SHANDI YONI VYAPAD

🔺CASE STUDY: SHANDI YONI VYAPAD

(Congenital intersex disorders such as Turner Syndrome or CAH)

🔺 NIDANAM (ETIOLOGY / CAUSES)
As per classical and modern understanding

• Beeja Dosha – Congenital defects in gametes

• Beejabhaga Avayava Dushti – Structural anomalies in components of sperm/ovum

• Karmaja – Results of past karmas

• Garbhashaya Vikriti – Uterine or intrauterine developmental anomalies

• Maternal Factors – Infection, metabolic disorders, stress during pregnancy

• Ahara-Vihara during Garbhavastha – Incompatible, unwholesome lifestyle and diet

References:
Charaka Samhita Sharira Sthana 4/30
Sushruta Samhita Sharira Sthana 2/19

🔺 PURVAROOPAM (PRODROMAL SYMPTOMS)
(Since congenital, prodromal symptoms not clearly described)

• Delayed secondary sexual characteristics

• Lack of breast development during puberty

• Absence or abnormal development of genital organs

🔺 LAKSHANA (SYMPTOMS)

• Naaritva Abhava – Absence of feminine features

• Primary Amenorrhea – No menstruation by expected age

• Underdeveloped Breasts

• Yoni Avayava Vikriti – Hypoplastic external/internal genitalia

• Lack of Libido

• Infertility

• Masculinization Signs – Seen in CAH (e.g., clitoromegaly, hirsutism)

References:
Charaka Chikitsa Sthana 30/14
Sushruta Sharira Sthana 2/19

🔺 GENERAL EXAMINATION

• Pallor – Rule out anemia

• BMI Assessment – Often underweight in Turner; obese in CAH

• Skin – Dry skin, acne, pigmentation

• Hair Distribution – Hirsutism, pubic hair anomalies

• Voice – Hoarseness or deepening

• Breast Development – Hypoplastic or absent

• Mental State – Depression, anxiety

🔺 SYSTEMIC EXAMINATION

• Thyroid – Look for enlargement/nodules

• Abdominal Palpation – Mass, tenderness

• Pelvic Exam –

  • Small/absent uterus or ovaries

  • Narrow vagina

• Tanner Staging – For sexual maturity

🔺 LABORATORY INVESTIGATIONS

Hormonal Profile:

• FSH / LH – Elevated (gonadal dysgenesis)

• Estrogen / Progesterone – Low

• Testosterone – High in CAH / AIS

• Prolactin, TSH – Rule out endocrinopathies

• AMH – Absent/low ovarian reserve

Genetic Tests:

• Karyotyping – Turner (45,XO), AIS (46,XY), CAH (46,XX)

• Y Chromosome Microdeletion (in AIS)

Imaging:

• Pelvic USG / MRI – Uterine or ovarian anomalies

Other:

• Blood Sugar / Lipid Profile – Rule out metabolic syndrome

• DEXA Scan – Bone loss due to estrogen deficiency

🔺 DIFFERENTIAL DIAGNOSIS (DD)

🔺 SAMPRAPTI (PATHOGENESIS)

• Beejabhaga Avayava Dushti (defect in sperm/ovum structure)

• Defective genital development in the embryo

• Dosha Involvement: Vata predominant (leads to deformity, underdevelopment)

• In CAH: Pitta-Kapha involvement (hyperfunction of adrenal glands → androgen excess)

🔺 SAMANYA CHIKITSA (GENERAL MANAGEMENT)

• Brumhana Chikitsa – Nourishment to enhance tissue quality

• Rasayana Chikitsa – Rejuvenation and immunity boosting

• Psychological Counseling – To manage anxiety, low self-esteem

• Ahara-Vihara – Supportive dietary and lifestyle modifications

• Not curable; aim is quality of life and symptom relief

🔺 UPASHAYA (RELIEVING FACTORS)

• Use of Stree pushtikara dravyas

• Abhyanga – Nourishing massage with medicated oils

• Shirodhara – For calming the mind

• Balanced diet, milk, ghee, fruits

🔺 ANUPASHAYA (AGGRAVATING FACTORS)

• Vata-provoking diet/lifestyle – Ruksha, Laghu, Vishama

• Excessive mental stress, exertion

• Exposure to cold, dry climate

🔺 VISHESHA CHIKITSA (SPECIFIC TREATMENT)

📌 INTERNAL MEDICINES:

📌 PANCHAKARMA:

• Snehana – Internal and external oleation

• Swedana – Mild fomentation

• Basti Karma – Ksheera Basti, Tikta Ksheera Basti for Vata anulomana

📌 RASAYANA THERAPY:

• Ashwagandha Rasayana, Shatavari Rasayana

• Yashtimadhu, Kapikacchu (if androgens low)

📌 SURGICAL MANAGEMENT (MODERN):

• Correction of external genitalia if indicated (plastic surgery)

• Hormonal therapy (Modern HRT) may be required under endocrinologist's guidance