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Imane Khelif Unfairly Attacked: What is Swyer Syndrome?

The boxing match between the Algerian and the Italian boxer in Paris 2024 has become a political affair.


Originally published on: La Voce Di Newyork




Imane Khelif Unfairly Attacked: What is Swyer Syndrome?
Imane Khelif of Algeria (Red) Angela Carini of Italy (Blue) in action during their women's 66kg preliminary round of 16 bout of the Boxing competitions in the Paris 2024 Olympic Games, at the North Paris Arena in Villepinte, France, 1 August 2024. ANSA / CIRO FUSCO


Swyer syndrome, or pure gonadal dysgenesis, affects patients who present a discrepancy between karyotype and sexual phenotype. Basically, they present with external female genitalia, which have not completely developed due to the absence of ovaries and the presence of a small uterus. This very rare condition belongs to the group of "disorders of sexual development." Patients affected by Swyer syndrome, after a thorough gynecological examination and tests on sexual hormones, present with altered sex hormones due to the absence of the SRY gene and experience intersexuality, socializing as women.

 

They can also have children after therapy and egg donation, although with all the difficulties associated with a small uterus and other hormonal implications. Being born with this syndrome is a physical and psychological challenge that is full of uncertainties and often requires psychological support as in fact many of the secondary sexual characteristics, such as breast development and menstrual cycle do not appear. The karyotype reveals XY, male chromosomes, while imaging shows the presence of a uterus.

 

This translates into a complex process that affects the missing "sexual differentiation." A recent publication in the journal "Gynecological Endocrinology" reported for the first time in the scientific literature the case of three sisters with a female phenotype and a male karyotype, all with different implications for general health.

 

To clarify, this syndrome is impactful and present at birth, and there is no talk of "transition" to male sex. Subject are born as woman and asks to express herself and socialize as intersexual individual, presenting others as woman in all cases, including sports.

 

Now this syndrome has come to the fore and gained enormous resonance due to the story linked to the boxing match at the Paris Olympics, which was held for only 46 seconds, despite fierce controversy regarding the alleged unequal performance of the two athletes, one Italian and the other Algerian, who is intersex. The match was authorized by the Olympic Committee based on the intersex athlete hormonal levels, which were within the permitted limits and the parameters of the Olympic rules.

 

The bone structure of a patient affected by Swyer syndrome is stronger, but there are no references associated with physical strength, muscle development, or differences in performance as compared to "normal" athletes. The presence of XY chromosomes is linked to the "malformation and deficiency of the SRY gene." Thus, the match could be played safely, given that science and the Olympic Committee had considered it "acceptable."

 

The fact that an athlete with a very rare syndrome cannot participate in an international competition such as the Olympics without being attacked by jokes, political attacks, prejudices, and pseudoscientific theories is very serious. This is even more so if we consider the difficult path that any person with this genetic condition faces from birth. Being intersex is a complex condition, both physically and psychologically, which does not require ideological, cultural, political, or religious implications but the sporting world, which is inclusive, can resolve by providing better clarity.

 

The personal choice of abandoning the match made by Angela Carini, who felt she had to leave because she perceived an unequal match up and danger to her safety, must be respected and understood, especially considering the ferocious controversy, which certainly had a significant influence on her choice and the state of mind in which she arrived at the ring.

 

Anyone who states that "special" categories, are an inconvenience for the Olympic Games, is discriminating. This is not a question of physical issues, but of identity. Born a woman, Imane Khelif has fought in the women's boxing category since she was a child and won a silver in Istanbul in 2022. However, in 2023, at the World Championships, she was disqualified for high levels of testosterone.

 

Fair competition has always been present in Khelif's path, which has suffered for the fact that parameters for minimum hormonal values are not aligned between different associations at international level. It may be necessary to intervene and agree upon with a single rule at world, European, or Olympic levels to avoid confusion.

The problem of safety in contact sports is a major issue that must be resolved on a case-by-case basis without impeding the rights of expression of an athlete with a syndrome that does not impact the fairness of a competition. Imane Khelif suffered a disproportionate, discriminatory attack for an Hormonal imbalance not strength.




Professor Antonio Giordano, M.D., Ph.D., is the creator and head of the Sbarro Health Research Organization, located at Temple University's College of Science and Technology in Philadelphia. Stay connected with him through his various social media platforms, including Facebook, LinkedIn, Twitter, and Instagram, to receive the latest updates.

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