James Pate, MD

IAAF offers to pay for Caster Semenya’s gender surgery if she fails verification test – Telegraph. This article was recently addressed in the Organisation Intersex International (OII) Forum and someone asserted that the reason why doctors remove testicles from women with androgen insensitivity syndrome (AIS) is because we want to prevent women from having them. So, I did a little research and this is what I found out:

There really isn’t a conspiracy to prevent women from having testes. The issue is that mammalian testes need to be cooler than core body temperature; thus testes have evolved to hang outside of the body in scrotums. Internalized testes are a cancer risk for both men and women. And the risk of cancer is greater in women with AIS than in men with undescended testes (UDT).

According to HM Wood (1):

The incidence of testicular cancer in men is 0.9 to 7.8 per 100,000 men per year
1.1 to 1.6% of boys have unilateral or bilateral undescended testes
Among men with testicular cancer, 5-10% have had a history of UDT
Men with a history of UDT have 2.75 to 8 times the risk of testicular cancer compared to men who don’t; the risk is even higher in men with bilateral UDT, associated genitourinary anomalies, or late (after age 10-12 years) or uncorrected UDT
Orchiopexy (repositioning testes outside the body) by age 10 to 12 years results in a 2 to 6-fold decrease in relative risk of cancer compared with orchiopexy after age 12 years or no orchiopexy

According to SJ Robboy (2):

The incidence of complete AIS is 1 in 20,000 live births
There is a risk for malignancy in AIS gonads owing to the occurrence of germ cell tumors. The cumulative risk for a germ cell tumor is greater than 30% by 50 years of age
The risk of malignancy in patients with testicular feminisation is only 4% by the age of 25 years, but reaches 33% by 50 years

Thus, women CAN have testes, but they should be removed if they aren’t located in a scrotum.

References:
(1) Wood HM. Elder JS. Cryptorchidism and testicular cancer: separating fact from fiction. Journal of Urology. 181(2):452-61, 2009 Feb.
(2) Robboy SJ. Jaubert F. Neoplasms and pathology of sexual developmental disorders (intersex). Pathology. 39(1):147-63, 2007 Feb.

Alice Park reports on Time.com that parents are talking with their kids too little too late according to a 2009 study in Pediatrics. In fact, approximately 40% will have sex before their parents finally bring up the subject of “the birds and the bees”. It certainly was true in my case.

I can remember being a teenager and one ordinary day my mother taking up the subject of sex. She just kept going on and on about how important it was to stay a virgin until marriage in spite of my protests “I know, Mom” and attempts to change the subject. Eventually I tired of her lecture and finally blurted out, “Mom, just stop. I’m not a virgin.” I still remember the look of shock in her eyes as she muttered, “I’m so disappointed in you” before walking away.

Frankly, I was disappointed in her. Waiting until your kid is 16 before having this conversation is way too long. I remember kids talking about sex on the playground in elementary school, don’t you? Kids aren’t dumb and kids are curious.

I took a different approach with my kids. Beginning in their toddler years I began addressing the subject of body parts using their correct anatomic names — a penis is not a “peepee” or “junk” nor is a vagina “private parts”. Eyes are eyes and noses are noses, why should sexual organs be any different? As their minds developed I added more to their knowledge, always addressing the subject in a matter of fact way and answering all of their questions. If a child is able to comprehend and formulate a question then s/he is mature enough to receive an answer.

I recently had a conversation with my son who is 11. He told me that now that he is in 6th grade he has to have health and sex education. He seemed rather annoyed by the idea and said, “I really don’t know why I have to learn about it in school, you’ve already taught me all about it.” I just listened and smiled.