Pregnancy in A Male: A Surprising Late Consequence of Mistaken Sex/Gender Assignment

ABSTRACT Objective: Gender/sex assignment is a crucial process in patients with genital ambiguity. This is a case report of a patient who had an anatomic anomaly and was misassigned with indeterminate sex and wrongfully assigned male sex for rearing. Methods: A 22-year-old unmarried male presented via the surgery department with progressively enlarging mass in the abdomen and vague abdominal discomfort. Examination revealed female secondary sexual characteristics and lack of facial/body hair. Radiologic investigations revealed a pregnancy of 26-weeks gestation. Karyotyping confirmed 46,XX. Results: Gender re-assignment was undertaken with multidisciplinary support. Baby was delivered at term, while maintaining strict confidentiality. This case reflects how flawed assessment and management of sexual ambiguity can be, even in cases handled in large tertiary care hospitals, despite the absence of clear sexual ambiguity. Careful handling of the social issues with regards to changes in gender expression and the fate of the baby may have saved lives in this case. Conclusion: A multidisciplinary conference of specialists interested in gender issues should be held in all cases of gender confusion so that mistakes like this do not happen.