Is it a boy or a girl? One of the first questions most new parents ask the doctor, however for approximately 1 in every 1500 babies the answer is not always as straight forward as they assume (American Psychological Association, 2006). Infants with ambiguous genitalia are known as intersex, gender assignment is not clear for these children as they have both male and female genitalia. The common medical practice has been to operate on the infant and assign them one sex, however this practice is not always medically needed and can lead to many negative side effects.There are two main views of intersex.
Firstly, that it is an abnormality which is likely to lead to great distress in both the individual and family, that intersex is pathological and requires immediate medical attention. The second view that it is a common anatomical variation and is neither medical or a social pathology. The common medical response to intersex babies follows the idea that it is an abnormality, doctors perform genital surgery in infancy to make genitals look more ‘normal’. This is done because doctors and parents are distressed by the appearance of intersex genitalia.They believe gender reassignment surgery will make a child’s life easier and less distressing.
John Money proposed that successful sexual reassignment was possible if it was carried out before a critical age, and if the child was raised unquestionably in the gender role consistent with their new sex (Money, Hampson and Hampson, 1995, as cited in Morgan, 2002). In order to ensure surgery would occur before the critical age, the birth of an intersex infant is framed as a ‘psycho-sexual emergency’ that needed to be addressed as soon as possible.However, when referring to Eric Parens’ well known classification of medical procedure as either ‘enhancements’ or ‘treatments’, the current surgical practice of intersex children fits neither category. (Parens, 1998: 1-15). According to Parens to be considered a treatment, a procedure must restore a specific or potential ability that allows a person to compete at an even level to their peers.
It aims to restore a bodily function required for autonomy and independence. An enhancement permits a person to perform at a higher standard.Gender reassignment surgery does neither of these, nothing has been ‘lost’ as often people who have had surgery are left with a decreased self image and impaired bodily functions. In our society we take for granted that sex has two categories; male and female. In school we learn that sex is created by chromosomes, XX for female and XY for male. This knowledge is reinforced in social classes and the world around us, where we learn about the social constructions of gender.
This has led to our society being predominantly two sexes.Intersex babies are seen as abnormal because they do not fit in with this binary sex system. For many parents, it is shocking to realise that the binary sex model is not always valid. Since the model is not only a theoretical tool, but also something they live by, they are forced to question the way they view sex. This can lead to confusion for parents who do not understand why doctors cannot clearly state what sex their child is based on their external genitals. This questions the idea that sex is primarily to do with genitals.
There is a general expectation that all humans will fit into one of the two clearly defined categories. Clinicians suggest that not performing gender reassignment surgery will result in children being raised without a clear gender identity, and thus not fit in. This idea implies that surgery is needed to protect him or her from a hostile and unwelcoming world, that surgery is in the best intentions of the child and parent. However, this idea makes many assumptions that are not true. Firstly, that un-gendered people would not have clear identities.Secondly, that people born with either male or female genitalia feel comfortable in their bodies and gender identity.
This idea implies that being intersex will lead to a lifetime of confusion and identity crises, while being typically gendered will ensure a smooth path to adulthood and contentment. When parents learn that their child is intersex, a condition no commonly encountered they may feel lost and look to doctors for support. When intersex is framed as a medical emergency they may think medical treatment is logical.As a society we have given medicine the authority to police the boundaries of male and female. Our fixation on cosmetic concerns is a large part of our culture and world.
In this way, it is difficult to separate medicine from society. This has led to giving doctors the freedom and authority to operate on intersex babies under the guise of a medical emergency, to ‘normalise’ them. The perspective of two sexes frames intersex as a medical abnormality that doctors feel need to be rectified and ‘normalised’ for the benefit of the parents and child.A possible reason babies are given sexual reassignment surgery is because of the need to fit intersex infants into the 2 sex society we have built. Although research suggests that 1 in every 1500 babies are born with ambiguous genitals (American Psychological Assocation, 2006) male and female are predominant genders.
Although it is possible doctors are acting in the best interest of the child, in the belief that sex reassignment surgery will normalise them, and therefore help them lead a life of acceptance and defined sexual identity.Many clinicians operate on intersex babies to put parents at ease. Parents, upon learning that their child has ambiguous genitalia may feel a variety of valid emotions including worry about what they will tell family and friends. There are also long term issues, such as the decision of whether or not to tell the child and how the subject will be broached. Parents may fear their child will look different from their peers and the effect this will have on their child throughout their life.These concerns may lead the parents into feeling shame and fear and attempt to completely erase the dilemma by surgical intervention suggested by the doctors in an attempt to ‘normalise’ the baby.
A number of parents report they feel they were not given the necessary facts to make an informed decision about the future of their child and the surgeries inherent risks (Lydia Guterman 2012). Although doctors can attempt to predict the infant’s future gender identity and match the genitals to that, only the child can truly know what gender it is.The potential to leave a child with conflicting sexual and gender identities is high, however sexual identity surgery still occurs. The question is raised, “Is surgery purely is in the infants well being or is to make parents feel more comfortable? ” There is evidence that surgery can leave scarring, loss of sensation and infertility.
There are also a number of intersex children who feel that their gender identity and sexual organs do not match (Latesha Switzer, 2005). A major implication of babies undergoing sexual reassignment surgery is the fact that the assigned sex does not match the gender the child is raised with.Children who do not identify with their assigned sex can have psycho-sexual delays and issues, and can face psychological trauma throughout their lives. Doctors have admitted that genital assignment is sometimes based on aesthetics and as surgeons find it easier to construct a vaginal opening, rather than trying to create or enlarge a penis, a higher percentage of intersex babies are assigned a female gender (Latesha Switzer, 2005).
This shows that the assigned gender is not always based on anything more than ease for a doctor.A less complex operation for the medical team may lead to life long trauma for a child. The reported main focus of intersex surgery is to enable children to lead a normal life with out gender identity crisis or confusion. However, many patients say that operations created a sense of abnormality. Parents of intersex children may not know how much they should tell their children about their condition, and at what age.
The lack of knowledge that surrounds intersexuality can make people think their condition is shameful which may lead to self doubt and a negative feeling about their body image.In conclusion, although the number of intersex babies are generally small, the way they are dealt with will have a major impact on the life of which they will lead. Intersex babies are operated on for the emotional benefit of parents as well as the need to place all babies into a typical sex. The emotional repercussions are life long and greatly impact a child’s well being and happiness. A possible course of action may be to not preform surgery and let the child choose whether they feel the need for medical intervention and gender.Referenceshttps://www.apa.org/topics/lgbt/intersex.pdfhttps://www.opensocietyfoundations.org/voices/why-are-doctors-still-performing-genital-surgery-on-infantshttps://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2011-1441http://www.diva-portal.org/smash/get/diva2:316225/fulltext01.pdf
