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假两性畸形

作者:大江 | 时间:2020-6-23 00:01:54 | 阅读:486| 显示全部楼层
假两性畸形(又称假性雌雄同体异形)是一种生物的古老临床术语,其天生具有一种性别的主要性别特征,但发展出的第二性特征与根据性腺组织所预期的特征不同(卵巢或睾丸)。可以将其与“真正的雌雄同体”一词进行对比,后者描述了同一个人存在睾丸和卵巢组织的情况。由于该术语的误解和贬义性含义,以及基于遗传的命名法的使用,该语言已不受欢迎。

当存在睾丸时使用术语雄性假两性人,而当存在卵巢时使用术语雌性假两性人。

在某些情况下,与假两性畸形相关的外部性器官看起来介于典型的阴蒂和阴茎之间。在其他情况下,外部性器官的外观可望与“相反的”性腺组织一起看到。因此,有时直到青春期或成年期才发现假两性畸形。

相关疾病包括5-α-还原酶缺乏症和雄激素不敏感性综合症。


内容
1 遗传学
2 管理
3 历史
4 术语
5 参考

遗传学
在受精过程中,性别决定和分化普遍表现为染色体性别。在早期阶段,表型性与染色体性不匹配,直到子宫内发育后期才达到性成熟。在子宫内发育过程中,雌性变为雄性,睾丸从具有发育中的阴囊的阴道盲袋以及最初类似于阴蒂的阴茎向下移动。睾丸激素水平增加会改变女性的表型。

影响雄激素受体(AR)基因的突变可能会导致完全或部分雄激素不敏感综合症。雄激素(用来描述一组性类固醇激素的术语)负责影响男性假两性畸形。胎儿在​​男性的分化发生在妊娠的第六或第七周。发育取决于睾丸决定因素:基因SRY(Y染色体上的性别决定区域)。在整个第9到第13周,男性生殖器的发育取决于生殖器靶组织内5α-还原酶的作用,将睾丸激素转化为更强的雄激素。内在的男性假两性畸形是持久性穆勒氏管综合征,它是通过合成穆勒抑制因子缺陷而发展而来的。在这种情况下,现在在46XY男性中有导管衍生品-其中包括子宫,输卵管和阴道上部。这些具有疝囊和肠loop的人与导管衍生物和睾丸一起被发现。

对雄性假两性小猫的一项研究表明,胃肠道和泌尿生殖器先天性异常合并存在。证实具有与男性假两性畸形相关的II型闭锁性肛门和直肠阴道瘘。

管理
主要文章:双性恋医疗干预与双性恋人
有时进行手术以改变生殖器的外观。但是,对两性恋者进行的许多手术缺乏必要性的明确证据,可被视为残害,并且在未经接受者知情同意的情况下进行,被普遍视为侵犯人权。

历史
主要文章:双性恋的历史和双性恋手术的历史
约翰·莫尼(John Money)可能是该领域最著名的早期研究人员。他的博士论文题目为“雌雄同体:对人类悖论的性质的探究”,并于1952年由哈佛大学颁发。

莫尼(Money)对于儿童时期所学到的性别认同的普遍看法后来与他的一位前病人戴维·赖默(David Reimer)在2001年出版的传记中直接矛盾。造成的影响之一是对约翰·莫尼(John Money)声誉的损害。不仅他的性别可塑性理论受到了沉重的打击,而且赖默尔的传记还描述了异常令人不愉快的童年疗法,并暗示Money忽略或掩盖了赖默尔重新分配给女性的进展不佳的证据。金钱的辩护者建议有关治疗疗程的某些指控可能是错误记忆综合症的结果。然而,雷默的弟弟和母亲都同意这种疗法没有“有效”的意义,因为雷默在接受钱博士治疗期间并未以任何方式发展女性的自我形象。金钱博士从未公开表示他的结论是错误的。

米尔顿·戴蒙德(Milton Diamond)在21世纪初期成为著名的公共两性专家。他是太平洋性与社会中心的主任。

术语
术语“假两性畸形”的使用可能会出现问题,现在被认为是多余的。 “假两性畸形”一词由埃德温·克莱布斯(Edwin Klebs)于1876年提出,早于对X染色体和Y染色体的遗传作用以及性别认同的社会成分进行了很好的描述,这就是为什么该术语通常用于描述不和谐的原因。性腺组织学与外生殖器外观之间的关系。

理查德·戈德施密特(Richard Goldschmidt)在1923年提出了“双性恋”一词。但是,“双性恋”一词也受到了挑战。 Lawson Wilkins儿科内分泌学会和欧洲儿科内分泌学会采用了基于性别发育障碍(DSD)的命名系统,该体系涵盖“染色体,性腺或解剖学性发育不典型的先天性疾病”,因此取代了许多不同的术语,包括但不限于基于“雌雄同体”的术语。

尽管它已经采用了打开“更多门”的用语,但现已解散的北美双性恋协会本身指出,双性不是一种障碍。 “ DSD”本身受到了激烈的竞争,其中包括民间社会组织,人权机构和学者。像格鲁吉亚·戴维斯(Georgiann Davis)和摩根·福尔摩斯(Morgan Holmes)这样的学者,以及泰格·德沃(Tiger Devore)这样的临床心理学家认为,DSD一词的设计是为了使两性尸体上的医疗权威“重新制度化”,使两性尸体更易于治疗,并且更具耻辱感。 (戴维斯)。2016年5月,Intersex青年互助者协会发表声明,反对以病态化语言来描述具有两性特征的人,并承认“增进了对该术语的普遍理解和接受” “ intersex””。

使用该术语所面临挑战的一个例子是患有完全雄激素不敏感综合症(CAIS)的女性。这些妇女通常具有其他妇女所具有的原发性和继发性特征;然而,它们是核型的,具有内部睾丸,而不是卵巢。他们有同样的可能性,一个有性别特征的XX女人享受性快感,但无法进行生物繁殖。他们的性别(同性恋,异性恋,双性恋等)不一定由这种综合征决定。尽管从科学上讲“男性”假两性人的描述可能适用于此类女性,但其社会不合适性仍存在争议。

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