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Paediatrician calls for early detection of intersex disorders

A paediatric surgeon, Dr. Sebastian Ekenze, has called for early detection of intersex disorders in children, saying that such will save the patients from stigma at a later stage in life.

Dr. Ekenze gave this advice on Wednesday, while reacting to the mob attack on a man who was discovered to be possessing female-size breasts last month in Sapele, Delta State.

Ekenze is a consultant paediatric surgeon, with the University of Nigeria Teaching Hospital, Enugu.

He also disclosed to The PUNCH that the UNTH has managed 39 children with intersex in the last 10 years.

The paediatric consultant outlined the major challenge in managing the disorder to include “delay in presentation, lack of diagnostic facilities, and inappropriate gender at presentation.”

He hinted that although the disorder could be easily managed when detected early enough, it could pose more psychological challenge to the patient and the parents if not handled early.

Ekenze described intersex disorder as “a condition in which the reproductive structures do not fit the typical male or female.”

According to him, “the anomaly has a worldwide occurrence and affects about 1 in 4500 children.”

He said, “Though most of the cases are evident at birth, some affected persons may be discovered at puberty or during investigation for infertility, and less commonly some cases may live and die with the disorder without anyone ever knowing.”

The consultant disclosed that these abnormalities occur “if there was defect in the sex chromosome, or there was abnormal development of the testes or ovaries, or there was abnormal production of the sex-related hormones, or there was failure of the body to respond normally to the sex-related hormones.”

He said, “The exact cause of these abnormalities is unknown. However, some of the cases are familiar, and some follow diseases in the mother, or drugs used by the mother during pregnancy.”

Ekenze classified the disorder to include “female intersex, male intersex, and true intersex,” noting further that “a person might be born appearing to be female on the outside, but having mostly male-typical anatomy on the inside.

He said, “Or a person may be born with genitals that seem to be in-between the usual male and female types. For example, a girl may be born with a noticeably large clitoris, or lacking a vaginal opening, or a boy may be born with a notably small penis, or with a scrotum that is divided so that it has formed more like labia.”

On the way forward, he said the child or person with suspected intersex would require thorough assessment by a team of medical and surgical specialists.

Ekenze stressed that the evaluation would be aimed at determining the accurate nature of the chromosomal sex, the internal sex organs, and the external genitalia, adding that based on this, proper gender is assigned to the child.

“The evaluation involves thorough physical examination, chromosomal studies, blood tests, scans, and when these are inconclusive, operation may be carried out to determine the actual nature of the internal sex organs. While waiting for the results, it is advisable to give the child a unisex name,” he said.

He also called for parents’ education during antenatal visits and public enlightenment to identify early features of the disease, plus the need and benefits of early treatment, education and re-education of primary and secondary care physicians and healthcare workers on early diagnosis.

He said that there was need for early referral for this disorder and other anomalies through regular workshop and outreach programmes.

He added that government may be compelled to increase healthcare funding and improve facilities.

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