A 25-year-old woman in eastern China who failed to fall pregnant after 12 months of trying, was shocked to discover she was actually born male and is intersex .

The woman, whose external female genitalia never forced her to question her sex, stumbled upon the discovery after an X-ray of her injured ankle was taken in a hospital in her hometown.

When the X-ray revealed that her bones had not developed past the age of adolescence, the doctor’s further probing uncovered the fact that Pingping, whose name has been changed to protect her identity, had never menstruated. She said she’d turned a blind eye to it out of embarrassment.

“When I was young my mum took me to the doctor. The doctor said I was just developing slower than others sexually, and that I could have my period in a few years,” she told the local doctor.

“After I grew up, I found this issue quite embarrassing so I didn’t treat it seriously.”

Despite the lack of menstruation, Pingping had no reason to suspect she was anything other than a biological woman because she had external female genitalia, the First Affiliated Hospital of College of Medicine, Zhejiang University said in a statement posted on WeChat this week.

During a visit to an endocrinologist at the hospital, Pingping said, “My husband and I have been trying to have a baby for a year although it’s been in vain. Is that also related [to my bone age and absence of a period]?”

Test results indicated that she suffered from high blood pressure and low blood potassium, a typical symptom of a disease called congenital adrenal hyperplasia, which could lead to a sexual development disorder. Doctors said this was possibly as a result of her parents being closely related.

The case highlighted the long-term problem of China’s sexual illiteracy and lack of compulsory sexual education in schools, one expert said.

A genetic test revealed her karyotype was 46,XY, a pattern normally found in males who have genitalia that is not clearly male or female, said Doctor Dong Fengqin, the endocrinologist.

Pingping learned that while she had no uterus or ovaries, she also lacked male genitalia or an Adam’s apple.

“We didn’t find hidden testes in her body, either. Maybe that’s because she’s old enough and it has degenerated and atrophied,” Dong was quoted as saying.

While her blood pressure and potassium levels are now under control, the hospital said she had not yet made up her mind about which gender she wanted to be.

Hu Shaohua, deputy director of the hospital’s Mental Health Center told the Post that physical issues aside, the most important thing now for Pingping was to rebuild a gender identity.

“It takes a long time to rebuild the social role and reconstruct the family and it’s going to be a painstaking process, where psychological intervention is necessary. But Pingping has not asked for help from us so far,” Hu said.

The doctor said earlier detection by the family would have made the process easier.

“They should have gone for check-ups years ago. This shows how seriously they lacked sexual knowledge,” he said.

Pingping’s parents’ consanguineous marriage and their ignorance of her condition highlighted the urgency of immediate and better sexual education in China, he added.

Although there are lessons on sexual health in textbooks, they are often skipped or briefly touched upon by biology teachers who find teaching the subject awkward.

From June, a recently amended law protecting minors, will require schools and kindergartens to conduct “age-appropriate” sex education.

This article was first published in South China Morning Post.

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