Cost of surgery limits options for child diagnosed with ambiguous genitalia

After Pakeeza Bibi turned 3, it became clear her body had not caught up with her outward appearance of a girl.


Muhammad Sadaqat October 14, 2013
“My daughter is in grade five; she behaves like a girl, her friends are girls. She has never complained of any physical problems even with her condition,” said the worried father. PHOTO: FILE

ABBOTABAD: Ten-year-old Pakeeza Bibi is a grade five student at the government-run girls primary school in Bharwal, Havelian tehsil. However, her father Yastaq Hussain, a grocer from Bharwal, explains his daughter has been diagnosed with ambiguous genitalia by doctors at the Ayub Teaching Hospital.

Hussain told journalists Pakeeza was born a “regular baby girl, but things changed when she turned three.” Around that time, it was discovered Pakeeza’s external genitalia had not developed in congruence with her physical appearance of a girl.

“We overlooked it initially, thinking she would become okay with time,” shared Hussain. When that never happened, Pakeeza started feeling uneasy with what her father explained as the “dual growth” and he took her to a woman doctor who referred the case to Ayub Teaching Hospital. He explained the gynaecologist who examined Pakeeza brought surgeon Dr Irfan Khattak on board – both doctors advised surgery for his minor daughter.



According to Hussain, the doctors told him Pakeeza’s case suggests there is more of a chance for Pakeeza to become a female instead of a male after surgery.

The cost of being a girl

Doctors prescribed five different medical tests before the surgery, rounding off the cost to Rs35,000. The surgery to complete Pakeeza’s physical transformation as a girl would be no less expensive than Rs200,000, they told the grocer.

“My daughter is in grade five; she behaves like a girl, her friends are girls. She has never complained of any physical problems even with her condition,” said the worried father, who is currently making no money as his grocery shop burnt down a few months ago. He was unable to even bear the bus fare from Bharwal to the hospital himself.

With one younger son and surmounting financial troubles, Hussain admits he would not have minded Pakeeza’s sex change to a boy. But this no longer matters to the father after the doctor explained she has a better chance to be a girl.



“I cannot tolerate Pakeeza’s future being compromised because of her physical condition,” which is what will happen without the funds required for her tests and procedures.

Hussain requested Khyber-Pakhtunkhwa’s government and philanthropists to help his daughter.

The doctors who examined Pakeeza were not available for comment. However, Havelian Hospital Medical Officer Dr Sehrish, who had also examined Pakeeza, confirmed the diagnosis of ambiguous genitalia. It is a rare condition, but, as the matter was surgical, Dr Sehrish added it was best to wait on tests to see whether Pakeeza had better chances of becoming a girl or a boy post surgery and treatment.

Ambiguous genitalia

According to MayoClinic.com, ambiguous genitalia is a birth defect which impacts sexual development; it is not a disease. In most cases, the condition is detected at birth or shortly after.

In this condition, it is hard to determine sex from the external appearance of genitalia. There are several possible causes for ambiguous genitalia, explains the US National Institutes of Health:

•   Pseudohermaphroditism – where a person has genitals of one sex but physical characteristics of both, or true hermaphrodism – where tissue from both ovaries and testes is present and external genitalia carries markers of both sexes.

•   Chromosomal abnormalities such as XXY or XO syndromes

•   Intake of steroids during pregnancy

•   Lack of testosterone cellular receptors

Published in The Express Tribune, October 15th, 2013.

COMMENTS (3)

Dr. Irfan U. Khattak | 10 years ago | Reply

Dear Sir, a very interesting article. It is difficult to place the patient, though it may be that the patient visited our hospital. One thing is very interesting though: when publishing an article like this, is it not the responsibility of the newspaper to make sure that the article is correct? Every single operation that is performed in KP Hospitals is TOTALLY FREE. No doctor or hospital charges any patient a single Rupee, when operation is performed in the KP hospital. And I assure the honourable readers and the writer of the article, and the publishers, that operations as complicated as these are not usually performed in private hospitals. Therefore, it is requested to please direct the poor family to see concerned doctors at the hospital, and to make sure that they arrive at one of the following OPD days: Tuesday and Friday, if they intend me to perform the surgery. A similar article was published, some times back, in one of the newspapers, with an exactly similar wording, I am sorry to say, I do not remember the writer or the newspaper, that required 200,000 Pakistani Rupees for a girl in Peshawar. I wrote a letter to the newspaper at that time, mentioning the same facts and that the patient may be directed to see me or a large number of my surgeon colleagues in Peshawar or Abbottabad or other cities for free operation: there won't be any problem. No one contacted me. It appears the worthy writer is more interested in getting some attention, rather than free treatment for the patients. Please do send the girl to the hospital for FREE TREATMENT, including FREE MEDICINES and SURGERY at one of the Government Hospitals in Abbottabad. Dr. Irfan U. Khattak Surgeon Abbottabad

Ayesha P. | 10 years ago | Reply

We should help this family ... any way to send money??

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