Ovotesticular Disorders of Sexual Development: A Case of Hernia Uteri Inguinalis

“Waking up” the sleeping metaphor of normality in connection to intersex or DSD: a scoping review of medical literature

“…One paper (Roen et al, 2018 ) expressed its critique on the term “disorder” by placing it between hyphens. The word hermaphrodite was mentioned in 10 of 75 papers (Barham et al, 2016 ; Caputo et al, 2019 ; Greeley et al, 2017 ; Hernández et al, 2016 ; Mirshahvalad et al, 2018 ; Özdemir et al, 2019 ; Rich et al, 2016 ; Schteingart et al, 2019 ; Şimşek et al, 2016 ; Yan et al, 2019 ), often in the context of ovotesticular DSD. Five papers used the outdated term to indicate that this condition was “previously known” as hermaphroditism (Barham et al, 2016 ; Caputo et al, 2019 ; Özdemir et al, 2019 ; Rich et al, 2016 ; Şimşek et al, 2016 ), 4 studies used it as a mere synonym (Greeley et al, 2017 ; Mirshahvalad et al, 2018 ; Schteingart et al, 2019 ; Yan et al, 2019 ) and only one article explicitly stated that the term has been replaced because it was considered stigmatizing (Hernández et al, 2016 ) (see Tables 2 , 3 , 4 , 5 , 6 ).…”

“…A total of 29 records (38.7%) included medical photographs of the patient’s body or body parts. In most cases, they were close-ups of genitals—mainly from infants or children (AbouZeid & Mohammad, 2020 ; Barham et al, 2016 ; Baskin, 2017 ; Deeb et al, 2016 ; Fadil Iturralde et al, 2020 ; Goncalves et al, 2019 ; Heo et al, 2018 ; Jayanthi et al, 2017 ; Jesus et al, 2018 ; Kearsey & Hutson, 2017 ; Marei et al, 2016 ; Matsumoto et al, 2017 ; Morozumi et al, 2018 ; Nasir et al, 2019 ; Ochi et al, 2019 ; Saikia et al, 2019 ; Şimşek et al, 2016 ; Sperling & Meyer, 2017 ; Wagner-Mahler et al, 2019 ), but in a few cases also of adolescents (Chouhan et al, 2017 ; Hunter et al, 2016 ; Tambo et al, 2016 ) and adults (Larios García & Bautista Delgado, 2016 ; Patil et al, 2019 ; Singh et al, 2016 ). Three papers also contained images of breasts (Singh et al, 2016 ) and/or fully body shots (Khare et al, 2017 ; Mirshahvalad et al, 2018 ) of adolescents whose eyes were obscured with a black line.…”

“…normal vagina, normal penis, normal ovaries, normal testes, normal labia, normal ovarian tubes, normal fallopian tubes, abnormality of scrotum). Only in some occasions did the authors explain in more detail why these organs were considered (ab)normal, namely in terms of appearance (Adrião et al, 2020 ; Barham et al, 2016 ; Chen et al, 2018 ; Chowdhury et al, 2018 ; Fadil Iturralde et al, 2020 ; Hernández et al, 2016 ; Nasir et al, 2019 ; Ochi et al, 2019 ; Özdemir et al, 2019 ; Patil et al, 2019 ; Roth et al, 2018 ; Schteingart et al, 2019 ; Weaver et al, 2019 ), size (Adrião et al, 2020 ; Marei et al, 2016 ; Matsumoto et al, 2017 ; Mondal et al, 2016 ; Rich et al, 2016 ; Schteingart et al, 2019 ), length (AbouZeid & Mohammad, 2020 ; Finlayson et al, 2019 ; Goncalves et al, 2019 ; Morandi et al, 2018 ; Raveenthiran, 2017 ; van Leeuwen et al, 2019 ), location (Finlayson et al, 2019 ), and function (Heo et al, 2018 ; Lepais et al, 2016 ; Poyrazoglu et al, 2017 ; Raveendran et al, 2019 ; Raveenthiran, 2017 ). Some examples include: normal looking genitalia, normal appearing uterus, normal penis size, abnormal enlargement of clitoris, vagina with normal length, normally descended testes, abnormal location of the urethral meatus, and normal testicular function.…”

“…There was no direct link between the use of normal/normality and medical interventions insofar some studies recommended early surgeries (Barham et al, 2016 ; Baskin, 2017 ; Deeb et al, 2019 ; Greeley et al, 2017 ; Hernández et al, 2016 ; Huang et al, 2019 ; Jayanthi et al, 2017 ; Khare et al, 2017 ; Larios García & Bautista Delgado, 2016 ; Matsumoto et al, 2017 ; Wagner-Mahler et al, 2019 ; Xu et al, 2018 ) and others suggested to postpone them and were more hesitant/conservative regarding gonadectomy (AbouZeid & Mohammad, 2020 ; Berberoğlu & Şıklar, 2018 ; Chen et al, 2018 ; Morandi et al, 2018 ; Ochi et al, 2019 ; Sperling & Meyer, 2017 ; Witchel, 2018 ). To illustrate this, we have selected a few quotes from the reviewed literature.…”

“…Normal appearance Based on expert opinion, the overwhelming majority of surgical specialists continue to recommend restoration of normal anatomy in female patients in early childhood (Baskin et al 2017 , p. 230) A 2-year-old child reared as a girl child was brought by parents with ambiguous genitalia noticed since birth (…) the child underwent bilateral gonadectomy and rehabilitated her to lead a life as a girl (Saikia, 2019 , p. 169) I.b. Risk of malignancy This case highlights the importance of thorough surgical exploration to ensure full excision of all gonadal tissue discordant with sex of rearing (…) Goals of surgery include achieving desirable cosmesis, establishing urinary function, preserving any future fertility, and eliminating or decreasing the risk of malignancy (Barham, 2016 , p. 195) Some recent studies have recommended gonad removal after puberty. In our patients, the gonads were removed before puberty reflecting the wishes of the parents to escape confusion for the patients’ gender identity (Heo, 2018, p. 224) I.c.…”