Abstract
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.
Highlights
Management of patients with disorders of sex development (DSD) is undoubtedly challenging
A recent fatwa in Malaysia decreed that it is permissible for male-assigned patients from these two groups to have gender reassignment surgery to female following diagnosis; the religious authority has yet to rule on the reassignment from female to male, if requested
Health-service providers involved in the care of Muslim patients with disorder of sex development (DSD) need to be aware of the Islamic perspectives on gender-related issues and involve expert religious authorities
Summary
Management of patients with disorders of sex development (DSD) is undoubtedly challenging. This was not the case for Chinese and Indian families, who on several occasions took off with their ambiguously born child when female sex assignment (or reassignment) was suggested.’’This was because in Malaysia, Malay Muslim women are entitled to inherit and control their own money, and with divorce, or when widowed, a woman’s fortune remains under her control, enabling her to be independent It was their impression that within the ethnic Chinese and Indian communities of Malaysia, much more prestige was associated with the male role and greater importance to the male offspring, similar to the situation in India and China. At present, her gender status is as yet undetermined
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