Intersex treatment: controversy and debate
What is the best course of treatment for children born with biological sex characteristics that aren't easily classified as male or female, commonly known as intersex?
This is a contentious issue for doctors, parents, and affected individuals.
For many years, it was common practice for doctors to operate on babies born with atypical sex development. Other medical interventions, including additional surgeries and hormone treatments, were also performed on children and adolescents (Greenfield, 2014).
Sometimes medical interventions were necessary to protect the health of a person born with an intersex condition, or to make sure that basic bodily functions are not impeded. Other times they were purely cosmetic.
In cases where a baby was born with ambiguous genitalia, doctors performed surgery to masculinize or feminize their body. The assumption was that children raised as male or female would identify accordingly.
A particularly famous case bolstered these beliefs. In 1966, a botched circumcision left an 8-month-old child without a penis. Johns Hopkins psychologist John Money persuaded the child's parents to have doctors perform sex reassignment surgery, accept subsequent hormone treatments and raise their child as a girl.
Dr. Money widely proclaimed the procedure to have been a success. He reported that the child--Brenda Reimer--was successfully raised as a girl. However, in 1997 it was revealed that Reimer had never adapted to identifying as a girl; as an adult, he took the name David and attempted to reverse some of the physical consequences of previous medical interventions. Tragically, David Reimer committed suicide in 2004 at the age of 38; his parents blamed their son's death on the psychological consequences of Dr. Money's treatment.
Dr. Money's premise--that doctors could successfully assign gender via medical intervention--contributed to the treatment of children born with an intersex variation for several decades. Doctors did not always communicate openly with parents about their child's situation, and many children grew up not knowing the truth about their bodies (Greenfield, 2014).
Beginning in the 1990s, these medical practices came under increasing scrutiny, with surgeries performed to normalize babies' genitalia coming under especially harsh criticism (Reardon, 2016).
Critics argued that children’s bodies were needlessly subject to risky operations and other treatments. Some procedures had unintended and painful side-effects, and resulted in infertility or loss of sensation.
At the same time, researchers and intersex activists raised questions about doctors' ability to accurately assign a gender to babies born intersex. Previously it was common for doctors and others to believe that gender was largely a function of socialization. The assumption was that doctors could assign a gender by performing the corresponding surgery on a child born with atypical or ambiguous sex anatomy.
Now, contrary to expectations, time has shown that gender cannot simply be "assigned." Some surgeries on children born with atypical sex anatomy have resulted in gender dysphoria, a condition where the assigned gender does not match a person’s gender identity – a deeply felt, internal sense of who they really are (Greenfield, 2014).
People with gender dysphoria experience acute psychological distress and feelings of being in the wrong body. This distress can be compounded for individuals with intersex variations, whose bodies have been irreversibly altered in ways that contradict their deepest sense of self.
In other words, doctors sometimes get it wrong when it comes to assigning the gender identity of a person born with an intersex variation. This can be a mistake with potentially devastating consequences for the affected individuals. Nevertheless, many parents request surgery for their child out of concern that the child will be stigmatized by their peers if their anatomy doesn't look "normal," and some individuals express appreciation for early medical intervention, noting that surgery and hormone treatment allowed them to come of age with physical features that match their gender identities.
Pressure from intersex advocates, coupled with advancing medical knowledge, has resulted in significant changes in the treatment of persons born with intersex traits. While there is still no consensus about the best approach, doctors are taking a more cautious approach to performing surgery and determining gender. Many are also taking a holistic approach to the care of children affected by an intersex variation, as well as doing more to communicate openly with parents and children themselves as they grow older (Viewpoints on DSD Care).
Read this article in Atlantic Magazine to learn more about debates surrounding medical treatment and gender assignment.
The geneticist Eric Villain has recently come under fire from intersex advocates for refusing to condemn all sex-assignment surgeries and the doctors who perform them, preferring instead to advocate for a case-by case approach. To learn more about the different viewpoints vis-a-vis sex assignment surgeries, take a look at this article published in the online journal Nature.
In 2013, parents of an intersex child brought a landmark lawsuit against the hospitals and doctors who reconstructed “M’s” genitals shortly after birth. Operated on to look more like a girl, M identifies as a boy. The case was closely watched because it was the first time that intersex surgeries were challenged in court. For more details about the lawsuit over baby “M,” take a look at this article.
Ghcorayshi, A. (2017, July 26). A landmark lawsuit about an intersex baby’s genital surgery just settled for $440,000. BuzzFeedNews. https://www.buzzfeed.com/azeenghorayshi/intersex-surgery-lawsuit-settles?utm_term=.if24OoWmp#.ot31g2...
Greenfield, C. (2014, July 8). Should we ‘fix’ intersex children? Atlantic. https://www.theatlantic.com/health/archive/2014/07/should-we-fix-intersex-children/373536/
Reardon, Sara. (2016). The spectrum of sex development: Eric Vilain and the intersex controversy. Nature, 533(7602), 160-163. https://www.nature.com/news/the-spectrum-of-sex-development-eric-vilain-and-the-intersex-controversy-1.19873
Viewpoints on DSD care. (n.d.). Accord Alliance. http://www.accordalliance.org/resources/viewpoints-on-dsd-care/
DeeWho is Dee?
Gender Identity Our core sense of who we are as a man, a woman, a mixture of both, or neither.
Gender Expression How we show up in the world through choices like clothing, hair style, mannerisms or tone of voice.
Attraction How we feel toward others sexually, romantically and/or emotionally.
Biological Sex Physical attributes such as reproductive organs and genitalia, chromosomes, genes and hormone levels.
Are you curious to learn more about the different viewpoints on how best to care for persons born with an intersex condition/DSD? The Accord Alliance, an organization dedicated to the care of people affected by DSDs, has compiled a variety of perspectives you can access here, including statements from medical and professional organizations, human rights organizations, and media outlets.