Ambiguous genitalia

Ambiguous genitalia

Double sex is a condition in which the shape of the genitals is not clear so that it looks like the genitals of a woman and a man at the same time . This condition occurs due to abnormalities in the development of the sex organs when the baby is still in the womb.

Double genitals or ambiguous genitalia can be caused by hormonal disturbances during pregnancy or due to chromosomal abnormalities. Dual sex is part of the disorder of sexual development  (DSD).

Multiple sex is generally not dangerous, but it can cause psychological and social disorders when the sufferer reaches adulthood. However, multiple sex caused by abnormalities in the adrenal glands ( congenital adrenal hyperplasia ) needs to be treated immediately.

Causes of Multiple Sexes

Double sex is caused by disorders of the development of the sex organs when the baby is still in the womb. As a result, when the baby is born, its gender is not clear.

Please note, the sex of the baby is determined by the combined chromosomes of the father's sperm cell and the mother's egg cell at conception. If at the time of conception the fetus receives one X chromosome from the father and one X chromosome from the mother, then the fetus will have two XX chromosomes and is female.

Meanwhile, if the fetus receives one X chromosome from the mother and one Y chromosome from the father, then the fetus will have an XY chromosome and be male.

Mother's hormonal disorders during pregnancy or genetic disorders in the baby can cause multiple sex. However, in some cases, the cause of multiple sex is not known with certainty.

In babies who are genetically male, there are several conditions that can cause  multiple sexes to appear , namely:

  • Failure to form testicles due to genetic disorders
  • Deficiency of the 5A-reductase enzyme, which is an enzyme that plays a role in the formation of androgen hormones in baby boys
  • Androgen insensitivity syndrome  due to the lack of response of the fetus's body to androgen hormones
  • Abnormalities in the structure and  function of the testicles  or the production of the hormone  testosterone

Meanwhile, the causes of multiple sexes in babies who are genetically female are:

  • Excessive exposure  to androgen hormones  during pregnancy, for example due to taking drugs containing androgen hormones
  • Tumors that interfere with the performance of hormones for the development of the female genital organs
  • Congenital adrenal hyperplasia, which is a genetic condition that causes excessive production of androgen hormones

Pregnant women who have had previous miscarriages or have family members who suffer from multiple sex are more at risk of having babies with this condition.

Multiple Genital Symptoms

Double sex can be known when the baby is still in the womb or at birth. Babies who experience ambiguous genitalia have no clear sex and look like they are multiple. As a result, it will be difficult to determine whether the baby born is a girl or a boy.

Some of the signs or symptoms that can be seen when a baby has multiple sex are:

Signs and symptoms in baby girls:

  • The labia are closed and swollen so they look like a scrotum
  • The clitoris enlarges so that it looks like a small penis
  • The opening of the urinary tract (urethra) is around the clitoris, it can be right on the clitoris or under the clitoris

Signs and symptoms in baby boys:

  • The location of the urinary tract hole is below ( hypospadias )
  • The penis is small or looks like an enlarged clitoris
  • Absence of testicles in the scrotum or scrotum ( cryptocism )
  • The part that should be the scrotum looks like the labia

When to see a doctor

Pregnant women need to carry out routine pregnancy checks according to the schedule determined by the doctor. That way, the development of the fetus and the condition of pregnant women can continue to be monitored.

Double sex can be detected by doctors when newborns. However, if you don't give birth at the doctor and your baby seems to have abnormalities as described above, immediately take the baby to  the doctor  for a thorough examination so that the doctor can provide the right treatment.

Multiple Gender Diagnosis

The doctor will ask about the mother's medical history, including drugs or supplements taken during pregnancy. After that, the doctor will do a thorough examination of the baby.

To confirm the diagnosis, the doctor will carry out several supporting examinations, such as:

  • Blood tests , to assess the levels of hormones and enzymes that affect the development of the baby's genital organs, such as the hormone testosterone, androgen receptors, 5A reductase enzyme
  • Chromosome examination, to determine the genetic sex of the baby
  • Ultrasound scan  , to ensure the location of the testicles in babies with cryptorchidism
  • Biopsy  by taking a sample of the baby's genital tissue, to determine whether there is ovarian tissue, testicular tissue, or both (ovotestis)

After confirming the diagnosis, the doctor will tell the parents about the sex of the baby genetically, what abnormalities occur in the baby, and the risks that can occur in the future.

Your Gender Treatment _

Multiple sex treatment aims to maintain the patient's sexual function and fertility when he is an adult, prevent social pressure from society, and maintain the patient's psychological condition.

Several treatment options that can be used to treat ambiguous genitalia are:


Surgery is the main method of dealing with multiple genitals. The purpose of surgery is to maintain the child's sexual function, as well as form the external appearance of the genital organs so that they look normal.

In girls, the function of the internal reproductive organs is often normal even though there are deformities of the external genital organs. If the vagina is covered by skin, the doctor will perform an operation to create a vaginal opening.

In boys, surgery aims to improve the shape of the penis so it can maintain erectile function as the child grows up.


If double sex is caused by a hormonal disorder, the doctor will give the baby hormone therapy to balance the hormone levels in his body. Hormone therapy can also be given during puberty.

Multiple Genital Complications

If not treated immediately, multiple sex or ambiguous genitalia can increase the risk of the following conditions:

  • Infertility or infertility
  • Orgasm disorder
  • Psychic disorders
  • Certain cancers, such as testicular cancer

Multiple Gender Prevention

Double sex is hard to prevent. However, pregnant women can take the following steps to reduce the risk of abnormalities in the fetus:

  • Living  a healthy lifestyle  during pregnancy, such as eating a healthy and nutritionally balanced diet, not smoking, and not consuming alcoholic beverages
  • Undergo routine pregnancy checks  and take supplements according to doctor's advice
  • Do not use random drugs or supplements, especially drugs that contain hormones
  • Do not use drugs , especially during pregnancy
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