The infant was brought to Dr Ashwin Pimpalwar, pediatric general and thoracic surgeon of the University of Missouri, in February when he had come down to India to help children with congenital abnormalities. The baby, who presented with mixed gonadal dysgenesis (MGD), was among many he examined earlier this year during the Bal Shalya Kriya Mission initiated by the Kasturba Medical College Hospital (Attavar) in collaboration with Peedh Parai International, Houston (US), and Bantwal Ananth Mallya charitable trust.
MGD is a common disorder of development (DSD) and is the second-most common cause of malformed sex organs.
The infant was born with vestigial sex organs and doctors suggested that the child would fare better as a female. Even if a phallus was created to make him male, they argued, there would be no real sense of manhood.
“The child was born with ambiguous genitalia. On the left side, the ovary was a little streak but there were no fallopian tubes. On the right, in the scrotum, there was some tissue like ovary and testes fused together,” Pimpalwar said. “Because there were no functional testes or ovaries and the internal organs of the child were rudimentary and like those of a female, we removed the organs and the ovaries because there could be risk of cancer.”
The parents were now faced with a dilemma – what should the gender of the child be? “It is better to bring up such a child as a female because it is difficult to fashion a functional phallus. The child will face psychological trauma when he grows up. So we suggested to the family that the child be brought up as a female. We could create a vagina as it was easier to do that,” said Pimpalwar. However, she would not be able to conceive on becoming an adult.
“We counselled the parents, who were well off, but they wanted a male child even if the imminent trauma would lead to suicidal tendencies,” said Pimpalwar.
Early February, in a five-hour operation, the child was given a neo-penis.
While Pimpalwar alleged that the well-off couple had made their choice for the love of a son in a patriarchal society. “In the US, there is an ethics committee for such cases when the patient or parent disagrees with the doctor. There is no such mechanism in India,” he said.
Social scientist Robert Da Silva disagreed. “A doctor at the operation table does not have the right to decide the sex of the child,” he said. “The talk of suicidal tendencies is unfounded as doctors cannot predict what behaviour the child may exhibit in future. The parents’ choice should be given preference since it is their child.”
Others felt it was a tough decision for the parents to make and might work in the long run.
“Now that the child has undergone the surgery, we have to wait and watch. Sexual inadequacy is a trauma, but it’s not killing,” said Dr SS Vasan, consultant andrologist at Manipal Hospitals.
“Since the surgery is done, the boy might get socially adjusted in future. However, due to the lack of an ethical committee and social service network, we can’t ascertain whether what’s being done is in the best interest of the child,” said Dr Karan Shetty, plastic surgeon at Sagar Hospitals.
Other medical experts TOI spoke to felt surgery could have waited for 4-5 years to allow the natural development of the child. “A chromosomal report of the child is essential to understand the genetic makeup. I’m surprised the baby withstood the major surgery at two months,” one of them said.
With inputs from Sunitha Rao in Bengaluru