CAIRO: Bahaa, 30, appears to be a male at a distance, but at closer range his movements and facial features can be those of a man or a woman. However, the fact that Bahaa (or Biba as he prefers to be called) is effeminate does not denote homosexual inclinations. Biba was born with ambiguous genitalia, that is, having both male and female organs.
Shocked at this discovery when he was three, his parents decided he should be a boy, even if it took putting him though a surgical procedure.
Biba’s female organ was made dysfunctional and he was given extra male hormones. But as time went by his feminine tendencies prevailed and it became clear that it would have been better if his parents had opted to have a daughter.
But now Biba s future is molded: his feminine identity has been physically distorted with the removal of his female genitalia and the persistence of his womanish traits can only place him in the company of homosexuals and transsexuals.
It is not by coincidence that the issue has come to limelight this week during a workshop organized by the National Research Center (NRC) in Cairo to focus on Disorders of Sex Development (DSD).
“Two decades ago we used to wait anxiously for a single case to emerge, said Dr Nabil Dessouky, professor of pediatric surgery at Cairo University. “Today we attend to no less than 10 or 12 cases each month.
Dr Inas Mazen, pediatric specialist at the NRC and the team leader charged with researching related cases told Daily News Egypt, “So far we don’t have accurate figures, but the rate declared in 1998 put newborns with ambiguous genitalia at 1 in every 3,000. But our investigations indicate that the number of cases has dramatically increased.
The first Egyptian-German workshop on DSD in Cairo brought together a large group of pediatricians, one Al-Azhar scholar and other doctors who discussed the medical and ethical angles of the issue.
The experts warned that, like other congenital defects, ambiguous genitalia could be the result of excessive intake of hormones as well the change in the genetic engineering of the local produce of fruits and vegetables.
Exposure to chemicals during pregnancy, which might disturb the mother’s hormones and chromosomes, was also cited as a possible cause.
But Dr Olaf Hiort, from the University of Schleswig in Germany, pointed to several cases that could have been the result of the preponderance of consanguine marriages among Egyptians.
“The relatively smaller rate in Germany has been put at 5 in every 8,000, but the only difference between Egypt and Germany is that we speak openly about the issue while the majority of patients’ families here remain silent about it, said Hiort.
But he contended that the social and the cultural implications must not be ignored because they complement the medical aspect and are part and parcel of treatment.
Because parents and doctors, especially in rural areas, fail to detect ambiguous genitalia which becomes more apparent as the child gets older, nurses at the vaccination centers are trained to identify the flaw and report it to specialists.
When parents are finally confronted with the news, they are challenged with making a decision for which they are not qualified even it they are highly educated.
“Most parents blindly go for the male option, said Dessouky. “In oriental cultures the male carries the father’s name. He inherits twice as much. He can work in any field, travel abroad on his own and has more options in a male-dominated society.
“Also culturally it is a stigma for a male to become a female, which could force him to leave his hometown altogether, which isn’t always affordable in impoverished areas.
Professor of comparative religion at Al-Azhar University Dr Hilali Saad El Din Hilali says that some Islamic scholars argue that ambiguous genitalia is God’s creation and should be left as it is until the person passes away.
This opinion, however, has been refuted for several reasons, he added.
But apart from the question of religion or social surroundings, neither parents nor specialists can ask a child if he/she wants to be a man or a woman, remarked Dr Claudia Wiesemann, of Gotettingen University in Germany.
Echoing Wiesemann’s view, Mazen said that medical reports could come in handy only in certain cases, but there are many cases where one cannot really predict if the child will be more inclined to male or female behavior.
Some 35 percent of the patients haven’t been diagnosed and we advise their parents to keep their eyes open on their behavioral patterns and prepare them for both options, said Wiesemann.
Mazen, however, believed that the earlier the case is detected the better because some cases emerge when it’s too late.
In Germany a national network funded by the education ministry has been created to cater to the needs of the DSD patients.
Three principles were also set by the concerned medical teams in dealing with such cases: fostering the security of the child, upholding his rights to case-related information as a child and adolescent and respecting the parent-child relationship.
“DSD is a psycho-social rather than a surgical emergency, said Wiesemann. In cases of intersex, the child s well-being can t be automatically ensured and an effort has to be made to safeguard his security, said the German expert.
She stressed that surgery aimed at normalizing the child cannot pass without a traumatizing effect. He must also visit the hospital regularly prior to the operation.
The child s self-esteem will only be safeguarded if he feels that his parents accept him. “True treatment is based on scientific evidence but if the evidence is hazy, postpone the surgery, she says. All information you give the child should also be in line with his age.
Hilali wrapped up by saying that the issue of intersex has been a subject of debate among Muslim scholars for ages. There are problematic cases where the child is born with two mechanisms that are equally functional and neither of them prevails over the other, he explained.
But generally, the rule is that the patient’s sex should be determined by the healthier organ, he added.
Hilali made it clear that Islam will always support the solution that serves the patients’ happiness and welfare.
Those who argue for not interfering with the creation of God have been accused of tawakul (dependence) and their logic has been widely rejected, he said.
