for Intersexed People
Surgery on Intersexed People
Sex Assignment Surgery
is often performed on people who are intersexed. These surgeries may
be performed shortly after birth, sometimes by doctors who do not tell
the parents or gain their permission, or may be performed during adolescence
or even later in life. It is not uncommon for intersexed people to undergo
a series of surgeries throughout their lives.
What is rather insidious
about Sex Assignment Surgery is that, for the most part, such surgeries
are medically unneccesary. Furthermore, that doctors have performed
such operations on children without parental consent or knowledge, and
often continue to lie to intersexed patients into adulthood. Many intersexed
people consider such surgery equal to "mutilation" of helpless
children, and the Intersex Society of
North America is one organization fighting to change current medical
practices that advocate such surgery on intersexed babies and children.
The sex assigned
to a newborn baby is often only based upon the appearance of its external
genitalia. If they appear to be "normally" male or female
then an baby that is actually intersexed may be unhesitatingly so assigned,
and its real condition only discovered weeks, months or even many years
later, e.g. at puberty.
Only if there are
ambiguities in the genitalia is further investigation likely before
a babies sex is assigned. When deciding the "best sex" to
assign to an intersexed child, the physician considers the following:
- a pelvic ultrasound
(to check for the presence of female reproductive organs)
- a genitourethrogram
to look at the urethra and vagina, if present
- a chromosomal
analysis (to help determine genetic sex: usually but not always 46,
XX or 46, XY)
- fertility potential
of a female pseudohermaphrodite
- size and potential
for growth of a penis present in a male pseudohermaphrodite
- ability of an
internal reproductive organ to produce appropriate sex hormones for
- risk of future
health conditions (i.e., cancer) that may develop in the original
reproductive organs later in life
- the actions of
male or female hormones on the fetal brain
- the parents opinion
or preference (when they bother to ask)
Such sex assignment
is usually done within a few days of birth. However, occasionally a
baby may be assigned to one sex at birth, but for various reasons the
physicians later recommend its re-assignment to the other sex because
of the discovery of viable testes in a supposed baby girl. The medical
community's belief is that the earlier this re-assignment is done the
It is relatively
rare after about 24 months of age for such reassignments to be done,
as many doctors believe that the baby's gender will be irreversibly
set by then. Most of the doctors who believe this are still following
the now outdated, and unfounded research of Dr. John Money (formerly
of Johns Hopkins), who theorized that one could surgically assign a
boy child as a girl, raise the child as a girl, and the child would
happily BE a girl. In generaly the theory that a baby's gender is irreversibly
set by 24 months may not be untrue - but there is no way of knowing,
in an infant so young, what the true gender identity of the child IS.
At best, the doctors get it right 50% of the time.
The term "sex
re-assignment" is also often used to refer to the deliberate legal
and social sex assignment of a baby contrary to its chromosomal sex
(e.g. assigning a "XY" baby as female), even if it was never
actually assigned to its chromosomal sex.
development of male and female genitals (click for larger picture)
Doctors have a list
of "standards" according to which they determine the "normality"
of a newborn's genitalia, which includes two functional assessments
of the adequacy of phallus size.
One criteria is
that the doctors believe young boys should be able to pee standing up
and thus to 'feel normal' during little-boy peeing contests; adult men,
meanwhile, need a penis big enough for vaginal penetration during sexual
intercourse. The assignment of a genetically male baby as a girl is
often due to a badly damaged or undeveloped penis - surgeons can make
a vagina relatively easily but it is hard to make a penis that is functional.
Underdeveloped penises are sometimes called a "Micropenis Condition"
(also called Absent Penis, Buried Penis, Concealed Penis, Hidden Penis,
Inconspicuous Penis, or Penile Agenesis, Trapped Penis, or Webbed Penis).
Boys are typically
born with a stretched penis ranging in length from 2.9 to 4.5 centimeters
(1.25 to 1.75 inches), with a urethra opening at the tip (rather than
on the side or base of the penis) that releases urine, and a scrotum
that contains testes.
For new-born girls,
clitoral length at birth typically ranges from 0.2 to 0.85 centimeters
(0.08 to 0.33 inches). Those falling in between these two sizes will
often have their organs shortened. A clitoris longer than 1 centimeter
is considered "unacceptably enlarged" and may be shaved down
purely for purposes of looking "normal." On the other hand
if the penis is less than 2.0 centimeters long, concern is often expressed
about whether the boy will be a "boy".
of a "pronounced penescrotal hypospadias" where urine
exits behind the penis.
A penis less than
1.5 centimeters long and 0.7 centimeters wide is usually considered
to be "unacceptably short" and "inadequate for later
sexual performance" and is usually deemed a clitoris, and he a
"she." In this instance, although a genetically "XY"
male, perhaps even with testes, the infant will be re-assigned as female
and her "micropenis" surgically altered to become a clitoris.
Such re-assignment is particularly likely if also the urethra does not
open at the tip of the phallus, a common condition known as hypospadias.
"If a baby
has hypospadias, the urinary function will not be the same as other
males," says Dr. Aydin Arici, a Yale-New Haven Hospital obstetrician
and gynaecologist who specialises in reproductive endocrinology, explaining
why male babies with such a condition might be reassigned. "For
example, that individual will not be able to urinate standing up."
Note that in most such cases urination is still POSSIBLE, and such surgery
is not "mecially necessary." It is performed only to conform
the child to social dictates of "normality."
It should also be
noted that, according to the chart of "normality" used by
doctors, the teminology "enlarged clitoris" or "micropenis,"
in fact, refer to the SAME antatomical structure. In a child with otherwise
ambiguous genitlia (where neither testes nor ovaries appear to be present),
other lab testing may be done to try and determine whether or not it
is a "penis" or "clitoris" based on chromosomal
makeup. In a chromosomally intersexed child it may still be impossible
to determine whether the structure, and the child, is "male"
Clearly the most
important factors in the sex assignment of intersexed children are achieving
a "normal" appearance of the genitalia in the assigned sex,
and sexual function. If
a male's phallus is deemed unlikely to be able to "perform"
adequately, then re-assignment as a female may become the preferred
medical choice. But appearance and sexual function is not the only factor
used in sex assignment - many laboratory tests are also done to determine
the child's genetics and potential for fertility. This is sometimes
criticized as a "Procreation Prejudice" due to the assumption
that EVERYONE wants to have children, and in many cases of reassignment
the mere prescence of sex organs is no indicator of future fertility.
In the vast majority of cases of significant ambiguity, however, a female
assignment is made - perhaps sometimes for the sake of medical expediency.
Some in the medical community quip "It's easier to dig a hole than
to build a pole." But once a sexual assignment is made, it's effectively
irreversible, especially if surgery must be performed.
So, in summary,
among the kinds of surgeries that might be performed on intersexed people
- Sewing a vagina
(or vaginal opening) shut
- Shaving a clitoris
- Removal of undescended
- Surgically descending
of a urethra and subsequent closing of the penile shaft
(rarely, due to the surgical difficulty)
(usually during adolescence).