女性两性畸形的诊治

人类正常性别分化包括染色体性别确定、性腺及附属性器官分化以及外生殖器分化三个生理过程。大多数人性染色体和生殖系统发育一致,表现为正常的男性或女性。如果某些患者的生殖器官,特别是外生殖器兼具男女两性特征,影响性别的确定,称为两性畸形。Anne Fausto-Ster-ling曾报道两性畸形的发生率为1·7%。Sax[1]则认为,这一数字包含如曲细精管发育不良(Klinefelter)综合征、特纳(Turner)综合征及晚发型肾上腺皮质增生症等大多数医生并不认为是两性畸形的情况。如将该名词定义为染色体性别与表型性别不一致,则两性畸形的发病率约为0·018%…     

腹腔镜手术治疗男性假两性畸形和真两性畸形各1例

病例1．患者14岁，社会性别女性，因发现外阴肿物6年余，于2006-02-24入院。6年前开始发现外阴有1．Ocm×0．5cm×0．5cm的肿物，近年来肿物逐渐长大约2．5cm×2．5cm×4．5cm，无疼痛。无月经来潮，二便正常。其他病史无特殊。体查：外观发育似男孩，头发较浓密，无明显喉结和颈蹼。有少许腋毛，双乳未发育。右腹股沟区可扪及一直径1em质偏硬索状物，活动度可。[第一段]     

假两性畸形的诊断与治疗(附20例临床分析)

对近10年来收治的20例仅两性畸形进行临床分析,旨在提高对该类疾病的认识,并结合文献讨论其诊断及治疗。雄激素不敏感综合征为最常见的男性假两性畸形12例;先天性肾上腺皮质增生症是导致女性假两性畸形的最常见类型,7例;单纯性XY性腺发育不全1例。     

单纯男性化先天性肾上腺皮质增生症致女性假两性畸形一例报告及文献复习

正女性假两性畸形是指核型为46,XX,内生殖器为女性生殖腺而外生殖器类似男性的一种常染色体隐性遗传疾病,在新生儿性别畸形中的发病率为1/16 000~1/20 000[1]。其中,单纯男性化先天性肾上腺皮质增生症(CAH)所致的女性假两性畸形,通常由于只有外阴发育异常而无失盐表现、患者及家属对此病的认识不足、患者的自卑情绪等精神心理障碍及就诊医院较低的医疗水平,导致就诊及确诊较晚,     

两性畸形31例临床分析

两性畸形的病因、分类和治疗复杂 ,本文总结我院收治的 3 1例资料完整、入院治疗的两性畸形患者 ,对其发病机制、分类及治疗分析如下。1　临床资料1979年 1月至 1999年 1月收治 3 1例两性畸形 ,同期妇科入院患者 4 9918例 ,发生率为 0 62‰ ,就诊年龄 4～ 2 4岁 ,平均 14岁。根据染色体、染色质检查、手术探查情况、术后性腺病理 ,按最新分类方法[1] ,分为以下 3大类。1 1　性激素异常　 10例均为先天性肾上腺皮质增生 ,年龄 4～ 15岁 ,社会性别均为女性。 9例查染色体核型为 4 6,ＸＸ ,1例未查。 10例口腔粘膜染色质检查见Ｘ小体。就诊时…     

两性畸形合并卵巢无性细胞瘤1例

两性畸形合并卵巢无性细胞瘤临床少见,如对此疾病及其关系认识不足,易延误诊断及治疗,现将1例报告如下.     

宫腹腔镜诊治46,XY真两性畸形2例分析

<正>1病例简介病例1,患者,13岁,社会性别女,因"发现外阴异常13年"于2010年10月5日入院。患者为第1胎足月顺产,其母否认孕期服用甾体激素类药物史,出生时阴蒂肥大,定期复查,阴蒂无明显增大,无月经来潮及周期性腹痛;生长发育及智力无异常。其祖父母为表兄妹结婚,家族中无类似患者。查体:身高145cm,指距145cm,体重32kg,颈部喉结未见明显突出;未见腋毛、阴毛,双侧乳房己发育,外阴呈女性发育,阴     

女性生殖器畸形合并泌尿系统畸形临床处理

不对称生殖道畸形合并泌尿系统畸形发生率较高,其中以阴道斜隔最常见,常合并有斜隔侧肾脏缺如。女性生殖器畸形合并泌尿道畸形的处理主要是解决患者的生殖器畸形,有意识的保护泌尿系统功能。     

女性生殖道畸形新分类

女性生殖道畸形是涉及子宫、宫颈、阴道、输卵管极其广泛的一大类先天性结构异常,且常合并生殖道以外的器官畸形。由于苗勒管（副中肾管）发育与午非管（中肾管）以及泌尿系发育在胚胎早期密切相关,其中以肾脏畸形最为常见。对不同生殖道畸形的分类目前主要取决于结构特征和临床表现,也力求与胚胎发育学相联系,最具代表性的分类法包括美国生育协会（AFS）分类法（1988）、阴道-宫颈-子宫-附件-相关畸形（VCUAM）分类法（2005）和欧洲人类生殖与胚胎学会和欧洲妇科内镜协会（ESHRE/ESGE）的女性生殖道先天异常分类法（2013）。文章将对各自的特点、优点以及局限性进行综述和评论。     

Missed opportunities for diagnosis of female genital mutilation

Objective

To investigate missed opportunities for diagnosing female genital mutilation (FGM) at an obstetrics and gynecology (OB/GYN) department in Switzerland.

Methods

In a retrospective study, we included 129 consecutive women with FGM who attended the FGM outpatient clinic at the Department of Gynecology and Obstetrics at the University Hospitals of Geneva between 2010 and 2012. The medical files of all women who had undergone at least 1 previous gynecologic exam performed by an OB/GYN doctor or a midwife at the study institution were reviewed. The type of FGM reported in the files was considered correct if it corresponded to that reported by the specialized gynecologist at the FGM clinic, according to WHO classification.

Results

In 48 (37.2%) cases, FGM was not mentioned in the medical file. In 34 (26.4%) women, the diagnosis was correct. FGM was identified but erroneously classified in 28 (21.7%) cases. There were no factors (women’s characteristics or FGM type) associated with missed diagnosis.

Conclusion

Opportunities to identify FGM are frequently missed. Measures should be taken to improve FGM diagnosis and care.     

2005年～2010年连州市女性淋病流行病学分析

目的:了解连州市女性淋病的流行状况,为今后制定女性淋病防治策略提供科学依据。方法:对国家疾病监测信息报告管理系统中女性淋病相关数据用描述性流行病学方法进行分析。结果:2005～2010年连州市共报告女性淋病93例,年发病率介于2.86/10万～12.18/10万之间,年均发病率为7.16/10万。高发年龄为20～29岁组,共报告38例,占报告病例总数的40.86%。职业以农民为主,共报告69例,占报告病例总数的74.19%。地区分布以连州镇报告病例最多,共报告23例,占报告病例总数的24.73%。结论:针对连州市女性淋病疫情情况,建议加强健康教育力度、加强对医务人员专业知识培训及政府各部门各司其职,阻断淋病的蔓延。     

Obstetric and neonatal outcomes for women with reversed and non-reversed type III female genital mutilation

Objective

To record and compare obstetric and neonatal complication rates in women with reversed and non-reversed type III female genital mutilation (FGM).

Methods

A retrospective observational study comparing cesarean delivery rates and neonatal outcomes of primiparous and multiparous women who had or had not undergone reversal of FGM III.

Results

Of the 250 women, 230 (92%) had an FGM reversal. Of these, 50 (21.7%) were primiparous (cesarean delivery rate 17/50; 34%) and 180 (78.3%) were multiparous (cesarean delivery rate 28/180; 15.6%). Of the 20 women who had not had an FGM reversal, 7 (35%) were primiparous (cesarean delivery rate 5/7; 71.4%) and 13 (65%) were multiparous (cesarean delivery rate 7/13; 53.8%). The cesarean delivery rates for primiparae and multiparae were 32.9% and 25%, respectively. Multiparous women with FGM III reversal had a lower possibility of cesarean delivery compared with the hospital multiparous population (P = 0.003) and multiparae who had not undergone FGM III reversal (P = 0.007). There was no significant association between Apgar scores or blood loss at vaginal delivery and FGM reversal.

Conclusion

Reversal of FGM III significantly reduced the increased risk of cesarean delivery seen with multiparae who have FGM III.     

Management of type III female genital mutilation in Birmingham,UK: A retrospective audit

Objectivesto audit clinical management of women with type III female genital mutilation (FGM) according to local guidelines. Secondary objectives were to describe the population that uses the service and compare obstetric outcomes of intrapartum deinfibulation and antenatal deinfibulation.Designretrospective audit.Settinga hospital midwifery-led FGM specialist service in Birmingham, UK.Participants253 women with type III FGM who gave birth between January 2008 and December 2009Methodsretrospective case analysis using patient records.Main outcome measuresproportion of women managed according to locally agreed criteria for the management of FGM; obstetric outcomes including perineal tears, episiotomy rates, estimated blood loss, infant APGAR scores and indications for caesarean section.Findings91 (36%) women booked into antenatal care after 16 weeks gestation. Only 26 (10.3%) were managed fully according to guidelines. The area with poorest performance was child protection, where the presence of normal genitalia was documented in only 52 (38.8%) of medical notes following birth of a female infant. The majority of women (214, 84.6%) had been deinfibulated in a previous pregnancy. Of the 39 infibulated at booking, only 9 (23.1%) were deinfibulated antenatally, the rest opted for intrapartum deinfibulation. Women who had intrapartum deinfibulation had a higher average blood loss and more tears than those deinfibulated antenatally, although this was not statistically significant.Conclusions and implications for practicealternative systems should be considered to improve documentation of child protection related information. Further research is needed to confirm or refute the adverse findings among those that delayed deinfibulation.     

女性生殖道感染中多种病原体的交互作用分析

目的了解育龄妇女生殖道感染（RTI）者中相关病原体的流行情况，初步探讨RTI中多种病原体的相互关系。方法对2005-03—2005-12东南大学附属中大医院354例妇科门诊育龄妇女进行妇科检查、各种RTI病原体的实验室检测以及流行病学调查。用叉生分析方法分析解脲支原体与其他病原体混合感染中的交互作用。结果生殖道解脲支原体和人型支原体的检出率分别为73．4％和47．6％；衣原体、线索细胞、假丝酵母菌和滴虫的检出率分别为17．8％、19．8％、15．9％和4％。叉生分析结果提示解脲支原体分别与衣原体、假丝酵母菌、加德纳菌等具有相乘和相加的交互作用。结论本地育龄妇女支原体的检出率较高，解脲支原体与女性生殖道其他常见病原体的混合感染对RTI的发生有协同作用。     

Factors determining whether Ethiopian women support continuation of female genital mutilation

Objective

To examine the factors influencing the opinions of women about whether female genital mutilation (FGM) should continue in Ethiopia.

Methods

Data from questionnaire surveys of women (n = 11 375) collected during the Ethiopia Demographic and Health Survey were analyzed. Factors influencing the opinions of women concerning whether FGM should continue as a practice in Ethiopia were examined using multiple logistic regression.

Results

Women who believed that FGM should continue were more likely to be aged 15-24 years (adjusted odds ratio [OR] 1.21; 95% confidence interval [CI],1.05-1.41); rural residents (OR, 2.73; CI, 2.38-3.12); Muslim (OR, 1.98; CI,1.80-2.17); married (OR, 1.26; CI, 1.09-1.46); uneducated (OR, 2.85; CI, 2.51-3.23); circumcised (OR, 3.46 CI, 2.94-4.06); and to have had no exposure to mass media (OR,1.57; CI,1.41-1.75).

Conclusion

To change the opinions of women regarding FGM, specific education and prevention programs should be designed to target these demographic groups of women.     

腹腔镜治疗女性不孕症效果分析

目的 探讨腹腔镜对女性不孕症患者的治疗价值。方法 回顾性分析59例不孕症患者腹腔镜手术后的治疗及妊娠结局。结果 59例患者中输卵管因素不孕34例,术后11例妊娠,妊娠率31.77％;14例子宫内膜异位症患者,5例妊娠,妊娠率35.71％;多囊卵巢综合征(PCOS)患者11例,6例妊娠,妊娠率54.55％。腹腔镜术后共妊娠22例,总妊娠率37.28％。结论 腹腔镜为治疗女性不孕症的有效方法,恰当的手术指征,可避免给病人带来不必要的经济负担,及时完善的术后辅助治疗,是提高术后妊娠率的关键环节。     

A crossover comparison of two types of female condom

Objective

To compare the performance and acceptability of 2 types of female condoms (FCs) among female sex workers (FSWs) in China.

Methods

The present crossover survey trial was conducted in Enping City between September and December 2007.

Results

There were no significant differences between the 2 types of condoms in cumulative rates of episodes of misdirection; participants experiencing discomfort or feeling the outer or inner ring of an FC; or the clinical breakage or turning inside out of an FC. The rates of total clinical failures were similar for both FC types. Moreover, 59.5% of the survey participants reported that either type was acceptable to them.

Conclusion

There were no statistically significantly differences in performance between the 2 types of FCs tested, and most participants would accept using either in the future.     

The impact of female genital cutting on health of newly married women.

OBJECTIVE: To detect the rate of female genital cutting among a sample of newly married women in Benha city, and make a comparison between circumcised and non-circumcised women regarding long-term health problems. METHODS: Randomly selected (264) newly married women were the subjects of this work. RESULTS: Circumcised group constitutes 75.8% of the sample. All non-circumcised women were living in an urban area. Dysmenorrhea was more common among circumcised rather than non-circumcised, with statistically significant difference (P<0.01). Marital problems (dyspareunia, loss of libido, failure of orgasm and husband's dissatisfaction) had statistically different levels of significance among circumcised women. Obstetric problems such as tears, episiotomy and consequently distressed babies were more events among circumcised mothers with statistical significance. Circumcised females had significant mental problems such as somatization, anxiety and phobia (P<0.001). CONCLUSION: Female genital cutting remains a widely practiced custom in our society. Grave complications of circumcision may last throughout women's life particularly the time of consummation of marriage and the time of childbirth.