Intersex Health Issues

Whereas transgender refers to individuals’ sense of their gender, intersex refers to the biology of individuals’ sex. Intersex refers to individuals who are born with physical markers of sex (such as genitalia, chromosomes, or gonads) that are nei- ther clearly male nor clearly female. Intersexuality can be caused by hormonal factors, chromosomal factors, or both. Up to 1.7% of babies are intersex.

Since the 1950s, surgery and hormonal manipulation have been the standard medical responses to the birth of intersex infants in the United States. Doctors typically urge parents to have the infants surgically “corrected” to more clearly fit into one sex category as soon as possible on the assumption that this will help children develop into the “appropriate” gender. Most often, doctors assign babies to a sex based on the size of the babies’ phalluses. If the doctors con- sider the phalluses to be large enough, the babies are assigned to be boys. If not, they are assigned to be girls.

Once this decision is made, parents are instructed to strictly socialize the chil- dren to their new gender. Parents may also be told to place the child on a steady diet of hormones to better match their assigned sex. In addition, surgeons “create” girls by removing or reducing clitorises (if larger than average), removing testes (if present), and creating artificial vaginas (if absent). All these surgeries involve removing healthy tissue, and all can impair or eliminate individuals’ ability to reproduce or to experience sexual pleasure.

More recently, however, this standard medical treatment has come under con- siderable attack from both scholars and activists, some of whom experienced sex assignment as children. Opponents of sex assignment point out that this treatment is based not on scientific evidence but on gender beliefs: that small penises are “unmanly,” that large clitorises are frightening, that children need strict socialization into “appropriate” gender behaviors, and that a vagina “works” if it allows penile penetration, even if it lacks natural lubrication, elasticity, or the ability to provide female sexual pleasure. Moreover, opponents argue, sex assignment reinforces children’s sense of difference and often depends on webs of deception among children, parents, and doctors that can create their own psy- chological nightmares.

These critiques have had some impact. In 2006, a series of discussions be- tween medical experts and activists led to an important but controversial consen- sus statement published by the American Academy of Pediatrics. That statement urged doctors to refrain from surgically altering the bodies of intersex babies for at least a few months after birth to give parents time to consider other options. It also stated that surgery should not be performed solely for cosmetic reasons—except for girls whose clitorises are exceptionally large. Finally, it recommended replacing the term intersex (which some consider pejorative) with a new diagnosis of disorders of sex development.

Although some activists approved of these recommendations, others do not believe that intersex is a disease (or “disorder”) and therefore reject the idea that intersex bodies need changing. Similarly, in 2015 the United Nations declared that medical and surgical procedures performed on intersex children constitute a violation of basic human rights. Meanwhile, however, surgery continues to be the norm.