![[Uzbekistan] Doctors at the Samarkand centre perform surgery.](https://assets.thenewhumanitarian.org/s3fs-public/styles/responsive_large_2x/public/images/200552.jpg.webp?itok=z5U9HWNs "Doctors at the Samarkand centre perform surgery on Gulya")
In a whitewashed Soviet-style operating room in the central Uzbek city of Samarkand, doctors operate on a patient while nurses help them in their scrupulous work. Gulya (not her real name), a 33-year-old patient, is among hundreds of people who annually come to this unique centre to get help for problems they cannot speak about openly.
Gulya was born with male pseudohermaphroditism and had testicular feminisation syndrome. In other words she had an intersex state. Intersex states occur when there is ambiguity or uncertainty about physical sexual status. Such a status arises when there is a problem in early embryonic sexual development.
There are several causes of male pseudohermaphroditism, the best known being testicular feminisation syndrome or ‘androgen insensitivity syndrome’ (the tissues that should develop into the male sex organs do not respond to the male hormones). The child appears to be a girl. In puberty she does not have periods. There is normal breast development but poor pubic and auxiliary (armpit) hair production.
Gulya was operated on when she was a child in Russia. She underwent the initial stage of reconstructive surgery and they removed her rudimental external male sexual organs. "She identifies herself and feels herself as a female. She found a man that she wants to marry and therefore decided to have an operation. We implanted a vagina made of a part of her large intestine," Bahodur Negmadjanov, chair of obstetrics and gynaecology at the Samarkand medical institute, told IRIN.
Gulya's case highlights not only a health, but a neglected social problem in conservative Uzbek society given that such issues are considered taboo, particularly in rural areas.
According to doctors, many of their patients suffer a lot. "If it were not for you doctor I would commit suicide, they say, and there are often suicide cases among them. These patients are as if reborn after operations; they easily adapt after surgery. Before the operation they are like invalids, nothing interests them and they are ready to commit suicide and sometimes they come to us with veins that they earlier tried to cut," Negmadjanov said.
Doctors noted that after the operation many patients got married, adopted children and thus integrated well into society. "They start working. There are prominent businessmen, cultural workers, artists and doctors among those whom we operated on," the doctor said.
But while there was no statistics on the number of such cases that needed surgical correction in the former Soviet republic, Negmadjanov conceded that they had had thousands of inquiries.
"We don't have data to judge whether it is on the rise or not. Perhaps the number of referrals to us has increased and the diagnostics have improved as earlier there was no such medical treatment in Samarkand. Patients used to go to Moscow," the professor explained.
His colleague Kakhor Berdiev, head of the reproductive health centre for adolescents at the institute, said that they were registering many cases with regard to sexual organ defects, including a complete lack of inner sexual organs, as well as a lack of both inner and outer sexual organs, including the uterus and vagina.
"Unfortunately these problems are very often detected not by a doctor but by the husband on the first marital night," he said, adding that it was a huge trauma for both spouses.
"In 99 percent of the cases the marriage ends up in divorce. Therefore, we should make reconstructive operations on them before they reach marriage age. The earlier the better it is and their sexual and social adaptation will be much more easier," Negmadjanov highlighted.
"We also have cases of boys that feel themselves male but at the same they lack some parts of their sexual organs. We carry out reconstructive surgery, like masculanisation plastic surgery operations so that they can sexually and socially get adapted to society. We also help young girls," he noted.
Since opening in 2002, more than 200 reconstructive operations have been carried out at the centre for adolescents, while around 100 to 200 operations were conducted at the centre for women over the past few years.
"The Samarkand hospital's adolescent reproductive health centre is actually more than that; it is an adolescent surgical centre for sexual reproductive malfunctions, disabilities or defects. This is one of the most unique centres in Central Asia and one of the few places in the world where sexual health matters are corrected surgically," Nesim Tümkaya, head of United Nations Population Fund (UNFPA) in Uzbekistan, told IRIN in the capital, Tashkent.
But the centre and the doctors are struggling to offer assistance to patients given a lack of resources and funding. The medical equipment is from the Soviet era and buildings are dilapidated, while sometimes doctors are forced to buy the necessary operating supplies themselves.
That situation is changing, however, with assistance from UNFPA worth around US $250,000, including major surgical equipment, while local authorities have donated around $150,000 for refurbishing of the centre building.
"From the UNFPA perspective we care very much about sexual and reproductive health. Reproductive health and sexual health are important for people's welfare and happiness. Therefore people who are unfortunate to be born with congenial deformities in their sexual organs should have a chance to have them corrected surgically," Tümkaya said.
Gulya was born with male pseudohermaphroditism and had testicular feminisation syndrome. In other words she had an intersex state. Intersex states occur when there is ambiguity or uncertainty about physical sexual status. Such a status arises when there is a problem in early embryonic sexual development.
There are several causes of male pseudohermaphroditism, the best known being testicular feminisation syndrome or ‘androgen insensitivity syndrome’ (the tissues that should develop into the male sex organs do not respond to the male hormones). The child appears to be a girl. In puberty she does not have periods. There is normal breast development but poor pubic and auxiliary (armpit) hair production.
Gulya was operated on when she was a child in Russia. She underwent the initial stage of reconstructive surgery and they removed her rudimental external male sexual organs. "She identifies herself and feels herself as a female. She found a man that she wants to marry and therefore decided to have an operation. We implanted a vagina made of a part of her large intestine," Bahodur Negmadjanov, chair of obstetrics and gynaecology at the Samarkand medical institute, told IRIN.
Gulya's case highlights not only a health, but a neglected social problem in conservative Uzbek society given that such issues are considered taboo, particularly in rural areas.
According to doctors, many of their patients suffer a lot. "If it were not for you doctor I would commit suicide, they say, and there are often suicide cases among them. These patients are as if reborn after operations; they easily adapt after surgery. Before the operation they are like invalids, nothing interests them and they are ready to commit suicide and sometimes they come to us with veins that they earlier tried to cut," Negmadjanov said.
Doctors noted that after the operation many patients got married, adopted children and thus integrated well into society. "They start working. There are prominent businessmen, cultural workers, artists and doctors among those whom we operated on," the doctor said.
But while there was no statistics on the number of such cases that needed surgical correction in the former Soviet republic, Negmadjanov conceded that they had had thousands of inquiries.
"We don't have data to judge whether it is on the rise or not. Perhaps the number of referrals to us has increased and the diagnostics have improved as earlier there was no such medical treatment in Samarkand. Patients used to go to Moscow," the professor explained.
His colleague Kakhor Berdiev, head of the reproductive health centre for adolescents at the institute, said that they were registering many cases with regard to sexual organ defects, including a complete lack of inner sexual organs, as well as a lack of both inner and outer sexual organs, including the uterus and vagina.
"Unfortunately these problems are very often detected not by a doctor but by the husband on the first marital night," he said, adding that it was a huge trauma for both spouses.
"In 99 percent of the cases the marriage ends up in divorce. Therefore, we should make reconstructive operations on them before they reach marriage age. The earlier the better it is and their sexual and social adaptation will be much more easier," Negmadjanov highlighted.
"We also have cases of boys that feel themselves male but at the same they lack some parts of their sexual organs. We carry out reconstructive surgery, like masculanisation plastic surgery operations so that they can sexually and socially get adapted to society. We also help young girls," he noted.
Since opening in 2002, more than 200 reconstructive operations have been carried out at the centre for adolescents, while around 100 to 200 operations were conducted at the centre for women over the past few years.
"The Samarkand hospital's adolescent reproductive health centre is actually more than that; it is an adolescent surgical centre for sexual reproductive malfunctions, disabilities or defects. This is one of the most unique centres in Central Asia and one of the few places in the world where sexual health matters are corrected surgically," Nesim Tümkaya, head of United Nations Population Fund (UNFPA) in Uzbekistan, told IRIN in the capital, Tashkent.
But the centre and the doctors are struggling to offer assistance to patients given a lack of resources and funding. The medical equipment is from the Soviet era and buildings are dilapidated, while sometimes doctors are forced to buy the necessary operating supplies themselves.
That situation is changing, however, with assistance from UNFPA worth around US $250,000, including major surgical equipment, while local authorities have donated around $150,000 for refurbishing of the centre building.
"From the UNFPA perspective we care very much about sexual and reproductive health. Reproductive health and sexual health are important for people's welfare and happiness. Therefore people who are unfortunate to be born with congenial deformities in their sexual organs should have a chance to have them corrected surgically," Tümkaya said.
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
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