwe-labia, esingase sibukeke njengesikhwama esiqukethe amasende.

Izitho zangasese ezingavamile kumntwana wesilisa onesifo sofuzo (ama-chromosome e-XY) zingafaka:

• Ipenisi ayikho nhlobo noma incane kakhulu, ibukeka njengepenisi ekhulisiwe (i-micropenis).
• Imbobo ye-urethra itholakala phansi kwepenis noma phakathi kwe-scrotum esikhundleni se-ekugcineni (lesi simo sibizwa nangokuthi 'i-Hypospadias').
• I-scrotum inciphile, ihlukaniswe kabili, futhi ibukeka njenge-labia.
• Amasende ehle esuka esiswini futhi awasekho esinqeni samasende ( amasende angavuki ).

Yiziphi ezinye izimpawu ze-'Atypical Genitalia'?

Ukubonakala kwezitho zangasese zangaphandle kuyisici esiyinhloko. Ngaphezu kwalokho, ungase ubone izinto ezifana nalezi:

• Ukungalingani kwama-hormone .
• Uma kwenzeka intombazane, ukuya esikhathini kungase kuqale kusenesikhathi, kuphuze, noma kungenzeki nhlobo.
• I-Hypospadias yilapho imbobo ye-urethra ingekho esicongweni sepenis.

Odokotela bakuthola kanjani lesi simo?

Odokotela bavame ukuxilonga lesi simo ngokushesha nje lapho umntwana ezalwa . Noma, ngesikhathi sokuhlolwa kokuqala kwengane kahle. Uma kungacaci ukuthi ingane ingumfana noma intombazane, udokotela wengane uzoyala ukuhlolwa okwengeziwe.

Yini ongayilindela ngesikhathi sokuhlolwa kwezokwelapha kwengane yakho?

Udokotela uzoqala ngokukubuza ngomlando wezokwelapha womndeni wakho. Ngemuva kwalokho, uzohlola ngokucophelela izitho zangasese zomntwana zangaphandle. Ukuhlolwa okulandelayo kungenziwa ukuze kutholakale ukuxilongwa okunembile:

• Ukuhlolwa kwegazi: Ukuhlola amazinga ama-hormone nama-chromosome engane.
• Ukuhlolwa kwezithombe: Lokhu kungabheka izitho zangasese zangaphakathi zomntwana, njenge-ultrasound, i-X-ray, noma i-MRI (Magnetic Resonance Imaging).
• I-Biopsy noma i-Laparoscopy: Ukuthatha ingxenye encane yezicubu ezivela kuma-gonad omntwana ukuze zihlolwe.

Ngezinye izikhathi ukuxilongwa kungenziwa ngokushesha. Kodwa ngezinye izikhathi kungathatha isikhathi. Ukuthola ukuxilongwa okunembile kubaluleke kakhulu. Yileyo ndlela ongathola ngayo isabelo socansi sengane futhi uhlele ukwelashwa okufanele.

Iphathwa kanjani i-'Atypical Genitalia'?

Ngaphambi kokuqala ukwelashwa, isinyathelo sokuqala ukuthola imbangela eqondile yalesi simo. Ngemuva kwalokho, ngokusekelwe emiphumeleni yokuhlolwa kwama-hormone kanye nokunye ukuhlolwa, ithimba lezokwelapha lizonquma uhlelo lokwelashwa kanye nokwabelwa kocansi okufanele kwengane. Njengoba lokhu kuyindaba eyinkimbinkimbi kakhulu futhi ebucayi, ithimba lezifundo eziningi lizobe likhona ukukusiza. Kubaluleke kakhulu ukuthola abantu abanolwazi kulezi zinhlobo zezimo. Yibo abangakunikeza iseluleko esingcono kakhulu. Leli thimba lingafaka ochwepheshe abanjengo:

• Udokotela Wezingane Ezisanda Kuzalwa
• Isazi sezakhi zofuzo
• Udokotela we-Endocrinologist
• Udokotela ohlinzayo
• Udokotela Wezifo Zomchamo
• Isazi sokusebenza kwengqondo

Ngokubambisana, wena kanye naleli thimba lezokwelapha nizokwenza izinqumo ezinhle kakhulu mayelana nenhlalakahle yengane yakho yesikhathi eside, ukusebenza kocansi kwesikhathi esizayo, kanye nokuzala. Ukwelashwa kuzoncika ezintweni eziningi, okuhlanganisa:

• Isizathu sesimo somntwana.
• Ukubonakala kwezitho zangasese zomntwana.
• Izifiso zomndeni wakho kanye nezinkolelo zamasiko.

Izinketho zokwelapha zingafaka:

• Ukwelashwa Kokufaka Ama-hormone (HRT): Uma kukhona ukungalingani kwama-hormone, lesi simo singalawulwa ngokwelashwa ngama-hormone kuphela.
• Ukuhlinzwa Okwakha Kabusha: Ngezinye izikhathi, ithimba lezokwelapha lingaxoxa nawe futhi liphakamise ukuhlinzwa ingane yakho isencane. Kodwa-ke, kunemibono ehlukene mayelana nalokhu kuhlinzwa okwakha kabusha kwe-'Atypical Genitalia'. Ngezinye izikhathi, isibonelo, uma ingane ingenayo indawo yokuphuma komchamo, ukuhlinzwa kuyadingeka ngokwezokwelapha. Kodwa-ke, uma ukuhlinzwa kuhloselwe ukuthuthukisa ukubukeka, abanye abazali bakhetha ukulinda kuze kube yilapho ingane isikhulile futhi ingenza izinqumo ngomzimba wayo. Lesi yisinqumo esibaluleke kakhulu nesicatshangelwe kahle.

Khumbula: Lesi sinqumo sokuhlinzwa singaba nomthelela omkhulu empilweni yengane yakho yesikhathi esizayo, ngakho-ke kuwumqondo omuhle ukukhuluma nomeluleki ochwepheshe kule ndawo.

Uma ingane yami ine-'Atypical Genitalia', yini okufanele ngiyilindele?

Lesi simo 'se-Atypical Genitalia' sinemiphumela ejulile enganeni hhayi ngokomzimba kuphela, kodwa nangokwenhlalo nangokwengqondo.Kungabangelwa uhlobo lwezitho zangasese, okungathinta umuzwa wengane. Isinqumo sokuhlinzwa singathinta ikhwalithi yokuphila kwengane. Yingakho kubalulekile ukufuna iseluleko sochwepheshe ngalokhu. Nakuba ukuxilongwa 'kwe-Atypical Genitalia' kungaba yinto ekhathazayo kakhulu, ithimba lakho lezokwelapha lizokusiza ukuthi unqume indlela yokwelashwa engcono kakhulu.

Kufanele ngifune nini iseluleko sezokwelapha mayelana nesimo 'se-Atypical Genitalia' sengane yami?

Udokotela uvame ukuxilonga lesi simo lapho ezalwa noma ngesikhathi sokuhlolwa kokuqala kwengane. Udokotela uzobe esexoxa nawe ngokuxilongwa kanye nezinketho zokwelapha.

Yimiphi imibuzo okufanele ngiyibuze udokotela wengane yami?

Ngesikhathi esinjengalesi, ungase ube nemibuzo eminingi engqondweni yakho. Le mibuzo ingakusiza:

• Ingabe ingane yami idinga ukwelashwa ngokushesha, noma singalinda isikhashana bese senza isinqumo kamuva?
• Yibaphi ochwepheshe okufanele ingane yami ibabone?
• Ingabe kufanele sibone umeluleki wezakhi zofuzo?
• Lizoba njani ikusasa lengane yami?
• Ingabe kukhona amaqembu okusekela abantu nemindeni ene-'Atypical Genitalia'?

Ingabe ingane yami izokwazi ukuba nezingane esikhathini esizayo?

Ukuzala kwesikhathi esizayo kanye nokusebenza kocansi kuncike embangela yalesi simo, i-Atypical Genitalia. Ezinye izifundo zithole ukuthi:

• Amantombazane ane-Congenital Adrenal Hyperplasia (CAH) angakhulelwa ngemva kokuthola ukwelashwa ngama-hormone.
• Abafana abanesende elilodwa okungenani elisebenza kahle cishe bazokwazi ukuba nobaba bezingane.
• Abantu abane-Ovotesticular DSD abane-ovary esebenza kahle bangase bakwazi ukuthola abantwana.
• Ngisho noma kukhona ukungasebenzi kahle kwesibeletho, labo abanesibeletho esikhule kahle bangakwazi ukusekela umbungu ofakwe.

Okokugcina, okufanele ukukhumbule (Umyalezo Wokuya Ekhaya)

Siyaqonda ukuthi ukuthola ukuthi ingane yakho esanda kuzalwa ine-'Atypical Genitalia' kungaba yinto ekucindezelayo kakhulu, ecasulayo nedidayo kuwe nomndeni wakho. Kuzodingeka uxoxe ngezinkinga eziningi zezokwelapha, zokuziphatha nezengqondo nomndeni wakho kanye nethimba lezokwelapha.

Kodwa sicela ukhumbule, awuwedwa kulolu hambo. Ithimba lakho lezokwelapha lizokunikeza ulwazi, ukwesekwa, kanye neseluleko osidingayo. Ngosizo lwabo, ungenza izinqumo ezinhle kakhulu mayelana nobulili nokwelashwa kwengane yakho, unike ingane yakho impilo engcono kakhulu, futhi uthole imiphumela engcono kakhulu. Ungalahli isibindi. Ngolwazi nokusekelwa okufanele, uzokwazi ukubhekana nale nselele.

---

'Izitho Zobulili Ezingavamile, Izitho Zobulili Ezingaqondakali, i-DSD, Izitho Zobulili, Ama-Hormones, Ama-Chromosomes, Impilo Yengane, Izimo Zofuzo, I-Congenital Adrenal Hyperplasia, Intuthuko Yocansi