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Pseudo-hermaphrodites are much more frequent than true ones. In them the glands are of a sex opposite from the person's general character and configuration. The genitalia may be a confusion of imperfect male & female parts. These defects may sometimes be remedied by surgeons to bring the pseudohermaphrodite into line with its glandular sex. In no case on record, though, has the patient subsequently succeeded in producing a child. In glandular males, undescended testicles are brought from the abdomen into the scrotum. If a phallus exists, bound down by adhesions or imbedded in flesh, delicate plastic work may free it sufficiently for male sex activity. That was the procedure in the case of Czechoslovakia's Zdenka Koubkova.
In female (ovarian) pseudo-hermaphrodites, after removal of the male-like appendages, the usual problem is to correct the vagina if it is rudimentary, or to create one if it is missing. The late Dr. L. Grant Baldwin of Columbus, Ohio, solved this difficult problem by cutting a channel into the pelvis, lining it with a narrow U-shaped loop of the patient's own intestine. After some time the inner loop of the U was removed, leaving the outer wall to form a mucous membranal tract resembling the normal vagina.
It sometimes happens in the case of a person brought up as a girl who turns out to be equipped with testes, that the physician deems it best for psychological reasons that she continue life as a female despite her male glands. A case history reported by Dr. Emil Novak, Johns Hopkins gynecologist: A college girl of 19, considered normal in childhood, had grown tall (6 ft. i in.), angular, flat-chested, hairy, deep-voiced. Examination revealed no womb, a rudimentary vagina, an overdeveloped clitoris, male gonads. Dr. Novak saw at once that it was impossible to adapt the clitoris for male activity. Moreover, the patient had a strong, deep-rooted feminine psychology to upset which he thought would be disastrous. Therefore he removed the testes and the clitoris, tried to restore female features by administrations of female hormone. This medication was partly successful.
When a child's sex is ambiguous at birth, it is almost always thought to be a female, sometimes rightly, sometimes wrongly. A wrong guess is usually the basis of "sex changes" which make headlines. At puberty the increased production of male hormones from the glands causes the alarming "change." Then the girl changes clothes and assumes the sex which, glandularly speaking, he actually had from the beginning. It sometimes happens, however, that a normal girl suddenly begins to acquire virile features. Medical men are convinced that this is due to tumorous growths which take root on the normal sex glands, rouse to activity the dormant, vestigial male cells. When the growths are extirpated, the girl usually reverts to femininity.