A Thursday morning in September about 10 years ago is a day the Ezehs often remember in a deep reflection. Mrs Ifeoma, Okoronkwo Ezeh’s wife, then in her 30s, welcomed a special child, one whose features still confuse her till date.

Mrs Ezeh, now 51, who gave birth at the Wesley Guild Hospital, Ilesa, Osun State, told Sunday PUNCH that this baby was born with genitalia features that looked tinier than the size of a regular manhood, a pair of undescended testes which appeared above the penile area, resting in what looks like a scrotal sac and an opening underneath the manhood said to be that of the female sex.

“I felt something was off with how the nurses reacted after they brought out the baby that Thursday evening.

“They simply told me that I had given birth to a baby boy, and then moved to clean him up. I was the one who said they should show his father first because we had been trying for a male child for years.

“We had given birth to five girls before the baby came so it was like a dream come through for the family giving birth to a ‘male’ child after all these years,” the Ebonyi State indigene said.

Her husband, she recounted, did not come to see her for a few minutes even after the baby was taken to him to see, and it was quite unusual. Ifeoma said her husband would be the first person she often saw whenever she opened her eyes after a delivery.

She said it was much later that he came and told her that they needed to take the child somewhere because there were some issues with the child.

“I was too weak to begin to think of anything bad. Since my husband had confirmed then that he was a boy, I didn’t really think it was any need to bother over any ‘issues’,” Ifeoma noted.

She said the child was wrapped in swaddling clothes and was taken to the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, for further assessment by daybreak.

Ezeh told Sunday PUNCH that his joy was dampened when he set his eyes on the genitals of the child as the nurses brought him.

“It was there (genital area) that my eyes first went to, and what I saw confused me. I had to feel it first to be sure I was not hallucinating. I asked the nurses what it was and they said it was nothing to worry about because they would “work on it.”

“I was still uneasy because in all my years on earth I had never seen such a thing before. I didn’t want to make my wife cry so I didn’t tell her what it was. I just told her we needed to go to Ife to see what could be done to help our child,” he added.

On getting to the OAUTH, Ezeh said the doctors first examined him and told him to bring the child back after one month for the first surgery.

As they went back home, Ezeh said he opened up to his wife who he said was also amazed at what she saw.

“It made us both confused on whether to call the child a male or a female. I remember some nights, I would sit up in my room and look at the child and begin to cry. It has been such a trying time for my family,” Ezeh said, pausing at intervals.

“When the doctors started the treatment at OAUTH, they found out that he had more male chromosomes so they concluded that he would be referred to as a male child. They also described the condition as a congenital abnormality that results in an intersex baby.

“I am not literate so those things confused me even more. The more the doctors tried to explain, the more dumbfounded I became.

“The major problem was trying to make sure no one knew about it. So, my wife and I made sure we stayed with the child every time so that if anyone came visiting, we would not let them see the genitals or attempt to bathe the child. It was tough. Some people were too nosy; they just wanted to know everything so it was just so difficult,” Ezeh added.

The couple said they had done six corrective surgeries already for the child who would turn 10 years in September. This, according to them, has shrunk their savings.

“The first surgery was done when he was about a month old. The second followed when the wounds of the first healed and that is how they have been opening up that child and closing him up because of solutions.

“I don’t want to begin to imagine the kind of pain that child has gone through in his lifetime. Imagine going to the theatre six times already for 10 years of one’s life. The doctors are saying he would still need a few more before getting better.

“Before now, he didn’t pee from his manhood because there was no opening. He used the vaginal opening to pass out urine, and because his anal opening is tiny, he finds it difficult to pass our faeces.

“Raising this child for 10 years has been extremely challenging for both of us. Do you know he still wears diapers even at 10 years old? This is because, even after the many surgeries, if he is pressed, urine rushes uncontrollably from the opening underneath his manhood,” Ifeoma narrated.

She said she hid him indoors so that nobody would see what was going on with him, but he would cry so hard that he wanted to play like other kids.

“One day, we brought him out to play, and as he did, the urine started dripping and all the children ran away. They told him not to join them in their games because he smells. He came back home crying and I joined him. It is a difficult thing. We are Christians so when we go to church, he sits afar from other kids because they would always laugh at him when they see him.

“I have heard some church members make some snide comments about our family, saying we were suffering as a result of our sins. My husband used to own a big phone accessories shop when we relocated to Ilesa, but because of the cost of the surgeries, we have lost everything.

“We are not educated, and bearing the cost of the treatments and raising the child is tough, not just on our finances but on our mental health as well,” she added.

Speaking to one of the siblings of the intersex child, 22-year-old Rebecca, she said people make fun of her family because of the condition and she was not spared either.

Rebecca works as a sales representative in Lagos said, “We (family) used to hide it because of the shame and stigma. Even we, his siblings, talk about the situation in hushed sounds because we didn’t want our brother to feel somehow.

“Because of shame and the many rejections from school, the young boy stayed home till four years ago when a school finally accepted him. He is now in Primary Two at 10 years old. He is the oldest in his class, and he sits alone far away from other kids. It is traumatising for the boy, but what do we do? We are even happy the school accepted the child.

“When my mom wanted to register the child, she was even confused on what sex to fill. She just summoned up courage and filled in ‘male’ since the doctors have said he had more male chromosomes than female ones,” she added.

The young child, Martins (pseudonym), sounded bright during an interview with Sunday PUNCH

“Hello, Uncle. Good afternoon. How are you,” the sharp voice blasted from the other end of the phone. Responding to our correspondent’s question on his preferred career choice, he said, “I want to be a doctor. Hmmm… This is because I love the way they are dressed and how they take care of people. They always play with me.”

Martins also said he would perform well in school, noting that he wanted everyone in his family to be happy for him.

He said he usually has a hard time coping at school as he is constantly bullied by his mates because of his conditions.

“If they insult me, my mummy said I should report to my teacher. If my teacher is not around, I always stand up and defend myself,” he said.

Burden of intersex persons

The Office of the High Commissioner of the United Nations defines intersex people as persons born with sex characteristics (including genitals, gonads and chromosome patterns) that do not fit typical binary notions of male or female bodies.

According to a 2019 publication of the European Union Agency for Fundamental Rights, the characteristics may be chromosomal, hormonal and/or anatomical and likely present in deferring degrees.

“Many variants of sex characteristics are immediately detected at birth, or even before. Sometimes these variants become evident only at later stages in life, often during puberty. While most intersex people are healthy, a very small percentage may have medical conditions which might be life-threatening, if not treated promptly,” part of the publication stated.

The UN noted that about 1.7 per cent of the world’s population are born with intersex traits.

The physiological abnormality, according to the Intersex Society of North America, occurs once in 2000 births around the world.

In recent years, awareness of intersex people and recognition of the specific human rights abuses they face has grown.

Apart from the Kano State Government, which in April said it was considering creating a centre for people with intersex complications, in partnership with the TETFund Centre of Excellence of Usmanu Danfodiyo University, Sokoto, there appears to be much attention paid to children born with this condition in the country.

Though the number of those living with the condition in Nigeria is not known, experts say there could be more hermaphrodites in the country, especially with many afraid to come out for fear of stigmatisation.

Experts’ views 

A consultant urologist, Dr Taiwo Alabi, said many assessments, examinations and tests would have to be conducted on the young child to know where exactly the sex lies.

“It is a good thing he was presented early at the hospital. Now, the experienced physicians would have to run a series of tests to determine whether the child is male or female. Once this is done, further recommendations can be made,” he said.

On causes of condition, Alabi said, “Intersex children can be formed when there is an abnormality which can make the sex-determining factor of the Y chromosome ineffective.

“So, most intersex people may have XXY; some may have XY, but the sex-determining region is defective instead of XX (for female) and XY (for male).

Another consultant urologist, Dr Gabriel Ogah, said intersex persons are best treated and addressed as individual cases, noting that each person may present with different peculiarities.

“If we say someone is intersex, that means biologically, the person doesn’t show him/herself as one particular sex. It is in between because normal sex or endo-sex is someone who has XY chromosome for male and XX for female.

“When someone has features which are in between, it may be because there is a genetic anomaly. The chromosomes have a delusion. Instead of the normal XX or XY, the person may be XXY or XXYY, or YYX. The person may have a penis or may not. He or she may have a uterus or may not, or may have a combination.

“When an individual is an intersex, (s)he must be assessed thoroughly by the physician who would place the person in a particular category.

“The category you place the patient on will determine what you would do for the person. This would determine whether or not the person would need surgery, and of what kind,” he said.

Also commenting, a professor of sociology at the University of Port Harcourt, Rivers State, Ifeanacho Ikechukwu, noted that the Nigerian society was not enlightened to the point of accepting intersex persons into mainstream public life.

 “It has to do with one being enlightened to know that such things happen and these people can lead normal lives without society’s stigmatisation. This family must have gone through a lot of worries. They have, unknown to them, transferred this worry to the young child.

“The parents need to seek the help of a professional counsellor to speak to the child in such a way that he can understand. This is because as he begins to develop, the child would begin to seek answers about life.

“This is going to affect the child’s mental, educational and psychosocial development, the conceptualisation of what society is. He may see society as a group of people that have rejected him for something that was not his making and are being victimised. If this is not controlled, it may lead to suicide.’’

He called on non-governmental organisations to come to the aid of the Ezehs.

Besides, the Executive Director, Centre for Health Equity and Justice, Mr Timothy Adewale, said Nigerians don’t understand the difference between being intersex and being gay or homosexual.

“They just feel it is the same. Nigerians are too religious. Whether we like it or not, there are people like that and the earlier we recognise them, the better for us all,” he said.

On her part, an educationist and child rights advocate, Mercy Chepaka, urged schools to be more open-minded, stating that their education was pivotal for the development of any child.

“Intersex children are special children; no school should reject them just because of that. The child never chose to be born intersex and it can happen to anyone. The educational sector must show a lot of empathy and encouragement for the parents,” she said.

In his view, a senior lecturer at the Department of Psychology, University of Nigeria, Nsukka, Enugu State, Dr Johnbosco Chukwuorji , noted that there should be a comprehensive approach to look at the condition.

He said, “It has to involve not just medical doctors but social workers, psychologists, educationalists, lawyers and others who should get involved in managing these people. On the part of the child, one of the major problems is adaptation and self-esteem. They may not have a sense of self-worth or value since they do not look like others. This brings up some form of social insecurity, which is the stigma associated with their gender identity.

“Society must be kind to these people so they do not begin to withdraw themselves from social life. It is going to affect the sexual satisfaction and development of such a person. We need to engage in massive sensitisation and education of the general populace on these kinds of situations so that when people no longer see these people as taboo but as special, then it is going to help us deal with it.’’