Hermaphroditism is referred to in medical parlance as a state of sexual ambiguity. It is difficult or impossible to define whether a hermaphrodite person is female or male. Very different cases exist.

Definition of hermaphroditism

Hermaphroditism is a term that today is often associated with intersex or intersexuality. The sex characteristics of intersex people are not clearly defined. In medical parlance, human hermaphroditism is defined as a state of sexual ambiguity characterized by a mixture of female and male sex characteristics.

Types of hermaphroditism

There can be many forms of intersex, or intersex. However, it would seem that three types of hermaphroditism stand out today:

• true hermaphroditism which is a very rare form characterized by the simultaneous development of ovarian and testicular tissue;
• male pseudohermaphroditism, or male pseudohermaphroditis, which is associated with individuals with an XY karyotype (defining a male individual) with ambiguous genital tracts and external genitalia;
• pseudo-hermaphroditism in women, or female pseudo-hermaphrodite, which is associated with people of karyotype XX (defining a female subject) with ovaries but ambiguous external genitalia.

Causes of hermaphroditism

With regard to the types presented above, hermaphroditism can be presented as the consequence of an incomplete embryonic evolution towards a phenotype (set of observable traits of an individual) female or male. This sexual differentiation disorder can have different causes.

True hermaphroditism results from an alteration on the sex chromosomes.

Male pseudo-hermaphroditis may be due to:

• abnormalities in the synthesis of testosterone;
• a deficiency in dihydrotestosterone, a hormone derived from testosterone that is involved in the differentiation of male genitalia. 

The female pseudo-hermaphrodite is caused by early exposure to androgens, i.e. hormones responsible for the development of male sexual characteristics. This exposure may be due to:

• congenital adrenal hyperplasia, an inherited disease affecting the adrenal glands that produce androgens;
• adrenal tumor in the mother of the hermaphroditic child;
• hormonal treatment not appropriate for androgens in pregnant women.

Diagnostic de l’hermaphrodisme

The diagnosis of hermaphroditism is usually made from birth by clinical examination. Additional tests, such as hormone tests or genetic analyzes, may be done to confirm the diagnosis.

Each hermaphrodite person can have different symptoms. However, some similarities were found between the types of hermaphroditism presented above.

• Characteristics of True Hermaphroditism: True hermaphroditism is often characterized by the presence of an ovotestis, a gonad having both the characteristics of an ovary and a testis. The degree of differentiation of the external genitalia is dependent on the degree of genetic abnormality.
• Characteristics of the male pseudo hermaphrodite: The genital tract and the external genitalia are ambiguous. They may exhibit characteristics of the female or male sex.
• Characteristics of the female pseudo hermaphrodite: The internal genitalia are those of the female sex while the external genitalia have characteristics of the male sex. These can be virilized to different degrees. In some cases, the external genitalia are totally virilized from birth but the testes are absent within the bursa

Management of hermaphroditism in children may be considered. However, it is delicate because it requires parents and the medico-surgical team to assign a gender or social identity to the child without being able to ask for his opinion. The choice is generally discussed according to the appearance and development of sexual characteristics. The treatment of hermaphroditism then relies on surgery to remove tissue from the opposite sex. Hormone replacement therapy is put in place.

No study has provided data on the prevention of hermaphroditism.