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Jolinn
04-29-05, 03:32 PM
<http://www.irinnews.org/report.asp?ReportID=F860&SelectRegion==Asia&Sel
ectCountry==UZBEKISTAN>

28 April 2005

UZBEKISTAN: UN-supported gender correction centre brings hope

[This report does not necessarily reflect the views of the UnitedNations]

SAMARKAND, 28 Apr 2005 (IRIN) - In a whitewashed Soviet-style operating room in the central Uzbek city of Samarkand, doctors operate on a patient
while nurses help them in their scrupulous work. Gulya (not her real name), a33-year-old patient, is among hundreds of people who annually come to
this unique centre to get help for problems they cannot speak about openly.

Gulya was born with male pseudohermaphroditism and had testicular feminisation syndrome. In other words she had an intersex state.
Intersex states occur when there is ambiguity or uncertainty about physicalsexual status. Such a status arises when there is a problem in early embryonic
sexual development.There are several causes of male pseudohermaphroditism, the best known being testicular feminisation syndrome or Œandrogen insensitivity
syndrome¹(the tissues that should develop into the male sex organs do not respond to the male hormones). The child appears to be a girl. In puberty she does not
have periods. There is normal breast development but poor pubic and auxiliary(armpit) hair production.

Gulya was operated on when she was a child in Russia. She underwent the initial stage of reconstructive surgery and they removed her rudimental
external male sexual organs. "She identifies herself and feels herselfas a female. She found a man that she wants to marry and therefore decided to
have an operation. We implanted a vagina made of a part of her large intestine," Bahodur Negmadjanov, chair of obstetrics and gynaecology at the
Samarkand medical institute, told IRIN.

Gulya's case highlights not only a health, but a neglected social problem in conservative Uzbek society given that such issues are considered taboo,
particularly in rural areas.According to doctors, many of their patients suffer a lot. "If it were notfor you doctor I would commit suicide, they say,
and there are often suicide cases among them. These patients are as if reborn after operations; they easily adapt after surgery. Before the operation
they are like invalids,nothing interests them and they are ready to commit suicide and sometimes they come to us with veins that they earlier tried to
cut," Negmadjanov said.

Doctors noted that after the operation many patients got married,adopted children and thus integrated well into society. "They start working.
There are prominent businessmen, cultural workers, artists and doctors among thosewhom we operated on," the doctor said.

But while there was no statistics on the number of such cases that needed surgical correction in the former Soviet republic, Negmadjanov conceded
that they had had thousands of inquiries."We don't have data to judge whether it is on the rise or not. Perhaps the number of referrals to us has
increased and the diagnostics have mproved as earlier there was no such medical treatment in Samarkand. Patients used to go to Moscow,
" the professor explained.

His colleague Kakhor Berdiev, head of the reproductive health centre for adolescents at the institute, said that they were registering many cases
with regard to sexual organ defects, including a complete lack of innersexual organs, as well as a lack of both inner and outer sexual organs,
including the uterus and vagina."Unfortunately these problems are very often detected not by a doctorbut by the husband on the first marital night,
" he said, adding that it was a huge trauma for both spouses."In 99 percent of the cases the marriage ends up in divorce. Therefore,we should make
reconstructive operations on them before they reach marriage age. The earlier the better it is and their sexual and social adaptation
will be much more easier," Negmadjanov highlighted.

"We also have cases of boys that feel themselves male but at the same theylack some parts of their sexual organs. We carry out reconstructive surgery,
like masculanisation plastic surgery operations so that they can sexually and socially get adapted to society. We also help young girls," he noted.

Since opening in 2002, more than 200 reconstructive operations have been carried out at the centre for adolescents, while around 100 to 200
operations were conducted at the centre for women over the past few years.

"The Samarkand hospital's adolescent reproductive health centre is actuallymore than that; it is an adolescent surgical centre for sexual reproductive
malfunctions, disabilities or defects. This is one of the most unique centres in Central Asia and one of the few places in the world where
sexual health matters are corrected surgically," Nesim Tümkaya, head of United Nations Population Fund (UNFPA) in Uzbekistan, told IRIN in the capital,
Tashkent.

But the centre and the doctors are struggling to offer assistance to patients given a lack of resources and funding. The medical equipment is
from the Soviet era and buildings are dilapidated, while sometimes doctors are forced to buy the necessary operating supplies themselves.

That situation is changing, however, with assistance from UNFPA worth around US $250,000, including major surgical equipment, while local authorities
have donated around $150,000 for refurbishing of the centre building."From the UNFPA perspective we care very much about sexual and reproductive
health. Reproductive health and sexual health are important for people's welfare and happiness. Therefore people who are unfortunate to be born with
congenial deformities in their sexual organs should have a chance to have them corrected surgically," Tümkaya said.

[ENDS]

Peter
04-29-05, 03:58 PM
I have mixed feelings about the report. However, it is interesting to note that the Uzbekistan authorities are willing to publicly admit the large numbers of intersex surgeries done. I suspect that in a country such as Uzbekistan, where there are limited resources, that only a fraction of intersex people undergo surgery. I gather from the article that the clinics are performing about 200 surgeries a year. With about 700,000 births for year in that county, that works out to about 1 in 3,500 births. Elsewhere in this forum, I have estimated that surgeries for intersex conditions that are not hypospadias run at about 1 in 4,000 births. Joan Roughgarden gives a figure of about 1 in 1,950 for hypospadias severe enough to require surgery. I believe that severe hypospadias is an intersex condition. Intersex surgery is not rare.

Peter

Jolinn
04-29-05, 05:44 PM
Peter,
I have no idea as to how good their numbers might be, I just find it interesting to hear what is going on in countrys that is more or less closed off from the western world. At least they do appear to making some inroads in the IS field. After all now days everything is global rather than limited like it use to be.
Have a nice day..