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At least 271 records · Page 15Linked to original sources
PubMed2006

Mammalian sexual differentiation: lessons from the spotted hyena.

Female spotted hyenas (Crocuta crocuta) are the only female mammals that lack an external vaginal opening. Mating and birth take place through a urogenital canal that exits at the tip of a hypertrophied clitoris. This 'masculine' phenotype spurred a search for an alternate source of fetal androgens. Although androstenedione from the maternal ovary is readily metabolized to testosterone by the hyena placenta, formation of the penile clitoris and scrotum appear to be largely androgen independent. However, secretions from the fetal testes underlie sex differences in the genitalia and central nervous system that are essential for male reproduction. Naturally circulating androgens, acting prenatally, reduce reproductive success in adult female spotted hyenas. Effects on aggression and dominance might offset these reproductive 'costs' of female androgenization in utero.

Androgens↗
PubMed2002

Female circumcision and obstetric complications.

OBJECTIVES: To examine whether complications at delivery are associated with female circumcision. METHOD: One thousand eight hundred and fifty-one women seeking family planning or antenatal care in three south-west Nigerian hospitals were interviewed and had a medical exam. The prevalence of complications at delivery for uncircumcised women and circumcised women with type 1 (partial or total removal of the clitoris) or type 2 (partial or total removal of the clitoris and part or all of the labia minora) were determined. Associations between self-reported complications at delivery and clinic-reported type of circumcision were analyzed using bivariate and multivariate logistic regression. RESULT: Forty-five percent were circumcised; 71% had type 1 and 24% had type 2. Circumcised women had significantly higher risks of tearing and stillbirths when all pregnancies were analyzed. CONCLUSION: Circumcised women experienced more obstetric complications, while there was no significant difference between women with type 1 and type 2.

Adolescent↗
PubMed2006

Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries.

BACKGROUND: Reliable evidence about the effect of female genital mutilation (FGM) on obstetric outcome is scarce. This study examines the effect of different types of FGM on obstetric outcome. METHODS: 28 393 women attending for singleton delivery between November, 2001, and March, 2003, at 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal, and Sudan were examined before delivery to ascertain whether or not they had undergone FGM, and were classified according to the WHO system: FGM I, removal of the prepuce or clitoris, or both; FGM II, removal of clitoris and labia minora; and FGM III, removal of part or all of the external genitalia with stitching or narrowing of the vaginal opening. Prospective information on demographic, health, and reproductive factors was gathered. Participants and their infants were followed up until maternal discharge from hospital. FINDINGS: Compared with women without FGM, the adjusted relative risks of certain obstetric complications were, in women with FGM I, II, and III, respectively: caesarean section 1.03 (95% CI 0.88-1.21), 1.29 (1.09-1.52), 1.31 (1.01-1.70); postpartum haemorrhage 1.03 (0.87-1.21), 1.21 (1.01-1.43), 1.69 (1.34-2.12); extended maternal hospital stay 1.15 (0.97-1.35), 1.51 (1.29-1.76), 1.98 (1.54-2.54); infant resuscitation 1.11 (0.95-1.28), 1.28 (1.10-1.49), 1.66 (1.31-2.10), stillbirth or early neonatal death 1.15 (0.94-1.41), 1.32 (1.08-1.62), 1.55 (1.12-2.16), and low birthweight 0.94 (0.82-1.07), 1.03 (0.89-1.18), 0.91 (0.74-1.11). Parity did not significantly affect these relative risks. FGM is estimated to lead to an extra one to two perinatal deaths per 100 deliveries. INTERPRETATION: Women with FGM are significantly more likely than those without FGM to have adverse obstetric outcomes. Risks seem to be greater with more extensive FGM.

Adult↗
PubMed1997

Does T1, N0-1 vulvar cancer treated by vulvectomy but not lymphadenectomy need inguinofemoral radiation?

PURPOSE: The objective of our study was to demonstrate differences in relapse rates, total survival times, and complication rates between inguinofemoral radiation and its absence in cases of invasive vulvar carcinoma without lymph node involvement (FIGO Stages T1, N0-1). METHODS AND MATERIALS: From 1974 to 1990, 135 patients with invasive vulvar carcinoma in Stage T1 without clinical evidence of inguinal lymph node involvement underwent simple vulvectomy performed by hot-knife resection without lymphadenectomy. Although 65 patients (Group 1) received postoperative inguinofemoral radiation therapy, 70 patients (Group 2) did not, and none received local vulva irradiation. RESULTS: The 5-year survival rates were 93.7% in Group 1 and 91.4% in Group 2 (p = NS). Although clitoris involvement was significantly more prevalent in the irradiation group (p = 0.04), inguinal relapse was found less frequently in Group 1 (4.6% or 3 out of 65 patients) than in group 2 (10% or 7 out of 70 patients) (p = 0.32). The complication rates were, 7.7% in Group 1 and 2.9% in Group 2, 2.7% for vaginal stenosis (two patients in each group), 1.5% for inguinal pain (one patient in Group 1), 1.5% for rectovaginal fistula (one patient in Group 1), 1.5% for vulvar infection (one patient in Group 1). CONCLUSION: No statistically significant differences in the relapse rates and survival times were found. Risk factors were equally distributed in both study groups except for clitoris involvement. The 5-year survival rates in both groups were similar to those reported in the literature for radical vulvectomy and inguinal lymph-node dissection (83-96%). Morbidity in our study was low. Although our data showed similar results in both groups, we are not recommending at this time to omit groin radiation in general, but it may be justified in low-risk cases.

Adenocarcinoma↗
PubMed2001

Male-to-female transsexualism: a technique, results and long-term follow-up in 66 patients.

OBJECTIVE: To report experience of a new surgical technique in male-to-female transsexual patients, the complications, and the functional and psychosocial long-term results. PATIENTS AND METHODS: From April 1995 to July 2000, 66 male patients underwent gender-transforming surgery at our institution and were registered prospectively. The operation should result in a normal appearing introitus, a vaginoplasty allowing for sexual intercourse and a sensitive clitoris. This was achieved by preserving the neurovascular bundle. The glans was transformed into a clitoris, the phallic cylinder used as a vagina and labia were formed from the scrotal folds. RESULTS: Major complications during, immediately and some time after surgery occurred in nine of the 66 patients (14%), including severe wound infections in six, a rectal lesion in three, necrosis of the glans in three and necrosis of the distal urethra in one. Minor complications, e.g. meatal stenosis in seven patients, occurred in 24 (36%) of patients. Ten patients with insufficient penile skin had the phallic cylinder augmented with a free-skin mesh graft, but in three of these patients an ileal augmentation was finally constructed because scarring occurred at the suture line between the penile skin and the augmented graft. A long-term follow-up questionnaire about the functional and psychosocial aspects was completed by 31 patients. More than 90% of the patients were satisfied with the cosmetic result and capacity for orgasm; 58% reported having sexual intercourse. CONCLUSION: Male-to-female surgery can achieve excellent cosmetic and functional results. Although the operative technique is partly standardized, surgery remains challenging because of several possible complications. None of the present patients claimed to regret their decision to undergo gender-transforming surgery.

Adult↗
PubMed1982

[Timing and technic of the surgical correction of childhood intersex genitals including the procedure for partial vaginal aplasia].

The author holds the opinion that surgical correction of intersexual outer genital should be performed before the second birthday. In case of an adrenogenital syndrome with deep (peripheral) junction of the vagina into the urogenital sinus, vaginoplasty of the introitus and displacement of the clitoris should be performed in a single session. The author describes his own operational technique. If the vagina enters the urogenital sinus near the bladder, the author recommends to employ the operation technique described by Hendrin for removal and reimplantation of the vagina into the perineum, combined with the author's own technique of displacing the clitoris. Partial absence or atrophy of the vagina was seen in 8 cases. The author describes his own abdominoperineal operation method for correcting this defect. In cases where the intersexual genital is to be corrected in the direction of a male genital, the author recommends shaft erection in the first session and urethroplasty in the second session according to the technique described by Denis Browne. In all, 132 patients were surgically treated for correction of an intersexual genital.

Child↗
PubMed2002

Exposure to naturally circulating androgens during foetal life incurs direct reproductive costs in female spotted hyenas, but is prerequisite for male mating.

Among all extant mammals, only the female spotted hyena (Crocuta crocuta) mates and gives birth through the tip of a peniform clitoris. Clitoral morphology is modulated by foetal exposure to endogenous, maternal androgens. First births through this organ are prolonged and remarkably difficult, often causing death in neonates. Additionally, mating poses a mechanical challenge for males, as they must reach an anterior position on the female's abdomen and then achieve entry at the site of the retracted clitoris. Here, we report that interfering with the actions of androgens prenatally permanently modifies hyena urogenital anatomy, facilitating subsequent parturition in nulliparous females who, thereby, produce live cubs. By contrast, comparable, permanent anatomical changes in males probably preclude reproduction, as exposure to prenatal anti-androgens produces a penis that is too short and has the wrong shape necessary for insertion during copulation. These data demonstrate that the reproductive costs of clitoral delivery result from exposure of the female foetus to naturally circulating androgens. Moreover, the same androgens that render an extremely unusual and laborious process even more reproductively costly in the female are apparently essential to the male's physical ability to reproduce with a normally masculinized female.

Androgen Antagonists↗
PubMed2004

Female epispadias: are we missing the diagnosis?

OBJECTIVE: To describe three of four female patients with occult epispadias, as usually epispadias is reported to be a rare condition in females (1/480,000), and obvious and easy to diagnose, but less severe variants may still involve urethral sphincter incompetence in the absence of obvious clinical signs. PATIENTS AND METHODS: The hospital records over a 10-year period (1 January 1991 to 31 December 2000) were reviewed to find all female patients diagnosed with epispadias. Data were collected from the Consultative Council on Obstetric and Paediatric Mortality and Morbidity for the number of live births per year for the decade studied, and the incidence of female epispadias determined. RESULTS: Over the 10-year period there were 13 patients with a diagnosis of epispadias, from 636,698 total live births; four were female and nine male. Each of the female patients had varying degrees of epispadias; three had subtle signs with apparently normal external genitalia, and only one had a bifid clitoris. However, even the most minor variant case had a palpable notch in the symphysis pubis, and an 'oblong' external urethral meatus. Thus the incidence of female epispadias is at least 1/160,000. CONCLUSION: Epispadias in females may be up to three times more common than previously expected, but even experienced clinicians can miss the diagnosis. The importance of a careful examination should be emphasized, especially in female patients with chronic wetting of unknown cause. A bifid clitoris is an important sign but not always present. Key diagnostic features include drug-resistant wetting, a very low leak pressure on cystometrography, a palpable gap in the pubic symphysis and an abnormal oval-shaped external urethral meatus.

Child↗
PubMed1987

Sacral reflex latency in acute retention in female patients.

Neurophysiological measurements of the innervation of the lower urinary tract were performed on 14 female patients presenting with unexplained acute urinary retention. The method consisted of (a) static electromyography (EMG) of the anal and urethral sphincter with the patient relaxed, coughing and gripping, (b) the study of sensory thresholds on the dorsal nerve of the clitoris and in the urethra, (c) the measurement of sacral reflex latencies (SRL) from the dorsal nerve of the clitoris to the anus and urethra and from the urethra to the anus. The results showed that all 14 patients had significant defects in the innervation of their lower urinary tract. These findings suggest that a neurological explanation for acute retention in women should always be sought before making any other diagnosis.

Acute Disease↗
PubMed2006

Antidepressant-induced inhibition of genital vascular responses is reversed by vardenafil in female rabbits.

INTRODUCTION: Administration of serotonin reuptake inhibitors (SRI) or serotonin and norepinephrine reuptake inhibitors (SNRI) relieves depressive symptoms but may cause sexual dysfunction in women and men. AIM: The aim of the present study was to evaluate the effects of the phosphodiesterase type 5 (PDE5) inhibitor, vardenafil, on inhibition of genital vascular responses (GVR) induced by SRI or SNRI administration in female rabbits. METHODS: Vaginal and clitoral vasodilatory responses to pelvic nerve electrical stimulation were measured by laser Doppler flow needle probes. RESULTS: GVR were significantly potentiated by vardenafil even at the low dose of 0.1 mg/kg, in clitoris and vagina (181 +/- 22% and 180 +/- 31% of control, in vagina and clitoris, respectively, at 8 Hz). The selective SRI, paroxetine (5 mg/kg), significantly inhibited GVR in female rabbits (54 +/- 5% and 48 +/- 6% of control). GVR were also significantly inhibited by the SNRIs, venlafaxine (5 mg/kg) (57 +/- 3% and 32 +/- 11%) and duloxetine (1 mg/kg) (40 +/- 7% and 28 +/- 5%). Treatment with vardenafil (0.1 and 0.3 mg/kg) completely reversed the inhibition of GVR induced by paroxetine, venlafaxine, or duloxetine. CONCLUSIONS: Potentiation of the nitric oxide (NO) pathway by vardenafil improves vascular sexual responses in female rabbits and overcomes the inhibitory effects of acutely administered antidepressants on GVR, irrespective of the underlying pathophysiologic mechanism, i.e., disruption of the NO pathway or enhancement of alpha-adrenergic mechanisms. PDE5 inhibition may represent a reasonable approach to treat SRI- or SRNI-induced female sexual dysfunction, in particular, arousal disorders.

Animals↗
PubMed2006

Reliability of self reported form of female genital mutilation and WHO classification: cross sectional study.

OBJECTIVE: To assess the reliability of self reported form of female genital mutilation (FGM) and to compare the extent of cutting verified by clinical examination with the corresponding World Health Organization classification. DESIGN: Cross sectional study. SETTINGS: One paediatric hospital and one gynaecological outpatient clinic in Khartoum, Sudan, 2003-4. PARTICIPANTS: 255 girls aged 4-9 and 282 women aged 17-35. MAIN OUTCOME MEASURES: The women's reports of FGMthe actual anatomical extent of the mutilation, and the corresponding types according to the WHO classification. RESULTS: All girls and women reported to have undergone FGM had this verified by genital inspection. None of those who said they had not undergone FGM were found to have it. Many said to have undergone "sunna circumcision" (excision of prepuce and part or all of clitoris, equivalent to WHO type I) had a form of FGM extending beyond the clitoris (10/23 (43%) girls and 20/35 (57%) women). Of those who said they had undergone this form, nine girls (39%) and 19 women (54%) actually had WHO type III (infibulation and excision of part or all of external genitalia). The anatomical extent of forms classified as WHO type III varies widely. In 12/32 girls (38%) and 27/245 women (11%) classified as having WHO type III, the labia majora were not involved. Thus there is a substantial overlap, in an anatomical sense, between WHO types II and III. CONCLUSION: The reliability of reported form of FGM is low. There is considerable under-reporting of the extent. The WHO classification fails to relate the defined forms to the severity of the operation. It is important to be aware of these aspects in the conduct and interpretation of epidemiological and clinical studies. WHO should revise its classification.

Adolescent↗
PubMed1982

Intersexuality associated with XX/XY mosaicism in a horned goat.

Anatomical, histological, and cytogenetic studies were undertaken on a horned intersex goat kid and three of its normal litter mates. The intersex had male type horns, male beard, vestigial mammary glands, female external genitalia, and an enlarged peniform clitoris, exuded a pungent male odor, had a male bleat, and came into estrus every 20 days. At laparotomy and subsequent slaughter, an ovotestes was observed on the right side and a testis and epididymal remnants on the left side. Uterine horn segments, cervix, vagina, and enlarged clitoris (2 cm) were also present. Histologically, spermatogenesis was not observed in either testis, but active Leydig cells were present. The ovary contained mature follicles. Chromosome analysis revealed 60XX/60XY cell populations in blood, bone marrow, and skin. Lymphocytic metaphases from the male and female cosibs showed single populations of 60XY and 60XX, respectively. Mosaicism associated with the horned condition in the intersex goat was established.

Animals↗
PubMed1991

A hospital study of the complications of female circumcision.

During one year 118 patients were admitted to the operative gynecological ward of Banadir Maternity Hospital, Mogadishu, Somalia, with diseases related to the practice of female circumcision. Fifty-five per cent of the patients were suffering from a dermoid cyst at the site of the excised clitoris. Thirty-six per cent had a vaginal stenosis and 9% an abscess at the site of the excised clitoris. These patients occupied the beds of the hospital for a total period of 1967 days which posed a significant constraint to the health services of the hospital.

Adolescent↗
PubMed1984

Virilization without adrenal hyperplasia in 21-hydroxylase deficiency during fetal life.

The characteristic excess production of androgens in the cortisol 21-hydroxylase defect is generally considered to be secondary to ACTH stimulation of alternate pathways. Whenever a morphological examination of the adrenals has been possible in this disorder, adrenocortical hyperplasia was a constant finding. The availability of methods for the prenatal diagnosis of the 21-hydroxylase defect has made it possible to examine some of the manifestations of this disorder during fetal life. We studied a severely virilized 20-week-old aborted female fetus with the 21-hydroxylase defect whose adrenals were neither grossly enlarged nor microscopically hyperplastic. In a pregnancy at risk for congenital adrenal hyperplasia due to a 21-hydroxylase deficiency, amniocentesis was performed in the 18th week of gestation. The 21-hydroxylase defect was established by HLA typing and highly elevated levels of 17-hydroxyprogesterone, testosterone, and androstendione in amniotic fluid. After counselling, the parents, who already had a girl with the salt-wasting form of 21-hydroxylase deficiency, wished termination of the pregnancy. The aborted 20-week-old fetus was within the normal range for gestational age in weight and height. The external genitalia were ambiguous and extremely virilized, with an enlarged clitoris and fused labioscrotal folds. A urogenital sinus opened at the base of the clitoris. The internal organs were female, with a normal uterus and ovaries. Both adrenals were normal in size and weight for their gestational age. Histological examination of the adrenals revealed no abnormalities, and no hyperplasia was detectable. Thus, the adrenals in the 21-hydroxylase defect during fetal life secrete excessive amounts of androgens and cause virilization in the absence of adrenocortical hyperplasia.

Adrenal Hyperplasia, Congenital↗
PubMed1985

Development of the external genitalia in rat fetuses.

Development of the external genitalia in rat fetuses was studied with special reference to the formation of the labia pudenda and the determination of the stage at which the sex difference could be recognized from changes in the external structures. The urogenital fold located on either side of the external structures. The urogenital fold located on either side of the urogenital groove gradually enlarges and begins to enclose the genital tubercle with its counter fold on day 20 of gestation. Thus, the urogenital folds, which are known to become the labia minora and the prepuce of clitoris in the human, are differentiated only into the prepuce of clitoris in the rat. The genital swellings situated caudally to the urogenital folds are not well developed and come to be inconspicuously flat in situ at the end of gestation. However, the labia majora are formed by the time of puberty when the vagina opens. Therefore, it seems that the genital swellings contribute to the formation of the labia majora after birth. Sex difference in development of the external genitalia is recognized on day 17 of gestation; a small oval urogenital orifice is larger in male than in female and the genital swellings are better developed in male than in female.

Animals↗
PubMed1999

Surgical anatomy of the somatic terminal innervation to the anal and urethral sphincters: role in anal and urethral surgery.

PURPOSE: The gross anatomy of the pudendal nerve branches was studied to identify more precisely the neuroanatomical relationship in the region of the anal canal, bladder neck and proximal urethra. Such knowledge is essential for the development of surgical techniques that avoid nerve injury in sphincteroplasty for anal and urinary stress incontinence, and in pudendal canal decompression. MATERIALS AND METHODS: The pudendal nerve terminal branches were dissected in 7 female and 5 male formalin fixed cadavers, including 6 fully mature neonates and 6 adults, a mean age of 37.6 years. The nerves were traced from the pudendal nerve to their termination in the anal and urethral sphincters, and pelvic floor muscles. RESULTS: The inferior rectal nerve occupied the lower half of the ischiorectal fossa. Immediately after emerging from the pudendal canal it extended a motor branch to the levator ani muscle and the cutaneous perianal and scrotal branches. The nerve terminated in the external anal sphincter at the 3 and 9 o'clock positions. Inside the pudendal canal the perineal nerve gave rise to a scrotal branch which joined the scrotal branch of the inferior rectal nerve to form the common scrotal nerve. About 2 to 3 cm. from the pudendal canal the perineal nerve extended a branch to the bulbocavernosus muscle and divided into the terminal scrotal and motor branches, which penetrated the striated urethral sphincter at the 3 and 9 o'clock positions. The deep dorsal nerve of penis or clitoris coursed forward into the ischiorectal fossa, emerged from the deep perineal pouch and penetrated the suspensory ligament to the dorsum of the penis or clitoris. CONCLUSIONS: The identification of the precise anatomical relation of the somatic nerve termination to the anal and urethral sphincters seems vital to avoid sphincter denervation during surgery for the correction of fecal and stress urinary incontinence.

Adult↗
PubMed1999

[Tactical diagnostic-therapeutic procedures in early stages of vulvar cancer].

The objective of this report is to present the diagnostic and therapeutic tactics in early vulvar carcinoma i.e. carcinoma in situ and carcinoma in I stage (IA and IB) which aim is to limit the radicalisation of the surgery. The clinical material is 57 women aged 27-63 years, colposcopy, cytology and histology diagnosed. The histology examination was made under colposcopic control, and the initial staging was settled i.e. ca in situ in 11 cases, carcinoma IA in 7 cases and carcinoma IB in 39 cases. In qualifying criteria for surgery, unifocal or multifocal location in carcinoma in situ was analysed, and presence of dystrophic lesions in ca in situ and ca IA was taken into consideration. In ca IB the additionally diameter of the lesion (1 cm and 1-2 cm), location (clitoris, perineum, or pudendal lip) and in carcinoma located within the pudendal lip, presence of metastases in lymphatic nodes of inguino-femoral region was taken into consideration. Local excision of lesion was therapeutical procedure in majority of cases in carcinoma in situ and carcinoma IA stage. In multifocal localisation of ca in situ or in coexistence of dystrophic lesions in ca in situ and ca IA vulvectomy was performed. But in carcinoma IB located within the pudendal lips, where lack of metastases to lymphatic nodes in intraoperative histopathology was confirmed, local excision of neoplastic lesion was performed. Presence of lesion within the clitoris, perineum or presence of metastases in lymphatic nodes led to more radical procedure including radical vulvectomy with bilateral lymphadenectomy of inguino-femoral region.

Adult↗
PubMed1999

[Sigmoid neovagina: apropos of 2 cases].

The presence of ambiguous external genitals can be related with a number of nosologic entities. We can find the female form with hypertrophic clitoris and vaginal hypoplasia in a wide variety of phenotype presentations. We have two young girls with ambiguous external genitals, where we notice hypertrophic clitoris and vaginal hypoplasia, with the diagnosis of mixed gonadal dysgenesis and androgen insensitivity syndrome (Morri's Syndrome). They have been operated several times: gonadectomy, genitoplasty, vaginoplasty and mammoplasty. We have made a neovagina, using a segment of sigma and preserving the walls of the former vagina. The surgical technique we used, consisted in the abdominoperineal descent of the segment of sigmoid colon and anastomosis with the back wall of the former vagina and the perineum; after that, we split the intervaginal septum, linking these two structures and reaching a lonely introitus vaginae. The hormonal treatment for the girl with mixed gonadal dysgenesis with estrogen and progestogen induces normal menstruations; we only use estrogen for the patient with Morri's Syndrome. The histology showed that there were dysgenetic gonads in one of the patients and testicular tissue without gonadal elements. Both girls have had a good evolution, with no problems and an excellent aesthetic and functional result.

Adolescent↗