Intersex people in the United States are subjected to medical practices that can inflict irreversible physical and psychological harm on them starting in infancy, harms that can last throughout their lives. These operations include clitoral reduction surgeries—procedures that reduce the size of the clitoris for cosmetic reasons. It also sets up the false dichotomy of child autonomy versus giving the child a “normal” life—when there is no evidence that these surgeries deliver on that promise. "Medically unnecessary irreversible surgery that carries a risk of lifelong harm should be one of those things." The new report says most of the 21 health professionals who were interviewed suggested that medically unnecessary surgeries were becoming less common, but none said their clinic had stopped doing them altogether. At present, too many medical practitioners advise surgery or conduct surgeries on intersex infants and young children, citing lack of data on the outcomes for children who do not undergo surgery. A Human Rights Watch researcher and a research consultant who is a practicing physician in California conducted the interviews cited in the report. Even as the new report was being compiled, it came under fire from the CARES Foundation , which advocates on behalf of families with children born with abnormal genitalia due to a condition called congenital adrenal hyperplasia, or CAH. Intersex is an umbrella term encompassing various conditions in which internal sex organs and external genitalia develop differently than for a typical boy or girl. Experts say roughly one of every 2,000 newborns has so-called differences of sex development that might prompt a doctor's recommendation for surgery or other medical intervention. Some intersex children discover their traits when they hit puberty. As a patient advocate, she sees parents worrying whether their children will be accepted by their peers. The AMA's Board of Trustees is proposing a new policy statement urging doctors to defer intersex surgery on infants and young children "except when life-threatening circumstances require emergency intervention." genital surgery).” 2015: The European Union’s Fundamental Rights Agency issues a report on intersex human rights issues, advising “Member States should avoid nonconsensual ‘sex-normalising’ medical treatments on intersex people.” 2015: Malta becomes the first country in the world to legally ban non-consensual medically unnecessary surgeries on intersex children. Meanwhile, more and more intersex adults came forward to say they had been harmed by such surgery. "We hope that professionals and parents who face this difficult decision will heed the growing consensus that the practice should stop." They think of genitals as something that mark whether a baby is a boy or a girl and not anything more than that. One of multiple reasons for the concern: Some intersex children may undergo surgery aimed at assigning them as male or female, yet grow up to identify as the other sex — a potentially traumatic situation. When she was a teenager, doctors removed the testes, telling her they were removing potentially cancerous ovaries. As she grew older, doctors discovered that — because of a rare chromosome condition — she lacked a uterus, and had internal testes rather than ovaries. "The choices available to parents and patients should not be limited," the foundation said. And on Tuesday, Human Rights Watch and InterACT a group advocating for intersex youth — are releasing a detailed report assailing the practice and urging Congress to ban it. In a 2017 commentary published by the Palm Center, Dr. M. Joycelyn Elders, Dr. David Satcher, and Dr. Richard Carmona, all former US Surgeons General, wrote that they believed “there is insufficient evidence that growing up with atypical genitalia leads to psychosocial distress,” and “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.” They said: “These surgeries violate an individual’s right to personal autonomy over their own future.” The three doctors concluded: Medical experts agree that more research is needed to determine the optimal treatment for children born with a DSD. The other, a 20-year-old woman with CAH, said she was glad her parents made her “look like all the other girls” her age when she was growing up, and she had never thought about sensation issues because she felt awkward discussing her genitalia with her peers. She explained: “My only fear when deciding [about surgery] for my children was: ‘what if my child grows up to be transgender?’ But I knew the statistics were in favor of that. "They say it gives them a feeling of relief to speak with someone like me who more fully understands what they and their children are going through." Another urologist said that in her experience, parents advocating strongly for surgery was rare. Barker guessed that most of the team's physicians would feel unduly restricted by a ban, even as early surgery becomes less common. She said: “I told the surgeon that the kid could not possibly understand what was going on.” The father was particularly concerned about his daughter being vulnerable to sexual assault because of an intellectual disability, and that assault risk being magnified by her atypical genitalia. The kids’ autonomy does not come up as much as it should.” She explained: We talk about the cosmetic surgery and we try to separate out the pieces that we feel might be more medically necessary—like proper urine flow or a kid with a very high risk of cancer—from the cosmetic piece, and try to help families think about those separately. One mother said: “It was because of the support group that I knew I could limit the people in the room for genital exams. And I think bringing up this experience from the advocates and from patients who’ve gone through this is very, very important. The American Academy of Pediatrics says it's reviewing the issue, and wants parents to understand the risks and benefits of any course of action. Yet this is what some surgeons in the U.S. do every year.
– A child who as an infant underwent surgery aimed at assigning his gender as female but who now identifies as male will get a hefty payout in what BuzzFeed calls a "landmark" settlement. Under the deal, the Medical University of South Carolina and the state's social services department will pay $270,000 to a settlement company, and the money will buy an annuity policy that will eventually result in a $440,000 payout to MC, now 12. Pam and Mark Crawford had waged a four-year legal battle against the hospital after MC, born with male and female genitalia, had his penis and testicular tissue removed when he was just a year old. The surgery, which took place when MC was in state custody, was not only unnecessary but meant MC's gender was decided for him, his parents said. MUSC "denied all claims of negligence and any liability for the alleged claims" in the settlement. An estimated one in 2,000 babies born are intersex, with genitals not clearly male or female, and many undergo surgeries to give them exclusively male or female genitalia. But these surgeries are fraught with complications. In a report out this week, Human Rights Watch accuses doctors of performing irreversible sex assignment surgeries "based on guesswork." Last month, a report by three former US surgeons general concluded intersex surgeries "violate an individual's right to personal autonomy over their own future" and "should be deferred until children are old enough to voice their own view about whether to undergo the surgery." The American Medical Association is now considering whether to discourage such surgeries, reports the AP.