- People tend to assume that everyone is born simply male or female. But nature shows us otherwise. About one in 2,000 babies is born with genitals roughly halfway between male and female types. Their genitals might include what looks rather like a penis along with what appears to be a vaginal opening. More subtle forms of in-between sex development are much more common than that. In fact, with modern science, we ﬁnd (Web Link) that as many as one in 100 of us might have some sex-development type other than the standard male or female, although some will never have occasion to ﬁnd out.
- Nevertheless, cultural attachment to the idea of a clear, simple division between (only) two sexes runs deep. Many physicians believe that there’s nothing we can do about that cultural anchor – You can’t change society, they say. So they think that, for the children’s sake, it’s sometimes necessary to do ‘corrective’ surgeries to make children who are born intersex look more typically female or male. Although statistics can be hard to pin down, it appears that in the United States today, at least one in 300 children is born with a diﬀerence of sex development (DSD) evident enough to the naked eye that a paediatrician might recommend an expert consultation.
- Variations on typical sex development occur most commonly in boys (Web Link), and most commonly in the form of hypospadias. Hypospadias is a condition in which the urinary opening is not on the very tip of the penis but lower down the head, or on the shaft of the penis, or, more rarely, at its base. Girls can be born with atypical sex development, too. For example, during foetal development, the clitoris might grow larger than average and can sometimes look like a small penis.
- Quite simply, these sex variations occur because the typical male and the typical female represent two ends of a developmental continuum. e clitoris and the penis grow from the same proto-organ in development. In the same way, the labia majora and the scrotum grow from the same tissue. Most newborns have developed genitalia at one end of the developmental spectrum or the other. But not everyone.
- And genitals are by no means the only component of sex biology that can vary. What we call simply ‘biological sex’ is in fact a many-factored trait involving various hormones, hormone receptors, external genitals, internal reproductive organs, and much more. Consequently, there are dozens of diﬀerent ways for what we could call ‘intersex’ development to occur.
- Paediatric specialists in this area have historically misrepresented the history of intersex, saying that parents cannot raise a child as a boy or a girl unless the child’s genitals look ‘gender-typical’. In fact, until the recent era, children with intersex genitals were raised as boys and girls with their genitals left intact. Children were, and can again be, preliminarily assigned genders as boys or girls based on best guesses. That’s actually what happened to all of us, whether we were born typically male, typically female, or intersex.
- In terms of recognising the sexual rights of children and youth, including the rights not to be subject to FGM or to sexual assault, and the right to be gay or lesbian, the world has come a long way. From this perspective, it feels like intersex rights will come next. Yet the tension between those who see intersex variation as a human-rights issue and those who see this as a ‘problem’ for medicine to ‘repair’ appears only to be rising, not resolving.
- The clinicians who are ﬁghting the activists are not bad people; they are aware of sexual stigma and want to prevent it (Web Link). There’s no doubt that stigma can accrue to those with intersex bodies. But stigma can and should be managed at the social and psychological levels – with professional help as necessary. A more medically conservative approach would be to take seriously the idea of ‘ﬁrst, do no harm’.
- Rather than expecting these children to be changed to ﬁt our social bodily norms, we can change what we expect of each other as parents in terms of behaviour. Parents used to be allowed to do whatever they thought right for their children. But when it comes to issues such as child labour and child abuse, the world shifted its views on ‘parental rights’. We can progress here, too, and recognise that the best approach for these children is to minimise harm and maximise acceptance of natural sex development variation. It’s high time for paediatricians to understand intersex as an issue of human rights, and to help parents to understand it, too.
- Sub-title: "Children born with in-between sex development are subject to surgeries that many believe violate their human rights."
- See Web Link
Text Colour Conventions (see disclaimer)
- Blue: Text by me; © Theo Todman, 2017
- Mauve: Text by correspondent(s) or other author(s); © the author(s)