Ukuphazamiseka kokuthuthuka kwesitho sowesifazane sangasese

Ukuphazamiseka kokuthuthuka kwendlela yokuzala yabesifazane kuyizinkinga ezithweni zokuzala zengane yentombazane. Zenzeka ngenkathi ekhula esibelethweni sikanina.

Izitho zokuzala zabesifazane zifaka phakathi isitho sangasese sowesifazane, amaqanda, isibeletho nomlomo wesibeletho.

Ingane iqala ukukhula ngezitho zayo zokuzala phakathi kwamasonto amane kuya kwayisihlanu ekhulelwe. Lokhu kuyaqhubeka kuze kube yisonto lama-20 lokukhulelwa.

Intuthuko inqubo eyinkimbinkimbi. Izinto eziningi zingathinta le nqubo. Ukuthi inkinga yengane yakho inzima kangakanani kuncike ekutheni ukuphazamiseka kwenzeke nini. Ngokuvamile, uma izinkinga zenzeka ngaphambi kwesikhathi esibelethweni, umphumela uzokwanda kakhulu.Izinkinga ekukhuleni kwezitho zokuzala zentombazane zingabangelwa:

• Izakhi zofuzo eziphukile noma ezingekho (ukukhubazeka kofuzo)
• Ukusetshenziswa kwemithi ethile ngesikhathi sokukhulelwa

Ezinye izingane zingaba nenkinga ezakhiweni zofuzo ezivimbela imizimba yazo ekukhiqizeni i-enzyme ebizwa nge-21-hydroxylase. Indlala ye-adrenal idinga le enzyme ukwenza ama-hormone afana ne-cortisol ne-aldosterone. Lesi simo sibizwa ngokuthi yi-congenital adrenal hyperplasia. Uma ingane yentombazane ekhulayo ingenayo le enzyme, iyozalwa ngesibeletho, ama-ovari, namashubhu e-fallopian. Kodwa-ke, izitho zakhe zangasese zangaphandle zizobukeka njengalezo ezitholakala kubafana.

Imithi ethile ethathwa ngumama ingadlula egazini lengane futhi iphazamise ukukhula komzimba. Umuthi owodwa owaziwa ngokwenza lokhu yi-diethylstilbestrol (DES). Abahlinzeki bezempilo bake banquma lo muthi kwabesifazane abakhulelwe ukuvimbela ukuphuphuma kwesisu nokusebenza ngaphambi kwesikhathi. Kodwa-ke, ososayensi bathola ukuthi izingane zamantombazane ezizalwe ngabesifazane abaphuza lo muthi zazinesibeletho esime ngendlela engajwayelekile. Lesi sidakamizwa siphinde sakhulisa amathuba amadodakazi okuthuthukisa uhlobo olungavamile lomdlavuza wesitho sangasese sowesifazane.

Kwezinye izimo, ukuphazamiseka kokukhula kungabonakala ngokushesha nje lapho umntwana ezalwa. Kungadala izimo ezisongela impilo enganeni esanda kuzalwa. Kwesinye isikhathi, lesi sifo asitholakali kuze kube yilapho intombazane ikhula.

Umgudu wokuzala ukhula eduze nomgudu wokuchama nezinso. Iphinde ikhule ngasikhathi sinye nezinye izitho eziningana. Ngenxa yalokhu, izinkinga zokukhula emkhakheni wokuzala wabesifazane kwesinye isikhathi zenzeka nezinkinga kwezinye izindawo. Lezi zindawo zingafaka umgudu wokuchama, izinso, amathumbu nomgogodla ophansi.

Izinkinga zokuthuthuka kwendlela yokuzala yabesifazane zifaka:

• I-Intersex
• Izitho zangasese eziyindida

Ezinye izinkinga zokukhula kwendlela yokuzala yabesifazane zifaka:

• Ukungajwayelekile kwe-Cloacal: I-cloaca iyisakhiwo esifana neshubhu. Ezigabeni zokuqala zokukhula, umgudu we-urinary, i-rectum, kanye nesitho sangasese sangasese konke kungenalutho kule tube eyodwa. Kamuva, izindawo ezi-3 ziyahlukana futhi zinokuvuleka kwazo. Uma i-cloaca iqhubeka njengoba ingane yentombazane ikhula esibelethweni, konke ukuvuleka akwenzi futhi kwehlukane. Isibonelo, ingane ingazalwa inokuvula okukodwa kuphela ezansi komzimba eduze kwendawo engunxande. Umchamo nendle akukwazi ukuphuma emzimbeni. Lokhu kungadala ukuvuvukala kwesisu. Okunye okungajwayelekile kwe-cloacal kungadala ukuthi ingane yentombazane ibukeke sengathi inepipi. Lokhu kukhubazeka kokuzalwa akuvamile.
• Izinkinga ngezitho zangasese zangaphandle: Izinkinga zentuthuko zingaholela ku-clitoris evuvukele noma i-labia exubile. I-labia ehlanganisiwe yisimo lapho amafolda wezicubu azungeze ukuvulwa kwesitho sangasese sowesifazane ehlangene khona. Izinkinga eziningi zezitho zangasese zangaphandle zihlobene ne-intersex kanye nezitho zobulili eziyinqaba.
• I-hymen engaphelele: I-hymen iyisicubu esincanyana esihlanganisa ukuvuleka kwesitho sangasese sowesifazane. I-hymen engafanele ivimba ngokuphelele ukuvuleka kwesitho sangasese sowesifazane. Lokhu kuvame ukuholela ekuvukeni okubuhlungu kwesitho sangasese sowesifazane. Kwesinye isikhathi, iculo lendoda linembobo encane kakhulu noma izimbobo ezincane ezincane. Le nkinga kungenzeka ingatholakali kuze kube ukuthomba. Ezinye izingane zamantombazane zizalwa zingenalo iculo. Lokhu akubhekwa njengokungajwayelekile.
• Izinkinga ze-Ovarian: Ingane yentombazane ingaba ne-ovary eyengeziwe, izicubu ezengeziwe ezifakwe kwi-ovary, noma izakhiwo ezibizwa ngokuthi ama-ovotestes anezicubu zomuntu wesilisa nowesifazane.
• Izinkinga zesibeletho nomlomo wesibeletho: Ingane yentombazane ingazalwa inesibeletho esengeziwe nesibeletho, isibeletho esakhiwe uhhafu, noma ukuvinjelwa kwesibeletho. Imvamisa, amantombazane azalwa enesigamu sesibeletho nengxenye eyodwa yesitho sangasese sangasese alahlekelwa izinso ngasohlangothini olufanayo lomzimba. Ngokuvamile, isibeletho singakha "nodonga" oluphakathi noma i-septum engxenyeni engenhla yesibeletho. Ukwehluka kwalesi sici kwenzeka lapho isiguli sizalwa sinomlomo wesibeletho esisodwa kepha ama-uteri amabili. Isibeletho esingenhla kwesinye isikhathi asixhumani nomlomo wesibeletho. Lokhu kuholela ukuvuvukala nobuhlungu. Konke okungahambi kahle kwesibeletho kungahlotshaniswa nezinkinga zokuzala.
• Izinkinga zesitho sangasese sowesifazane: Ingane yentombazane ingazalwa ingenaso isitho sangasese sowesifazane noma ivuleke isitho sangasese sangasese ivinjwe ungqimba lwamaseli aphakeme kakhulu esithweni sangasese kunalapho kunendumiso. Isitho sangasese sowesifazane esilahlekile sivame kakhulu ngenxa yesifo sikaMayer-Rokitansky-Kuster-Hauser syndrome. Kulesi sifo, ingane ilahlekile ingxenye noma zonke izitho zangaphakathi zokuzala (isibeletho, umlomo wesibeletho, namashubhu e-fallopian). Okunye okungahambi kahle kufaka phakathi ukuba nezitho sangasese sangasese ezi-2 noma isitho sangasese sowesifazane esivuleka emgudwini wokuchama. Amanye amantombazane angaba nesibeletho esimise okwenhliziyo noma isibeletho esinodonga maphakathi nomgodi.

Izimpawu ziyahluka ngokuya ngenkinga ethile. Zingafaka:

• Amabele awakhuli
• Ayikwazi ukukhipha isinye
• Isigaxa esiswini, imvamisa ngenxa yegazi noma amafinyila angakwazi ukuphuma
• Ukugeleza kokuya esikhathini okwenzeka ngaphandle kokusebenzisa itampon (uphawu lwesitho sowesifazane sangasese sesibili)
• Ukuqunjelwa noma ubuhlungu benyanga, ngaphandle kokuya esikhathini
• Akukho ukuya esikhathini (amenorrhea)
• Ubuhlungu ngocansi
• Ukuphuphuma kwesisu okuphindaphindiwe noma ukuzalwa kwangaphambi kokubeletha (kungahle kube ngenxa yesibeletho esingajwayelekile)

Umhlinzeki angaqaphela izimpawu zesifo sokukhula ngokushesha. Izimpawu ezinjalo zingafaka:

• Isitho sangasese esingajwayelekile
• Umlomo wesibeletho ongajwayelekile noma olahlekile
• Isinye ngaphandle komzimba
• Izitho zobulili okunzima ukuzibona njengentombazane noma umfana (izitho zangasese eziyindida)
• I-Labia enamathele ndawonye noma engalingani ngosayizi
• Akukho ukuvuleka endaweni yesitho sangasese noma ukuvuleka okukodwa okune-rectal
• I-clitoris evuvukile

Indawo yesisu ingahle ivuvuke noma kuzwakale isigaxa esiswini noma esiswini. Umhlinzeki angaqaphela ukuthi isibeletho asizizwa sijwayelekile.

Ukuhlolwa kungafaka:

• I-Endoscopy yesisu
• I-Karyotyping (ukuhlolwa kofuzo)
• Izinga le-Hormone, ikakhulukazi i-testosterone ne-cortisol
• I-Ultrasound noma i-MRI yendawo ye-pelvic
• Umchamo kanye ne-serum electrolyte

Odokotela bavame ukusikisela ukuhlinzekwa kwamantombazane anezinkinga zokukhula zezitho zokuzala zangaphakathi. Isibonelo, isitho sangasese sowesifazane esivinjiwe kaningi singalungiswa ngokuhlinzwa.

Uma ingane yentombazane ilahlekelwe isitho sangasese sowesifazane, umhlinzeki angaqoka i-dilator lapho ingane ifinyelela ebudaleni. I-dilator umshini osiza ukwelula noma ukunweba indawo lapho isitho sangasese sowesifazane kufanele sibe khona. Le nqubo ithatha izinyanga ezi-4 kuye kwezi-6. Ukuhlinzwa kungenziwa futhi ukudala isitho sowesifazane sangasese esisha. Ukuhlinzwa kufanele kwenziwe lapho owesifazane osemusha ekwazi ukusebenzisa i-dilator ukugcina isitho sangasese sowesifazane esisha sivulekile.

Kubikwe imiphumela emihle ngazo zombili izindlela zokuhlinzwa nezokuhlinzwa.

Ukwelashwa kokungajwayelekile kwe-cloacal kuvame ukufaka ukuhlinza okuyinkimbinkimbi okuningi. Lokhu kuhlinza kulungisa izinkinga nge-rectum, vaginal, kanye ne-urinary tract.

Uma ukukhubazeka kokuzalwa kubangela izinkinga ezibulalayo, ukuhlinzwa kokuqala kwenziwa ngemuva nje kokuzalwa. Ukuhlinzwa kokunye ukuphazamiseka kokuzala kungenziwa ngenkathi ingane isewusana. Okunye ukuhlinzwa kungabambezeleka ingane ize ikhule kakhulu.

Ukutholwa kwangaphambi kwesikhathi kubalulekile, ikakhulukazi ezimweni zokuzala ezingaqondakali. Umhlinzeki kufanele ahlole ngokucophelela ngaphambi kokuthatha isinqumo sokuthi ingane umfana noma intombazane. Lokhu kubizwa nangokuthi ukwabela ubulili. Ukwelashwa kufanele kubandakanye ukwelulekwa kwabazali. Ingane izodinga nokwelulekwa njengoba ikhula.

Izinsizakusebenza ezilandelayo zinganikeza imininingwane eminingi ngezifo ezahlukahlukene zokuthuthuka:

• ICARES Foundation - www.caresfoundation.org
• I-DES Action USA - www.desaction.org
• I-Intersex Society yaseNyakatho Melika - www.isna.org

Ukungajwayelekile kwamabala kungadala izinkinga ezibulalayo lapho uzalwa.

Izinkinga ezingaba khona zingakhula uma ukuxilongwa kwenziwa sekwephuzile noma akulungile. Izingane ezinezitho zobulili eziyindida ezinikezwa ubulili obunye zingase zitholakale kamuva ukuthi zinezitho zangaphakathi ezihlobene nobulili obuhlukile lapho zikhuliswe khona. Lokhu kungadala ukucindezeleka okukhulu kwengqondo.

Izinkinga ezingatholakali emkhakheni wokuzala wentombazane zingaholela ekungatholini nasezinkingeni zocansi.

Ezinye izinkinga ezenzeka kamuva empilweni zifaka:

• I-Endometriosis
• Ukuya emsebenzini ngaphambi kwesikhathi (ukulethwa ngaphambi kwesikhathi)
• Izigaxa zesisu ezibuhlungu ezidinga ukuhlinzwa
• Izisu eziphindaphindwayo

Shayela umhlinzeki wakho uma indodakazi yakho ine:

• Izitho zangasese ezibukeka ngendlela engajwayelekile
• Izici zobudoda
• Ubuhlungu be-pelvic benyanga nenyanga, kepha abuyi esikhathini
• Akuqalanga ukuya esikhathini ngeminyaka engu-16
• Akukho ukukhula kwebele ngesikhathi sokuthomba
• Azikho izinwele zasendlini lapho uthomba
• Izigaxa ezingajwayelekile esiswini noma emgodini

Abesifazane abakhulelwe akufanele bathathe noma yiziphi izinto eziqukethe ama-hormone wesilisa. Kufanele bahlole umhlinzeki ngaphambi kokuthatha noma yiluphi uhlobo lomuthi noma izithasiselo.

Noma umama enza yonke imizamo yokuqinisekisa ukukhulelwa okunempilo, izinkinga zokukhula enganeni zisengenzeka.

Isici sokuzalwa - isitho sangasese sowesifazane, amaqanda, isibeletho nomlomo wesibeletho; Ukukhubazeka kokuzalwa - isitho sangasese sowesifazane, amaqanda, isibeletho nomlomo wesibeletho; Ukuphazamiseka kokuthuthuka kwendlela yokuzala yabesifazane

• Ukuphazamiseka kokuthuthuka kwesitho sangasese sowesifazane kanye nesitho sangasese
• Okuzenzakalelayo kokuzalwa kwesibeletho

IDayimane DA, Yu RN. Ukuphazamiseka kokuthuthuka kwezocansi: i-etiology, ukuhlolwa, kanye nokuphathwa kwezokwelapha. Ku: Wein AJ, Kavoussi LR, Partin AW, Peters CA, ama-eds. ICampbell-Walsh Urology. Umhla ka-11. IPhiladelphia, PA: Elsevier; 2016: isahluko 150.

U-Eskew AM, uMerritt DF. Okudidayo kwe-Vulvovaginal ne-mullerian. Ku: Kliegman RM, St Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Incwadi kaNelson Yezingane. Umhlaka 21. IPhiladelphia, PA: Elsevier; 2020: isahluko 569.

UKaefer M. Ukuphathwa kokungajwayelekile kwesitho sangasese emantombazaneni. Ku: Wein AJ, Kavoussi LR, Partin AW, Peters CA, ama-eds. ICampbell-Walsh Urology. Umhla ka-11. IPhiladelphia, PA: Elsevier; 2016: isahluko 149.

I-Rackow BW, i-Lobo RA, i-Lentz GM. Ukungajwayelekile kokuzalwa kwepheshana lokuzala labesifazane: ukungafani kwesitho sowesifazane sangasese, umlomo wesibeletho, isibeletho kanye ne-adnexa. Ku: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. I-Gynecology ephelele. Umhla wesi-7. IPhiladelphia, PA: Elsevier; I-2017: isahluko 11.