Nā maʻi ulu o ka wahine wahine

ʻO nā maʻi hoʻomohala o ka wahine reproductive tract he mau pilikia i nā ʻohana hānau o kahi kaikamahine pēpē. Kū aʻe lākou i ka wā e ulu ana i ka ʻōpū o kona makuahine.

ʻO nā lālā hānau wahine e pili pū me ka lua, ovaries, uterus, a me ka cervix.

Hoʻomaka kahi pēpē e hoʻomohala i kāna mau hua hānau ma waena o nā pule 4 a me 5 o ka hāpai keiki. Hoʻomau kēia a hiki i ka hebedoma 20 o ka hāpai keiki.

ʻO ka hoʻomohala kahi hana paʻakikī. Hiki i nā mea he nui ke hoʻololi i kēia kaʻina. Pehea ka nui o ka pilikia o kāu pēpē e pili ana i ka wā i kū ai ka interruption. Ma ka laulā, inā kū nā pilikia ma mua o ka ʻōpū, e pālahalaha loa ka hopena.ʻO nā pilikia i ka hoʻomohala ʻana i nā lālā hānau o kahi kaikamahine e kumu ʻia e:

• Nānā i haki a i ʻole nalowale (genes defect)
• Hoʻohana o kekahi mau lāʻau i ka wā hāpai

Hiki paha i kekahi mau pēpē ke kīnā i kā lākou mau ʻāpana e pale ai i ko lākou kino mai ka hana ʻana i kahi enzyme i kapa ʻia 21-hydroxylase. Pono ka adrenal gland i kēia enzyme e hana i nā hormoni e like me cortisol a me aldosterone. Kapa ʻia kēia ʻano ʻo hyperplasia adrenal congenital. Inā nele kahi pēpē e ulu ana i kēia enzyme, e hānau ʻia ʻo ia me ka pūpū, nā ovaries, a me nā paipu fallopian. Eia nō naʻe, e like ke ʻano o kāna genital o waho me nā mea i loaʻa i nā keikikāne.

ʻO kekahi mau lāʻau a ka makuahine e lawe ai hiki ke hele i loko o ke kahe o ke pēpē a hoʻopilikia i ka ulu ʻana o nā meaola. ʻO kahi lāʻau i ʻike ʻia e hana i kēia ʻo diethylstilbestrol (DES). Hoʻonohonoho nā lawelawe mālama ola i kēia lāʻau i nā wahine hāpai e pale i ka hāʻule ʻole a me ka hana mua. Eia naʻe, ua aʻo ka poʻe ʻepekema ua hānau ʻia nā kaikamahine pēpē i nā wahine i lawe i kēia lāʻau i loaʻa i kahi kōpū maikaʻi ʻole. Ua hoʻonui ka lāʻau i nā manawa a nā kaikamahine e hoʻomohala ai i kahi ʻano maʻi ʻole o ka maʻi ʻaʻai wahine.

I kekahi mau hihia, hiki ke ʻike ʻia kahi maʻi hoʻomohala ke hānau ʻia ka pēpē. Hoʻokumu paha ia i nā kūlana hoʻoweliweli i ke keiki hānau hou. I nā manawa ʻē aʻe, ʻaʻole ʻike ʻia ke ʻano a ʻelemakule ke kaikamahine.

Hoʻokumu ka tract reproductive kokoke i ka urinary tract a me nā puʻupaʻa. Hoʻolālā pū ia i ka manawa like me nā mea ʻē aʻe ʻē aʻe. ʻO ka hopena, nā pilikia hoʻomohala i ka wahine reproductive tract i kekahi manawa me nā pilikia i nā wahi ʻē aʻe. Hiki i kēia mau wahi ke komo i ka mimi, nā puʻupaʻa, ka ʻōpū, a me ka iwi i lalo.

ʻO nā maʻi ulu o ka wahine reproductive tract e komo pū me:

• Intersex
• ʻO genitalia ambiguous

ʻO nā maʻi hoʻomohala ʻē aʻe o ka wahine reproductive tract e komo pū me:

• Nā Cloacal abnormalities: ʻO ka cloaca kahi ʻano like o ka Tube. I nā wā mua o ka hoʻomohala ʻana, ka ipu urinary, ka pololei, a me nā ʻōpala āpau e waiho wale ʻia i loko o kēia paipu hoʻokahi. Ma hope, hoʻokaʻawale nā ​​wahi ʻekolu a loaʻa i kā lākou mau wehe ponoʻī. Inā hoʻomau ka cloaca i ka ulu ʻana o kahi kaikamahine pēpē i loko o ka ʻōpū, ʻaʻole puka a kaʻawale nā ​​puka āpau. ʻO kahi laʻana, hānau ʻia paha kahi pēpē me hoʻokahi wehe wale ʻana ma ka lalo o ke kino e kokoke ana i ka wahi ʻoi. ʻAʻole hiki i ka mimi a me nā feces ke hoʻokahe i waho o ke kino. Hiki i kēia ke hoʻoulu i ka ʻōpū. Hoʻokumu paha kekahi mau mea kīlohelohe i ka cloacal i ke kaikamahine pēpē e like me kāna penis. Kākaʻikahi kēia mau hānau hānau.
• Nā pilikia me nā genital kūwaho: hiki i nā pilikia hoʻomohala ke alakaʻi i kahi clitoris pehu a i ʻole labia i hoʻopili ʻia. ʻO Fuse labia kahi ʻano kahi e hoʻopili pū ʻia ai nā pā o nā kiko a puni ka wehe ʻana o ka ʻōpū. ʻO ka hapa nui o nā pilikia ʻē aʻe o nā genital o waho e pili ana i ka ʻōiwi ʻōiwi a me ka geniguous ambiguous.
• Hymen Imperforate: ʻO ka hymen kahi mea lahilahi e uhi hapa i ka wehe i ka lua. Pale loa kahi hymen imperforate i ka wehe ʻana o ka ʻōpū. Alakaʻi pinepine kēia i ka pehu ʻeha o ka ʻōpū. I kekahi manawa, he wahi liʻiliʻi liʻiliʻi wale nā ​​hymen a i ʻole nā ​​puka liʻiliʻi liʻiliʻi. ʻAʻole ʻike ʻia kēia pilikia a hiki i ka wā ʻōpio. Hānau ʻia kekahi mau kaikamahine pēpē me ka ʻole o ka hymen. ʻAʻole kēia i manaʻo ʻia he maikaʻi ʻole.
• Nā pilikia Ovarian: Loaʻa paha i kahi kaikamahine pēpē kahi ovary keu, nā mea keu i hoʻopili ʻia i kahi ovary, a i ʻole nā ​​hale i kapa ʻia he ovotestes i loaʻa i nā kāne a me nā wahine.
• Nā pilikia o ka uterus a me ka cervix: Hānau ʻia paha kahi kaikamahine pēpē me kahi cervix a me ka uterus keu, kahi kōpū hapa hapa, a i ʻole ke ālai ʻana o ka kōpū. ʻO ka maʻa mau, ʻo nā kaikamahine i hānau ʻia me ka hapalua o ka pūpū a me ka hapalua o ka liʻiliʻi e nalowale ana i ka puʻuwai ma ka ʻaoʻao like o ke kino. ʻO ka mea maʻamau, hiki i ka kōpū ke hana me kahi "pā" waena a i ʻole septum ma ka ʻāpana kiʻekiʻe o ka kōpū. Kū kekahi ʻano ʻē aʻe o kēia kīnā ke hānau ʻia ka mea maʻi me ka cervix hoʻokahi akā ʻelua ʻūrii. ʻAʻole kamaʻilio ka luna kiʻekiʻe i kekahi manawa me ka cervix. ʻO kēia ke alakaʻi i ka pehu a me ka ʻeha. Hiki ke hoʻopili ʻia nā ʻano ʻē uterine āpau me nā pilikia hoʻohua.
• Nā pilikia puʻupuʻu: Hānau ʻia kahi kaikamahine pēpē me ka ʻole o ka ʻōpala a i ʻole ke ākea ʻia o ka puka ʻōpala e kahi papa o nā hunaola i ʻoi aku i luna i ka ʻōpala ma mua o kahi o ka hymen. ʻO kahi ʻōpena nalowale ma muli o ka maʻi ʻo Mayer-Rokitansky-Kuster-Hauser. I loko o kēia maʻi, ua nalowale ka pēpē i nā ʻāpana a i ʻole nā ​​ʻaoʻao hānau hānau o loko (uterus, cervix, and fallopian tubes). ʻO nā mea ʻē aʻe ʻē aʻe e pili ana i ka loaʻa ʻana o nā pūpū ʻelua a i ʻole he ʻōpala e hāmama i loko o ka maʻi urinary. Loaʻa paha i kekahi mau kaikamahine kahi puʻuwai puʻuwai a i ʻole he kōpū me ka paia ma ka waena o ka lua.

Hoʻololi nā ʻōuli e like me ka pilikia kikoʻī. Pākuʻi ʻia lākou:

• ʻAʻole ulu ka umauma
• ʻAʻole hiki ke hoʻonele i ka ʻōpū
• Lū i loko o ka ʻōpū, ma muli o ke koko a i ʻole nā ​​mucus ʻaʻole hiki ke kahe i waho
• Hiki ke kahe Menstrual me ka hoʻohana ʻana i kahi tampon (kahi hōʻailona o ka lua o ka lua)
• Hoʻohui a ʻeha paha ka mahina, me ka ʻole o ka menstruation
• No menstruation (amenorrhea)
• ʻEha me ka moekolohe
• Nā hanau hou a hanau paha o ka hānau mua ʻole (ma muli paha o kahi kōpū ʻole)

Hoʻomaopopo paha ka mea hāʻawi i nā hōʻailona o kahi maʻi hoʻomohala koke. Pēlā nā hōʻailona:

• ʻĀpala kino ʻole
• Cervix maʻamau a nalowale paha
• ʻO Bladder ma waho o ke kino
• Nā genital paʻakikī e hoʻomaopopo he kaikamahine a keikikāne paha (ambiguous genitalia)
• Pākuʻi ʻia ʻo Labia a i ʻole kū ʻole i ka nui
• ʻAʻohe puka ma ka genital area a i hoʻokahi wehe rectal
• Pākuʻi pehu

Pehu paha ka ʻōpū a i ʻole he puʻupuʻu i loko o ke aʻa a i ʻole ʻike ʻia ka ʻōpū. Hoʻomaopopo paha ka mea hāʻawi i ka uterus ʻaʻole manaʻo he maʻamau.

E komo pū paha nā hoʻāʻo:

• Endoscopy o ka ʻōpū
• Karyotyping (ʻike hoʻāʻo)
• Nā pae Hormone, ʻo ka testosterone a me ka cortisol
• ʻO Ultrasound a MRI paha o ka wahi pelvic
• Mīkini a me nā electrolytes serum

Hōʻike pinepine nā kauka i ke ʻoki no nā kaikamahine me nā pilikia ulu o nā ʻōpū hānau o loko. ʻO kahi laʻana, hiki ke hoʻoponopono pinepine ʻia i kahi ʻōpala me ke ʻoki.

Inā nalowale kahi kaikamahine pēpē i kahi ʻōpala, hiki i ka mea hāʻawi ke kuhikuhi i kahi dilator ke hiki i ke keiki i ka wā ʻōpio. ʻO kahi dilator kahi mea kōkua e hoʻolōʻihi a ākea paha i kahi kahi e manaʻo ʻia ai ʻo ka ʻōpala. Hana kēia hana i 4 a 6 mau mahina. Hiki ke hana ʻoki ʻia e hana i kahi ʻōpena hou. Pono e hana i ke kaha inā hiki i ka wahine ʻōpio ke hoʻohana i kahi dilator e hāmama ai ka ʻōpū hou.

Ua hōʻike ʻia nā hopena maikaʻi me nā ʻano ʻoki a me nā hana nonsurgical.

Hoʻomaʻamaʻa pinepine i nā ʻōlohelohe cloacal i nā ʻōkuhi paʻakikī he nui. Hoʻoponopono kēia mau ʻoki ʻana i nā pilikia me ke kīhā, ka ʻōpū, a me ka mimi.

Inā kū ka maʻi hānau i nā pilikia make, hana ke ʻoki mua ma hope koke o ka hānau ʻana. ʻO nā ʻoki lāʻau no nā maʻi hānau hānau ʻē aʻe hiki ke hana ʻia ʻoiai he pēpē ka pēpē. Hiki ke hoʻopaneʻe ʻia kekahi mau ʻoki a hiki i ka nui ʻana o ke keiki.

He mea nui ka ʻike mua ʻana, keu hoʻi i nā hihia o ka genitalia kānalua. E nānā pono ka mea hāʻawi ma mua o ka hoʻoholo ʻana he keiki kāne a kaikamahine paha ke keiki. Kāhea ʻia kēia i ka hāʻawi ʻana i kahi kāne. Pono e hoʻopili i ka ʻōlelo aʻo no nā mākua. Pono ke keiki i ka ʻōlelo aʻoaʻo ke hele a makua.

Hiki i nā kumuwaiwai aʻe ke hāʻawi i ka ʻikepili hou aʻe e pili ana i nā maʻi ulu ʻokoʻa.

• Kumu Foundation - www.caresfoundation.org
• DES Action USA - www.desaction.org
• Intersex Society of North America - www.isna.org

Hiki i nā abnormalities Cloacal ke hana i nā pilikia make ma ka wā hānau.

Hiki ke hoʻomohala i nā pilikia kūpono inā ua lohi a hewa paha ka maʻi. ʻO nā keiki me ka genigu wahine kānalua i hoʻokau ʻia i hoʻokahi kāne ʻike ʻia ma hope ke loaʻa nā kino o loko e pili ana i ka moekolohe ma kahi o lākou i hānai ʻia ai. Hiki i kēia ke kumu i ke kaumaha psychological koʻikoʻi.

ʻO nā pilikia i hōʻike ʻole ʻia i loko o ka tract reproductive a ke kaikamahine hiki ke alakaʻi i ka infertility a me nā pilikia moekolohe.

ʻO nā pilikia ʻē aʻe e hiki mai ana ma hope o ke ola me:

• Endometriosis
• Ke hele nei i ka hana i ka wanaʻao (lawe mua)
• ʻO nā puʻupuʻu ʻehaʻeha e koi ana i ke ʻoki
• Nā hana hewa hou ʻole

Kāhea i kāu mea hāʻawi inā loaʻa i kāu kaikamahine:

• ʻO nā genital nānā ʻole
• Nā ʻano kāne
• ʻO kaʻeha pelvic o ka mahina a me ka cramping, akā ʻaʻole menstruate
• ʻAʻole i hoʻomaka ka menstruation e ka makahiki 16
• ʻAʻohe ulu ulu i ka wā ʻōpio
• ʻAʻohe lauoho lauoho i ka wā ʻōpio
• ʻO nā puʻupuʻu maʻamau ʻole i loko o ka ʻōpū a i ʻole ke aʻa

ʻAʻole pono nā wahine hāpai e lawe i nā mea i loaʻa i nā kāne kāne. E nānā pono lākou me ka mea hāʻawi ma mua o ka lawe ʻana i kekahi ʻano lāʻau a i ʻole nā ​​mea hoʻohui.

ʻOiai inā hana ka makuahine i nā hana āpau e hōʻoia i kahi hāpai olakino, hiki ke loaʻa nā pilikia ulu i kahi pēpē.

Hewa hānau - ʻōpū, ovaries, ʻōpū, a me ka cervix; Hema hānau - ʻōpū, ovaries, kōpū, a me ka cervix; ʻO ka maʻi ulu o ka wahine hānau hānau

• Nā maʻi ulu o ka ʻōpū a me ka pūpū
• ʻO nā anomalies uterine uterus

ʻO Diamond DA, Yu RN. Nā maʻi o ka hoʻomohala moekolohe: etiology, loiloi, a me ka hoʻokele olakino. I: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th hua. Piladelapia, PA: Elsevier; 2016: chap 150.

ʻO Eskew AM, Merritt DF. Nā anomalies o Vulvovaginal a me mullerian. I: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. ʻO Puka Textbook of Pediatrics ʻo Nelson. 21st ed. Piladelapia, PA: Elsevier; 2020: chap 569.

Kaefer M. Ka mālama ʻana i nā mea kūpono ʻole o ka genitalia i nā kaikamahine. I: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th hua. Piladelapia, PA: Elsevier; 2016: chap 149.

Rackow BW, Lobo RA, Lentz GM. ʻO nā mea kūpono ʻole o ka wahine reproductive tract: anomalies o ka puki, cervix, uterus, a me adnexa. I: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Gynecology Comprehensive. ʻEpekema 7 Piladelapia, PA: Elsevier; 2017: chap 11.