Culture Clash Involving Intersex (Case Study‪)‬

Parents from a Middle Easter country bring their thirteen-year-old son to the hospital seeking treatment for a minor abnormality of the penis (hypospadias) and for breast development. The child has had two episodes of bleeding through the penis. The physician determines that the boy had a 46XX karyotype, both a uterus and ovaries, and severe congenital adrenal hyperplasia, which caused the child to virilize in utero. The bleeding was actually menstruation. The physician tells the parents that a hysterectomy and an oophorectomy are necessary to prevent further bleeding. Also, one of the child's kidneys is not functioning and needs to be removed. The parents ask the pediatric urologist to perform hypospadias surgery, a bilateral mastectomy, hysterectomy, oopherectomy, and nephrectomy. Further, they want them performed all at once time (because they cannot remain in the country very long) and without involving the child in the decisionmaking or informing him of his medical condition or of his potential female reproductive capacity. The child expresses a desire to have the mastectomies performed in order to avoid teasing.