People Will Throw Rocks at Him

My pre-med students were confused.

We were discussing a real life case study about a 14 year-old boy from India. His wealthy (and embarrassed) parents had brought him all the way to New York for a double mastectomy. He was getting teased at school about his growing breasts.

After they arrived the boy started bleeding through the penis. The doctors determined he had begun to menstruate.

As well, the doctors discovered he urinated (and bled) though an opening in the bottom of his penis, rather than the tip. The servant who raised him from birth had avoided telling his parents.

As the students considered the case, uncomfortable questions floated around the room.

     The child had a penis. That had to mean he was a boy, right? But only girls grow breasts and menstruate, right? Would she be sexually attracted to boys? If so, would that make him a homosexual?

The students from Pakistan and India recognized the condition as dire. Even a suspicion of gender ambiguity could be fatal in the child's home culture. "People will throw rocks at him," one said.

The girl was a boy only on her birth certificate

The essential facts of the case were these: fourteen years previously a doctor had delivered a baby, saw a penis and scrotum, and certified the child a boy. However, the child was actually a girl.

The doctor had no immediate way of determining that, despite the male appearance of her sex organs, she was born with female genes, chromosomes, hormones, general anatomy, and psyche. When she grew up she would look, act, and think like a woman.

For the parents, the revelations in New York constituted a cultural and medical emergency. They demanded "corrective surgery." They wanted her breasts removed. They wanted her ovaries taken out. They wanted the penile defect corrected (a relatively minor procedure).

The parents had left India with a son; they wanted to return with a son. And they wanted the extent of the surgery kept secret, even from "him."

How did it happen; what's to be done?

The title of the course was Medical Ethics. Therefore the question confronting my students that morning was:

Should the doctors go ahead and operate, as the parents requested? Would that decision be consistent with the ethics of the medical profession?

Before my students could think about ethics, however, they needed to get the biology of the case figured out. How can a girl be born with a penis?

We'll return to both the biological question and the ethical question in the March 10 post.

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