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Marrying a relative and using medicine during pregnancy might confuse the sex of your offspring, a study at two leading hospitals in Nairobi shows.

A study of 71 intersex children and adolescents at Kenyatta National Hospital and Gertrude’s Children’s Hospital in Nairobi showed mating with relatives is not a good idea.

A significant number of the intersex children, 12 per cent of 24 cases, were of related parents. While the researchers say the rate of relatives’ marriages in Kenya is low, it could lead to children with sex disorders.

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The study published early this month in the International Journal of Endocrinology found high probability of sex disorders in children of mating relatives.

Of 58 patients, six reported a history of family genital ambiguity, says the study led by Prisca Amolo of the Paediatric Endocrinology Training Centre for Africa.

This programme is run at the Gertrude’s Children’s Hospital, in partnership with the University of Nairobi, Kenyatta National Hospital, and the Aga Khan University Hospital, Nairobi. Also in the study was Erasmus University of The Netherlands. 

One patient, the report says, had a maternal cousin who was initially female and later changed to a male. Another had a history of wrongly placed penis opening (hypospadias) in a first-born sibling.

Another patient diagnosed with both testis and ovaries had a history of an abnormally small penis (micropenis) in a family member.

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A patient with testicular disorder also had a cousin with a history of undescended testes.

“Two patients also had a history of micropenis in a maternal uncle and an uncle with ambiguous genitalia, respectively.”

Family history

In an interesting turn of events, five patients had a family history of infertility.

“All these five patients had the history of infertility reported in the paternal aunt,” says the study.

The team also reported the use of medication, even common ones like aspirin, could lead to a birth with sex disorders.

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One patient who had been exposed to aspirin throughout pregnancy for mother’s hypertension was born with clubfoot, tongue, lip and urinary tract problems.

A second patient diagnosed with the developmental disorder called Edwards syndrome had been exposed to a type of medicine given to pregnant women to stop spontaneous abortion.

The report says most of the patients – 93 per cent – had presented to the hospital with ambiguous genitalia, though there were exceptions.

Exceptions, for example, included a child with microcephaly (small head) and another with the growth of male-pattern hair on a woman's face, chest and back.

Despite the fact that a large proportion of patients were delivered in hospital, ambiguous genitalia was initially observed by the patient’s mother in majority of the cases.

The study covered an eight-year period among the 71 patients aged 0 to 19 years with 16 per cent born prematurely and more than half coming from Nairobi.

Assigned gender

Thirty-six (50.7 per cent) patients were reared as male while 31 (43.7 per cent) had been raised as females, but the remaining four had not been assigned a gender from birth.

Thirty-nine (54.9 per cent) patients were finally assigned a male gender, while 16 (22.5 per cent) were assigned a female gender by a team of experts.

Seventeen (23.9 per cent) of the cases had a gender reassignment at final diagnosis. Among these patients, 76.5 per cent were reassigned from female to male gender while 23.5 per cent were reassigned from male to female gender.

Thirty six per cent of the patients, the report say had undergone various surgical procedures to correct the problem or reassign the gender.

The experts say treatment and diagnoses for sex disorders is an expensive affair in Kenya with lack of necessary facilities and skills and more needs to be invested.

Gertrude’s Children’s Hospital Kenyatta National Hospital
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