When gender is a puzzle

NST: Two-year-old Ain (not her real name) will have the painful task of deciding her sex when she becomes an adult.
For the time being, though, the toddler who suffers from ambiguous sexuality is officially a girl.
Her parents decided that Ain should grow up as a girl as she has a vagina despite the fact that blood tests proved the child to be a male.
This is to allow easier realignment of the sex organ as a vagina rather than a penis through surgery later on in adulthood.
She is among scores of infants who suffer from a disorder that makes it difficult to determine the sex of a child by looking at the external genitalia.
On the surface, the toddler looks like any other female child.
Her parents were shocked when told after her birth that she was genetically a male.
"I cried when the doctor told me there was some problem concerning my baby’s gender," said Ain’s father, who preferred to remain anonymous.
The joy he and his wife had experienced after their first-born’s birth turned to sorrow in minutes after the nurse on duty refused to say whether the child was a male or female.
"She told me to ask the doctor and that’s when I suspected something was not right."
Still in a state of confusion, Ain’s parents had a tough decision to make: they had to decide whether the child was a male or female.
They were encouraged to seek religious advice.
They at last decided the baby would be a female, a decision they have stuck with.
This was followed by a series of treatments including surgery and hormone shots at Universiti Sains Malaysia hospital.
More and more cases of ambiguous sexuality have been reported of late.
According to USM’s Human Genome Centre in Kubang Kerian here, no fewer than 200 cases such as Ain’s have been referred to the centre in the past 10 years.
Genome Centre director Dr Zil Falil Alwi said marriage among close relatives could be among reasons behind the phenomenon.
Such marriages could lead to hormone deficiencies among infants.
Dr Zil said children born with ambiguous genitalia may fall into either the True hermaphroditism or Congenital adrenal hyperplasia (CAH) groups.
True hermaphroditism occurs with children who have both ovarian and testicular tissues — both genders’ internal reproductive organs — and external genitalia that are partially ambiguous.
CAH, meanwhile, is the most common cause of ambiguous genitalia in newborns and occurs when an infant has external genitalia that are ambiguous.
"Normally, a baby girl has a clitoris in the vagina, but a baby girl with CAH is born with an enlarged clitoris that resembles a penis and a partly- fused labia that resembles testicles."
He said the normal practice in such cases was for medical experts to discuss the next move with the parents involved.
In Malaysia, the views of religious officials and family members are often taken into consideration.
In cases where parents preferred their newborns who were suffering from ambiguous sexuality to be females, hormones are given to match the gender realignment, especially when they reach puberty.
Dr Zil does not rule out the possibility that many cases of ambiguous genitalia go unreported in Malaysia, mostly by choice.
Many shun treatment due to embarrassment and the lack of confidence to deal with the problem.
"This is not the right move as these children should be treated at the earliest stage possible so that they can lead a normal life like other children."