US: Re-Thinking Genital Surgeries on Intersex Infants

On October 26, 2016, the 20th anniversary of Intersex Awareness Day, the U.S. State Department issued a statement recognizing that “intersex persons routinely face forced medical surgeries that are conducted at a young age without free or informed consent. These interventions jeopardize their physical integrity and ability to live free.” 

The U.S. government is one of many that have recently raised questions about infant genitoplasty, cosmetic genital surgery meant to make an infant’s genitals “match” the binary sex category they are assigned by adults entrusted with their care. Genitoplasty is often performed on infants with intersex traits, a condition known as DSD, or Disorders/Differences of Sex Development. Although well-intentioned—many parents and physicians believe it is more trying for individuals to live with atypical genitalia than to have it “corrected” early on—there is growing recognition that this belief is based on untested assumptions rather than medical research, and that cosmetic genital surgery performed on infants usually causes more harm than good.

Fortunately, a consensus is emerging that concludes that children born with atypical genitalia should not have genitoplasty performed on them absent a need to ensure physical functioning. Government agencies in Germany, Switzerland, Australia, Chile, Argentina, and Malta, as well as human rights groups, including the World Health Organization, have examined this issue and found that these irreversible medical procedures, which are performed before individuals can articulate whether they wish to undergo such surgery, are not necessary to ensure healthy physical functioning, and that such surgery is not justified when performed on infants. These bodies have called for a moratorium on cosmetic infant genitoplasty so as to allow individuals with a DSD to have substantive input into decisions affecting their own identity and appearance.

Performing cosmetic infant genitoplasty was not always the default practice. Before the middle of the twentieth century, most children born with genitalia that did not fit the male-female binary norm were not subjected to surgery. Beginning in the 1950s, however, an era when pressure to conform to social norms was often unyielding, the standard treatment protocol shifted.

Since this period, as a 2016 consensus statement notes, good-faith disagreement has existed among physicians about whether and when cosmetic infant genitoplasty should be performed.2 Some physicians recommend surgery because they believe it will decrease the likelihood that children will suffer emotional trauma from having atypical gender characteristics. While we do not doubt that doctors who support and perform these surgeries have the best interests of patients and their parents at heart, our review of the available evidence has persuaded us that cosmetic infant genitoplasty is not justified absent a need to ensure physical functioning, and we hope that professionals and parents who face this difficult decision will heed the growing consensus that the practice should stop.

Our view is based on three simple and compelling rationales. First, there is insufficient evidence that growing up with atypical genitalia leads to psychosocial distress. Second, while there is little evidence that cosmetic infant genitoplasty is necessary to reduce psychological damage, evidence does show that the surgery itself can cause severe and irreversible physical harm and emotional distress. Finally, these surgeries violate an individual’s right to personal autonomy over their own future. Read more via the Palm Center