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"Parents and doctors still far too often put social investment into normalising the appearance of genitals above the needs of the infant or child," writes Emily McAvan.
Emily McAvan

18 Oct 2016 - 3:17 PM  UPDATED 18 Oct 2016 - 3:17 PM

The UN Committee on the Rights of the Child has recently passed down some observations about the treatment of intersex children in its 73rd session. It has urged New Zealand and South Africa to guarantee the self-determination of intersex children, expressing concern at the number of medically unnecessary surgical interventions on intersex infants and children. The UN committee noted the “high prevalence of harmful practices in the State party, including intersex genital mutilation” in South Africa. Furthermore, it urged New Zealand to adopt a “child rights-based health care protocol for intersex children.”

The harmful and coercive treatment of intersex people is a problem here too in Australia. Intersex is a form of biological diversity in which physical sex characteristics do not fit the prevailing norms of male or female. This may be genetic, chromosomal, hormonal or anatomic variance. There are at least 40 variations known to science.

Historically, surgery and hormone treatments have been used to “correct” the appearance and sexual functioning of intersex people, including in Australia. Concerns about genital appearance especially have dominated parental and medical decision-making, which has rarely taken into account the wishes of intersex people themselves.

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As a result, intersex activist organisations like OII, Organisation Intersexual International Australia, have worked to prevent surgical interventions on healthy intersex babies and children. OII’s website states that: “We regard all such interventions without personal and fully informed, prior consent as reprehensible; we campaign to end them.” Surgeries may reduce sexual pleasure or functioning, as well as being psychologically traumatising. Many intersex people historically have had surgeries or hormone treatments without even being told that they even are intersex. This can have devastating consequences when people find out later in life that they have compromised - or no - fertility; that they have ongoing health problems; that the ‘illness’ they were told they had to endure painful surgery for was in fact a naturally occurring human variation; or, perhaps most distressing, they realise that the gender they were forcibly made to conform to by doctors at birth simply because it made for the easiest surgical ‘correction’  is not the gender that they would have chosen.

A 2013 cross-party Senate Committee report into the practice stated that "normalisation surgery is more than physical reconstruction. The surgery is intended to deconstruct an intersex physiology and, in turn, construct an identity that conforms with stereotypical male and female gender categories.”

There has been some recent progress made in Australia in the recognition of intersex people’s need for self-determination, including state recognition of the identities of the minority of intersex people who identify as neither male nor female. Intersex (and transgender people) who do not identify with the sex/gender binary may receive a passport marked with an “X” sex marker, for intersex or indeterminate.

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And yet, OII still hears from parents and clinicians in Australia of surgical interventions “when a child’s clitoris is deemed too “big” or a boy can’t stand pee”. Though intersex people have worked hard to intervene into broader discourses of sex and gender normalisation, the socialnot medicalneed to produce a coherently sexed body remains just as pressing in the present day. The international hysteria over intersex athlete Caster Semenya has shown just how much anxiety about sex and gender still exists. There remains a great deal of stigma about “abnormally” sexed bodies. Parents would not be worried about the need to surgically “correct” intersex children if there were not an overwhelming societal interest in maintaining the body norms of the gender binary.

As a result, parents and doctors still far too often put social investment into normalising the appearance of genitals above the needs of the infant or child. Children cannot meaningfully consent to such surgeries, and there is no reason not to wait until they are old enough to make up their own minds. Here, just as in South Africa and New Zealand, more work needs to be done to respectfully maintain the integrity of intersex bodies.