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It's A Boy!! - Christians And Ambiguous Genitalia

By Angela Chetta,  BIO 779, Clinical Issues in Bioethics

     April Howington shifted uncomfortably in the seat of her car on the way to the local obstetrician’s office for a prenatal checkup. April, a 38-year-old woman, and her husband Keith had longed for a baby. Now that she had finally conceived, worries filled her mind. “ I just don’t feel well”, she thought, “Something is wrong”. Although 19 weeks pregnant, April had still not felt the little baby move.

     In the office, an accompanying friend asked if it was a boy or a girl. “That’s the least of my worries”, April thought as she watched a disturbed look pass over the sonographer’s face. “The baby is too small, Mrs. Howington”, she said. “He is 3.5 weeks smaller than what he should be at this gestation age.”

     The doctor immediately made April an appointment with a maternal fetal specialist in Atlanta. Fighting back tears, April went home to fix supper for company. Keith would be home soon. Feeling very sad, April phoned their pastor, and asked him to pray. He then phoned several others who also joined in prayer. Two days later, Keith drove April to see the specialist. “ The baby will probably die within the month”, she said. This has got to be the hardest day of my life, April grieved.

     However, after 5 weeks, the baby was still alive. By this time, approximately 9 churches and many individual people were praying for the Howington family. Attending physicians suggested that April have an abortion to save herself the emotional stress. Shocked, Keith and April refused to even consider such an option.

     On the second trip to the specialist, April had an amniocentesis to check the baby’s development. The test came back: 46XY (boy), no chromosomal or genetic problems. But the baby’s fetal distress worsened and April was hospitalized on November 20, 1996. She had pregnancy induced hypertension and the amniotic fluid was critically low. The blood flow through the umbilical cord was inconsistent. According to measurements taken by sonogram the baby weighed about 398 grams (less than one pound).

     Keith and April decided to name the baby Jonathan because it means “whom Jehovah gave” in Hebrew. The couple felt strongly that God had given them a child and decided to do their best to raise him. They continued to pray for God’s protection.

     After 4 days in the hospital, an immediate cesarean section was recommended by the doctor who believed that little Jonathan would otherwise not make it through the night because of the distressing womb conditions, and if delivery was successful there would only be about a 10% chance that the baby would live outside the womb. After prayer Keith said, “OK, doctor, we believe God has led us to go ahead with the C-section, because there is a 100% chance that this baby will live if it is God’s will, and if it is God’s will that this baby die then he has 0% chance. Either way we will accept what God has for us”. April was awake and talking with the hospital staff during the operation. Keith was taking pictures and snapped a shot just as tiny Jonathan, weighing 507 grams (17.5 oz) was lifted out of the womb. Not knowing the results of the amniocentesis, the neonatologist exclaimed, “It’s a girl!”. Groggy from the pain medication, April said, “That can’t be right, Keith, it can’t be a girl…. Did he say it was a girl?”

     Keith and April did not know what to think. In truth, the tiny baby had what is known as ambiguous genitalia, with a phallus only 1-2 mm long. That is the smallest human I have ever seen, April thought. Priority number one, however, was keeping this child alive and breathing. With an APGAR of zero, there were many complications. The baby’s extreme prematurity from being born at the age of 29 gestational weeks, resulted in multiple health problems, including respiratory failure, a grade III interventricular brain hemorrahage, congestive heart failure, hypothyrodism, gastro esophageal reflux which led to failure to thrive issues, possible blindness, cerebral palsy and mental retardation, and many, many other issues that eventually added up to a five-page hospital discharge summary. It would be months before the baby was stable enough to declare with any certainty that it would live to see a world outside the NICU (neonatal ICU).

     Added to the daily stress of the question “will my baby live through today?” the couple also struggled over the gender assignment question that the doctors plagued them with. They felt an immense amount of pressure from the doctors to assign this child the female gender.

     The medical staff was unanimous: female gender assignment should be made. The traditional and case evidence seemed to support this conclusion. Traditionally, ambiguous genitalia in infants phenotypically suggest a female sex assignment.

     Keith and April did not agree so quickly. They had never heard of these terms before and decided to do a little research on their own. They spent hours in the medical library researching the terms used by the doctors. Their pastor was adamantly opposed to the doctor’s advice, saying that God had made this baby a boy and he should stay that way. They also looked into the Bible to find out more about eunuchs. They found that there are eunuchs from birth mentioned in the Old Testament that received double honor. They settled in their hearts that this may very well be what Jonathan was.

     How distressing for parents expecting a boy, with blue ribbons on the door and all, to suddenly be faced with a very different kind of confusion. Intersex, genetic abnormalities that cause a person’s sex to be obscured both phenotypically and genotypically, is an issue for many people in North America today, especially in the Christian community. It is a topic that needs to be investigated, addressed and resolved Scripturally. The problem of intersex in patients is more common even than many other commonly discussed genetic disorders. Christians need to dig deeply within the Bible to find the answers to troubling ethical issues, and deeply within their own souls for the love necessary to give hope and proper care to struggling individuals. The Bible is clear that God determines our gender from the foundation of the earth and who are we to change what God has made.

     Keith and April decided that Jonathan would stay a little boy. They also had good evidence that a female gender assignment would be devastating. For one thing, the little boy had no female organs, no uterus or vagina and no amount of surgery can produce this. Of the wide spectrum of cases of intersex, this little baby’s case was mild in comparison to many other fully AIS patients who have no testosterone sensitivity at all. Little Jonathan did have partial sensitivity and later responded well to the male hormones with phenomenal growth of the penis. Hypospadias is also a rather common abnormality that is repairable by surgery. Some day little Jonathan will need this surgery for functional and possible cosmetic purposes. Testes were located in the baby’s abdominal cavity that someday can be surgically relocated in the scrotum. Another question to be answered is whether or not the person is in fact a hermaphrodite in which case the body may appear female in one area and male in another, and the chromosomes of these individuals are not easy to read.

     The doctors continued the pressure, however, with their own interests in mind. This was very untraditional to not make a gender reassignment. After agonizing for months and watching the tiny infant gain one painstaking ounce at a time, and weighing only 6 pounds at the time of discharge at 6 months of age, Keith and April gained more and more peace with God in completely acting in opposition to all medical advice that was being given them. Through all of the difficulties, God marvelously supplied all of their needs both spiritually and financially. Many, many days of work were lost but there was always a check in the mail or a check would be given them from the church.

     That was six years ago. Today the medical community is bringing new evidence to bear. Little Jonathan is a miracle baby, but all babies are. However, new evidence suggests that traditional thinking on intersex needs to be re-evaluated. These intersex cases range from mild to severe, but all need to be handled in light of Scripture, not simply phenotypically as in the past. Dr. Dan Beals, a pediatric surgeon, claims that something called A testosterone imprinting is much more powerful than what many in the medical community today think. This is because testosterone affects much more than just the genitalia, and it is not simply a matter that, if they do not look like a boy, then they must be a girl. This default clause is not holding up anymore.

     Psychologically, gender assignments can be devastating for a patient. The issue of intersex is clouded by bitterness and anger in people who in the past have been misinformed and mistreated. Although the Intersex Society of North America would advocate a spectrum of genders, that is simply not consistent with a Biblical worldview. Because of the Fall of Man, human bodies suffer abnormalities. There are people who have success stories in this area and are very happy. Others must live with a difficult situation much the same as those with other deformities and handicaps.

     A message of love needs to be introduced to these patients, their families, and society in general. One bitter woman asked, “Who can accept damaged goods?” The answer is, God can and does accept the damaged goods of every person who has ever received the free gift of salvation. While there still remain unanswered questions, and different situations require different approaches and solutions, God has not forgotten His groaning creation. He has a special purpose for every person that surpasses their physical limitations, including gender maladies.

     April’s note: Jonathan is now 8 years old and a happy little boy who loves his life, his family and his church. He is learning about Jesus and what it means to be saved. He has the mental capability of a 4 year old and has CP, he is legally blind but sees well enough to operate a computer and get around his world. He is fed through a feeding tube because of his reflux issues. He’s had 5 major surgeries to correct various problems. He is still not toilet trained but we are working on it. He can read on a first grade level and can count to about 50. He is a typical boy in every way. He loves playing trucks with Daddy and doing the guy thing. We are so thankful to have him a part of our lives and so thankful to our Lord and Savior for helping us through a very difficult time.