Question: What should our point of view about intersex (Hermaphroditism) be? What should those who have this type of children do?
Intersex is a situation where sexual development is not parallel to biological sex (genetic/chromosomal). Internal and external reproductive organs are either not well-developed or developed ambiguously (male like female, female like male or mixed). This is a congenital anomaly just like disorders in hand, foot, mouth, nose, etc.
A baby with congenital anomaly like disorder in hand, foot, nose-mouth etc can be identified whether it’s a boy or girl by looking at its normal genitals. However, if the anomaly is in the baby’s genitals, it cannot be determined whether it’s a boy or a girl just looking at external genitalia. Chromosome analyses are then required. According to our medical knowledge, genetic gender of the embryo is determined during the fertilization process (boy if chromosomes are 46XY, girl if 46XX). How sex is determined during the fertilization is stated in the following verse of Quran:
“He it is Who created the two mates, the male and the female. He (created) them from a zygote when the measure was set.” (An-Najm/ The Star 53:45-46)
Development of Genitalia According to Sex
Although the gender is determined at the phase of fertilization, embryo is still ambiguous in the first 7 weeks of pregnancy. Development process of genitalia begins with 8th week (fetal period). If genetic sex is male -46XY-, testosterone is secreted in gonads(egg) and this hormone helps internal and external genitalia to develop as male (testicle, epididymis, vas deferens, Seminal vesicle, prostate, penis and scrotum). If genetic sex is female -46XX-, testosterone is not secreted and feminine development occurs (ovaries, uterus, tuba uterine, vagina, clitoris, labia major). Estrogen secreted from ovaries contributes to feminine development. Any defect during this process in the womb (deficient or excessive hormone production or male’s exposure to estrogen/female’s exposure to testosterone etc.) may cause to sex development disorders. There may be a female whose genitals look like those of male and vice versa.
What To Do?
Those who appear to be intersex are actually male or female. But their sexes are not distinguished by looking at their genitals. It is needed to make chromosomal analysis and apply medical tests. If chromosome structure is 46XY then it’s male, if 46XX then it’s female.
Once the sex is distinguished after chromosome analysis, necessary treatments (medication and/or operation) could be administered. However, a committee consisting of experts (urologist, endocrinologist, gynecologist, psychologist, etc.) can make the decision.
Majority of the intersexes can be distinguished by chromosome analysis. However, even though very limited, some may have complicated chromosome structure (mosaic or chimera). They do not have pure 46XY (male) or 46XX (female) structure but mixed ones like 45X/46XY or 46XX/46XY. This type of patients may have both testicles and ovaries (ovotestis). It could be a problem to distinguish this group of patients. However, even in this mixed types, it is possible to decide according to chromosomes that form more than 50%. This decision must be done by an expert committee.
As a result, each human is either male or female even if they are born with congenital disorders. Allah says He created human as males and females:
“Human beings, We created you all from a male and a female.” (Al-Hujurat / The Chambers 49:13)
Then, each human created is either male or female. There is no third category. Intersex people can be identified and treated by relevant specialists. Those who changed their sex although they have no such a problem (transsexuals) are in completely different category and not relevant to this subject.
Prof. Zeki Bayraktar
Urologist
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