A married woman in China went to the doctor for an ankle injury, only to be told she was “born a man” and intersex. After trying to get pregnant for a year, she suddenly learned why efforts had not been successful. Now, the woman, called Pingping to protect her privacy is unsure about which gender she wants to be going forward, reports ABS CBS News.

Doctors at the local hospital took an X-ray of her ankle injury and found that her bones hadn’t developed past adolescence. Upon questioning Pingping, doctors learned that she had never menstruated. Out of embarrassment, she had avoided talking about the matter.

“When I was young, my mum took me to the doctor. The doctor said I was just developing slower than others sexually and that I could have my period in a few years,” she told the local doctor.

“After I grew up, I found this issue quite embarrassing, so I didn’t treat it seriously,” Pingping said.

Pingping had no reason to question her biological gender because she has external female genitalia, according to a statement from the First Affiliated Hospital of College of Medicine, Zhejiang University.

After learning about her underdeveloped bones, she questioned an endocrinologist.

“My husband and I have been trying to have a baby for a year although it’s been in vain. Is that also related [to my bone age and absence of a period]?”

Further testing revealed that Pingping suffered from congenital adrenal hyperplasia (CAH), a genetic disorder that affects the adrenal glands and hormones. She was being treated for high blood pressure and low blood potassium. The Doctors ascribed the condition to parents who were “closely related.” 

The Mayo Clinic states kids with CAH “have two parents who either have CAH themselves or who are both carriers of the genetic mutation that causes the condition.”

46, XY Chromosome Pattern

Later, further genetic testing revealed Pingping’s karyotype, a picture of a person’s chromosomes. She has a 46, XY chromosome pattern. Such a karyotype is typical for men and boys – but not always. 

Sometimes, people are born with Swyer syndrome, with typical female external genitalia and the 46, XY karyotype. In Swyer syndrome, “sexual development does not match the affected individual’s chromosomal makeup,” states MedlinePlus. 

Affected people may have underdeveloped gonads (ovaries or testes) that aren’t functional. In PingPing’s case, doctors suggested they may have been present but later “degenerated and atrophied.”

Typically, people born with Swyer syndrome are raised as girls and have a female gender identity, but not necessarily. Sometimes, they may be raised as boys and may not have ostensibly female organs.

With hormone replacement therapy during adolescence, doctors can induce menstruation. If people with Swyers choose to become pregnant, it’s possible with a donated egg or embryo.

The National Organization for Rare Disorders notes that Swyer Syndrome affects one in 80,000 births. Sometimes, people have been shocked to learn that doctors concealed the diagnosis later in life. Other times, people may never learn they have Swyer Syndrome.

See more about Swyer Syndrome from TLC:

Social Roles

After being told that she was “born a man,” as reported in the South China Morning Post, the hospital says Pingping “had not yet made up her mind about which gender she wanted to be.” The hospital’s Mental Health director expressed an interest in “psychological intervention” and claimed the family should have detected the issue earlier.

“They should have gone for check-ups years ago. This shows how seriously they lacked sexual knowledge,” said Hu Shaohua.

Now, the hospital suggests Pingping may need to change her social roles.

“It takes a long time to rebuild the social role and reconstruct the family, and it’s going to be a painstaking process, where psychological intervention is necessary. But Pingping has not asked for help from us so far,” Hu said.

Further, Hu suggested better sexual education in China may have prevented what happened to Pingping. In China, sexual education is “almost nonexistent, in particular terms such as intersex,” states the South China Morning Post. 

Unfortunately, people worldwide are not well-versed with intersex issues or have misconceptions about gender identity, sexual orientation, and assigned sex. Thus, better education about the complex realities of these subjects is needed everywhere. Although societies place great pressure on assigning gender roles, there isn’t a convenient gender binary. 

In reality, gender sits on a spectrum with possible nonbinary, transgender, and other identities. Due to a lack of understanding, people who don’t fit neatly on the binary face constant attacks. For example, state legislators in the US have filed a record number of bills in 2021 that would impact the rights of transgender people, according to an LGBTQ advocacy group.

Related: California School Board President Fears Teaching That LGBT People Exist May Turn Kids Gay

Intersex and Gender Identity

Every culture has its standards about how people are expected to behave based on gender. Although a doctor may assign a “biological sex,” it may not align with an individual’s body, feelings, or identity.

Ultimately, each person determines their gender identity, an internal feeling that people have early in life. If a person’s anatomy doesn’t fit with typical definitions, they may be described as intersex.

“Intersex is an umbrella term that describes bodies that fall outside the strict male/female binary,” states Planned Parenthood.

In some cases, doctors have performed surgeries on intersex babies and kids so they will conform to the binary of “male” or “female.” Unfortunately, this doesn’t necessarily fit with that person’s gender identity.

Although it’s not commonly discussed, as many as 1-2 in 100 people are born intersex in the United States. It’s a naturally occurring variation and not a medical problem. However, parents and doctors may believe they must conform to a male or female role. Hopefully one day, people will be better educated and more understanding about the natural variations in gender, sex, and identity.

Below, a woman tells Oprah what it was like growing up intersex:

Featured image: image via Pixabay