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Hermaphrodite or Intersex? Raising an intersex child

 

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Definition of terms

Intersex: A person whose sex cannot be biologically determined to be either male or female.

Transsexual: A person who was born male or female but feels like they are supposed to be the opposite sex. They may undergo surgery to make them male or female.

Hermaphrodite: A person who has both male and female genitalia: a vagina and a penis

Homosexual: A person whose sex is not in question but whose sexual orientation is towards people of his own sex: a man desiring another man (gay) or a woman desiring another woman (lesbian).

Bisexual: A man or a woman who has sexual desire for both males and females.

Last week SUNDAY laid bare the intersex phenomenon and quickly came to the realization that the subject is even more complex than it appears. It is a labyrinth of aspersions, doubts and misconceptions.

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That is the roller coaster that Cecilia Wanjiru Ndung'u, a mother of two girls and a boy (who has undergone genetic testing and been found to be a girl), finds herself stuck on.

"He is the only boy I have. I would love for him to continue being a boy if it is God's wish that he stays so," Cecilia says when we ask what she hopes for after her son, Joseph Ndung'u's diagnosis.

It will be an uphill task if Ndung'u is to continue being a boy. He has experienced menstruation and has had to take yearly hormonal injections to suppress feminine features that threaten to overrun his body when female hormones take charge.

"It has been deeply unsettling for him. It has interfered with his emotions and sometimes he doesn't even want to eat," Cecilia says.

Welcome to the world of parenting an intersex child.

A baby is a blessing, so goes the cliché. And while there's no doubt in her mind as to the warmth she felt in her heart when she gave birth to Ndung'u, Cecilia hasn't grasped the ramifications of her son being born with both genitalia.

Perhaps, it was a sign of what was to come when her then husband, Ndung'u's father, took off in denial, leaving her to fend for herself and their child.

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"Even to date he still tells me that I am not a full woman. He says that I couldn't give him a proper child," she says.

The first question Cecilia asked the doctor after the birth of her son was: "What is that hole in my son's genitalia?"

The doctor, either in an attempt to smother possible shock, or because he was negligent in spite of the glaring medical situation before him, brushed her fears aside and went on to perform some rather unbelievable patchwork.

'It is nothing,' she recalls the medic saying, adding; 'I will just get some flesh from his thigh and block the hole.'

The surgery, as Cecilia attests, was never successful.

"That hole just wouldn't go away. I would go back to the doctor to ask why it was not patching up and why urine came through it but he would tell me to give it more time," she says.

The 'hole' never closed. It is during puberty that the essence of the 'hole' would be discovered. Ndung'u shed blood – an experience that only girls are supposed to have – in what science calls menstruation.

Cecilia did well keeping Ndungu's condition from the society. After her husband left she didn't quite know how everyone else would react to the news. Plus she felt that the stigma would have made their lives difficult.

But she is not alone in this. James Karanja was born Mary Waithera – a girl. Owing to the media's spotlight on his case he is now a household name.

What many don't know, and which he now admits to, is how his intersex condition pushed his mother to the brink; she is now in a mental institution.

Being the child, James cannot fully fathom the mental anguish his mother must have gone through.

"In our society ambiguous genitalia does not make sense: a child is either born male or female," Julia Kagunda, a psychologist, says.

"It is very confusing for the parents too, knowing that as this child is growing, you have to give them an identity," she adds.

According to Kagunda, in the traditional African society 'intersex' was a taboo subject. As such, the repercussions would be as dire as putting the child to death.

In an ideal situation, Kagunda says, parents with intersex children ought to undergo counselling.

She says: "It is unfortunate that counselling is not embraced in our society. But it is important for such a parent to understand the medical options available at their disposal. They need to understand and accept their child."

Kagunda also adds that it is important for society to treat intersex persons with dignity and respect.

The confusion that ensued when James started noticing that he was not developing in the same way as his peers caused him to question what he had been told.

"My voice broke. My shoulders broadened. My chest was flat – I was not developing breasts. Also, deep inside, I felt like a boy," he says.

In high school, a girls' boarding school, where he served as a deputy head girl and subsequently as head girl, James was meticulously careful to conceal his 'maleness' from the other girls.

"He would wake up early to get ready. By the time everybody else was waking up he was ready and dressed up. In the evening he would come to the dormitory very late after everyone else has bathed and slept," Joy Wambui, Jame's friend even to date, confirmed to SUNDAY.

Teresia Waithera, Jame's grandmother, confesses to not being sure herself if James was really a girl or a boy.

"We let him grow as a girl. I didn't want to tell him anything. Had I confessed to him about it I was afraid he wouldn't have gone to school."

For Cecilia, the implications of having an intersex child have been overwhelming financially.

"Ndung'u needs yearly hormone injections. And the surgical attempts to fix his genitalia have been costly. For a single mother like me of average means it is an uphill task," she says

Intersex: The intersection between law and science

Kenyan law, according to John Chigiti, an advocate of the High Court, recognizes sex in a broad spectrum, "ranging between male and female."

This is a conclusion drawn by a ruling made by a three-judge bench in 2007, where it was determined that sex falls in a broad spectrum and is not limited to just male and female.

"The law however, does not explicitly mention 'intersex'. However, intersex persons are protected under Article 260 of the Constitution, which addresses marginalized groups," Chigiti says.

Medical science on the other hand is more objective. According to Dr. Elly Odongo, a fellow-gynecologic oncologist and secretary general of the Kenya Obstetrics and Gynaecology Society (KOGS), sex can either be genotypic (based on genes) or phenotypic (based on the external appearance of genitalia).

"The X and Y chromosomes determine who is genotypically male or female. If a baby has XX chromosomes they are female. If they are XY they are male," he says.

It gets easier with phenotypic sex identification. "Phenotypically a baby is classified as male if they have a penis. A baby is female if she has a vagina," Dr. Odongo says.

But he says that sometimes "a baby won't physically manifest as distinctly male or female, due to ambiguous genitalia". Also, some babies have both male and female organs, and hence are called hermaphrodites.

Biologically, as a baby develops in the womb, sex is determined by the mullerian system. "So that if the child's genotype is XY, the Y inhibits the mullerian hormone, prompting genitalia to develop as male," Dr. Odongo says.

If the child is XX, a girl, the mullerian hormone is not inhibited and its effect is that genitalia develops as female. It is a process that no parent can stop or compromise in terms of outcome.

In many societies, intersex children are brought up as either male or female. This is also true in Kenya, as Zeinab Hussein, the Permanent Secretary in the Ministry of Youth and Gender acknowledges.

"First, the Constitution says that no one should be discriminated against because of their sex. That includes intersex people. We are however, aware that intersex people want to be identified under their own gender. It is our hope that Parliament will legislate on this matter so that we can help them effectively," Hussein says.

On changing names and gender, Chigiti says that the low is silent. "Chances are the registrar will refuse to grant such a wish. One has to prove beyond doubt that they are female and not male or vice versa," he says.

It is Dr. Odongo's opinion that intersex persons be given a different gender assignment. However, he says, there are legal loopholes that have to be sealed to prevent people from exploiting such a legislation.

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