Rethinking "Normalization" in Intersex Care
In 1965, an infant boy named David Reimer lost his penis during a botched circumcision. Following advice from psychologist John Money, surgeons removed his testicles, reconstructed female genitalia, and David became "Brenda"—a living experiment in gender plasticity 1 4 . This tragic case, later revealed as a catastrophic failure when David transitioned back to male and ultimately died by suicide, became the foundation for decades of non-consensual intersex interventions.
Medical protocols established in the 1950s still prioritize surgical "correction" over bodily autonomy, leaving thousands bearing physical and psychological scars.
Intersex existence isn't new—Byzantine surgeons performed genital "corrections" as early as the 7th century 1 . But modern medicalization began in the Victorian era when:
Doctors declared individuals "truly male" if testes were present, regardless of anatomy 4
First recorded infant genital reconstruction occurred in 1779 on a 7-year-old reassigned male 1
"Doctors couldn't tell by looking at external genitalia. Errors led to telling an eight-year-old boy: 'We discovered you're really a girl'" 1 .
Psychologist John Money's theory claimed gender identity was malleable before age 3. Surgeons adopted a pragmatic rule: "It's easier to dig a hole than build a pole" 1 . This justified:
| Variation | Estimated Frequency | Common Medical Response |
|---|---|---|
| Congenital Adrenal Hyperplasia (XX) | 1:10,000–1:15,000 | Clitoral reduction, vaginoplasty |
| Androgen Insensitivity (XY) | 1:20,000 | Gonadectomy, feminizing surgery |
| Klinefelter Syndrome (XXY) | 1:600 males | Testosterone therapy, breast reduction |
| Hypospadias | 1:200–1:300 males | Urethral repositioning surgeries |
David Reimer's case (1965–2004) became medicine's most influential intersex case study:
"The case proved gender identity as inherent... Surgeries caused irreversible gender dysphoria" 1 .
This experiment exposed critical flaws:
Prenatal androgen exposure influences identity
Genital sensation loss and scarring are common
Bodily autonomy cannot be outsourced
| Outcome Measure | % Affected | Study Findings |
|---|---|---|
| Sexual dysfunction | 50–80% | Reduced sensation, pain during intercourse 3 |
| Multiple corrective surgeries | 60% | Average 4–5 operations by adulthood 6 |
| Regret/anger about treatment | 42% | Feelings of mutilation and betrayal |
| Mental health disorders | 62% | Depression, anxiety, PTSD diagnoses 3 6 |
Intersex adults report systemic harm:
"I was shown pictures of my genitals as a 'before' shot without consent" 6
50% reject the term "Disorders of Sex Development" (DSD) as stigmatizing 6
31% of LGBTQ+ intersex people report discrimination when seeking IDs 3
Modern advocacy demands:
Postpone surgeries until informed consent possible
Address stigma without altering bodies 6
| Traditional Model | Affirmative Model |
|---|---|
| "Ambiguous genitalia = social emergency" | "Genital diversity = natural variation" |
| Surgery to enable penetrative sex | Focus on sexual function/pleasure |
| Conceal diagnosis to reduce stigma | Full disclosure and peer support |
| Parental consent as sufficient | Adolescent involvement in decisions |
Chromosomal analysis (e.g., XXY, XO)
Identify cancer risks, not justify surgery 1
Measure testosterone/cortisol levels
Diagnose adrenal crises in CAH, not "virilization" 6
Visualize internal structures
Map Mullerian tissue without exploratory surgery
Assess psychosocial outcomes
Center patient experiences, not cosmetic results 6
"We apologize... The medical field has failed these children" – Ann & Robert H. Lurie Children's Hospital, 2020 8
Recent legislation reveals painful contradictions: 26 U.S. states ban gender-affirming care for transgender youth while explicitly allowing non-consensual intersex surgeries 5 . Yet change is emerging. Malta, Portugal, Chile, and Spain's Catalonia region now prohibit childhood "normalization" surgeries . Hospitals like Boston Children's and Lurie have suspended cosmetic genital procedures 8 9 .
As geneticist Fausto-Sterling observes: Human bodies naturally vary. True healing begins not with scalpels, but with acceptance 8 .