The emergence of Alterina Hofan’s case is only an iceberg phenomenon of the many sufferers of sexual confusion in Indonesia. However, the evidence shows the irony that sufferers of sexual ambiguity are still victims of the ignorance of the community.
As an illustration, Alterina Hofan was prosecuted by a seven-year prison prosecutor for being accused of falsifying identity — previously women became men in December 2006.
Alter was later known to be a sufferer of Klinefelter syndrome. Patients with XXY chromosomes have physical characteristics like women, such as breasts that grow and do not appear in several parts of the body but are genetically male.
The head of the genital adjustment team at the Dr. Kariadi Central Hospital (RSUP) Semarang, Sultana, said that Klinefelter syndrome is only one of many cases of sexual confusion. Chromosomal aberrations or gene mutations can cause this sex confusion. There are also suspected external influences, such as the use of hormonal drugs in pregnant women.
Generally, this disease is not caused by hereditary factors. However, for the case of Congenital Adrenal Hyperplasia (CAH), the illness experienced by patients is obtained from parents who have a carrier gene (carrier). CAH sufferers are women who suffer enlargement of the penis-like clitoris and are often recognized as men.
Sufferers of sexual ambiguity can be male or female physically or vice versa, as in the case of CAH. Symptoms vary depending on the stage.
Usually, men who suffer from sexual confusion have small penises and testicles, accompanied by growing breasts. There are also those who experience hypospadias or leak in the urethra between the scrotum so that urine does not come out through the tip of the penis.
If this case befalls women, sufferers will look like men because the breasts do not grow, the clitoris enlarges to resemble the penis, the development of the body is like a man, and sometimes has fungus.
An andrologist from the Medical Faculty of Diponegoro University and a member of the sex adjustment team, Zulfa Juniarto, revealed that there was a chance for a sexually ambiguous sufferer 1: 4,500 babies born.
Sexual confusion or intersex is different from transsexuals. In cases of sexual confusion, physical development does not match the genes or chromosomes. Whereas in the case of transsexuals, physical development is not following the psychology of the patient concerned.
“Genetically and physically, transsexual patients don’t have problems. “However, his mentality is not following his physical development,” Zulfa said.
To deal with cases of sexual confusion, early detection needs to be in the form of examining chromosomes and deoxyribonucleic acid (DNA) in newborns, checking for abnormalities.
Detection is to avoid the psychological and legal effects that can be accepted by patients with gender confusion in the future. “That awareness does not yet exist for doctors or birth attendants who do not know,” said Sultana.
Under certain conditions, a pregnancy or prenatal diagnosis is also needed to ensure the presence or absence of defects in the fetus. This examination is carried out if there are certain risk factors for the mother, such as being pregnant over the age of 35 years, having had children who suffer from sexual confusion, and have experienced recurrent miscarriages.
Errors in sex identification in newborns can be fatal when the child has already grown up. For example, a person who is genetically male, but lives a small living as a woman, will be used to using a woman’s perspective and sexual orientation. “For that, when it was decided to be a man again, what was changed was not only his physical but also his psychological side,” said Anastasia Ediati, a psychologist in the team.
Since 2004, the sexual adjustment team of Dr. Kariadi Hospital has handled more than 500 cases. Eleven of them eventually underwent sex reassignment surgery.
In the team, there are various experts, such as genetics, andrology, urology (genital reconstruction), psychology, psychiatry, anesthesia, endocrinology (hormone experts), radiology, clinical pathology, and religious leaders.
Before deciding on sex change, the team of doctors must already know the sex that matches the chromosome or gene and the psychological aspects of the patient. Patients will go through a long process through various consultations. “Even though the chromosome is known, if there is rejection from the patient because they are not ready to change sex, we cannot force it,” Anastasia said.
According to him, the psychological condition of the sufferers is greatly influenced by the surrounding environment. The existence of a negative assessment from the community on the physical condition of the patient increasingly makes the concerned close himself and difficult to accept his situation. “They need support because they are considered different from physical or physical