This guest post was authored by intersex advocate and educator Cary Gabriel Costello, author of the blog The Intersex Roadshow.
Imagine a world in which doctors and parents imposed sex change surgeries on infants, too young to say anything about the matter. “You wanted a girl but your baby was born with a penis? Don’t worry, we’ll remove that right away!”
And yet 1 in every 150 children in the U.S. today is subjected to surgical genital reconstruction, to which they are given no chance to object. This takes place because they are diagnosed with “DSDs”- Disorders of Sex Development – the medical catchphrase for being intersex, with a body intermediate between society’s male and female norms.
The surgeries performed on the genitals and reproductive organs of intersex children can have lifelong consequences, including lost capacity for sexual sensation, recurrent bladder and other infections, chronic pain, loss of fertility, and many other side effects. These surgeries, performed because we have atypical-looking genitals, often result in genitals that still look atypical. And some of us grow up not to identify with the sex we were assigned at birth, which means that surgeons have removed exactly those aspects of our bodies with which we identify.
The number one goal of the intersex community is to put an end to this practice of performing cosmetic genital surgery on intersex children. In a tiny percentage of cases, an intersex child may be born with an anatomic issue that poses a health risk, and of course we agree that should be treated. But in the vast majority of cases, intersex genitals and reproductive organs pose no physical danger. Intersex people in preindustrial societies have lived fulfilled lives for millennia without “normalizing” genital surgery.
The reasons doctors in the U.S. continue to impose genital reconstructive surgery on intersex children are almost always social, not medical. The claim is that being born sexually intermediate is socially intolerable. Our society views sex as a binary, with male and female being the only legal options to be declared on birth certificates, school records, drivers’ licenses, etc. Having bodies that violate this social expectation, doctors say, we will face extreme stigma—lack of parental love, mockery by peers, panic in bathrooms, rejection in romantic situations—which will be so damaging we may commit suicide. Thus, they argue, we must be assigned to a binary sex, our bodies must be modified to conform to it, and this should be done as soon as possible, to minimize harm.
What a strange worldview these doctors have! First, there’s the idea that parents only love babies who are perfectly typical, instead of accepting and loving children with all sorts of quirks and differences. Secondly, the effective way to address social stigma is with a social campaign against it. It’s true that today darker-skinned children are still likely to grow up to earn less than lighter-skinned children. But the solution is anti-racism campaigns—not for doctors to “treat” darker-skinned children with dangerous skin-lighteners. Thirdly—and here’s a shocker—children usually wear clothing that covers their genitalia. There are some circumstances that could make a child who is shy about their genital difference uncomfortable, such as a group shower in a gym, but there is a simple nonsurgical solution to this: make private stalls available.
Yet doctors in the U.S. persist in imposing cosmetic genital surgery on children they diagnose with “disorders of sex development,” and social stigma persists.
So what can you do as an ally of intersex people? Here are a few key ideas:
1. Remind people that sex is not really binary—it is, by nature, a spectrum. Most people and animals are born with bodies that fall near the male or female ends of the spectrum, but there have always been animals and people born in the middle of it.
2. Work to help ban cosmetic infant genital “normalizing” surgery.
3. When new parents are aware that some babies are born intersex, and that this poses no physical danger to them, they are much more likely to question doctors who urge surgery. So advocate for sex education and childbirth preparation classes to include information on intersexuality.
4. When an intersex child is born, it’s fine to select a provisional binary sex of rearing without any surgery. But be open with the child about being born atypical, and accept the possibility that they may not identify with the provisional sex of rearing.
5. When intersex individuals mature, enable them to access any medical treatments they feel would be worth the attendant risks for them.
6. Urge schools to teach about intersexuality. Biology and medical textbooks that only show an idealized male and female form when teaching about sex differences are inaccurate and damaging.
7. Argue against the requirement that a binary sex be listed on a child’s birth certificate. Most states in the U.S. used to require that doctors designate a race on birth certificates to help identify the child, but today this is not longer the case. Having to select “M” or “F” in the first 24-48 hours of life forces hasty decisions with lifelong consequences for intersex people. And it’s so unnecessary, in an age where footprints and blood samples are taken at birth, and children can be much more accurately identified through these.
8. Advocate for inclusion of intersex characters in children’s and adult media.
9. Protect sex-variant people (and trans and gender-variant folks as well) by making single-stall, gender-neutral restrooms and locker rooms available in schools, gyms, businesses, and public venues.