“I knew something was wrong when as a girl, I didn’t have feelings for boys. I was attracted to girls instead.” Tommy [not real name] from Lamwo District in Northern Uganda says as he lowers his head to examine his large roughed palm hardened by years of domestic chores and gardening as the world assigned him traditional African female gender roles. Tommy was born with two genitalia – both male and female.
In most cases, because ambiguous genitalia resemble the vagina more than the penis, parents often choose for them to become girls. So, with a surgical intervention, the genitals may be wrongly reconstructed to form a vagina. This cannot be undone, posing a lifelong challenge to one’s health.
A long stare into an empty space as though in meditation, Tommy was a bit shy as he looked up, gathering all his strength from within to tell this journalist how the 19 years of his life had more questions than answers. He wished he could open up and let the world know that his body spoke manhood when he became a teen.
“I was told I could get help and that my condition could be corrected at Lacor Hospital. I was initially scared, but Dr. Moses and our village catechist assured me that all shall be well.” The surgical procedure came with anxiety, and emotions, as the thought of finally becoming a male lingered in his mind.
Throughout his childhood, Tommy’s body defied clear gender identity. His parents decided he would be female and dressed him in girl clothes to avoid raising eyebrows in a village so immersed in superstition that identity squabbles could easily slip into witchcraft whispers.
Known to the world for fifteen years as Sheila, Tommy’s mother had a little suspicion because she saw that whenever her baby would urinate, something seemed to be blocking urine passage. But she would quickly dismiss the thought after convincing herself that it was the labia majora, a prominent pair of cutaneous skin folds forming the lateral longitudinal borders of the vulval clefts that interfered with the passing of urine.
Society knew Tommy as a girl, something that he too believed.
But as he grew older, his peers began noticing some differences. While bathing in a stream at the foot of Lamwo Hill, where they go to fetch water, his female friends noticed that his genitals were different from theirs and teased him about it. This forced him to withdraw from showing his nakedness to his colleagues.
That awkward encounter only compounded his misery. “Whenever someone gets annoyed with me, they would just say; ‘ah, even you’re two in one’ and my life was not easy,” Tommy narrates.
The news of him being intersex was the talk of the village and as the bullying intensified, Tommy and his parents sought answers. “We suffered greatly,” Tommy’s mother confides. “We even sought answers from traditional healers, hoping to solve the mystery of our child’s condition.”
Apart from having ambiguous genitalia, Tommy experienced pain in the waist akin to menstrual pain except that he shaded no blood. This pain that came once every month and lasted 2-3 days, made Tommy and his parents believe even more that he was a girl.
But it wasn’t until the cusp of adulthood, at fifteen, that Tommy’s inner turmoil began to find a voice.
“I started developing feelings for girls, but I could not tell anyone,” Tommy recalls. “When I reached primary five, I started changing the way I dress.”
He adds, “I started refusing to do the things that girls do. I would sit in the evening among men at the fireplace and I would refuse to go inside even if they yelled at me.”
Realising the magnitude of the situation, his father, Mr. Okumu, decided to examine him although with a lot of fear.
“He was a grown-up already and I was afraid of seeing the nakedness of my daughter, but the situation was getting out of hand, so I decided to do it myself,” Mr. Okumu recalls. By this time, he had separated from Tommy’s mother for nearly ten years.
After the examination, Mr. Okumu was convinced that Tommy was actually a boy as evidenced by the emergence of a tiny penis, from what they had thought was a clitoris. He gave him a new name and from Sheila, he became Tommy.
But Tommy needed more than just a change of name to be a man. His penis was curved and had never known what a proper erection felt like. It was then that he decided to seek answers in the medical world.
At Potika Health Center II, Tommy met Lubanga Onena Moses, the in-charge of the facility who ran a youth-friendly service that provided a safe space for Tommy to open up.
“When I met Tommy and his family, I knew we had to act,” Moses recounts. “Connecting them to Lacor Hospital was the first step towards a solution.”
Lacor Hospital is one of the largest private not-for-profit hospitals in Sub-Saharan Africa. The hospital conducts an annual pediatric surgical camp that treats conditions such as Tommy’s. This camp brings in specialist surgeons from Surgery for Children, an Italian organisation that helps children around the world access quality care for free.
Tommy was wheeled into the operating room on April 13, 2024, and what followed was more than a medical procedure; it was the sculpting of Tommy’s true self, as his body was aligned with his male identity.
“All I wanted was to be made a man as I have always felt, but I still look like a girl in my opinion because I still have to squat when urinating as the urine would scatter everywhere if I try to stand,” said Tommy after the surgery.
Dr. Martin Ogwang, the Institutional Director and a Consultant Surgeon at the hospital, explains Tommy’s condition in medical terms. “There was a wound from where the urine was coming and the testes were hidden and swollen on both sides, so they [parents] mistook that appearance for a vagina.”
He described the ambiguity as undescended testes which also affected the growth and development of the penis and the urethra, causing him to pass urine through an opening on the urethra at the side of the penis.
“When we’re formed we [both male and female] all look the same. The scrotum and the labia look the same. The only difference is that for a man, instead of having the labia, you have a testis inside there and the two fuse together,” he said. “The clitoris of a woman is actually what we call the penis in a man. What changes is just the hormones.”
He further explained that it is the testosterone hormone that makes the penis to grow. But Tommy did not lack the testosterone hormone, so the surgeons only worked on the undescended testes. Dr. Ogwang said that the urethra was not in its natural position which caused the penis to bend and curve inwards, making it look like a vagina.
“The goal of the surgery was to improve the physical appearance and function of the genitalia. So, the undescended testes were released and secured in place to prevent them from moving back up into the groin.”
Dr. Ogwang believes that the pain Tommy experienced in the waist was due to the pressure exerted on the testes held up in the groin.
Although the surgery was a success, Tommy will have to wait until next year when the Italian surgeons will perform the second surgery to know if his transformation into a man is complete.
Next year’s surgery will involve, placing the urethra in its natural position, closing the opening at the side of the penis and creating an opening on the tip of the penis to urinate normally. The team hopes that this will straighten the penis and allow him to form and sustain erection.
“Before he can think of having a family, we’ll have to examine his ability to form mature sperms because the testes remained in the groin for so long and this could have affected his ability to produce healthy sperms,” says Dr. Ogwang.
According to Dr. Ogwang, the surgery Tommy underwent could cost as much as $20,000 and it requires specialist surgeons like those from Surgery for Children. Unfortunately, for many like Tommy, this could be a dream too far in a region with a very high poverty rate.
According to the latest data from the Uganda Bureau of Statistics (UBOS), the poverty rate in the Northern region of Uganda is 63%. This makes it the region with the highest level of multidimensional poverty in the country.
The term intersex has been used to refer to variations in sex characteristics that do not fit typical binary notions of male or female bodies. It’s a rare occurrence, affecting approximately 0.05% to 1.7% of the global population according to the World Health Organisation.
Historically, intersex people were often killed in African traditional societies, and mothers were accused of witchcraft according to a 2013 report by Nkumba University on the plight of intersex people in Uganda. In Acholi in particular, they were alienated and considered messengers of deities (jogi).
“My financial situation started improving shortly after Tommy was born and people started saying that we sacrificed our baby to get rich,” says Mr. Okumu, Tommy’s father.
Tommy’s transformation left many in shock, including his childhood friends. “We played together, grew up together, and always saw Tommy as one of us girls,” says Laplan Jennifer, a close friend. “But we started asking ourselves many questions when we saw him wearing trousers and his name was also changed.”
Anek Consy, a traditional birth attendant who has delivered many women for more than 24 years, recalls the day Tommy was born.
“I saw a baby girl,” she says, still visibly shaken by the memory. “To hear that this child is now a boy, it’s something that I never expected.”
Post-surgery, Tommy has embraced traditionally male roles in society. “I plough with oxen, and cut trees,” he says, “but I still enjoy the games I played with the girls. They understand me.”
Now at nineteen, Tommy looks to the future with renewed hope. His female friends promised to help him find a girlfriend.
Although surgical interventions give intersex people acceptance, Patricia Atto, who herself underwent a similar procedure and is now working with an intersex organisation, believes that more needs to be done beyond the surgical intervention.
“My experience with this surgery has been life-changing,” she admits.
Her organisation is following up on 38 intersex people who underwent transformative surgeries, understanding the challenges children are facing while growing up including issues of hormonal imbalance, metabolism that causes obesity and those assigned female genitals failing to develop breasts.
“Most of the surgeries have been reconstruction of vaginas, but for a child who has grown without breasts and the system down was already manipulated, it becomes very difficult for medical practitioners to reverse [make them male],” she says.
The biggest challenge for the intersex community in Uganda is perhaps the Anti-Homosexuality Act. Signed into law in May 2023, the Act has had significant repercussions for the LGBTQIA+ community, including intersex individuals. While the Act primarily targets gay and lesbian individuals, its broader effects extend to intersex people who face increased stigma, discrimination, and vulnerability due to the Act’s harsh provisions.
Section 14 of the Act allows for forced medical examinations to gather evidence of homosexual conduct. Intersex individuals might be subjected to invasive and non-consensual medical procedures, violating their privacy and bodily autonomy.
“We cannot easily visit the hospital. We always live in hide and seek. We want to visit any health facility and be treated without being asked too much of who you are,” says Atto.
Chapter Four Uganda, an independent not-for-profit organisation dedicated to the protection of civil liberties and promotion of human rights for all, raised concerns about the broad impact of the Act in a report published in November 2023.
“The vagueness and overbroad reach of the Act’s text ensures that the conduct of a wide range of actors, including those outside of the community, can be criminalised,” reads the report in part.
The lack of community sensitization and awareness means that many mistake intersex people for being gays and lesbians causing a lot of persecution, trauma and stigma. Uganda also lacks comprehensive legal protection for intersex people, leaving them vulnerable to harmful surgeries and non-consensual cosmetic interventions.
This story was produced with support from the Aga Khan University’s Graduate School of Media and Communications under the Advancing Gender Equality in Media and Communications (AGEMCS) fellowship project.