Menstruating man: female internal, male external genitalia

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27 years old male complain of bleed through penis since he was 9 years old. A rare case of ambiguous genitalia discovered during Ultrasound examination. The patient was discovered to have both ovaries and uterus even though he has only male external genitalia.

The coexistence of a male phallus and a uterus in one individual is a rare form of ambiguous genitalia, often linked to disorders of sex development (DSDs). This condition can result from atypical chromosomal, gonadal, or hormonal development during fetal growth.

Possible Causes:

1. Ovotesticular DSD (True Hermaphroditism): Individuals have both ovarian and testicular tissue, which may produce a mix of male and female reproductive structures.

2. Androgen Insensitivity Syndrome (AIS): Partial AIS can cause ambiguous genitalia due to incomplete masculinization.

3. Congenital Adrenal Hyperplasia (CAH): This can lead to ambiguous genitalia due to excessive androgen production.

4. Persistent Müllerian Duct Syndrome (PMDS): Genetic males (46,XY) with PMDS may have both male genitalia and a uterus due to the failure of Müllerian duct regression.

Diagnosis:

Chromosomal Analysis (Karyotyping): Determines genetic sex (e.g., 46,XX, 46,XY).

Hormonal Tests: Measure levels of sex hormones (testosterone, estrogen, AMH).

Imaging Studies: Ultrasound, MRI, or laparoscopy to detect internal reproductive organs.

Histological Examination: In some cases, biopsy of gonadal tissue is needed.

Management:

Medical Care: Hormonal therapy may be necessary to balance sex hormone levels.

Surgical Intervention: Reconstructive surgery may be considered based on medical, functional, and psychological needs.

Psychological Support: Counseling for the individual and family is crucial.

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