A Lecture ON MALFORMATIONS OF THE FEMALE GENITAL ORGANS IN THEIR CLINICAL ASPECTS: Delivered at the Medical Graduates' College and Polyclinic
Authors: A. E. Giles
Journal: BMJ (1911)

So.ME, kinds of m-lalformllatioln, tlhouighi of great initerest fromll a mlioriphological or deveelopniielntal point of view%v, cani.notbe saidl to possess aniy clinical importance.Otilers are both initerestingo aii(1 imIportanmt f'roiX a clinical point of view, anli I propose to illustrate miiy remarks by cases that lhave come ulIder mliy personal observatioln.Time clinical aspects of malform11ation iaveC relationi to the quiestion of sex, to mienstruation, to niarriage, andl to child-hearing.1. AIalfor)uatlious Leadiiuq to Con fusio)n of Sex.These form the gronlp known as pseudo-hernmaphrodism.In .tllecase of the ordinary cllild the external sex orgapls are regarded as affording sufficient indication of sex.Time 'testes," as the name indicates, are the witnesses that tlle clhild is a boy; and if they shouild be undescended at birtlh, tlle penis and scrotunm are regarded as circumstantial evidencee, penidinig time later appearance of tlle authentic witlnesses.Sinuilarlv the vtulva is taken to indicate that tlie clhild is a girl.B3ut in the case of pseudo-liermaplrodites, tlhese indications are inidecisive or misleading: an essential male, possessing testes that lhave lnot descended, may have the outward conformationi of a female, when the condition is described as androgyna; or an essential feiniale with ovaries tllat mllay eitlier reimain in tIme pelvis or comi-e down thlroLglh the inguinal rings, m-ay possess a well-formed penis and sinmulate the miiale; this is time conmdition kniow-tn as gynianidrta.It is remarkable that we should be unable to tell tlle sex of a person witlh certainty excopt byimicroscopical exaniination of the geinital glands.The follow%ing case illustrates this difficdlty: CASE I.-A CLse ,M thlo!/y)q,/ tile Putient iitinq (1 il1( ))id I 1o11)1(111.Son-e years ago a wVomami, agedl 28, wio hiad beeim married teIn -ts, came to the out-patienit (lepartment, complainhig of a isw -lung iIn the left iii-ruiiial reglioni.It felt like an irreducible lie iiia.A snatemeit to tie effect tiat shielhandonly-menstrtiated tw cc icc lm er life led to aim exim iimatioii, wrieni I founl(d tl-hat tile vainIa vwas shiorter thianl usiultl, amll( eii(led above in a smooti ciil-(ie-sac, in whlicl tiere was iio trace of a cervix.Bimanually thlen wi-.s no signi of a utertis.The vulva was (mtite iiormal in appearance, anul tIme breasts were faielv well (Ievelope(l.Slic wias admitted, anid the "lhernia " was ohperatedl ilpoli.It was soou evident that it was iiot a lieriiia of bowel iii fact, tihere was io true peritoneal sac, but a glandular structuire was dis- c,-)vered, extraperitoneal in positioni.rThis was removedl, the heritolneal cavity was openied, ami(i a Iinigem ilitro(luce(l.Tiiere \Vas 10o uiterLus, the peritoimeulii passinig dowim from the back (if tIle bladder oim to the rectum, as in tile male; all( oil the might sidle,-at the bhinm of timehl)elvis,aglandtlularstructure -was felt, like tihe onle in the left inguiiial canal.The lherinial orifice was closed, anld subsequenit microscopic examination of the gla'm(I removedl shlowed that it lia(n the typical structure of tile testes.The patieilt was anl example of aiidrogyniy.-'.~~~~~~~~~~~~~~~~~~C