Let Intersex Individuals Choose Their Destiny

The California Senate is considering a bill requiring postponement of non‐​lifesaving surgery to change the sex characteristics of an intersex minor until that individual becomes old enough to give informed consent.
July 24, 2019 • Commentary
This article appeared in the Orange County Register on July 24, 2019.

Well‐​intentioned parents sometimes let doctors make unalterable and potentially tragic changes to their babies’ bodies. The practice of performing “normalizing” surgery on infants born with what clinicians call “intersex” or disorders of sexual development has been going on since the 1960s.

Being born intersex is still a complicated and rare circumstance, and with it comes many tough questions. What’s clear, however, is most of these individuals deserve time to answer those question for themselves.

Before the 1960s, parents of intersex children made their best guess and assigned a sex to their children, raising them according to gender norms. Oftentimes these children experienced harassment and discrimination as they grew to adulthood, but many had happy and successful lives.

Most medical scientists believe approximately 1.7 percent of babies are born intersex. A prospective study reported in June found the incidence of babies being born with “ambiguous genitalia,” one form of intersex in which the baby is born with genitals where it is unclear if the baby is a boy or girl, is 1 in 1000. But intersex is on a spectrum. Some babies have both male and female gonadal tissue or reproductive organs, and some can be “mosaic,” where some of their cells have one combination of sex chromosomes while other cells have a different combination. Some types of intersex don’t become evident until the child matures.

The rationale behind intersex surgery is to “normalize” the baby by surgically redesigning their genitals and/​or removing organs or tissue of one of the two sexes, hoping to spare the child from psychological stress and stigma while maturing. However, there is little evidence that growing up with atypical genitalia leads to psychosocial disorders. A significant number of children will develop a different gender identity than the one chosen for them by their parents, so surgically assigning their gender as babies runs the risk of severe trauma later in life. Furthermore, many adults who had intersex surgery as children later suffer from sexual dysfunction,including severe pain or difficulties with arousal during intercourse.

The American Academy of Family Practice opposes genital surgery in intersex children except in cases where an imminent threat to life must be averted—for example, correcting a defect that prevents the baby from urinating. A July 2018 declaration from its Board of Directors claimed that intersex genital surgery can lead to an increase in substance abuse disorders and suicide and stated, “Scientific evidence does not support the notion that variant genitalia confer a greater risk of psychosocial problems.” Three former U.S. surgeons general from Republican and Democrat administrations issued a statement in 2017 condemning intersex surgery except in cases where a threat to life was imminent without an intervention, saying surgery should “be deferred until children are old enough to voice their own view about whether to undergo surgery.”

This not only makes sense medically—it makes sense morally. When a non‐​life‐​or‐​death decision is made by doctors or parents to subject a child to surgery that can permanently impact their entire future adult happiness, it is a violation of the autonomy and sovereignty of that individual to proceed without informed consent. Because there is no imminent threat to life, parents should raise intersex children in a gender‐​neutral manner and allow them to identify with whichever gender they feel more comfortable—or both—leaving the decision up to them as to surgically correcting ambiguities once they reach the age of consent. In many cases intersex adults feel happiest as intersex.

For all of the above reasons, the World Health Organization and the United Nations condemn intersex surgery except in life‐​threatening situations until the child is old enough to give informed consent. In 2015 Malta became the first country to outlaw the practice in children. Now California might become the first state in the U.S. to do so. The California Senate is considering a bill (SB 201) requiring postponement of non‐​lifesaving surgery to change the sex characteristics of an intersex minor until that individual becomes old enough to give informed consent.

It is important to respect parental rights. A high threshold must be met in order to permit the government to expand its scope in parental medical decision‐​making. Yet parents’ rights to make decisions about their children’s bodies are already limited in several situations. Parents aren’t entitled to abuse their children, sell them to other people, or refuse to let them have lifesaving procedures. They should not be allowed to infringe on their right to choose their own sexual destiny.

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