Yet the biggest complication El-Gergawy has to contend with in Upper Egypt isn't genetic, but cultural: female circumcision. The doctor notes that many of the genetically male children his team has treated have had their penises amputated at a young age because they were mistakenly identified as females. The penis, seen as an oversized clitoris, was simply reduced or excised completely.
Circumcision is an informal law in Upper Egyptian families. In most villages, they circumcise the girl 40 days after her birth. So in intersexed cases, they simply cut off the penis, putting us and the patient in a more difficult situation, he says. We then have to start from scratch, constructing a new penis. Female circumcision is a crime that should be banned by all means. As you can see, it doesn't only damage a girls life, it can also destroy the future of a male.
But not all patients jump at the chance of becoming men, El-Aqad notes, recalling Fatma, a masculine but attractive married woman referred by her gynecologist, to whom she went complaining of amenorrhea and problems getting pregnant.
The gynecologist quickly determined that Fatma had no vagina. Worse, she had been having intercourse with her husband through her abnormally large urethra, which was stretched and torn by the act.
It was intolerably painful and inhumane, El-Aqad says, but strangely enough, they satisfied each other sexually. Our [genetic and physical] tests indicated Fatma was born as a boy, but her penis was amputated during circumcision. Ignorance on her part and that of her husband to say nothing of her physician and parents saw the problem go from bad to worse. In her case, we kept her a female.
At the end of the day, its the patient who makes the final decision. She loved her husband and was [sexually] excited by being with a man, so we removed the remains of the testicles and constructed a vagina. Now, she's having intercourse in a much more pleasurable environment, which is better for her. We gave her female hormones, so her breasts grew bigger and her body hair thinned. Her husband married another woman so he could have a child, but he didn't divorce her, El-Aqad says.
- Azza Khattab. “Sally’s Story”. Egypt Today. July 2004. http://www.egypttoday.com/article.aspx?ArticleID=1737.
This is one case where John Money’s assumptions pan out.
As intersex activists have pointed out many times, surgical mutilation of intersexed babies and traditional (female) circumcision are related issues. Here we see circumcision mutilating male babies who may not even be intersex.