Gender reassignment: Pink for a boy, blue for a girl

Gender ambiguity is a hush-hush topic, and lack of awareness among health practitioners delays timely diagnosis.

KARACHI:

“I thought all girls are built like me but there was some difference,” said 13-year-old boy Ahmed who was a girl called Sadia until last March. We were sitting in a room at the National Institute of Child Health (NICH).

“Ahmed’s anatomical features weren’t distinctly male or female. He suffered from sexual differentiation disorder which usually remains undiagnosed at birth,” said Dr Tayyaba Batool, a paediatric surgeon at NICH.

His mother, Farzana, a resident of poverty-ridden Musa Colony, took little Sadia to a private doctor for a check-up when she noticed that the child’s genitals were not quite distinctly female.

She recalled, “Even after taking ultrasound not once or twice but thrice, the doctor wasn’t very sure if it was a girl or a boy.”

After consulting other doctors, the case was finally referred to the NICH paediatric surgery department and the child underwent tests and treatment. Finaly, Sadia came out as Ahmed.  It costs 2-3 lakhs of rupees at a private hospital but nothing at government hospitals.

Welcome to the family, son!

“Everyone in the family was happy, and gave Ahmed money,” his mother beamed, at the idea of having one more son. “The barber asked me why I wanted my daughter’s hair cut short, I explained to him that she was now a boy. He congratulated me and asked earnestly, ‘I have four daughters; would it be possible to turn all of them into boys?”

Farzana said that in the beginning people in the neighborhood rebuked and passed odd remarks. “But it was Allah’s will. People babble; they can say whatever they want but I will support my child.”

Life as a boy

In the past, Sadia stayed at home and helped her mother do house chores, Ahmed mostly stays outside. He said, “I now spend much of my time in a mosque earning good deeds; it is all so peaceful there.”

“I went to a girls’ school earlier. When I visited my school after recovering from my operation, my friends happily hugged me. The principal wasn’t pleased at all.” he said, adding, “I don’t talk to my old schoolmates anymore. The boys in the neighborhood are not my friends. They tease me and call me a girl.”

Social stigma

“There is a need to educate parents that their child’s happiness should be the primary goal and they shouldn’t be proud only of the male child because of the concept that he would grow into a man and become the breadwinner for his family,” said Professor Farhat Moazam, chairperson of the Centre of Biomedical Ethics and Culture,.

“The first question that the parents ask when their child is diagnosed with ambiguous genitalia is, ‘Will the child be able to get married?’” Dr Batool said.

“Ambiguous genitalia come as a shock for the family,” said the NICH Director and Paediatric Endocrinologist Professor Jamal Raza. “Marriages break up because in some families the mother is blamed for the gender of the baby.”

“We have to address the stigma attached to sex reassignment surgery,” said Prof. Raza, adding that the concept of third gender in our society is very weak. He said society usually doesn’t accept such cases and, instead, chooses to ridicule parents and look down upon the child. Genital ambiguity should be detected at an early age. When the patients are diagnosed early, the parents can be given appropriate direction to deal with the problem.

“Lack of education and awareness is a major culprit. Usually the parents fear that their child is what is called a hijra, which symoblises, begging on the roads and involving in prostitution,” Prof Raza added, as he stressed the role of social services and child psychologists.

The doctor’s job

“The society assigns gender at birth. Blue for a boy, pink for a girl,” said Dr Moazam.  The gender identity that is given by our culture and society is deep-rooted in our psyche.

There is no awareness about the long-term consequences of the surgery as sexual topics are a taboo in our society. “When a child undergoes surgery for gender reassignment, there is a possibility that the child will be unable to be sexually active in the adult life.”

“An ambiguous genitalia patient should get complete assessment at birth for early treatment, as, with age, the hormonal imprinting on the child’s brain deepens,” said The Indus Hospital Director of Medical Services and Paediatric Urologist, Dr S Zafar Zaidi. He has operated 20 ambiguous patients this year, their ages ranging from four to 23.

“The younger the child, the better chances of getting adjusted in society,” the doctor explained.

Published in The Express Tribune, August 29^th, 2013.