A genital reconstruction surgery planned for a five-year-old child at the State-run St. George’s Hospital in Mumbai has triggered a debate on whether such procedures can be carried out on minors who are not in a position to give an informed consent. Parents of Aiman Khan, who was raised as a girl in Beed’s Majalgaon village, are carrying out the documentation to change the child’s name to Aman, the identity he will assume after the surgery, planned in the first week of September.
Plastic surgeon Dr. Rajat Kapoor from St George’s Hospital said a karyotype (a chromosome identity) study shows the child has the presence of male XY chromosomes. “The detailed evaluation we carried out also shows the presence of testes, a male reproductive organ, and the absence of female internal organs. The genitalia looks like that of a female due to underdevelopment,” said Dr. Kapoor, who has carried out more than 70 genital reconstruction surgeries in the past 10 years, including those with ambiguous genitalia due to underdevelopment, congenital abnormalities or trauma. “The youngest patient I have operated on was a two-year-old with congenital malformation,” he said.
The minor’s father, Sayyed Mohammad Khan, a driver, said the child was born at Shri Swami Samarth Hospital in Beed on September 18, 2013. “We were told it was a girl and raised her that way. There was no reason to doubt that as her genitals looked like those of a female child,” said Mr. Khan. In 2016, the child developed an infection, for which they sought a doctor’s opinion. “That is when a doctor first told us that it was a male child. They advised several tests and referred us to a bigger hospital but we didn’t pursue it further due to financial difficulties,” he said. Last year, when Beed constable Lalita Salve made news for a genital construction surgery to become Lalit, Mr. Khan saw hope. Mr. Salve is posted at Majalgaon, where Mr. Khan lives. “After his surgery, I went for guidance and he suggested I take my child to St George’s,” said Mr. Khan.
‘Medically unnecessary’
Satya Nagpaul, founder of Sampoorna, a network of trans and intersex Indians, says ambiguous genitalia and karyotype are a textbook case of intersex variation and therefore no surgery needs to be performed to ‘normalise’ organs. “This is a medically unnecessary surgery performed on a child. Ideally, the child and family should be given long-term assistance like counselling and peer support, until the child is of an age to give informed consent.”
Nadika Nadja, a member who leads the Sampoorna Working Group on intersex issues, says the procedure has serious long-term and life-determining implications. “Construction of sex and gender is an ongoing process and not a one-off effort. There is no telling what the child will grow up to identify as, and performing such medically unnecessary procedures will leave physical and mental scars in the person, often lasting well into adulthood,” she said. Dr. Kapoor, however, disagrees. “The mental and social trauma to undergo such a massive change is way too much for an adult, as compared to a child who will grow up with that identity.”
