Intersex people or khunthā in the Middle East – How they are perceived, accepted, & treated: qualitative evidence synthesis & framework analysis

ABSTRACT

In Islamic fiqh (jurisprudence), an intersex person is called a khunthā. This research aimed to synthesise the existing literature exploring data on khunthā in the Middle East on how they are perceived, accepted, and treated. Qualitative Evidence Synthesis and Framework Analysis. Five electronic literature databases were searched, covering the fields of healthcare sciences, ethics, and religion from 2016 to 2022. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), six studies were selected for final review and framework analysis. The framework analysis (FA) of included studies resulted in three themes and nine sub-themes: 1) ‘Gender manifestation’ - (i) Parental role and influence, (ii) Health outcomes of experiments, (iii) Socio-cultural prejudice; 2) ‘Physicians as decision makers’ - (i) Experiments vs. knowledge, (ii) Intersex vs. khunthā vs. DSD, (iii) Fixing dysfunctional gender; 3) ‘Islamic bioethics’ - (i) Legal and financial importance of gender, (ii) Scientific evidence vs. symbols, (iii) Medical ethics. Parents and physicians’ decisions are heavily influenced by socio-cultural attitudes about sex and gender, with a lack of sensibility for intersex persons at the later stages of their lives, and attempts to conceal this ‘imperfection’ by ‘fixing dysfunctional gender’.

KEYWORDS:

• Sex and gender
• intersex
• khunthā
• social attitudes
• Islamic bioethics

Acknowledgments

The author would like to express his immense and sincerest gratitude to Yale Interdisciplinary Center for Bioethics, where he conducted this research. The research would not have been possible without the genuine support of the centre. He also would like to extent his deep and unreserved gratitude to faculty, peers, and Harvey Cushing & John Hay Whitney Medical Library at Yale School of Medicine.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

PROSPERO statement

The review protocol was published in the international prospective register of systematic reviews (PROSPERO) website – registration number CRD42023425584.

Notes

1. As part of this research work, terms were used to represent a holistic picture of the subject. None of the terms used are intended to offend or violate the rights of DSD people in any part of the world but rather to discuss knowledge gaps and encourage further in-depth research.

Additional information

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.