Charley had complained of vague abdominal pain for about three days before she awoke to excruciating right-sided belly pain on her sixteenth birthday. She refused to allow Charles examine her, so he asked a surgical colleague to see her. Dr. Farmer did a quick exam of her belly and felt Charles’s diagnosis was spot on. Scheduling his daughter for immediate surgery, Charles was concerned, but not unduly alarmed as he waited. He expected to see her back in recovery in about an hour. The surgeon looked grave when he sought Charles right after takng her into surgery.
“Is she okay? Had the appendix ruptured?” he asked.
“She’s fine but it’s not her appendix. I haven’t started surgery yet, but there’s something we need to talk about. Let’s go to a private area.” They moved into Charley’s assigned room. Sit down, Charles. It wasn’t appendicitis. I saw no reason to do a pelvic exam prior to surgery, but when Charley was moved to the table, some abnormalities were noted. Charley has ambiguous genitalia, some male, some female. She has a fully developed vagina with a very large clitoris or a small penis. When erect, it might be three and a half inches. Her right labia has a partially descended testicle which is likely incarcerated. I have manually rotated it and returned the blood flow for the present, but it is likely the cord will twist again. That is the cause of her pain and must be explored. There is no obvious testicle on the left, but there could be one that hasn’t descended. We need to let her wake up and inform her before going ahead with surgery in this life-altering situation.”
“Dear God, that’s why she was so secretive. She doesn’t know, but at birth, she had what I thought was an abnormally large clitoris and I removed it, thinking that would take care of the problem. She looked like a perfect female in every other way. What have I done to my child?” Charles cried out his grief.
Dr. Farmer tried to comfort him. “I might have done the same thing. How could you know it would turn out this way? That fact is, Charley needs to know the situation. The penile tissue that’s left is healthy, just shorter. She may choose to live as a man. She should be awake in a few minutes and we can talk to her.”
“Oh my God. This will be the hardest talk I’ve ever had.”