Decision-Making and Implications of Sex-Reassignment Surgery in Intersex Individuals in the Arab World: A Case Series

Background: Knowledge, clinical guidelines, and medicolegal frameworks regarding intersex individuals are inexistent in the Arab world. Some medical professionals view intersexuality as a disorder of sexual development that often needs sex-reassignment surgery to correct while others view intersexuality as a natural variation along the sex spectrum. No study to date addresses the vast gap in the literature.  Methods: We contacted eleven non-governmental and civil society organizations involved in matters of sexuality and gender in the Arab world through email. Eight organizations answered but only one, Helem, had been directly involved in supporting intersex individuals and agreed to an interview. We conducted a semi-structured interview with Helem after consent was taken from intersex individuals or their legal guardians to share their experiences. Results: We studied three cases of intersex individuals, of which two underwent sex-reassignment surgery at a young age. The surgeries were experimental in nature and had negative health consequences. Decision-making is influenced by physician factors, notably lack of knowledge, and parental factors, like stigma. Sociocultural reasons factor in the decision more than scientific evidence. Physicians, in the cases presented, dealt with intersexuality as a rare pathology requiring urgent surgical intervention. Parents of intersex individuals suffer significant psychosocial stressors. Conclusion: Medical professionals are ill-equipped to deal with intersex individuals in the Arab world, often performing unethical and abusive practices for which they are not held accountable. Parent education and referral to intersex-knowledgeable physicians seem to deter parents from opting for SRS. Intersexuality is severely understudied and ignored in the medical field. Guidelines and medicolegal frameworks are required to address this issue.