Work organized by professors Gil Guerra Júnior and Andréa Maciel Guerra, both from FCM, has two volumes and is co-authored by 44 experts
When the book “Boy or Girl?” was released in 2002. – Sex Differentiation Disorders”, organized by professors Gil Guerra Júnior and Andréa Trevas Maciel Guerra, both professors at the Faculty of Medical Sciences (FCM) at Unicamp, brought important contributions to a better understanding of cases related to the topic. Over the years and the consequent advancement of knowledge, the work was updated and expanded, gaining a second edition in 2010 and a third in 2019. The latter was presented to the public recently, on April 13, during an annual course on sexual differentiation offered by the duo for professionals linked to the medical field from all over Brazil.
According to professor Andréa Guerra, the great advance recorded since the launch of the first edition of the book was the advent of molecular diagnosis. The tool allows the identification of the origin of a given anomaly. “Through this resource, we can make an accurate diagnosis, which is important from both a medical and social point of view. Another relevant aspect is that, from determining the nature of the problem, we can draw up a prognosis about the risk of comorbidities [development of associated diseases, such as neoplasms] or about issues related to development during puberty or fertility in adulthood” , explains.
Professor Gil Guerra notes that it is not always possible to determine sex immediately after birth. Sometimes, he reports, the difference between typically male and female genitalia is not easily noticeable. “If there is no investigation at this stage, the problem will emerge late, in adolescence, which will cause a series of difficulties and, often, embarrassment for the patient”, he points out. At Unicamp, these cases are handled by the Interdisciplinary Group for Studies on Sex Determination and Differentiation (GIEDDS), created in 1988 and linked to the Department of Medical Genetics and Genomic Medicine at FCM.
The GIEDDS outpatient clinic is located at the Hospital de Clínicas (HC). “Here, we serve babies from newborns to adults. The latter come to us mainly because of fertility problems arising from testicular dysfunction.. In fact, people get a lot of confusion about our work. We do not offer treatment for cases of psychological sexual disorders. We deal exclusively with malformations of the reproductive system, something that may or may not be noticeable at birth”, says Gil Guerra.
A point addressed in the most recent edition of the book is the fundamental role played by the family during the patient's sexual definition process. Professor Andréa Guerra observes that every couple expects their child to be born perfect. “When the baby presents a problem, the family needs to experience a kind of 'perfect child mourning' and then deal with reality. We need to understand that just as there are people who are born with heart disorders, there are also those who are born with abnormalities in their reproductive systems. Our objective is to diagnose the problem and start treatment as early as possible”, points out the teacher.
Still on family participation, Gil Guerra comments that one of GIEDDS's tasks is to provide genetic counseling to parents, given that there is a risk of recurrence of malformations among siblings. “The couple needs to be alerted to consider this possibility if they choose to have a new pregnancy,” says Andréa Guerra, who adds: “We provide a service that covers everything from the fetus to the elderly. This experience gives us a different characteristic from other initiatives in this area. I would venture to say that in terms of clinical quality and outpatient support, we have nothing to do with similar experiences abroad”, she analyzes.
The third edition of the book “Boy or Girl? – Disorders of Sex Differentiation” has the participation of 44 co-authors, from different specialties. Published by Appris, in two volumes, the work can be purchased on the publisher's website for 1 volume and for the 2 volume and, soon, in bookstores. It is also available in an e-book version. Over the course of 13 chapters, the genetic, embryological, endocrine and psychological aspects of human sexual differentiation, the diagnostic criteria, the classification and description of the different types of disorders, the systematic clinical and laboratory investigation and the therapeutic approach are presented.
Issues relating to the definition of breeding sex, hormone replacement, surgical correction, possible association with neoplasms, psychological and social monitoring and genetic counseling are emphasized, in addition to medico-legal issues related to the change of civil registration. The content is organized to be a source of reference for undergraduate, medical residency and postgraduate teaching and for the daily practice of health professionals.
Service
Title: Boy or girl? – Disorders of Sex Differentiation
Organizers: Gil Guerra Júnior and Andréa Trevas Maciel Guerra
Authors: Several
Publishing company: Appris
pages: 343
Binding: Brochure
Suggested price: R$ 75,00 (print version of each volume, totaling R$ 150,00 for both volumes) and R$ 41,25 (digital version of each volume, totaling R$ 82,50 for both volumes)