The causes of this can be male hormones taken during pregnancy, congenital adrenal hyperplasia, male-hormone-producing tumors in the mother and aromatase deficiency. 46, XY intersex
This condition used to be called "male pseudohermaphroditism". This is defined as incomplete masculinization of the external genitalia. Thus, the person has the chromosomes of a man, but the external genitals are incompletely formed, ambiguous, or clearly female. This condition is also called 46, XY with undervirilization. 46, XY intersex has many possible causes, which can be problems with the testes and testosterone formation. Also, there can be problems with using testosterone. Some people lack the enzyme needed to convert testosterone to dihydrotestosterone, which is a cause of 5-alpha-reductase deficiency. Androgen insensitivity syndrome is the most common cause of 46, XY intersex. True gonadal intersex
This condition used to be called "true hermaphroditism". This is defined as having asymmetrical gonads with ovarian and testicular differentiation on either sides separately or combined as ovotestis. In most cases, the cause of this condition is unknown. Complex or undetermined intersex
This is the condition of having any chromosome configurations rather than 46, XX or 46, XY intersex. This condition does not result in an imbalance between internal and external genitalia. However, there may be problems with sex hormone levels, overall sexual development, and altered numbers of sex chromosomes. Conditions
There are a variety of opinions on what conditions or traits are and are not intersex, dependent on the definition of intersex that is used.
He stated, "There still other masturbatory techniques which were regularly or occasionally employed by some 11 percent of the females in the sample ... enemas, and other anal insertions, ... were employed.Sadomasochistic activities may incorporate enemas for erotic humiliation or for physical discomfort. BDSM punishment scenes can involve administering an enema in a manner that is humiliating and painful and for producing pain and cramps an extra-large volumes or highly irritating substances can be injected. Among the attractions to enema play in BDSM are erotic humiliation, dominance and submission, discipline, psychodrama, power exchange, and so on. An erotic enema allows acting out vulnerability in a primal form. Classification
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) classifies klismaphilia under the diagnosis of "Paraphilias, Not Otherwise Specified". The diagnostic code is 302.9. Proactive treatment for klismaphilics is not generally recommended, due to the lack of any significant desire to be "cured". Health treatment for klismaphilia thus is typically only focused on ensuring the techniques employed and chemicals used are not harmful to the practitioner. Caution should always be maintained on the part of the practitioners experimenting with new techniques and concoctions; in certain cases cramps produced by the chemicals used have led to hospitalizations, in other circumstances the effects can even be life-threatening. References

Notes

Agnew, J. (2000). "Klismaphilia". Venereology. 13 (2): 75–79. ISSN 1032-1012. Retrieved 29 September 2018. Brame, Gloria; Brame, William D.; Jacobs, Jon (1993). Different loving – The World of Sexual Dominance and Submission. Villard Books. ISBN 978-0-6797-6956-9.