September 17, 2018
The American Academy of Family Physicians (AAFP), one of the United States’ oldest and largest medical organizations, has issued a policy opposing medically unnecessary surgeries on intersex children.
“Intersex” refers to the up to 1.7 percent of the population born with a range of bodily traits that do not fit conventional expectations of male or female. Their biological sex characteristics, such as chromosomes, gonads, or genitals, may differ from social expectations. These variations are medically benign, however in the 1960s surgeons popularized “normalizing” cosmetic operations. The procedures are not designed to treat a medical problem, as there generally is no medical problem. And no data has ever demonstrated that the operations help children “fit in” or “function in society,” which some surgeons say is the aim of the procedures. The operations do carry high risks of scarring, incontinence, sterilization, and psychological trauma.
“Many intersex children are subjected to genitalia-altering surgeries in infancy and early childhood without their consent or assent,” the AAFP policy reads. “Scientific evidence does not support the notion that variant genitalia confer a greater risk of psychosocial problems.”
Additionally, the policy states: “Genital surgeries should only be recommended for intersex infants and children for the purpose of resolving significant functional impairment or removing imminent and substantial risk of developing a health- or life-threatening condition.” This reflects what intersex patient advocates have been demanding for decades.
Medically unnecessary surgery on intersex children has been condemned by the World Health Organization, three former US surgeons-general, Physicians for Human Rights, the AIS-DSD Support Group for intersex people and their families, Amnesty International, UN experts, Lambda Legal, the ACLU, two pediatrics professional bodies, and intersex-led organizations worldwide.
A recent non-binding California Senate resolution called on medical associations to do exactly what the AAFP has done—create clear policy in support of the human rights and bodily autonomy of intersex youth.
Patient advocates have worked with the medical community for decades to develop standards. But medical professional associations, despite some brave physician voices, have by and large failed to regulate the practice. Other medical groups should catch up with the times and follow The AAFP’s lead, creating policies that respect the rights of all patients to bodily autonomy—even if their bodies are a little different.