I have embarrassing problem, I need help.

[Bintu]

I have been offered admissions at a few XXXXXX schools. Including XXXXX and XXXXX. I only applied to XXXXX schools. I just got my green card a year and one half ago. I am from XXXX.
My problem be that these schools want me to get a health services exam. The exam includes a breast exam and a pelvic exam. I have always avoided these exams for employment and school. I don't know how to avoid these medical school ones.
The problem is that I have ambiguous genitalia. According to Nigerian law I am a girl but according to American law I would be a man. I don't consider myself a boy. I have no breasts and inside I have male genitalia and I have a Y chromosome. But I have lived my life and I feel like I am a woman. If I tell anyone now I am afraid I will open a pandora's box both legally and medically. I am very upset, how do I get around it?
Lastly, I have been offered scholarships (little money) for being an African Women, it just gets more complicated.

 

[lukeday99]

Uhhhhhhh, you serious? Because if you are, no big deal, they're doctors. You'll still get your money, don't worry, it's illegal for them to discriminate against you based on physical characteristics. There is alot of stuff out there that states that legally, if someone considers themselves a certain gender, they are just that. Do no worry, get the exam but explain your situation to the physician beforehand. Wow, weird problems, but no big deal, carry on as you were before, and good luck!

 

[omores]

Bintu.

First of all, congratulations on getting into medical school and winning a scholarship!

The purpose of the physical exam they want you to have is -- I assume -- to ensure that you're healthy, physically capable of attending medical school, and don't have any diseases you might transmit to patients. Your genitalia, however ambiguous, should have no bearing on the matter.

Your medical records are confidential by law. What your doctor learns about you during your exam will not be divulged to the medical school administration or your fellow students. My advice is to have the exam, since this is a requirement for medical school, but explain the situation to your doctor. He or she is not going to force you into a pelvic exam if you don't have a vagina.

About the scholarship: since Nigerian law considers you female and you live your life as a woman, I don't think the Y chromosome is relevant. You're entitled to it. Enjoy.

 

[lessismoe]

hi Bintu,

Yes, congrats on your acceptances!

About your problem, I don't know exactly what your "ambiguous genetalia" look like, but maybe I can help a bit with my background in genetics. There are actually a couple of ways that one could be an "XY" female, and depending on your situation, you may or may not need to worry.

If you are like Jamie Lee Curtis, an XY female with a vagina-like blind duct, but no uterus and male gonads where your ovaries would be, then I'm almost positive that for all intents and purposes, you are 100% considered a woman legally.

If you have no opening and have female-like genetalia due to an estrogen release during development, things are a little fuzzier. However, I honestly think that, since you are legally a woman in Nigeria, if you tell your doctor this before your exam and, if you need to, remind him that this is very personal for you and you would like your records to be kept 100% confidential, I think you are going to be okay. I agree with previous posters that it would be extremely unethical and probably illegal for a doctor to disclose that information, and also for schools to take anything away from you.

Best of luck!

 

[lotanna]

I have been offered admissions at a few New York schools. Including downstate and upstate. I only applied to New York schools. I just got my green card a year and one half ago. I am from Nigeria.
My problem be that these schools want me to get a health services exam. The exam includes a breast exam and a pelvic exam. I have always avoided these exams for employment and school. I don't know how to avoid these medical school ones.
The problem is that I have ambiguous genitalia. According to Nigerian law I am a girl but according to American law I would be a man. I don't consider myself a boy. I have no breasts and inside I have male genitalia and I have a Y chromosome. But I have lived my life and I feel like I am a woman. If I tell anyone now I am afraid I will open a pandora's box both legally and medically. I am very upset, how do I get around it?
Lastly, I have been offered scholarships (little money) for being an African Women, it just gets more complicated.

Are u 4 real?
what Nigerian law?

 

[lessismoe]

Okay, so I just looked it up.

The law in this country concerning ambiguous genetalia is that the parents and the doctor can decide the child's sex at birth, but should the child later decide that that gender identity does not fit, the child has the option of changing his/her legal sex later on.

So, given that your parents and your doctor made you a woman legally in Nigeria, you are 100% considered a woman, no matter what.

 

[oldtimer]

If you are like Jamie Lee Curtis, an XY female with a vagina-like blind duct, but no uterus and male gonads where your ovaries would be, then I'm almost positive that for all intents and purposes, you are 100% considered a woman legally.

Are you serious that Jamie Lee Curtis is genetically male?? Damn, I got turned on by her stripping scene in True Lies too. With those tattas, there's no way, unless they're implants.

 

[lessismoe]

I didn't mean to gross you out oldtimer, but you know, there's a LOT more to "sex" than chromosomes.

So everyone knows that fetuses start out undifferentiated, as neither male nor female. This is also true of the germ line. At a certain point in development, the reproductive cells determine their ultimate fate by checking to see if there is a certain gene present (TDF- "testes determining factor") which is usually present on the Y chromosome. If TDF is there, the gonads turn into testes. If not, they turn into ovaries.

Now, meanwhile, the rest of the body tissues don't know any of this is going on. Presence of TDF only matters to the gonads. What your body tissues respond to is actually your sex hormones!! So, if you have testicles, you produce androgens that masculinize your tissues, and if you have ovaries, you produce estrogens that make you look like a woman (this is grossly oversimplified). So, if your mom pumps out a whole bunch of estrogen at some point in your development and you are a boy, you may be effeminized.

HOWEVER, Jamie Lee Curtis (who is a very beautiful woman) has a different problem. Her development got to the point where she grew her testes (which she had removed, btw) and they produced androgens, BUT she lacks the cell surface receptor on all of her cells which senses testosterone in the environment. Thus, she has excess testosterone, but her body can't sense it!! The excess testosterone is broken down, and gets converted into estrogen, which her body CAN sense, and she ended up as a very beautiful woman!

So, not to scare anyone, but this class of XY woman is usually very beautiful, and there is a larger proportion of these women in the entertainment field because they are so pretty. One of the only ways you can "tell" from afar if a woman is this class of XY is if she has no body hair... pubic included, which has always led me to wonder about the whole "shaved" thing in American Pie.

Just my 2 cents. Lecture ended

 

[oldtimer]

HOWEVER, Jamie Lee Curtis (who is a very beautiful woman) has a different problem. Her development got to the point where she grew her testes (which she had removed, btw) and they produced androgens, BUT she lacks the cell surface receptor on all of her cells which senses testosterone in the environment. Thus, she has excess testosterone, but her body can't sense it!! The excess testosterone is broken down, and gets converted into estrogen, which her body CAN sense, and she ended up as a very beautiful woman!

Wait a minute. Testosterone and estrogen are both steroids and as anyone who has taken the MCAT knows steroids can easily pass through the plasma membrane. Steroids bind to sites in the nucleus and not any surface cell receptors. Are you actually saying that testosterone can't bind to nuclear sites in Jamie Lee Curtis?

 

[Bintu]

Okay, so I just looked it up.

The law in this country concerning ambiguous genetalia is that the parents and the doctor can decide the child's sex at birth, but should the child later decide that that gender identity does not fit, the child has the option of changing his/her legal sex later on.

So, given that your parents and your doctor made you a woman legally in Nigeria, you are 100% considered a woman, no matter what.

These solutions don't get me around the potential problem.
Maybe some of you are right, the doctor would understand. But what if she/he doesn't? I don't have the money to shop doctors. I just want to wait until I have my MD degree and then I can afford a lawyer if there are any legal problems.
I still plead for help, how can I avoid these exams? The forms that I have to turn into the school asked the doctor to list anything abnormal about the area being examined. I all ready lie on the forms that ask about my period, when I first had it and how often and regular it is.

 

[SOBEIT]

Bintu,

Not to scare you in any way, but if I were you I would edit out the possible schools you will be attending from this post. I could be wrong but, I doubt there are all that many female Nigerian medical students without breasts at the schools you listed. It is unfortunate, but it seems that the pre-med crowd are some of the most immature people I have met and I would hate to see that have an impact on your education.

 

[scootad.]

What you are describing about Jamie Lee Curtis is Testicular Feminization Syndrome. You will learn this in medical school but Testicular Feminization is a defective DHT receptor. Testosterone normally gets converted to DHT by 5 alpha reductase. DHT is responsible for masculinizing the external genitalia (giving one a scrotum instead of labia majora, penis head instead of clitoris, etc.).

The OP is likely describing a different ambiguous genitalia disorder such as the 17,20 desmolase deficiency disorder which is a 46 XY (like Test. Feminiz) but in which pt has no breasts.

Good luck to the OP. You are a human being above all and should be treated like one.

 

[courtyard]

Now, meanwhile, the rest of the body tissues don't know any of this is going on. Presence of TDF only matters to the gonads. Just my 2 cents. Lecture ended

i am not sure, but i remember reading somewhere that actually other body tissues, (such as the brain) also detect these sex-determining factors like TDF. and subsequently, differentiation of male and female brain.
maybe i am wrong.

CY.

 

[lessismoe]

oh, duh! I'm sorry, oldtimer, you're totally right. Steroids diffuse through plasma membranes. It's the transcription factor inside the nucleus that it can't bind to, then.

As to your situation, Bintu, you have 2 things on your side. First, unless the medical school specifically wants you to release WHAT YOUR SEX IS, under HIPAA, it cannot be released. So, in this case, your doctor would be violating a SERIOUS law, in which case you have the right to sue and he is liable to be disciplined. So, you can always threaten with HIPAA if your doctor seems unsympathetic, which I would think unlikely. If you are seriously worried about how understanding your potential doctor will be, I recommend interviewing a few of them before choosing one.

Secondly, if somehow your med school found out and tried to take anything away from you, you DO have your legal sex on your side. If you have been living your life as a woman and your documentation from Nigeria says you are a woman, you are legally a woman. If worse comes to worse, though, you could probably find an advocacy agency to stand up for you. It would definitely be a case of discrimination. My suspicion is that, out of fear of bad PR, a med school would back down under the threat of suing, whether or not you have a lawyer.

 

[lessismoe]

Scootad and courtyard, you're both probably more right than I am-- I was trying to simplify things, and I'm sure I butchered some things along the way. Thanks a bunch for catching my mistakes and clearing things up!!

 

[krebse]

i am not sure, but i remember reading somewhere that actually other body tissues, (such as the brain) also detect these sex-determining factors like TDF. and subsequently, differentiation of male and female brain.
maybe i am wrong.

CY.

WTF? Am I the only one who read this thread expecting to not deal with MCAT-esque topics and listen to ridiculous premeds lecturing about testes determining factor? Seriously, chill, we all know how smart you are...

 

[lessismoe]

WTF? Am I the only one who read this thread expecting to not deal with MCAT-esque topics and listen to ridiculous premeds lecturing about testes determining factor? Seriously, chill, we all know how smart you are...

Sorry, Krebse, I didn't mean to "lecture". I was just trying to explain how complex the whole process of sex-differentiation is, and how it isn't so simple as XX vs. XY.

 

[fullefect1]

haha, so does this mean that I am gay, because i thought Jamie Lee Curtis was amazingly hot especially in those black panties? (i think they were black)

 

[lessismoe]

haha, so does this mean that I am gay, because i thought Jamie Lee Curtis was amazingly hot especially in those black panties? (i think they were black)

Well, if you think about it, aren't the tissues of her body developed like a woman's? So, you were attracted to the female tissues, which is definitely not gay.

I guess this is a philosophical question, but what do y'all think: Is sex a genotype or a phenotype, or a mental state (or a mixture)? I'm inclined to think it is a mental state, personally.

 

[jlee9531]

These solutions don't get me around the potential problem.
Maybe some of you are right, the doctor would understand. But what if she/he doesn't? I don't have the money to shop doctors. I just want to wait until I have my MD degree and then I can afford a lawyer if there are any legal problems.
I still plead for help, how can I avoid these exams? The forms that I have to turn into the school asked the doctor to list anything abnormal about the area being examined. I all ready lie on the forms that ask about my period, when I first had it and how often and regular it is.

well unfortunately you are required to take these medical exams to get into medical school. there is no way to get around them. the med schools have to be sure that you are of proper health. lying on the forms was not a good idea, but i guess you can still explain your side of the story when being questioned by a physician.

you say you have ambigious genitalia but you have no breasts and have a penis. do you have anything that would resemble any part of the female genitalia? Are you in the group of people that lessismoe has described? If you explain these things to a physician, I am sure you guys can talk about the options available to you to get on with everything.

 

[beanbean]

I wouldn't worry about the medical exam. Make an appointment to see a physician - perhaps a friend can refer you to one - and explain your situation. Plenty of woman decline to have pelvic exams during physical exams if they have not been previously sexually active and still have an intact hymen.

In regards to the scholarship issue...You have been raised as a female and are seen legally as a female in Nigeria. It should not be an issue.

It is important for you to find a doctor that you can be comfortable discussing your health with now and in the future.

 

[felipe5]

I agree with the previous posters....find a physician whom you can confide in and discuss this issue. Also, this brings up another interesting issue.....can medical schools decline your matriculation if you are found to have some sort of condition or disease???

 

[AlternateSome1]

http://www.snopes.com/movies/actors/jamie.htm

Are you sure Jamie Lee is a hermaphrodite?

~AS1~

 

[pigpen]

now i've heard it all...

 

[beriberi]

Medical schools can deny admission to people who cannot perform the tasks of being a doctor. They have easily excluded people who are in wheelchairs, have tremors, etc. They have knowingly admitted students with diabetes, epilepsy, bi-polar disease and more. There has even been a quadriplegic who has completed medical school in the United States with the help of a Physician Assistant.

Your concern, OP, should be that the medical school might find out something that would prevent you from performing the functions of a physician. Your disorder is not one of those things. You will be required to sign a form at some point where you will be asked to explain if you have any conditions that affect your ability to do a list of tasks. Again, should not be a concern.

You have not been deceptive to the medical schools in any way; there would be no appropriate way to tell them of your disease (unless you wrote the tragic personal statement about it). Because you believe yourself to be female, even accepting financial aid as an African woman is not deceptive. If a student was of black and white heritage but considered themselves black, there would be no problem accepting money intended for black students.

Finally, the medical school is in the interesting position of directly administering your health care for the next few years (at many schools, students do not have insurance but are providing care for their students by establishing a student clinic). For that reason, the medical school expects to know what type of health you are in before you arrive. It is that reason that they wish that you have a full physical exam.

For your own health, a full physical exam is important. I don't know what type of care you recieved in Nigeria, but if you have undescended testicles, these will need to be removed (there is a significant, about 2 percent, chance of cancer occuring). Secondly, you may need or benefit from hormone replacement therapy. As you stated that you have avoided such exams in the past, it is important that you see a physician now. Their honest reporting of your condition has everything to do with the University providing health care to you and nothing to do with you becoming a student there.

Lastly, the health care form (at my school) may not be required until you make use of health services. It may make you feel better to wait until you have begun orientation to hand it over. If it were me, I would send it now so that any questions (and I expect there should be NONE) would be out of the way and you could sleep better at night.

Please let us know how things go, I am confident this is a tremendous issue only to you (and not the medical school--which is how it should be).

 

[Newquagmire]

These solutions don't get me around the potential problem.
Maybe some of you are right, the doctor would understand. But what if she/he doesn't? I don't have the money to shop doctors. I just want to wait until I have my MD degree and then I can afford a lawyer if there are any legal problems.
I still plead for help, how can I avoid these exams? The forms that I have to turn into the school asked the doctor to list anything abnormal about the area being examined. I all ready lie on the forms that ask about my period, when I first had it and how often and regular it is.

i think the OP's concern is that with all these questions about sex and gender, the med school could cite the clause that something was found misrepresented with the applicant's characteristics or application.

i agree with jlee9531 that lying on the forms was not the best option (albeit too late to change), and also agree that completely avoiding the physicial will probably not be a likely option. good luck finding a physician who understands...

 

[IlianaSedai]

Bintu, congratulations on your acceptance, and best wishes deciding where you want to go.

The point has been made that you may not be able to avoid a medical exam. In the event that you have to undergo it -- like every other student -- perhaps the best approach I could suggest is simply to be honest. You do not need to lie about yourself. I think it is very unlikely you would lose your scholarships.

Sometimes we don't know how others will respond. We can only hope. But maybe hoping they respond well to our honesty is better than lying about ourselves year after year.

 

[Superwuwu]

Bintu, as you've probably noticed, a mojority, if not all of us here at sdn believe that you should not have a problem with your exam/medical school admittance. Now concidering that we represent the next generation of physicians, if we say it's cool then most likely the doctor/school will also understand. So, stop worring about the exam and start enjoying your multiple acceptances to med school.

 

[StanfordGirl]

To the OP: Congratulations on your acceptance and your scholarship!!!! I, like many others in this forum, believe you have not misrepresented yourself in any way and that all will be fine with your scholarships and with medical school. But it probably would be better for you to get the physical sooner rather than later so you can take this concern off your mind.

On a related note, perhaps I just haven't received this information yet, but are we all required to have a physical exam before starting med school?

 

[Spitting Camel]

About the physical, I think it's standard. I already got mine for BU (which they required)... My doctor was down there for quite a while

 

[MichiMO]

Okay, this may sounds stupid...but how can medical schools require a pelvic exam? That sounds crazy to me. General physical, immunizations...okay. But pelvic exam...it sounds like maybe it is just something on a generalized form that is not necessarily required. I don't know that they could actually require that. I would consult your school to make sure. I know it was definitly not required for my school.

 

[MichiMO]

"may sounds stupid"....sounds really stupid now

 

[StanfordGirl]

Thanks, AlreadyInDebt.

I was just curious, because none of the schools have sent me any information about a required physical exam or mentioned anything about it. How long after you were accepted did they tell you about this?

Thanks in advance.

 

[pigpen]

will this thread ever die?

 

[Blade28]

Wow, that is tough. Good luck, no matter what happens.

 

[Blade28]

What you are describing about Jamie Lee Curtis is Testicular Feminization Syndrome.

Thought this was just an urban legend, unverified?

 

[ndi_amaka]

Nigeria has a law like this?? Since when?? And all my school requires is an update of my immunization records. I did a search on here and no one has ever had to take a pelvic exam before entering med school...that has to go against some sort of right to privacy.

Something smells fishy.

 

[StanfordGirl]

Fishy Indeed! Of 5 schools, none has asked for anything more than an immunization update/record. Perhaps this comes later, but I can't find any info on the websites of any of the schools I applied to about mandatory pre-matriculation physical exams.

 

[Outer Space]

Okay, this may sounds stupid...but how can medical schools require a pelvic exam? That sounds crazy to me. General physical, immunizations...okay. But pelvic exam...it sounds like maybe it is just something on a generalized form that is not necessarily required. I don't know that they could actually require that. I would consult your school to make sure. I know it was definitly not required for my school.

Honestly, I don't think pelvic or any genital exam can be required in order to matriculate unless you are attending the US Health Services Academy. I don't think legally any school can force you to undergo it since reproductive health is not exactly crucial to being a competent doctor.

 

[indo]

Also, that whole Jamie Lee Curtis thing is a rumor that gets brought up in every genetics related class in every school in America. That story has about as much credibility as the Richard Gere/ Gerbil story.

 

[ndi_amaka]

The only thing is what would be the mtivation?? The thread doesn't sound particularly trollish.

 

[ndi_amaka]

Also, that whole Jamie Lee Curtis thing is a rumor that gets brought up in every genetics related class in every school in America. That story has about as much credibility as the Richard Gere/ Gerbil story.

What Richard Gere/Gerbil story?!

 

[StanfordGirl]

The only thing is what would be the mtivation?? The thread doesn't sound particularly trollish.

Maybe just a misunderstanding. As one of the previous posters suggested, a physical exam could be "strongly suggested" for the health of entering students but not mandatory...

 

[indo]

What Richard Gere/Gerbil story?!

Its not for SDN consumption. Search for it on google and I think you'll find the story. BTW, is that how gerbil is spelled? Gerble, gerbil. hmm.

 

[jlee9531]

Nigeria has a law like this?? Since when?? And all my school requires is an update of my immunization records. I did a search on here and no one has ever had to take a pelvic exam before entering med school...that has to go against some sort of right to privacy.

Something smells fishy.

some schools dont accept an update of just immunization records. need to get titers etc...

 

[supereagles]

Are u 4 real?
what Nigerian law?

As a fellow Nigerian, this story appears highly suspicious but in the event that it is true, i don't think you would have that much of a problem. As a Nigerian born Citizen, you have always been classified as a female. Ignorance could certainly work to your advantage and in regards to confidentiality, I doubt if any doctor would go against your wishes and make your case public. Anyway, Congrats on your acceptances and keep that flame alive. You are certainly an inspiration to us all.

 

[NRAI2001]

cough cough troll cough

 

[NRAI2001]

He has only two posts, hes obviously a troll.

 

[ndi_amaka]

some schools dont accept an update of just immunization records. need to get titers etc...

And so??? A blood serum test will suffice in that case. What does that have to do with getting a pelvic exam?

 

[godmode]

the fact that jamie lee curtis is an xy female is an urban legend. dont believe everything u hear... nobody knows for sure