Wednesday, August 19, 2015

Intersex kids

One issue in bioethics and pastoral ministry is what, if anything, to do about intersex kids. I'm going to repost some comments I recently made, which started out as a Facebook discussion. I'm combining some comments from Facebook and email. 

The wrongness of routine pediatric sex reassignment surgery is one of those areas on which the left and right are starting to converge into complete agreement, but by and large neither recognizes the other as doing so.

BioEdge: Parents sue over intersex surgery
They allege that their adopted child was unable to give consent to genital reconstruction.

i) What about the genetic sex of the child? What would be the child's "orientation" once the sex hormones kick in?

I mean that depending on their genetic makeup, when they hit adolescence their system will be flooded with sex hormones of a particular gender, and that would be a natural consideration for the direction to take in genital reconstruction. 

Do intersex individuals begin to produce male or female hormones around the time they hit puberty? If so, can that be known in advance? If so, won't they have a corresponding male or female sex drive? Wouldn't it not make sense to reconstruct their ambiguous genitalia to match their sex drive? 

Seems to me it would be better to subdivide the issue. Given the genetic makeup of a given intersex baby, can we predict whether male or female sex hormones will naturally kick in when they reach puberty? If so, then it would not be unconscionable to reconstruct their genitalia consistent with that complementary development. If, however, that's not predictable, then surgery should be postponed.

ii) To call it "sex reassignment surgery" is misleading. That implies going from one clearly identifiable biological gender to another. Genital reconstruction of intersex individuals presupposes ambiguous genitalia, right? It would be more accurate to call it "sex assignment surgery." Assigning a definite sex for the first time.

iii) I assume there are limitations to reconstructive genital surgery. For instance, I assume that medical science cannot, as of yet, make a clitoris from generic tissue. 

iv) Another issue which goes to the question of timing is if parents enroll an intersex child in a group athletic activity (e.g. swimming class) where the child will disrobe in front of other kids the same age (e.g. suiting up in the locker room). That would be a humiliating experience. Normal kids would taunt a child with ambiguous genitalia. 

And if some of them are neighborhood kids or kids who attend the same school as the intesex child, then that's not a one-time humiliation. It will go straight into the rumor mill. The intersex child won't be able to live that down. All the other kids will know about his condition. And they don't be kind. Kids are very cruel about that sort of thing. That will make the intersex kid prone to self-loathing and self-harm.

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