Abstract:

Intersexuality includes a variety of conditions in which there is a mismatch between the external and the internal genitals (the testes and ovaries). There are several possible causes, the most common of which is congenital adrenal hyperplasia. People affected by intersex struggle with psychological, social and health difficulties, and are often rejected and misunderstood by society. Some of these disorders are based on rare mutations that alter the expression pattern of different enzymes involved in biochemical pathways. As a result, the synthesis of some hormones (cortisol, androgens, progesterone, oestrogens) is altered and crucial physiological processes (e.g., hypothalamic-pituitary axis) are disregulated, leading to a range of health dysfunctions and an intersex phenotype. To study these conditions, we created a seminar, based on active learning, in which a small group of first-year medical students were confronted with different learning challenges. Our main objectives were to address the different dimensions of sexuality (psychological, social, biological), delving into the biochemical aspects of 4 selected disorders. We also discussed the ethical aspects involved in medical procedures, and patients' experiences and testimonies. To conduct our goal, we create a collection of different materials (articles, videos, quizzes, Instagram stories, informative publications, etc.) that allowed the students to learn about a previously assigned disorder. We started the session by showing a photo gallery with portraits of different people (all having an intersex condition, although the students were not informed about that detail) and collected students’ thoughts and reflections to the question “What do you appreciate in each photo?”. We went back to this issue at the end of the seminary. The students then worked in small groups of 4 people for 90 minutes, after which the main topics were exposed in a round table discussion. This was followed by a documentary film showing a patient's experience and testimony, and an informal discussion. Finally, we asked the students to rethink their previous responses to the gallery slide show, telling them now that all the people in the photos have an intersex disorder. We also encouraged them to express their opinions and reflections on the seminar, on the ethical implications regarding the medical procedures studied, or anything else they wanted to express in relation to the topic studied. This final reflection was individual and anonymous. One week after the end of the seminary we sent an opinion survey to the students, to collect their impressions on different aspects of the seminary. Moreover, we analysed the responses to the final reflection activity following a specific protocol for qualitative research. We assigned the different reflections into categories in order to discuss and deduce conclusions. This final part of the project is still ongoing, and we estimate that it will be completed by the end of August.

Keywords:

Intersexuality, Biochemical pathway, ethics, medical procedures, patient experience, rare mutation.