Commenting note: this is about intersex surgery. This is not about male or female circumcision. Please keep your comments to the topic of intersex surgery.
We talk a lot about female and male genital circumcision, but a topic that is sadly undercovered, in my experience, is the surgery performed on children with intersex genitalia.
An intersex person is born with some features typically associated with female bodies and some features typically associated with male bodies (this condition is usualyl medically called a “disorder of sex development”). For instance, their genitalia may look midway between a penis and a clitoris, or they be born with a Y chromosome but be unable to process testosterone, or they may even have two X chromosomes and a Y chromosome. Approximately 1 in 2000 people are intersex; most intersex people identify as either male or female.
Many intersex conditions require surgery for the sake of the child’s health: for instance, the child may need to have a urinary opening created or malignant tissue removed. However, many times, intersex children have genital surgery performed on them for no reason other than to make their genitals look “normal.” Parents may be anxious or distressed if their children don’t look the way a boy or a girl is “supposed” to. It was thought to make the children less likely to identify as the gender that they were assigned if they had ambiguous genitalia.
Okay, what? That’s FUCKED. Let me count the ways in which it’s fucked:
- Sometimes, when you assign someone a gender, you assign them the wrong gender. Let them speak up about what their gender is before you go chopping their genitals up willy-nilly.
- Many people who have had intersex surgery report sexual dysfunction, reduced sensation, or even chronic pain.
- Children raised with ambiguous genitalia are no more at risk for psychosocial problems than children who aren’t.
- Children are fucking acceptable and lovable regardless of what their fucking genitals look like, and people should have the fucking right to decide what happens with their own fucking genitalia.
Basic rule: we should not perform cosmetic genital surgery on infants. Ever. Maaaaaaybe a harm-reduction exception for religious people who would otherwise have their children circumcised in unsafe conditions to please God, but even then we should be working to change the religion’s doctrine to something more respectful of bodily autonomy. Anyway, I don’t think there are a hell of a lot of religions that say “thou shalt not have baby girls with enlarged clitorises”, so we’re in the clear here.
All genital surgery not directly necessary to preserve the child’s health should be delayed until the child is old enough to have an opinion on it. When possible, surgery should be delayed until the child is 18, to prevent the parents from having undue pressure on the children and so that a prepubescent or barely pubescent child won’t decide that looking normal is more important than the risk of never having an orgasm when they’ve never had an orgasm.
Fortunately, at the moment, thanks to the assiduous work of advocates for intersex children, the current standards of care for intersex children have reached the standard of basic human decency. Most clinicians agree that affected individuals and families should be told about the diagnosis, that boys born with micropenises should not be routinely assigned as girls, that surgeries should generally be delayed until puberty, and that not all people need surgical sex assignment at all. Unfortunately, this is for some reason not yet a universal consensus. Progress has been made, but there’s still work to be done in destigmatizing intersex conditions and making sure that intersex people have full bodily autonomy.
For more information about intersex conditions, look at Accord Alliance, the major source for this article.
Ozyfrants? I’ve been a fan of yours for a while (I hope you remember), though I hardly ever comment. Don’t take that the wrong way – I mostly don’t comment because you have things handled. The rarity should be a compliment. But this time I have to say: “ambiguous genitals” is still a phrase in use in a number of places, but it requires messed up teleological assumptions that the (or at least “one”) purpose of genitals is to signify dichotomous sex. The genitals of those among us who are intersex are, in fact, quite clearly genitals. There isn’t anything… Read more »
The first question people will ask you if you have a baby: “Is it a boy or a girl?’ One (good) consequence of trans/genderqueer people and their allies shaking up the gender binary will be making life easier for intersex children and their families.
I don’t know how performing such surgery on an infant for cosmetic reasons remotely qualifies as ethical. This isn’t something we know enough about to make that decision for someone else before they’re even developed. Do we know for sure how their organs are going to develop years later after puberty? And even if we did know what would happen physically it should still be up to that individual to decide which gender s/he wants to live as (or neither gender!)
It depends on the nature of the mutation. With some mutations, an individual’s gender identity can be predicted as close to perfectly as realistically possible, while in others, it’s a total crapshoot. If you know what gender the child will identify as, it actually pays to act quickly, as the surgical results will be considerably improved both initially and as the child grows. Fortunately, we live in a day and age when doing genetic testing for all known mutations is fast, easy, cheap and reliable. Of course, this brings up some interesting questions about gender – if it is possible… Read more »
If it can be determined by a genetics test, it’s sex, rather than gender. Sex is biological; gender is social.
Transsexual people identify as one sex, a biological reality, not gender, a social one. Though sex implies gender, gender doesn’t imply sex, this also means something. I can add that I identify as female, which makes me a woman in most people’s eyes. I don’t identify as a woman which makes me seen as female. I’m also quite androgynous in that I barely pass the threshold for girly girl (no hips, small breasts, very moderate interests in girl-only stuff), and might not pass the threshold for masculine either for a gay guy comparison (no shoulder, no armpit hair, no chest… Read more »
Forgive my lack of knowledge on the subject, I’ve never met anyone that is trans in any way. I’m guessing you mean you have a female body, XX vs XY? But you identify as female vs woman? I’m unsure of what the difference between female and woman is, is it female = the body and woman = the mind? And your gender identity is in the middle between masculine and feminine?
I have a female brain, XY, raised as a boy because I was born with a penis. Never identified as male. Even less as a man. I identify as female, and female makes people assume woman. I can’t identify specifically as woman, because it’s a much-constrained sociological concept, rich with landmines and stupid explanations for why I can’t REALLY identify that way (ask the radfems*). So I identify as female, and society conflated gender and sex. I live as female in my everyday life, am seen as female, etc. My sex identity (not gender identity, this doesn’t exist) is female.… Read more »
Ah ok, thanks for the comment, you’re the first trans person that been able to comment with so it’s a whole new world so to speak. Clears it up quite a bit. If you have taken any hormone replacement, do you find your thoughts/feelings were any different?
Uh, the *author* of the post is a trans person.
Make that two! Wasn’t completely sure if you were or not, or if you just didn’t want to be labeled a gender at all. My apologies.
Thanks for a good article. Unfortunately, while many doctors acknowledge that cosmetic genital surgery on infants with intersex conditions is “controversial,” or even that it would be ideal to wait until the child can participate in the decision, genital surgery on these children is still routine in the US and the rest of the western world. Advocates for Informed Choice is another organization that is fighting to protect the legal and human rights of children with intersex conditions/DSD. Check out our website and facebook page for updates!
Website is http://www.aiclegal.org.
“Total number of people whose bodies differ from standard male or female|one in 100 births”
ISNA
And I cite them without liking them much. ISNA was pretty anti-trans when it existed. Same as AISSG. Claiming that trans women were wannabes. Not REALLY female (unlike intersex women), and all that.
I am naive on the topic but can a person have both testes and ovaries, causing a conflict in the dominant hormones? Or is it mainly just the clitoral/penile bits?
You can have both, you need chimeric DNA for it. Chimeras have more than one set of chromosomes, possibly more than one set of gonads.
“A chimera or chimaera is a single organism (usually an animal) that is composed of two or more different populations of genetically distinct cells that originated from different zygotes involved in sexual reproduction. If the different cells have emerged from the same zygote, the organism is called a mosaic. ”
From wiki on chimera.
For chimeric people, if they have one gender would it be best to perform any corrective surgery before puberty so that their body could grow to a male type or female type? I’d assume that having both would cause some havoc with the sex hormones and the body growth would be a mix between masculine n feminine, breast growth + body hair, facial hair etc?
It is not “havoc”. It is a mix of hormone levels that is less typical of human development but not harmful. Saying it would be “better” to chop off body parts because someone might end up with breasts and some body hair is exactly the problem we’re fighting. Why is it so horrible to have a beard or body hair? If it is that horrible, should we castrate all men, save a few kept around in labs for producing the sperm used during in vitro fertilization? If it’s so horrible to have breasts, why don’t we recommend breast reduction surgery… Read more »
If you want any decent chance of attracting the opposite sex than a woman having a beard, a man having large breasts, not gonna work. I try to be open minded but I have absolutely zero zero zero attraction to a woman with a beard, it’s a turnoff, but I am still highly attracted to woman with small breasts. Forgive me for assuming most humans want to be attractive to the gender they are attracted to, considering how many women and men i hear describing the sheer horror of having body features similar to the opposite gender, I am of… Read more »
Contrary Schala, there are indeed genetic abnormalities which can cause the gonads to contain both ovarian and testicular tissue.
However, we have no idea about the long-term effects of this configuration because these gonads are always removed, quite simply because they are -always- cancerous, and would kill the kid within a few years if left.
Your ratio of intersex here, might be the ratio of those who have heavy surgery as infants. Because the ratio of intersex is around 1/100 to 1/200.
The ratio comes directly from the Accord Alliance. What’s your source?