Proposed Best Solution

What do we consider as the Best solution and Why?

The issue of intersexed children is a very complicated and sensitive one that definitely requires time to reach a more complex and global solution. However, one thing shouts out loud and clear. The fact that there is such large number of intersexed children, with rough gauge of 1 in every 2000 infants, demands an immediate attention of the society.

Having discussed some possible solutions and consequences in the earlier posts, out group has reached the conclusion that postponing the surgical intervention till the baby is old enough to make autonomous decision is the best way out.

The modern medical science, though it has made some incredible breakthroughs, is yet to clearly define the boundaries of intersexed children, let alone assign genders for them. Hence there is high possibility of intersexed children growing up and finding themselves stuck in a gender that they never asked for. About one in every 2,000 births is declared intersex. About five such operations are performed each day in U.S. hospitals on uncomplaining infants who have no chance to participate in or be informed on procedures that will affect their lives, bodies, and future sexual functioning Although considered “compassionate surgery,” in actuality the vast majority of early gender-determining surgeries involve otherwise unremarkable infants who simply have clitorises larger than an arbitrary standard of about 3/8 inch. While it is impossible to imagine boys undergoing surgery because their penises are larger than that of standard size, nonetheless large clitorises are seen as omens of lesbianism, lack of male interest, or unfemininity. But can mere size of genital parts be a determinant of intersex and an influential factor for early surgical intervention? Medicine cannot determine the baby’s “true sex.” For example, chromosomes do not necessarily dictate one’s gender identity, as it is obvious from the fact that most people born with androgen insensitivity syndrome live as women despite having XY chromosomes. In other words: science can measure how large a clitoris is, but cannot conclude how large or small it needs to be. Although doctors do go through careful examination before they actually make surgical changes, they are under constant pressure from the babies’ parents to quickly reach a conclusion. Considering the ambiguity in how intersex children are assigned their genders, as well as the lack of medical technology to accurately define their genders, the true sex of the baby can only be determined when they become sexually aware.

While we consider the argument that if the gender of the child is not decided as soon as possible, the child and his family might go through confusion and possible panic, the recurring cases of people growing up with wrongly assigned sex tell us that we should consider the child’s right and freedom to know and choose for himself what is to be done on his body. We believe that parents and doctors should not rush into assigning a gender for the intersex child if the child is perfectly healthy as it was born. The attempt to alter their genitals into the “ideal medical condition” have resulted in recurring failures and confused children growing up in wrongly assigned sex.
Here is a quote from 16 years old girl, who has been assigned with wrong gender.
“Firstly, The shame and secrecy of early genital surgery never goes away.

“Secondly, the medical community views the world in terms of normal and abnormal. Anything abnormal must be corrected. We are telling the medical community to do nothing, and doctors have difficulty not treating a patient. They should know that their efforts and secrecy do not heal us. They harm us.”

How can we be responsible for those who grow up only to realize that he or she has been assigned a gender which he or she cannot conform to? It tells us that although surgical intervention can alter genitals, but cannot change or reinforce gender or sexual preference. In today’s wildly accepted solution-to carry out early surgical intervention-deprives the children who are most directly affected choice and consent. The surgical alternation should only be carried out under child’s consent when he or she fully understands his or her sexual origins.

While above argument strongly points to the need to postpone any surgical intervention till the child can take full autonomy, how do we explain the choices of parents and doctors who go ahead with early surgical interventions? The biggest concern is that if the child grows up without a specific gender assigned to them, or with genitals that do not conform to modern medical standard, they will definitely face confusion, and have to live in secrecy, or face hostility from society in general. These possible consequences deter parents and doctors from giving the child a freedom to choose their own sex, or what is to be done to their body.

Hence there is a strong need to increase social awareness regarding the intersexed children and society has to be more accommodating to this group of people.
When the society accepts the possible existence of the third sex, and does not discriminate against these people, the surgical intervention can wait till the children can make decisions of their own. There are 1 in every 2000 babies with indistinct gender, and that is a large number. Acknowledging the fact that adults who escaped early genital surgery also experience their own trauma of growing up unique, rather than putting them through the risk of wrong gender assignment and traumas following that, the society has to be more open to this genetic possibility and understand that they are also part of this society and that we should respect their rights and choice.

Stakeholders and Values

The stakeholders who will determine an intersex child’s fate include the parents of the child, medical experts, attorneys and intersex activists.

Firstly, all parents of intersex babies face a crossroad which will inevitably affect the baby’s future and their future too. It is of human nature to want to be part of the majority and to want to assimilate into society easily. To have a baby whose gender is ambiguous will definitely take a big toll on the parents and the parents will have to decide on the sex assignment of the baby because it is “not normal” to be neither male nor female. After deciding on the sex of the baby, parents are required to sign a contract of agreement. From then on, the baby’s gender will be sealed.

Secondly, medical experts will be brought in to examine the baby and using various means such as measurement of the baby’s genitals and examination of the baby’s genes. Doctors will then come to a consensus of what gender the baby should adopt and make necessary surgical procedures if necessary. Medical experts play a large role in assigning a sex to an intersex baby as most parents will listen to the advice given by them, so they are definitely one of the stakeholders involved. Many doctors advise parents to determine the sex of the baby as soon as possible, stating reasons such as the identity crisis the baby will face in the future if no action is being taken.

Intersex activists will also be embroiled in cases of intersex humans. Many intersex activists believe that parents and doctors should not change the baby’s sex until the baby is old enough to decide for him or herself. One of the reasons intersex activists give is that the child may not be happy with his or her assigned gender in the future but will have to live with it in the future because surgery in the same area is highly dangerous.

Attorneys are also involved in cases of ambiguous gender. This is because society dictates that there are only two genders- male and female. Anyone who is unable to be classified under these two categories is considered as “abnormal”. Parents, who will decide on the sex of the baby, will have to include the name of their child in the birth certificate and such “trivial” decisions may be difficult due to the baby’s medical conditions.

There are many values related to the issue of intersex humans. Firstly, people will have to learn how to conform to social pressure and understanding of what is normal. In many aspects of our life, society dictates who we are, how we act and why we act this way. Intersex humans, who cannot be “fully” classified as male or female, have faced many difficulties in leading a “normal life”, whether they have experienced surgery to fix their gender at a young age or not. Society and community often shun these people because of their medical condition. We should learn to be more receptive and embrace these people with disorders of sex development because they can still contribute to our society. To accept them and integrate them in our society, we must constantly remind ourselves that everyone is different no matter what and the beauty of being difference is that we are able to create a vibrant and diverse community with different perspectives and attitudes.

The second value identified is the parents’ concern about the child’s future and love for their child. All parents love their children and want the best for their children. It is not exaggerating to say a parent is willing to do anything for his or her child. Many parents want their intersex children to live a “normal lifestyle” and hence assign a gender to the baby. However, parents must realise that such decisions cannot be rushed into and the real test is not the assignment of gender, but what happens after the surgery.

The third value is child’s rights and freedom. Many intersex activists, such as National Organisation for Women, believe that parents and doctors should not rush into assigning a gender for the intersex child if the child is perfectly healthy and fine. Many Intersex Genital Mutilation patients who have gone through the surgery to alter their genitals into the “ideal medical condition” have regretted not being able to choose their sex and “living in a world created for them”.

The last value is doctor’s professional sense of responsibility. To be a doctor is not an easy task because you have the lives of your patients’ in your hands. Doctors who receive cases of intersex babies will have to do intensive research and examination on the baby before reaching to a conclusion of which gender the baby should adopt. It is essential that whatever doctors do, they must bear in the mind what is best for the baby and the family.

Solutions

Our group has classified the viable options for an intersex children into three following categories : early surgical tntervention, postponed surgical intervention, no surgical intervention.

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1. Early Surgical Interventions.

Why?

Parents are concerned with the bornt abnormalities of the child, therefore they want to do surgery correction to the child as soon as possible so that he/she can fit into society easily.

How?

This is a choice made by parents to assign the gender of the child, solely based on biological reports which suggest the better gender choice of the two available ones. Physical surgical interventions and hormones therapy will be practised to reach the desired outcome.

Unpredicted Risk :

This option has a 50% chance of success only. The biological report is not fully accurate and dependable. Some intersex children, who have undergone early surgical gender corrections, have indicated resentment and dissatisfaction towards the gender determined by their parents earlier on. Some of them have developed liking towards others of the same gender, simply because they grow to be different from their predicted gender-liking. (Read more in Testimonials)

The Consequences :

The child will grow up with a permanent physical scar. It is possible that the child might sink into depression or feel outcasted as he/she uncovers about their unusual past. Also, although the child has a physically “corrected” sexual orientation, the child might turn into a homosexual because the sexual preference of an individual is unaltered. Lastly, the child might be diagnosed with surgical fetish and what follows after is a lifelong rejection and resulted trauma towards one’s sexual assignment.

Read the excerpt below for more information :

A child subjected to surgery without consent grows up and rejects the sex assigned only to find that they are diagnosed as having a surgical fetish, a paraphilia known as autogynephilia.  This is one of the cruelest forms of medical abuse because the very person who has been surgically altered without consent is diagnosed as having a surgical fetish for rejecting and denouncing the very medical procedures which caused the suffering to begin with – surgery

The inaccuracies and inadequacies of the medical technology has made the choice of surgical interventions, a very hard one. This has created a dilema amongst parents and many ethical questions are raised and involved. Some believe that the child deserves the right to determine his/her own sexual orientation, instead of the parents and this brings us to the next viable option worth considering.

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2. Postponed Surgical Interventions.

Why?

Parents might choose this alternative due to the worrying concern of wrong gender assignment at birth. Many of them lack faith in today’s related biological reports’ indications, as some decision made based on it have already proven to be inaccurate. Since being intersex does not result in any detrimental health effects or cause any loss of life, some parents choose to decide on the gender at a later time, especially puberty age whereby gender indication on the child is much more apparent. Much as they want to do the most accurate gender assignment for the intersex child, they also want to provide their child with the respect and freedom to choose his/her gender out of her own will.

How?

This solution requires no actions to be taken until decision-making process comes in at a much later date. The mature child will discuss with the parents about their choice of gender assignment and reach a mutual agreement to help the abnormal child to finally fit into society as he/she would love to. Some possible problems involved could be the naming of the child at birth and the gender indication that is required on the birth certificated. Our group suggests a possibility of implementation of a special system to allow swift ammendments to the birth certificate for such children. The parents can choose a “temporary” and most appropriate gender indication for the child at birth. Also, the system gives them special privillige to many necessary alteration to the certificate once the interchildren finally confirmed their gender after operation. Parents could also give their child unisex name, like Ashley and Jamie, to eliminate inconvenience of renaming as gender decided at first becomes subjected to changes later on.

The Consequences :

Intersex children put under the post-surgerical scheme might face identity crisis as a result of confusion of one’s gender. Also, they might be ostracised and a childhood trauma might also haunt them because other children might probably see them in a different light, outcast and label them as “freaks”. Such will affect the child mentally and affect their growth in a way.

As the number of cases of intersex children is a skyhigh figure of 1 in every 2000 children, the problem implicated with such children might one day escalate and grow in scale to cause a social panic as people are unable to accept the changing society just in time, as they hold onto their traditional values and stereotypical views.

Pressing need :

Our group feel that there is a need to introduce a new set of social values to inculcate respect intersex children among public. People must exhibit tolerance and accept them to help them fit into society, especially when such children are becoming more and more common. This will prevent society from uneccesary panic and social division. With that, everyone can live harmoniously together by practising respect every individuals on earth deserve.

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3. No Surgical Interventions.

Some people believe that we should not play god, therefore they would prefer to leave the babies as they are bornt. Some surgery-corrected intersex children actually indicated that they would prefer to remain as they once were. ( Refer to videos under Reel Time for reference )

Also, in some countries like India, intersex babies are actually believed to be descendents of god. Hence, such suggests that conformity to social norm might be uneccesary in today’s modern society already. Perhaps, it could be possible that in years to come, the need of providing solutions to such extraordinary babies may cease to exist.

The Consequences :

The intersex child might forever be alienated by the public if the society continues to stereotype against them and discriminate them.

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Aside from the options and solution available for the intersex child, there is also a need to have solution to address problem of social discriminations by public on the rising numbers of intersex children.

Therefore, our group presents our fourth solution pertaining to this issue :

4. Public Campaign for Intersex Children

The public campaign serves to create acceptance towards intersex children by the public. The campaign will educate public about such unfortunate children and create tolerance towards them. All these actions serve to help such children integrate into society, so that they can function normally in the social body.

The Consequences (if campaign fails) :

There will be a possible social problem and panic caused as the intersex children will continue to be discriminated against. It will be a even bigger problem as the numbers of intersex children all over the world are constantly believed to be on the rise.

Ethical questions raised

1) Should surgical intervention be postponed till the child can make an autonomous decision regarding his or her body?

2)Should the intersex conditions of the child be largely kept at private? For example, during school medical checkups.

3) Should society accept intersex people for who they are? Should there even be prejudice against them?

Intersex conditions and surgery

Who are intersex children?

“Intersex” is a general term used for any form of congenital (inborn) mixed sex anatomy. 

It is important to understand that intersex does not always involve ambiguous genitalia. Sometimes, a child or adult who is intersexed can look quite unambiguous sexually, although internally their sex anatomy is mixed.

So basically, intersex children are born with external genitalia, internal reproductive organs, and/or endocrine systems that are different from most other people.

There is no particular “intersex body”. What makes intersex people similar are their experiences of medicalisation, not biology.

Generally, intersex is not an identity category. While some intersex people do reclaim “intersex” as part of their identity, most regard it as a medical condition, or just a unique physical state.

Intersex conditions are also known as “disorders of sex development” (DSD) in the medical community.

How common are intersex conditions?

It is roughly estimated that 1 in every 2000 infants are both intersex.

Due to the secrecy surrounding intersex conditions and also that there is no concrete boundary to the definition of “intersex”, no one really knows the exact number of infants born with intersex conditions.

 Are intersex conditions life-threatening?

Many infants born with intersex conditions are perfectly healthy and do not require any medical intervention other than diagnostic tests.

However, some intersex conditions are associated with serious health issues, which need to be treated medically. For example, when an infant is born without any urinary opening, medical interventions must be done on an emergency basis.

Is there a test to find out the infants’ true sex?

Medicine cannot determine the infant’s “true sex”. Chromosomes do not necessarily dictate one’s gender identity.

Androgen insensitivity syndrome (AIS) is a condition resulting in a failure of normal masculinization of the external genitalia in chromosomally male individuals. Most people born with androgen insensitivity syndrome live as women despite having XY chromosomes. This example can be used to support the statements in the previous paragraph.

When infants are born with ambiguous genitalia, surgeons often operate in order to bring the child’s body into accordance with our expectations for “correct” male or female genitalia, even when the actual morphology of their bodies causes no dysfunction or harm.

Infant clitorises longer than 0.9 cm are considered too large, and penises that are shorter than 2.5cm are considered too short.

Science can measure how large a clitoris is, but cannot conclude how large or small it needs to be. That is a societal determination. 

What are the impacts of surgical intervention at birth?

The surgeries are irreversible and will definitely leave physical scars on the infants’ genitals.

20% to 30% of surgical cases result in a loss of sexual sensation.

Some children grow up to reject the sex assigned to them at birth and this will impact them emotionally. These children may also face identity crises.

Since almost all such surgeries are undertaken to fashion female genitalia for the infant, it is more difficult for the child to present as male if they later select a male identity.

Some people feel that surgery should have been performed later in their lives, when they were able to have  their own say in matters regarding their bodies.