Psychological aspects of intersex in Saudi patients

Abstract

Four cases of male pseudo-hermaphrodism were seen post pubertal. All had been reared as females unambiguously since birth. Two cases developed male gender identity post pubertal, but failed to declare themselves to their families and society until a similar case had been publicized in the local newspaper. The third case did not reveal her problem to her family even after being informed by a doctor at the age of 15, and was discovered accidentally at the age of 22 on routine medical examination. The fourth was discovered accidentally at age 40 after having been married and divorced. The families of the four cases shared a strong desire for their children to be reassigned to the male sex including the third case, irrespective of being assured of her female gender identity by physicians. Psychiatric and social problems encountered pre- and post-operatively are discussed with particular emphasis on the role of culture and traditions.

Apparent Male Gender Identity in a Patient with Complete Androgen Insensitivity Syndrome

“…On follow-up, all these patients were financially independent, seemed to cherish the male role in spite of a small phallic size, the need for multiple genitoplasties, and unmarried status for all except one patient. Similar cases were also reported by other authors from the patriarchal Arab community where male sex was opted for by the patients or families against physician advice (Elsayed, Al-Maghraby, Hafeiz, & Taha, 1988). The present case is still more difficult.…”

Sex Reassignment: A Challenging Problem—Current Medical and Islamic Guidelines

“…The cases in this group were due to congenital adrenal hyperplasia because of 21-hydroxylase deficiency in 20 (74%) and 11β-hydroxylase deficiency in seven (26%), the two conditions characterized by elevated 17α-hydroxyprogesterone and 11-deoxycortisol respectively. 16 This high occurrence is a reflection of the not uncommon autosomal recessive disorder, namely congenital adrenal hyperplasia, seen in this community, 1,[4][5][6][7] which is most likely due to the high rate of consanguinity. 17 As indicated above, there should be no debate on reassigning the sex of these children to the correct female gender.…”

“…5α-reductase deficiency, a condition first described in 1974 and characterized by ambiguity of the genitalia in a genetic male and elevated T to DHT ratio 25 is also not uncommon in our community. 7 This has been reported to cause improper sex assignment in at least one local case, with no details of the outcome, if ever made, of the sex reassignment of the young male who was raised as a female. 26 Of equal importance is androgen insensitivity, which we also feel to be frequent in this community (unpublished data).…”

“…3 In a community where this condition is. not uncommon, 1,[4][5][6][7] health personnel will continue to face improperly sex-assigned children and young adults at different ages and circumstances. In this study, we retrospectively reviewed 30 cases in which sex reassignment was indicated.…”

A clínica da intersexualidade e seus desafios para os profissionais de saúde

“…Em suma, um panorama geral das investigações revela que têm sido privilegiadas variáveis como identidade e papel de gênero (Santos, 2000), imagem corporal (Santos, 2000), comportamento agressivo (Hines & Kaufman, 1994), cirurgia genital (Quattrin, Aronica & Mazur, 1990), (re)designação sexual (Reiner, 1996, Elsayed, Al-Maghrby, Hafeiz & Taha, 1988, desordem de identidade de gênero (Zucker, 1996, Araujo & Santos, 1999, Santos & Araujo, 1999, psicopatologia geral (Slijper, 1998) e desenvolvimento cognitivo ( Hurtig, 1983). As técnicas mais utilizadas para explorar tais variáveis envolvem instrumentos como: entrevistas, testes projetivos, inventários, questionários, protocolos de observação comportamental (Hines & Kaufman, 1994) e, conforme discutido acima, os dados também vêm sendo obtidos a partir das contribuições advindas de investigações clínicas, visando sobretudo à delimitação mais precisa de critérios de intervenção próprios a tal casuística (Zavaschi, Zaslavsky, Nicilovitz & Dorfman, 1985, Elsayed, 1988, Quattrin, Aronica & Mazur, 1990, Reiner, 1996.…”