Monday, March 22, 2010

xx or xy??


Assalamualaikum wbt.

Tengahari tadi, waktu lunch time teman belek2 majalah2 yang ada kat bilik rehat misi2 kat hkl tu...teman ternampak satu perkataan...."khunsa".....

Khunsa...apa sebenarnya khunsa tu?masa sekolah dulu, ustaz and ustazah teman pernah menyebut khunsa ni adalah org yg mempunyai 2 alat kelamin...dan, seingat teman...khunsa ni tak boleh jadi imam, kerana sifat nalurinya yang berubah2...

Tapi, sejak teman bekeja di hospital ni, sebenarnya teman tak pernah berjumpa dgn org atau baby baru lahir yang mempunyai 2 alat kelamin....itu membuatkan teman terfikir, mungkinkah khunsa ni ada maksud tersirat yang lain??

sejak teman mendalami ilmu perubatan ni, ada 2 keadaan yang teman dah jumpa, yang mungkin memasukkan pesakit2 ni dalam kategori khunsa...

1- Ambiguus genitalia

ambiguus ni satu perkataan english yang bermaksud "kurang jelas", dan "genitalia" tu maksudnya alat kelamin le....keadaan macam ni jarang dijumpai sebenarnya, tapi sejak teman bekerja selama 5 tahun ni, ada la kot 4-5 baby yg teman jumpa ada keadaan mcm ni...baby2 tu selalunya sihat2 belaka, cumanya alat kelamin baby tu susah ditafsirkan utk nak kata lelaki atau perempuan....kesian sebenarnya tengok baby2 mcmni....kena ambik darah untuk DNA, and apabila dah dipastikan lelaki atau perempuan, kalau ibubapa berkehendak, baby tu boleh la dirujuk utk pembedahan plastic. hmmm...hukum pembedahan plastik tu jgn tanya teman ye...ya, teman tau..mesti ada yg tak setuju...teman pun tak pasti sebenarnya, perkara2 mcm ni perlulah kita rujuk kepada yg lebih arif...

2- testicular feminization syndrome (TFS)

this is a rare condition, yang mana seseorang tu dilahirkan dgn susuk tubuh badan perempuan dan alat kelaminnya pun kalau dilihat dari luar, macam perempuan.. tapi kalau dibuat scan...pesakit itu akan didapati bahawa dia tidak mempunyai ovari, rahim atau fallopian tube. faraj/ vagina selalunya ada..tetapi sempit dan tidak terbentuk dgn sempurna.
Dan, kuasa Allah yg Maha Agung, pesakit tersebut..kalau dibuat ujian DNA, keputusannya akan menjadi 'XY' yg menandakan jantina pesakit tersebut adalah lelaki sebenarnya...cuma luarannya yang menyerupai perempuan....malah kalau diperiksa betul2 di bahagian ari2 dan abdomen, mungkin akan terjumpa testes yg mengesahkan jantina pesakit tersebut.

Complicated kan????hmm...kalau berminat, silalah google perkataan testicular feminization syndrome tu...byk benda kalu belajar dlm dunia ni...samada kita je yang nak ke...tak nak...

bercakap tentang TFS ni, sejak teman bekerja selama 5 tahun, yg teman pernah jumpa dalam 3 org je sebenarnya...and i still remember vividly of my 1st experience bertemu dgn patient with TFS ni...

i was still a medical student...masa tu tgh duduk dalam klinik O&G dgn Prof of the most respected O&G consultant in ni macam atuk2 sgt belajar dgn dia...he was very dedicated to his work and at the same time one of the best teachers i ever had. haha...he was so good that he wrote a complimentary book on O&G that was selling for RM2 only...and i passed my O&G just by reading that thin and simple book.

anyway, while we were seeing patients...a very sweet chinese lady came in the room...she was dressed in a pink blouse, floral skirt..and had a clip in her hair...she looked a bit like those taiwanese movie actresses that we see nowadays, u know what i mean?

as she sat down in front of prof, i could see that she was trying to hide her anxiety behind her sweet innocent smile...,

Prof: hello dear, how are u....

Lady: im fine...thank u...

Prof: so, u were referred here from a private hospital because u never had your menses?

Lady: now 22 years old.

Prof: i see....and that got you worried...?(smiling)

Lady: Yes (with a teary smile)

Prof: We'll see what we can sort out for u...ya??(smiled again), what are you doing now...?studying, working?

Lady: Im a trainee at a telecommunication company

Prof: Oh.. i came alone today?is your mother with u?

Lady: No, she's at home

Prof: It's okay, im just wondering if your mother also had late menses, sometimes daughters tend to follow their mother's age of attaining puberty.

Lady: mum got her menses when she was 13....I think my problem is something else... (and the patient looked at an envelope she was holding)

Prof: what's that big envelope that u have dear?u want to show me??

Lady: ya.....

Prof opened the big envelope....there were many CT scan films.....he didnt say anything...he just stood in front of the x ray box for a long long time....teman lagi le tak tau nak buat apa...the room was so silent and i just pretended as though i knew what i was looking for on the CT by one film was put on the box..and was still silent....when he turned to the patient again, he asked gently...."do you have anything else u want to show me?"

the sweet lady nodded and handed him some blood scanned the results through...and i was just standing there looking like a lamp post....

prof then asked the lady to sit down in front of him and spoke to her gently:

Prof: Has anyone told u anything about your condition dear?

Lady: A bit....but i dont understand.....(started to have tears in her eyes again...i still remember the way she was crumpling her skirt into a fist)

Prof: Right....right.....okay, im going to explain to u about your condition....and just stop me anytime if u cant get what im trying to say okay?

Lady: (Nodded....tears already streaming down her face)

Prof: Right, the reason why u still do not have menses is because u dont have ovaries and uterus...

Lady: ya...i know that...the previous doctor has already told me....but does that mean, that i can never have a baby of my own??

Prof: (nodded sadly....) yes.....that's true.....and im very sorry to be the one to tell you that............are u married dear.....?

Lady: No, my fiance' just broke up with me last week....

Prof: (Gently...)Why....because of this...??

Lady: (Nodded quitely....)

that moment was sad....very sad....even i had tears in my eyes then when i saw that lady crying helplessly....Prof then gave her some time and when she was ready...he continued to explain about TFS...about how the body did not respond to her hormones....and showed her the CT scan which revealed an absent uterus and ovaries...

but none of that prepared me for the next round of moment of truth...

With as much courage that she could muster, she turned to prof and asked...

Lady: Prof....the blood showed that my DNA was XY......what does it mean....????doe it mean that i'm

poor poor heart reached out for her.....
and great professor lived up to his great reputation of being an understanding and wonderful doctor...

Prof: No!!! Not at all.....! from what i can see....u're a woman....u're a woman...through and through....u speak like a lady...u dress like a lady...and u behave like a TRUE never ever think otherwise....because as far as im concern, u're more of a lady than many of them whom i know.....

the patient gave him a teary smile...i smiled too....i guess what prof was trying to convey to her was that....nothing could be done to change the situation...but she was whom she was...her upbringing....her appearance...her hobbies....her whole life was whom she was....and what she had achieved....and there was no need at all for her to readjust her life based on what she had just found out....

the sweet lady asked again...."can i get married, Dr?"

with much optimistism, prof answered, "Of course you can....and we'll try our best to make sure that u can have a normal sexual's just the 'children' part that u may need to adopt...if u want any....."

Lady: (Nodded again...)

the patient looked better then...things were clearer....i didnt know what was in her mind then but she did appear to be more relaxed and even more graceful when she continued the consultation with her sweet sweet smile....kudos to my very inspirational prof who managed to handle the situation been put in the spot to break such mindblowing news....setakat handle kes uncle kuat seks ada la....hehe...

so.....looking at the cases that i described above.....since gender issue was the problem, that was why i thought that these two diagnosis were some sort of tersirat meaning to the word 'khunsa'....mmm.....but my ilmu is terlalu sikit....and there is high possibility that i may be DO NOT....i repeat...DO NOT quote me's just my own thought that im sharing in my own, konklusi pada hari ini ialah....

1- we should always seek for extra knowledge untuk melengkapkan diri kita...baik ilmu dunia...atau akhirat

2- to my juniors who aspires to be doctors....i've illustrated a good personality of how u should communicate with your patients!

and to whoever who has further knowledge on this issue, kindly share or even do me a favour by correcting me ya....!



  1. poor her.. or him..or her..or apa2 lah.

    tidak Tuhan jadikan sesuatu utk kita belajar mengenainya.

    teruskan menimba ilmu,dear!

  2. hmm jap. why dont u find out from ur O&G specialists abt this situation? i mean, the possibility to have 2 genitals in an individual. also, for ambiguus genitalia case, kenape bole jadik tak clear? how is the genital like? distorted ke ape?

  3. ive googled and found out! all i can say is, wow. subhanallah.