Here’s how sex and gender are different things

A 15-year-old girl from Satara district of Maharashtra approached a doctor in Pune because she hadn’t started her period yet. Tests revealed that the girl has a condition called Androgen insensitivity syndrome (AIS), that affects only four in 100,000 people.

In AIS, androgen, a hormone found in greater quantities in males, is suppressed and the secondary sex characteristics may or may not resemble that of a male’s.

In the case of the young girl, she was unable to menstruate because she does not have ovaries.

A team of doctors from the hospital is now helping the young girl to continue to live her life in her chosen gender. The condition disallows her from becoming pregnant, though she may still have children through other procedures like surrogacy or adoption if she so chooses.

Dr Manish Machave, gynaecologist and endoscopic surgeon from Ruby Hall Clinic, who diagnosed and treated her said that the girl had her gonads (testes) removed through laparoscopy and also had a breast augmentation surgery. She will receive hormone injections that will help sustain her through the rest of her teenage years and early adulthood.

“She had gonads (testes) positioned in the abdomen and another in the inguinal canal and because of the position of gonads, she had a risk of developing a form of cancer called gonadoblastoma. Hence, we first performed laparoscopic gonadectomy and removed testes from both the sides, around three months ago. Once she turns 18-year-old, we will perform laparoscopic vaginoplasty,” Machave said.

Dr Anupama Mane, breast surgeon from Ruby Hall Clinic, who performed the girl’s breast augmentation surgery said, “She was brought up as a girl and hence she wanted to remain so. We performed breast augmentation surgery for her. Hormonal injections will be required for things like hair growth to stop. We are assisting her to complete her transition as a female. The medical treatment to give her feminine characteristics will go on for years.”

Activists say that AIS is often used as a means to stigmatise intersex people by bringing their bodies under intense scrutiny, and which the medical fraternity then attempts to correct through surgery. Activists argue that intersex persons like the 15-year-old girl are subjected to a misplaced understanding of what bodies of men and women should look like.

However, as gender and sexuality rights activists point out, all bodies are different and neither gender nor sexuality is derived from a person’s biological sex. As the case of this teenager shows, gender does not lie in the body but in the mind.