Page 172 - EFI-RAV ZILBERSTIN_VOL 8.EFI-RAV ZILBERSTIN_VOL 8.1A

Pg: 172 - 6-Front 21-10-31

ɳ Question

I wish to consult you about a 15 year old girl who is being treated in
our clinic.

The girl has been suffering for a number of years from hirsuteness
[excessive hair growth] and obesity. In the past, she has undergone
endocrine testing but there were no findings. During continued en-
docrine testing secondary sexual characteristics developed normally
but since she was not menstruating, she was sent for an ultrasound
examination of her lower abdomen. The test showed one small ova-
ry, with the second ovary missing entirely. It was uncertain whether
she had a uterus, though the vagina appeared normal. As a result of
these findings, she was referred for chromosome analysis. This test
showed that the karyotype in 65% of the cells that were checked was
XY46 (male) and in 35% of the cells, it was XO45. In other words,
this is a girl whose external appearance is female but most of whose
chromosomes are male. Since there is reason to suspect that the ovary
that was seen is actually a testicle, and that there might be another,
atrophied testicle in the abdominal cavity, another examination must
be carried out, and the option of surgery to remove the testicles must
be weighed owing to the danger of malignancies. In addition, it is
almost certain that this girl will be unable to conceive in the future,
though she will be apparently be able to maintain marital life.

We seek the rav’s advice regarding the following questions:
1. How should we convey the information that we have, firstly to
the parents, and then to the girl herself?
2. Should it become likely that the girl will need plastic surgeries in
order to have marital relations, how does halachah view this?
3. What is this person’s halachic status? Is she viewed as a woman,
or as an androgynous (hermaphrodite)?

Dr. Y. Caspi

ɳ Response

1. At the outset, I want to convey a personal message to Yossi and

156 1 Medical-Halachic Responsa of Rav Zilberstein