Some interesting debate has been going on in the circumcision post about genital surgery on children. Therefore, I felt it was time to bring up one of the most important and overlooked issues about children and genital surgery.

The intersex.

An intersex person was born with anatomy that doesn’t match the ordinary definitions of female or male: for instance, an intersex person might have some cells with XY and some with XX chromosomes, or female-type anatomy on the outside and male-type on the inside, or female genitalia without a vagina. Somewhere between 1 in 1500 and 1 in 2000 babies have anatomical differences so severe that a specialist in sex differentiation is called in; others may discover their intersex condition at puberty, when trying to reproduce, or when autopsied at death.

Traditionally, intersex conditions have been treated using a strategy called the ”Hopkins model” or the “optimum gender of rearing” system. Gender was believed to be 100% a social construct; if you took a child who was born female and made her body look like a boy’s and made her and her parents believe her gender assignment, then she would essentially become a boy.

In support of a child acquiring a “normal gender,” doctors would often lie to their patients about their intersex condition, often hiding their medical records. Even worse, doctors would perform “normalizing” surgery on the genitalia of children. For instance, the American Academy of Pediatrics recommends that “infants raised as girls will usually require clitoral reduction,” although it reassures the reader that “current techniques will result not only in a normal-looking vulva but preservation of a functional clitoris.”

Oh good. I’m so glad that not only is the genital surgery you’re performing on children will lead to them not only looking normal, which is clearly the important bit, but a clitoris that’s functional and everything. It’s not like cutting off part of a person’s clitoris and/or penis could possibly interfere with their future sex life!

There is no medical evidence which suggests that performing cosmetic surgery on children’s genitalia to make them more conventional-looking makes the child have better life outcomes. The development of “normal” genitals is not necessary for someone to identify as male or female. It is one of the key insights of trans activism that gender is not based on genitalia, but on identity. If a person with a penis identifies as female, then she is a woman; if a person with a vagina identifies as male, then he is a man. If a child with ambiguous genitalia identifies (or, practically, is identified based on hormonal, genetic and radiological tests, subject to the child’s own self-identification later in life) as one gender, then that child is that gender.

Without those concerns, many of the reasons for the surgery on children’s genitalia are for the parents: they might be distressed at the sight of their child with an intersex condition; the parents might have to explain it to family members and babysitters. In addition, the child may be bullied for his or her genitalia. It seems to me the solution here is not genital surgery– which may be dangerous or reduce sexual pleasure later in life, not to mention being a major violation of bodily autonomy– but counselling for both parent and child, peer support from other intersex people and a shame-free, open environment with complete disclosure.

Of course an intersex person may choose surgery later in life. However, it is a violation of human rights for a parent to choose for his or her child what their genitalia “should” look like. Intersexuality is a problem of trauma and stigma, not a problem of gender.

For more information about intersex conditions, I recommend the Intersex Society of North America.