Hermaphroditism
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Suggested Reading Koff, R. S. (2003). Hepatitis A and E. In D. Zakim & T. D. Boyer (Eds.), Hepatology: A textbook of liver disease (pp. 939–958). Philadelphia: W.B. Saunders. Nair, S., & Perrillo, R. P. (2003). Hepatitis B and D. In D. Zakim & T. D. Boyer (Eds.), Hepatology: A textbook of liver disease (pp. 959–1016). Philadelphia: W.B. Saunders. Younossi, Z. M., Ong, J. P., & O’Shea R. (2003). Contemporary diagnosis and management of Hepatitis C. Newton, PA: Handbooks in Health Care.
ROBERT S. O’SHEA
Hermaphroditism The term hermaphrodite derives from Greek mythology. Hermaphroditus was the son of Aphrodite and Hermes, endowed with the beauty of both deities. One day, he was walking by a lake when the nymph Samalcis instantly fell in love with him. She pleaded for his love, which he soundly rejected. When he later disrobed and jumped into the lake for a swim, Samalcis followed and embraced him, but he tried to escape. Samalcis prayed to the gods that the two would never be separated. The gods answered her prayer by fusing Samalcis and Hermaphroditus into one body. The medical establishment throughout history has used the term hermaphrodite (or in some cases gynandromorphy) to describe a cluster of genetic and physiological departures from the typical gestational sex development pathway that result in individuals born with variations in the appearance of external genitalia and/or incongruence between internal sex organs and external genitalia. Hence, the analogy to Hermaphroditus is clear. The term has largely fallen out of usage due to the action of intersex activists who feel that it sensationalizes and dehumanizes individuals who have suffered extreme physiological and psychological trauma stemming from surgical interventions to correct these conditions, but that in actuality are more akin to genital mutilation. For purposes of classification, the medical establishment historically has made distinctions between true hermaphrodites and pseudo-hermaphrodites. True hermaphrodites, also known as genetic mosaics, are rare in occurrence. Although most people think of sex at the individual (or organism) level, each cell in the body also can be viewed as having a chromosomal sex—XX (female) or XY (male). Thus, genetic mosaic refers to individuals born with cell patches throughout the body that are XX and other patches that are XY. When a patch crosses through gonadal tissue, the typical result is an individual born with at least one ovotestis (a hybrid of ovary and testicular tissues) accompanied by varying degrees of genital virilization. Pseudo-hermaphrodite refers to all other variations resulting from an absence or insufficiency of certain enzymes that act at points along the human sex determination pathway. The prefix pseudo is applied because these individuals are not genetic mosaics. Because the overall ground state for human sex development is female—or put another way, male is a biological modification of an elemental female form—a
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