Status of Women in Islam by Yusuf Al-Hajj Ahmad

Key tasks that, over the past few decades, have caused much controversy among patients, their families, and clinicians involved in their care include (1) gender assignment, (2) gender-affirming surgery, and (3) disclosure of information.

Management of patients with disorders of sex development (DSD) is undoubtedly challenging. To ensure holistic care, health-service providers involved in the care of Muslim patients with DSDs need to be aware of the Islamic perspectives on gender-related issues and involve expert religious authorities. Gender-related issues from the perspective of Islamic jurisprudence are highlighted and discussed. For purposes of illustration, this article includes three case reports on Muslim patients with DSD in Malaysia, focusing on issues of gender assignment: (1) a patient with 46,XX CAH, assigned as female, requesting reassignment to male (2) a patient with 46,XX CAH, assigned female, and gender dysphoric, but undecided on the gender to be and (3) a patient with 46,XY complete gonadal dysgenesis, raised female due to her phenotype at birth, diagnosed late, at age 18 years, and content to remain female. The different schools of law in Islam agree on some aspects of gender-related issues like the position of khunsa in prayer congregations, but differ in their opinions on others such as property inheritance and bathing rituals. A recent fatwa (religious edict) in Malaysia decreed that it is permissible for male-assigned patients from these two groups to have gender reassignment surgery to female following diagnosis however, the religious authority has yet to rule on the reassignment from female to male, if requested.

Two types of khunsa are distinguished: wadhih (discernible) and musykil (intractable). In Islam, the person with somatic sex ambiguity due to a disorder of sex development (DSD), such as 46,XX congenital adrenal hyperplasia or 46,XY androgen insensitivity, is recognized as khunsa.

Status of Women in Islam by Yusuf Al-Hajj Ahmad