Abstract
In Western countries, soon after birth, all individuals are assigned to the female or male sex on a social and legal level. These two culturally recognized categories of sex and gender are usually unquestioned, because they are considered as “natural” and “normal.” The natural argument has been used to justify different social gender roles and expectations, supposed different abilities, gender discrimination and inequality. Individuals born with variations of sex characteristics, who do not fit in the sex/gender binarism, have been subjected to cosmetic, non-life-saving, non-consensual medical treatments with irreversible damaging effects. This chapter discusses the current medical practices, from a sociological and legal perspective, highlighting how medical and parental authority influences the decision-making process and the practices themselves. It further questions how the legal-rational authority of the law can intervene to protect the fundamental human right to self-determination and bodily integrity of individuals with intersex characteristics.
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Notes
- 1.
This chapter is the result of a common work, but academically the authorship can be attributed as follows: Michela Balocchi is the author of sections “Research Frame, Definitions and Terminology,” “Pathologization of Differences and Dominant Medical Practices” and “Concluding Remarks”; Ino Kehrer is the author of sections “Medical Authority” and “Parental Authority.”
- 2.
The research was funded by the Seventh Framework Program FP7-PEOPLE-2013 IOF of the European Union Marie Curie Actions n. 627162 (2014–2017).
- 3.
The conference was organized in Chicago by the Lawson Wilkins Pediatric Endòcrine Society and the European Society for Pediatric Endocrinology, with the aim to write a Consensus Statement for the management of the VSC; some patient advocates, and only two intersex activists, were present too.
- 4.
As we can read on the Darlington Statement: Joint Consensus Statement from the Intersex Community Retreat in Darlington (March 2017): “the word ‘intersex’ […], belongs equally to all people born with variations of sex characteristics.” Balocchi , “The Medicalization of Intersexuality”; Davis , “DSD is a Perfectly Fine Term.”
- 5.
Greenberg , “Legal Aspects of Gender Assignment.”
- 6.
The OGR was based on the idea that the newborns’ gender identity was like a tabula rasa, moldable through a gendered education but also influenced by the appearance of external genitalia. The protocol for intersex newborns indicated cosmetic surgery within eighteen months from birth, followed by a strictly binary gendered education to the related gender role and expression. Money and Ehrhardt, Man & Woman.
- 7.
Weber, Theory of Social and Economic Organizations.
- 8.
Diamond and Sigmundson , “Management of Intersexuality.”
- 9.
Marchetti , L’invenzione della bisessualità.
- 10.
Benadusi , “Dalla Paura al Mito dell’Indeterminatezza.”
- 11.
Busi , “La Nuda Vita degli Ermafroditi.”
- 12.
See Laslett et al., Gender and Scientific Authority; Karkazis , Fixing Sex.
- 13.
In fact, there are only a few cases of necessary early medical intervention (such as when the urinary tract is obstructed). See Karkazis et al., “Genital Surgery.”
- 14.
Comitato Nazionale per la Bioetica, I disturbi della differenziazione.
- 15.
Kipnis and Diamond, “Pediatric Ethics,” 405.
- 16.
Clitoroplasty aims to modify the size and form of the clitoris and is purely aesthetic. Vaginoplasty interventions are described as “functional,” meaning that a vagina is constructed, or the existing vaginal canal is widened in view of future penetrative and heterosexual intercourses (in line with the already mentioned mainstream heteronormative medical approach).
- 17.
The removal of healthy viable testes and/or ovaries is recommended to prevent gonadal tumor, but the risk of developing a tumor varies among the different types of intersex traits. For example, in case of low risk—inferior than that of breast cancer—it could be sufficient to monitor the gonads, while in many other cases, gonadectomy (leading to sterilization) could be safely postponed to a later age, as in almost every case cancer occurrence is very low before puberty. Deans et al., “Timing of Gonadectomy”; Lee et al., “Global Disorders of Sex Development.”
- 18.
Roen , “Intersex or Diverse Sex Development,” 7.
- 19.
During childhood, individuals with intersex variations are often subjected to unnecessary, repeated exposure to photographs of their genitalia: among the consequences of this practice is the perception of having an ugly/wrong body. Bauer and Truffer, “NGO Report”; Creighton et al., “Medical Photography.”
- 20.
Although there are not enough certain quantitative data yet, according to the researches below an average of between 8% and 20% of children develop a gender identity that is different from the one they were assigned at birth. Hughes et al., “Consensus Statement”; Furtado et al., “Gender Dysphoria.”
- 21.
Minto et al., “The Effect of Clitoral Surgery.”
- 22.
Meoded Danon et al., “Between Concealing and Revealing”; Vaknin et al., “Termination of Pregnancy.”
- 23.
Department of Health and Human Services, Health and wellbeing, 19.
- 24.
Foucault, The Birth of the Clinic; Foucault, “The Subject and Power.”
- 25.
Foucault, Society Must be Defended, 33.
- 26.
Dreyfus and Rabinow , Michel Foucault.
- 27.
Farrell and Lillis , “An Adaptation to.”
- 28.
Balocchi , “Un Apparente Paradosso.”
- 29.
Foucault, The Birth of, 115, 89.
- 30.
Farrell, “An Adaptation to.”
- 31.
Lalatta , “Diagnosi e Consulenza.”
- 32.
Jones , “Intersex and Family.”
- 33.
Tamar-Mattis , “Exceptions”; Beh and Diamond, “An Emerging Ethical and Medical Dilemma.”
- 34.
Zieselman , “Invisible Harm.”
- 35.
Streuli et al., “Shaping Parents”; Roen and Pasterski , “Psychological Research.”
- 36.
According to the OGR model, without having complete information, parents would be more able to bond with their children, also avoiding the “risk” that they may reveal the difficult and possibly shocking truth.
- 37.
Roen, “Intersex or Diverse.”
- 38.
Columbian Constitutional Court, Sentencia T-551/99 Bogota, Aug. 2 1999.
- 39.
Beh, “An Emerging.”
- 40.
UN Committee on the Rights of the Child (2013), “General comment n.14.”
- 41.
Kopelman , “Using the Best Interest Standard.”
- 42.
Slijper et al., “Androgen Insensitivity Syndrome”; Gough et al., “They did not Have a Word.”
- 43.
Mattioli and Jasonni , “Andrologia chirurgica pediatrica.”
- 44.
Ghattas , Human Rights Between the Sexes.
- 45.
Sanders et al., “Parents Need to Protect,” 3318.
- 46.
Tamar-Mattis, “Exceptions.”
- 47.
Sanders, “Parents Need”; Crissman et al., “Children with Disorders.”
- 48.
- 49.
That means a vagina which is able to hold a penis and a penis which is able to penetrate a vagina.
- 50.
Feinberg , Freedom and Fulfilment; Kon , “The Shared Decision-Making Continuum.”
- 51.
Ehrenreich and Barr , “Intersex Surgery”; Jones , “Intersex Genital Mutilation.”
- 52.
For a full list of committees of the United Nations that have so far condemned unnecessary surgeries on intersex infants, see http://stop.genitalmutilation.org/post/IAD-2016-Soon-20-UN-Reprimands-for-Intersex-Genital-Mutilations
- 53.
Carpenter , “The Human Rights of Intersex People.”
- 54.
ILGA Europe, “3rd International Intersex Forum Concluded.”
- 55.
Countries such as Argentina, Australia, Bangladesh, Canada, Denmark, Germany, India, Malta, Nepal, the Netherlands, New Zealand and Pakistan.
- 56.
Starting from January 1, 2019, Germany became the first European country to introduce a fourth option on birth certificates: along the F and M options, and the possibility to leave the entry blank, individuals with certified VSC can be registered as divers [other].
- 57.
Carpenter, “Identification documents”; Agius , “Third Gender”; Bauer and Truffer, “Intersex: Third Gender.”
- 58.
Frader et al., “Health Care Professionals,” 428.
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Balocchi, M., Kehrer, I. (2020). The Bio-medicalization of Intersex Variations Between Medical and Parental Authority. In: Bardazzi, A., Bazzoni, A. (eds) Gender and Authority across Disciplines, Space and Time. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-45160-8_7
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