Reconstructing the child's gender

Congenital defects such as hypospadias (a condition where the urethral opening is low) or undescended testicles are common conditions that lead to gender confusion at birth. Many children grow up with genitalia resembling female but are actually male, or vice versa. Only when they take their child to the hospital for examination and testing do parents discover their child is living with a gender identity that is different from their true gender.

Many children are confused about their gender identity.

Caring for her child in the hospital bed, Ms. LTH (38 years old, residing in Dong Nai ) said that her child, now 12 years old, has undergone surgery four times. "When he was born, he was diagnosed with hypospadias, so doctors performed surgery to open the urethral opening. The second time, he had a urethral fistula and needed another surgery, the third time was to repair the fistula. The fourth time, during a routine check-up, we discovered he had urethral stricture and residual urine in his bladder, requiring further surgery," Ms. H. recounted.

According to Ms. H., her child was fortunate that doctors detected an abnormality in the genitals in time, allowing for timely intervention and treatment. This also helped her child grow up according to their true gender and did not significantly affect their psychological and emotional development.

Identifying and restoring a child's true gender identity is a humane act.

In the case of Mr. TCT's (36 years old) child, unfortunately, the child lived with the wrong gender for many years before the diagnosis was made. Mr. T. said that the child was born with male genitalia, so the family tried to guide the child in terms of clothing, communication, and daily life to be like a boy. However, as the child grew up, he felt that he didn't fit in, so the family took him for a medical examination and discovered that he had no testicles but had ovaries, a uterus, and a vagina.

Dr. Pham Ngoc Thach, Deputy Director of Children's Hospital 2 (Ho Chi Minh City), said that the hospital has detected many cases where children come for examination, diagnosis, and intervention to help them live according to their true gender. This is also the only unit in the South that reissues gender confirmation certificates for children.

"Children's Hospital 2 is one of three facilities in Vietnam approved by the Ministry of Health to be able to confirm gender and perform surgical interventions for congenital gender defects in children. The rate of children with gender development disorders where the external genitalia are not clearly male or female is approximately 1 in 5,000 children. In the past, the hospital has intervened to restore the true gender of 53 children with congenital defects, including 34 cases where the gender was confirmed as male and 19 as female," Dr. Thach informed.

Golden period: 8 to 18 months

According to Dr. Thach, one of the causes of gender confusion is hypospadias, undescended testicles, mixed gonadal dysplasia, congenital adrenal hyperplasia, etc. Among these, the two most common groups of diseases are hypospadias (with or without undescended testicles) and congenital adrenal hyperplasia.

"If gender confusion is not addressed promptly, children may experience psychological problems later in life due to feelings of inferiority or being teased. In particular, some cases where individuals rediscover their true gender after adulthood can negatively impact their lives. Therefore, if parents have any doubts about their child's gender, they should take them to the hospital for screening to ensure timely intervention. The optimal time for intervention in congenital defects is between 8 and 18 months," Dr. Thach emphasized.

To determine the sex of a patient with ambiguous genitalia, diagnosis and surgical intervention are necessary. Diagnosis involves clinical examination and all necessary tests such as: sex chromosome testing, ultrasound, CT scan, assessment of the degree of external genital malformations leaning towards male or female, biopsy of the gonads, psychological evaluation of the child, etc.

Treatment for children requires the collaboration of multiple specialties such as endocrinology, urology, and psychology to ensure the best possible care. The medical board will base its decision on clinical and paraclinical results, laboratory tests, or post-surgical treatment of the defect to issue a certificate confirming the child's true gender.

However, not all cases are easy to identify and intervene in, especially with intersex cases – children who possess both male and female reproductive organs. For these children, it is necessary to wait until they are older and choose their true gender. The treatment process to restore their true gender is crucial, but most importantly, to ensure the child's reproductive function is maximized later in life.

"For children undergoing gender reassignment surgery, doctors will reconstruct the external genitalia to match their gender identity. For example, if the child has a hypospadias, they will raise the urethral opening; if the penis is curved, they will straighten it... After the surgery, a psychologist will counsel the child and their family to help the child gradually orient themselves towards their appropriate gender identity later on," said Dr. Thach.

Dr. Thach also pointed out that if parents have concerns about abnormalities in their child's genitals, they should take them for examination. Some common identifying characteristics include: in girls, the clitoris is overly exposed, the labia majora and minora are abnormal (too large, too small)...; in boys, the genitals are smaller than other children, the penis is positioned low under the scrotum, the scrotum resembles the labia majora of a female, and there are no testicles...

"Reassigning a child's gender requires considering many medical criteria (chromosomes, gonads, hormones, fertility, surgery, etc.) as well as the psychology and awareness of the patient and their parents. This is a humane act, ensuring that each person can live according to their true gender," shared Dr. Thach.

Currently, although gender transition is recognized, gender reassignment surgery is still not permitted in Vietnam.

Further explaining this, Dr. Mai Bá Tiến Dũng, Head of the Andrology Department at Bình Dân Hospital (Ho Chi Minh City), said that the hospital has established a gender identity clinic for the LGBTQ+ community and has observed a high demand for gender reassignment surgery. However, if a gender reassignment law is enacted, it will affect the quality of life, the Marriage and Family Law, inheritance, military service obligations, etc. Therefore, the Ministry of Health only allows gender reassignment surgery for patients with genital abnormalities but whose chromosomal system matches their sex. For example, the external genitalia are female but the patient's chromosomes are male. "Therefore, it is necessary to reassess the needs and desires of both the family and the patient. When performing the procedure, it must be approved by a gender assessment board," Dr. Dũng noted.

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