Disorder of Sex Development
Marilyn Thipthorpe
Gender identity plays a big role in who we are as a person- What happens if you wake up one morning and realize you’re not what you thought yourself to be? I’m talking in riddles here; the point I’m getting to, is: What is a sex development disorder and how is it possible to completely mistake a male from a female and what prejudices go along with that fact.
The Disorders of sex development often referred to as a disorder of sex differentiation is a medical condition affecting the reproductive system. Now it’s not hereditary but cases have been reported where the genome has been passed down from parent to child. DSD refers to a pre-birth condition that causes the development of the chromosomal, gonadal or anatomical sex to be atypical. The WHO has refrained from determining the affliction as a ‘disorder’ rather referring to it as having intersex traits or conditions.
Did you know that 1 in 45,000 births in born with a case of genital anomalies? It’s not as uncommon as you might have thought and it’s certainly not some freak of nature as we treat it. Many stigmas have attached itself to the condition particularly in our corner of the world. The recent coverage of Ishrak Jahan in the news of Bangladesh has raised eyebrows that cases like this do exist here. Previously news of this sort was never acknowledged due to fear. In Bangladesh, the ‘hijras’ are a common go to if you want to study this case, many of these people are born with DSD and not knowing their position in society or whether in fact they are male or female, they take on atypical female traits. Shunned by family and friends, confused and alone, they seek out peers instead of doctors and hence are subjects to intense prejudice and mockery.
But what is DSD exactly and how does it come about? To put it in layman’s terms it’s a condition that presents itself before birth or during early infancy due to the misalignment of chromosomes that lead to sex determination. I’m not sure if that was easy to take in or not, but a basic knowledge, of biology and reproduction, should get you there. There are various types of DSDs and their effects on both the external and internal reproductive organs vary significantly.
The topic is rather a touchy one and has been open to various studies and tests; even so it is a grey area. A frequently used medical term for DSD is ‘inter-sex’, this literally means that the body is in between 2 sexes i.e. male and female. Most of the people carrying the disorder are often unaware of it or even knowing they prefer to assign themselves to either the role of a male or a female. It’s not as simple however doctors involved in such case studies must determine distinctions between biological sex, social gender and a person’s sexual orientation. Yes, each are very different, just because you’re born a certain gender does not mean you prefer it, can do anything about it or wish to it keep-this is due to a hormonal imbalance present at birth during the conceiving of a child. Studies and clinical observation allows doctors to differentiate between being intersex, transgender or being gay/lesbian.
The most common form of DSD is Congenital Adrenal Hyperplasia (CAH), which results in female genitalia looking distinctly male. Mild cases of CAH result in a slight enlargement of the clitoris while severe cases have most doctors perturbed on whether the organ is indeed male or female (just by looking)-this is called having ambiguous genitals. It most cases it goes undiagnosed due to social stigma and causes acute gender identity confusion. Another case of DSD is Androgen Insensitive Syndrome (AIS), this is when a male (XY) chromosome does not react to testosterone is the usual way, leading the body to look effeminate. In Complete Androgen Insensitive Syndrome (CAIS) a male body develops a completely female look, including genitals and breasts, most people afflicted by the syndrome consider themselves to be females until they fail to menstruate and go to a doctor, where if they undergo extensive research and tests the source can be identified. However these cases are more often than not misdiagnosed and the male grows up as a female, unable to reproduce and often having a sexual inclination towards the same sex. A lesser variety known as Partial Androgen Insensitive Syndrome (PAIS) occurs when the genitals can vary between mostly female to completely male, this can be corrected by the intake of hormone or surgery.
The important thing to take home from this is the bias associated with people with gender identity confusion; they are not to blame and are just as confused and scared as the rest of us. Guidance and counseling and heath checkups are a mandatory right for people with DSD.