Amnesty International's report on the treatment of intersex people in Denmark and Germany highlights the global need for the medical community to stop performing invasive and irreversible 'normalising' surgeries on children.
Simon Copland

17 May 2017 - 10:37 AM  UPDATED 17 May 2017 - 10:37 AM

Amnesty International has released a new report condemning invasive ‘normalising’ surgeries committed against people born with intersex variations.

The report, titled First, Do No Harm, was released last week and documents a range of human rights violations, focusing in particular on “the violation of their rights to a private life, to the highest attainable standard of health, to bodily integrity, self-determination and recognition before the law”. These violations, the report states, are largely “experienced in the course of non-emergency, invasive and irreversible ‘normalising’ surgeries and other medical practices, and the failure of the state to protect individuals against these violations.”

First, Do No Harm focuses its research on medical practices in Denmark and Germany. In addition to conducting a review of legislation and medical practices, Amnesty has spoken to 16 individuals with intersex variations, eight parents of children with these variation, 15 intersex activists, and 31 medical and health professionals involved in the treatment of children and adults with intersex variations.

While noting that some variations in sex characteristics require urgent medical intervention, Amnesty found that in both countries intersex people “undergo non-emergency, invasive and irreversible surgery and hormonal treatment that can cause short and long term harm.” The most common of these surgeries are ones to hide an enlarged clitoris, remove the gonads, or to reposition the urethra to the tip of the penis. Cosmetic operations on the vagina in order to make it look more ‘feminine’ are also common.

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Speaking to research participants, Amnesty found that these operations occurred largely to reinforce gender binaries.

Sandrao, a participant who lives in Germany had their gonads removed at the age of five, telling Amnesty:

“The medical profession only thinks in this gender binary system. Instead of saying your child is normal, and will grow up healthily, they say something is wrong and it can be fixed with surgery.”

“I knew I was different, I thought I was some kind of monster. I was unable to develop a gender identity. I was pressed into the female role, I had to wear skirts, I had to have long hair. It was painful to have sex with men and I thought this was normal.”

H*, from Denmark, had an operation in 1984 at the age of five for hypospadias—something he only discovered by accident when he accessed an old medical journal in 2016. Looking back on it, however, H* remembered the impact of the surgery:

“I had to pee and it just hurt really [badly], so I held back my urine because it hurt so much. I was screaming in the toilet, running around, I had no clothes on. In the end, I peed all over – I screamed, I was afraid, I didn’t understand what has happening. I was a bit embarrassed for peeing all over the place.”

“When I think about what happened, I get upset, because it wasn’t something for anyone else to decide—it could have waited. I get sad when I think about the fact that it is considered necessary to operate on these children, only because other people [think] it should be done.”

The stories presented by this report are very similar to those documented in Australia. Following the high-profile ‘Carla Case’ last year, in which The Family Court approved gender reassignment surgery on a five-year-old intersex child, attention on ‘normalising practices’ in Australia has increased, with the Australian Human Rights Commission recently stating this issue to be one of major concern

Similar to the Australian situation, Amnesty has found that the majority of the human rights violations in Denmark and Germany are due to failed health guidelines, with Denmark’s Health Authority having no guidelines for the treatment of intersex individuals, while Germany’s guidelines have been deemed insufficient to prevent the documented violation of human rights.

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Amnesty has recommends that for both countries develop and implement a rights-based healthcare protocol for individuals with variations of sex characteristics. This includes: postponing non-emergency invasive and irreversible genital surgery or hormone treatment on children until they have the capacity to meaningfully participate in decision making, as well as ensuring medical and healthcare professionals receive training on gender and bodily diversity. Amnesty has also called for increased availability of psychosocial support for children and adults with variations of sex characteristics, and for Germany and Denmark to explicitly include sex characteristics as protected grounds in anti-discrimination provisions.

Calls for similar policy changes have been made in Australia. The Darlington Statement, released by intersex activists last year, called “for the immediate prohibition as a criminal act of deferrable medical interventions, including surgical and hormonal interventions, that alter the sex characteristics of infants and children without personal consent”. The statement also argued “for the implementation of advisory bodies to develop appropriate human rights-based, lifetime, intersex standards of care with full and meaningful participation by intersex community representatives and human rights institutions”.

Amnesty International’s report highlights the international nature of this issue, documenting a range of abuses that cross international borders. While specific details differ, the practice of ‘normalising’ surgeries is a clear issue that continues to need to be addressed, whether in Germany and Denmark, or in Australia.