Reports of young girls in distant northeastern African countries pinned to the ground by female relatives and subjected to female genital mutilation with razors wielded by village circumcisers to satisfy the social norms of their cultures persist. Disturbing and shocking, thankfully this custom is unheard of in our country.
But cosmetic genital surgery is a standard of care performed in hospitals across the United States on intersex babies. Surgery performed for the sole purpose of changing the appearance of non-standard sexual anatomy in order to satisfy social norms. Social surgeries.
Intersex
What is intersex? An umbrella term for people born with variations in their sexual anatomy, intersex is when the external genitalia, reproductive organs, chromosomes and hormones fail to align in the expected binary fashion. It’s estimated 1-2% of babies are born with intersex traits but the incidence is not tracked. Many people do not know they have intersex characteristics until puberty, adulthood, or when an unrelated surgery incidentally reveals opposite sex organs, such as ovaries discovered in a male.
At birth, doctors proclaim, “It’s a boy!” or “It’s a girl!” at first sight. But when a newborn infant presents with a small member combined with undescended testicles, that member could be deemed an enlarged privy parts. Is the newborn a male or female? It’s an untenable question. We can’t handle genital ambiguity. To be told their baby is neither clearly male nor female is terrifying to parents.
But in the absence of pathology, surgery is not the solution to parenteral distress. Humans are diverse in every way possible but as interACT: Advocates for Intersex Youth point out, being different does not mean being diseased.
Gender-normalizing Surgery
Termed “gender normalizing” by those who believe that sexual anomalies need fixing, these concealment-centered surgeries are often shrouded in secrecy, thus instilling shame.
The goal is to make these infants look as female or male as possible. Most babies are surgically re-designed to look like females as it’s considered easier to take away than to add. This may include redirecting the urethra, reducing the privy parts and creating a lady parts (infant vaginoplasty). Gonads and ovaries may be removed.
It sounds horrific but the initial surgery is only the beginning. There are usually multiple surgeries coupled with complications that include incontinence, sterility, and lack of sensation. Lifelong hormone replacement therapy is needed and many are left with significant scarring. Artificial lady partss need to be dilated regularly throughout infancy and childhood, causing emotional distress and physical discomfort.
Repeated exposure to anesthesia can have harmful effects on developing brains.
This old but still prevalent concealment-centered treatment gained traction in the 1950s largely due to Dr. John Money, a psychologist affiliated with Johns Hopkins. He believed that children with “unfinished genitals” could easily be made into whichever sex was decided. It didn’t matter which sex one was born. What mattered was convincing genitalia.
The decision-makers for surgery were the doctor and the parents, with the doctor carrying a bias of authority. Parents have later said they weren’t given all the information needed and were unduly influenced at a time of heightened anxiety to make a decision in favor of surgery. Indeed, the situation was sometimes presented as a psycho-social emergency demanding immediate action if the child was to ever have a normal life.
One of Dr. Money’s patients was David Reimer, an identical twin boy born in 1965, whose member was completely destroyed in a botched circumcision. Eager to experiment with his nurture over nature theory, Dr. Money recommended sex-rearing David as a girl, assuring the devastated parents that as long as they started at an early age and never wavered, David need never be told he was born male.
Despite being called Brenda Lee, despite wearing frilly dresses and given dolls, despite the removal of his testes and the addition of a lady parts, Brenda acted like a boy, walked like a boy, sat like a boy, and even insisted on standing up to urinate like a boy. His childhood was marked by dreaded and traumatizing trips to Johns Hopkins, where he endured repeated medical genital examinations and exhibitions. He suffered deep confusion, humiliation and shame. Brenda finally changed his name to David and insisted on living as a boy at age 15.
After a tragically tormented life marked by failed relationships and severe depression, David died of suicide by gunshot at the age of thirty-eight. Collateral damage included David’s twin brother Brian, who died of an overdose of antidepressants at the age of thirty-six.
CA Senate Bill 225
Senate Bill 225, introduced by Sen. Scott Wiener (D-San Francisco bans 4 types of non-medically required surgery on children under the age of 6. Known as the Bodily Autonomy, Dignity and Choice Act, it’s civil rights on behalf of infants.
According to the Gender and Sexuality Development Clinic at Children’s Hospital of Philadelphia, a sense of gender identity starts between 3 and 5 years of age.
The bill delays all non-essential procedures until the child can participate in the decision and the parents have had time to absorb the information and sort out the situation.
California Medical Association (CMA) Opposition
Thus far, the CMA has been a powerful opponent. Despite the lack of evidence for nurture over nature, and despite evidence that surgery can cause unwanted irreversible conditions, CMA has opposed the bill.
But progress and momentum have begun. The new model calls for patient-centered care, not concealment-centered care. Two premier pediatric hospitals, Boston Children’s Hospital of Massachusetts and a Harvard teaching hospital, and Lurie Hospital of Chicago have ceased doing surgeries. Lurie Hospital even apologized for what they call an “approach (that) was harmful and wrong”.
Help Do No Harm
Advocates and human rights groups recommend waiting until the child can participate in the decision. Medically unnecessary, irreversible procedures should be delayed. Teams of Difference of Sex Development (DSD) experts can provide sensitive and non-discriminatory care.
Join the World Health Organization, three former U.S. surgeons general and Human Rights Watch, the American Academy of Family Physicians, in calling for the end of these surgeries until research shows clear evidence of benefit.
Similar legislation to CA SB 225 is expected in New York.
L&D nurses everywhere should educate themselves about the issue, identify their beliefs and provide support to their patients. CA residents, contact your CA State Assemblymember using Find My Rep and ask for their vote on SB 225.
Thanks for reading this and your support is appreciated. I would love to hear your thoughts on this topic.
Nurse Beth,
Author, First-Year Nurse and How to Land Your First Nursing Job...and your next!
References
Colapinto, J. (2000). As nature made him: The boy who was raised as a girl. Toronto: HarperCollins Publishers.
Gutierrez, Melody. A new effort to ban cosmetic genital surgery on children launches in California legislature. 2021. Retrieved January 16, 2021
Intersex Care at Lurie Children’s and Our Sex Development Clinic. 2020. Retrieved Jan 11, 2020
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It is my hope that you also consider the confounding variables of the evidence in the studies that support your assertions. All the studies that I have looked at hitherto, including several that I did not include herein have listed no conflict of interest. I will review the mentioned variables and their effect on the studies. If you can look at the studies that I have referenced and the studies in the systematic reviews and find any variables that were significantly overlooked and unaccounted, please inform me, as that would be gross negligence of phenomena that is quite important in society. Otherwise, this will be a futile engagement of covert hypocrisy.