exudates and Disorders-of-Sex-Development

Management of newborns with disorders of sex development (DSD), especially in deciding the need for a sex assignment surgery, is a complex matter. It is associated with many bioethical issues, such as concerns about the rights and welfare of the newborns and the reliability of parents' consent to the paternalistic disposition of physicians in making the best decisions. This paper, containing interviews with six medical experts and three religious' experts, aims to raise awareness of the multidisciplinary approach, which uses a combination of medicine, religion, and ethics in managing children with DSD, particularly in Malaysia, to avoid unnecessary psychological, biological, emotional, and societal ramifications.

Topics: Bioethical Issues; Child; Disorders of Sex Development; Humans; Infant, Newborn; Islam; Malaysia; Religion and Medicine; Reproducibility of Results

In Islam, the person with somatic sex ambiguity due to a disorder of sex development (DSD), such as 46,XX congenital adrenal hyperplasia or 46,XY androgen insensitivity, is recognized as khunsa. Two types of khunsa are distinguished: wadhih (discernible) and musykil (intractable). A recent fatwa (religious edict) in Malaysia decreed that it is permissible for male-assigned patients from these two groups to have gender reassignment surgery to female following diagnosis; however, the religious authority has yet to rule on the reassignment from female to male, if requested. The different schools of law in Islam agree on some aspects of gender-related issues like the position of khunsa in prayer congregations, but differ in their opinions on others such as property inheritance and bathing rituals. For purposes of illustration, this article includes three case reports on Muslim patients with DSD in Malaysia, focusing on issues of gender assignment: (1) a patient with 46,XX CAH, assigned as female, requesting reassignment to male; (2) a patient with 46,XX CAH, assigned female, and gender dysphoric, but undecided on the gender to be; and (3) a patient with 46,XY complete gonadal dysgenesis, raised female due to her phenotype at birth, diagnosed late, at age 18 years, and content to remain female. Gender-related issues from the perspective of Islamic jurisprudence are highlighted and discussed. To ensure holistic care, health-service providers involved in the care of Muslim patients with DSDs need to be aware of the Islamic perspectives on gender-related issues and involve expert religious authorities.

Topics: Adolescent; Adult; Disorders of Sex Development; Female; Humans; Islam; Malaysia; Male; Young Adult

The morphological expressions and histopathological analysis of the gonads of a tropical marine neogastropod species (Thais sp.) from East Malaysia revealed new evidence of mechanical sterility in the imposex affected females. The gradual development of imposex was classified into five stages (Stage 0 to Stage 4) with three types of sterility conditions; Type A caused prohibition of copulation and capsule formation; Type B prohibits the releasing process of eggs; and gonads in Type C are infertile. Further analysis is needed to confirm, if the gonad malformation in imposex affected snails is generated specifically by tributyltin (TBT) or by other possible factors. The levels of imposex incidence (stages and percentages) were greater in a marina and decreased with increasing distance from the marina. Organotin tissue burden across the sexes showed that dibutyltin (DBT) as well as TBT might be the elements inducing imposex in Thais sp. from Miri in East Malaysia.

Topics: Animals; Disorders of Sex Development; Female; Gastropoda; Gonads; Malaysia; Male; Trialkyltin Compounds; Water Pollutants, Chemical

Topics: Animals; Disease Vectors; Disorders of Sex Development; Echinostoma; Gonads; Larva; Lymnaea; Malaysia; Oviducts; Reproduction; Snails; Trematode Infections