Medical Science
— In a move that some have hailed as
groundbreaking, researchers told physicians at a Feb. 18
meeting of the American Association for the Advancement
of Science <http://www.aaas.org/>
to postpone surgery for intersex children until they
determine their own sex.
Dr. William Reiner of the
Oklahoma University Health Science Center
<http://www.ouhsc.edu/>told
the gathering that “ [t]o discover who or
what a child is ... you have to ask [that
person]”, according to an Associated
Press report.
Reiner, who once
performed sex-reassignment surgery on babies as a
urologist, said that doctors once thought that external
reproductive organs were enough to determine gender.
However, he began seeing children who were assigned to
one gender as babies but identified themselves with the
other as they grew older. Reiner then became a
psychiatrist to study these children. His latest review
of children found that over half of the genetic males
crossed over to become boys even though they were raised
as girls —with some starting the transition as early
as 4-1/2 years old. These results have led Reiner to
advise parents to wait before agreeing to surgery for an
intersex baby; he feels that there is no need for an
intersex individual to go through the agony of
irreversible surgery in addition to social
trauma.
Dr. Eric Vilain
<http://www.healthcare.ucla.edu/>
of the University of California-Los Angeles echoed
Reiner’s thoughts at the conference. Vilain
identified 54 genes that work different in male and
female mouse embryo brains just a few days after
conception—and before sex hormones are ever made,
underscoring that gender can be independent of
genitalia.
“Intersex” is a
term that describes approximately one in 4,000 babies
born with male and female characteristics. One of the
most common combinations is called congenital adrenal
hyperplasia. While in the womb, genetic girls with XX
chromosomes are exposed to such high levels of androgen
(the hormone responsible for male development) that they
appear male externally while possessing female
reproductive organs.
Reactions to the
researchers’ recommendation has generally been
positive from the intersex community. Lynnell Long, a
local activist, told Windy City Times that she
feels “really good that doctors have finally started
to listen to intersex activists and older individuals who
wish that people had waited for surgery. It was great for
Dr. Reiner to [air] his opinions where they can
be widely viewed.” Long added that parents probably
will listen because physicians can make more of an
impression saying the same thing that an intersex
advocate urges: “For some reason, parents tend to
think that doctors are God so they listen to them more
than they would to someone who been in the same
position.”
Riki Wilchins, founder
and executive director of Gender Public Advocacy
Coalition <http://www.gpac.org/>,
also praised Reiner’s advice. “I think that
there has been this growing awareness in the medical
profession for some time that the treatment protocols for
intersex children were seriously out of joint,
hyper-aggressive, and intersex-phobic. This announcement
is an acknowledgment of that—and it’s long
overdue,” Wilchins told Windy City Times.
“Doctors are recognizing that [ intersexuality
] is not a medical emergency; they now feel that they
should see what gender the child is and, if possible, let
the child participate in decisions regarding
surgery.” As for what to advise the parent of an
intersex baby, Wilchins simply recommends “loving
your child and not taking any unnecessary and
irreversible medical steps.”
Cheryl Chase, executive
director of the Intersex Society of North America (ISNA)
<http://www.isna.org/>,
agreed that the doctors’ recommendation was good but
felt that key elements were omitted. “The AP article
completely missed the legal aspect,” Chase remarked
to Windy City Times. (Indeed, ISNA’s Web site
mentions several legal issues, such as individuals being
denied civil rights because they do not fit into a
particular gender.) “Also, the article said that
surgery shouldn’t be done because the child may not
turn out to be the sex that you pick. That’s true,
but what’s really important is ... the child may
turn out to be really unhappy—even if you get the
sex right. A lot of these surgeries are performed on
girls who grow up to be women who are upset that someone
removed parts of their clitoris and rearranged parts of
their vaginas. That is definitely
harmful.”
