In Call the Midwife Season 8, Episode 5, Dr Patrick Turner (Stephen McGann) and Nurse Trixie Franklin (Helen George) help a young bride-to-be Lois Parry who comes to the new cervical screening clinic for a smear test but is found to have no womb or ovaries.
She later admits to nurse Trixie that she has never had a period. It turns out that she had been pretending to her family and friends that she was having periods.
The doctors confirm that she is an intersex individual with a condition called testicular feminization syndrome.
Lois is distraught to learn that she will never have children the natural way and she attempts suicide. But her family gives support and when her fiance learns the truth he says he still loves her and that he still wants to marry her.
Since the episode aired on PBS many fans have since been wondering what testicular feminization syndrome is.
Here is everything you need to know about the rare condition.
What is testicular feminization syndrome?
Lois Parry appears to be female and believes she is female because she has what appears to be a normal female anatomy. But as her wedding date approaches she becomes concerned about her reproductive health because she has never seen her period although she is 22-years-old.
Lois is eventually diagnosed with a rare intersex condition called testicular feminization syndrome which medical experts now refer to as androgen insensitivity syndrome (AIS).
Intersex individuals with the condition used to be called hermaphrodites but medical experts have since dropped the term because it is considered not only technically inaccurate but also offensive.
AIS is a genetic condition that the mother as a carrier passes to her child. Individuals with the condition are genetically male because they have the X and Y chromosomes but the outward appearance of their genitals is female.
The condition develops because the bodies of individuals with AIS are insensitive to the effects of testosterone which is the male sex hormone. The inability of their bodies to respond to testosterone makes them unable to develop into normal adult males.
In the typical case, the penis fails to develop and the testes may partially or fully fail to descend. The result is a genetically male individual with external genitalia that looks female. But what looks outwardly like a vagina is usually a short pouch and there are no ovaries, a womb or other related structures, such as the Fallopian tubes.
Instead, there is a testis or both testes either located where the ovaries should be or only partially descended.
Due to the absence of normal female sex organs, including a womb and ovaries or a penis and testes, intersex individuals are unable to have children.
AIS manifests in different forms and depending on the form, individuals may be diagnosed at birth or much later in life.
It is better for the condition to be diagnosed very early in life, especially at birth, because diagnosis later in life when the individual has reached adulthood can result in serious emotional or psychologically trauma.
When the diagnosis occurs early in life, parents usually have to decide whether to raise the child as a boy or as a girl. With recent developments in medicine and surgery, it is possible for people diagnosed with the condition to undergo surgery to make the genitals male or female.
Patients can also undergo hormone therapy so as to promote the development of either male or female sexual organs.
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