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Unformatted text preview: I feel I was treated pretty well by the medical profession. Dilation was
not a part of a vaginoplasty in 1968. I went through a period of sexual
inactivity and lost some vaginal length. As it happens, I am now in a 108 Between XX and XY lesbian relationship, so I don’t see this as a major concern. One interesting note,” she continues, “the gynecologist I saw was a very shy man; it
took my GP to ask me if I was experiencing orgasm.”
Nicky finally realized that this was more than she could face alone.
In the end, she turned to therapy. “At twenty-five, I thought I had dealt
with it, and I had a good intellectual understanding of my condition.” It
wasn’t until four years later that the emotional aspect hit her. “I had to
deal with feelings of inadequacy about not being a ‘real’ female. [And I
had to] address my feelings around not being able to have children. The
therapy helped a lot, and I would like for such help to be made available to all young girls with androgen insensitivity syndrome.”
When I asked Nicky what she would like for others to know about
her, she said:
I am financially secure and in a stable relationship. My spouse
and I were married in 2003, when same-sex marriages became
legal in British Columbia. My spouse had her gender reassigned
[from male to female] in 1992, just prior to my meeting her.
We live in a townhouse, get along reasonably well with
our neighbors, and are very similar to other retired couples. I
would like society in general to be able to grow up a bit around
issues of sexuality and gender. I happen to have AIS, which is a
condition passed down through the X chromosome. If it were
color blindness, which is passed the same way, no one would
think it was a big deal. Because it is tied in with issues of sexuality and gender, it becomes something to be laughed about or
discussed with discomfort.
I remember having to be very quiet and careful in high
school when the conversation turned to menstrual periods. I
would really like it to be safe for young women with AIS to
disclose their conditions.
I do believe there is a naivete about the way we ignore the
fact that some people don’t fit neatly into the either-or of gender. I believe that gender is rather a continuum than an eitheror proposition. Where Our Sexes Come From 109 Children Who Change Their Sexes: 5-Alpha Reductase Deficiencies
Some researchers refer to male and female pseudohermaphrodites, people with AIS for example, as sex reversals, meaning that the sexes of
the external and internal genitalia do not correspond. This, of course,
is not sex reversal, it is simply another situation that does not fit very
tidily into a two-sex world. There is, however, one enzyme deficiency
that leads to something that is very nearly a sex reversal, at least in the
minds of those who experience it.
Normally, the final strokes in the creation of a baby boy require
two hormones, testosterone and a derivative of testosterone called dihydrotestosterone. The developing testes produce testosterone, but an
enzyme derived from another source is necessary for the conversion of
testosterone to dihydrotestosterone. That enzyme is 5-alpha reductase
type 2, normally produced from the SRD5A2 gene at relatively high
levels during the sexual development of boys.
But nearly thirty known mutations in the SRD5A2 gene result in
inadequate production of functional 5-alpha reductase type 2. When
that happens, 46,XY fetuses develop normal testes, but the testes don’t
descend, and their genitals look like those of baby girls. As a result, at
birth they are almost always identified as baby girls. And they nearly
are, except they have testes, and what seems to be a vagina is only a
small closed pouch that leads nowhere. Only a few of these children
have sufficiently ambiguous genitalia that physicians recognize their
condition at birth. So most often the first words baby boys with 5-apha
reductase type 2 deficiency hear are, “It’s a girl.” And usually that’s the
way it remains until puberty—the child lives its life as a girl. All the
while, though, a storm is brewing, and at puberty that storm erupts in
all its fury.
As sexual maturity approaches, another form of 5-alpha reductase
called type 1 appears along with a big boost in testosterone. Perhaps
it is the addition of the other form of 5-alpha reductase and/or all the
testosterone that causes the changes. Regardless, the results are remarkable. What everyone thought was a clitoris begins to grow to as much as
three inches long, the voice deepens, muscles enlarge, and the owner of 110 Between XX and XY that brand-new almost-penis begins to have sexual feelings for others,
feelings that can cause erections. And apart from the physical changes,
there is the psychosocial upheaval that these people must experience. A
girl until age twelve or thirteen abruptly becomes mostly a man.
Fishy Sex: Changing Times
To most of us, a girl becoming a boy is astounding. Not so with fish.
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- Spring '14