By Tarah Demant, Director of Gender, Sexuality, and Identity Program at Amnesty International
When Sandrao was 5 years old living in Germany, they underwent a surgery that was meant to “normalize” their body. Sandrao described life after the surgery:
“I knew I was different, I thought I was some kind of monster. I was unable to develop a gender identity. I was pressed into the female role, I had to wear skirts, I had to have long hair. It was painful to have sex with men and I thought this was normal.”
Sandrao was born intersex, meaning they were born with sex characteristics that didn’t quite fit into society’s typical expectations of what makes a “girl” or a “boy.” Such definitions are strongly held across societies and they can have devastating consequences for those people whose bodies don’t quite fit in the sex or gender binary boxes.
Sandrao’s experience is not uncommon for intersex people; as both Amnesty International and Human Rights Watch have documented, intersex children are routinely subjected to invasive surgeries based not on medical necessity, but on harmful gender stereotypes. And for many intersex people, these surgeries not only violate their rights but also have lasting negative impacts on their health, sexual lives, psychological well-being, and gender identity.
What does it mean to be intersex?
“Is it a boy or a girl?” is often the first thing we ask when a baby is born. It’s a question based on the assumption that the world is neatly and clearly divided into two “male” and “female.” But that’s not really the case: an estimated 1.7% of children in the world are born every year with variations of sex characteristics.
Sex characteristics are used to determine a person’s biological sex, and while there are many variations of human biology in these categories, we as a society have simplified and limited the sex categories to “male” and “female.” An intersex person is someone whose sexual anatomy doesn’t seem to fit these categories. These variations are diverse; for instance, some children have genitalia outside the standard norms for boys or girls, for example, a penis that is deemed “too small,” or a clitoris that is deemed “too large” (these definitions are completely arbitrary; there is no clinical size definition for a penis or a clitoris).
While there are certainly many natural differences between people, nature doesn’t decide where the category of “male” or “female” ends, humans decide. And humans (mostly doctors) decide whether a child’s body needs to be “normalized” through invasive, irreversible surgery.
Why are surgeries being conducted on children?
“Normalizing” surgeries are intended to construct the genitalia or bodies of a person to comply with the normative medical standards of “male” or “female” appearance — surgeries like clitoral reduction surgery, which cuts and removes sensitive, erectile tissue in order to reduce the size of the clitoris for cosmetic reasons — this surgery carries the risk of pain, nerve damage, and scarring, and yields no medical benefit.
Many surgeries performed on intersex children are not performed for emergency reasons or to address an urgent health. Instead these surgeries aim to “normalize” intersex children, whose bodies don’t meet certain societal expectations. Such “normalizing” surgeries can have negative impacts on intersex children that last through their adulthood.
As one endocrinologist explained:
“When we’re trying to force people into cultural normative, hetero-normative situations, there’s a high chance that we’re going to make some major mistakes and harm people irreparably.”
Many children are too young to consent at the time of the “normalizing” surgery, and their parents are often not given adequate information and support to make informed decisions about what is best for their children.
What’s the problem with these surgeries?
In both Amnesty International’s and Human Rights Watch’s research, many people reported lasting negative impacts on their health, sexual lives, psychological well-being, and gender identity. Intersex adults repeatedly told researchers about the lifelong trauma these surgeries caused. Parents, too, described the struggles of their children. One mother, whose 17-year-old son was assigned female at birth through a surgical procedure, explained:
“When you cut, and you slap a label on somebody, that’s irreversible for that person. My child tried so hard to be a girl because that’s what the doctors told my child he was.”
Intersex children’s parents are often pressured by medical professionals without being provided with enough information. One mother of 3 described her experience as a parent with an intersex infant:
“[…] the medical community was all hush hush, rush rush, slap a diagnosis on so we can sign papers and go home. It was forced sterilization. I feel like my child’s rights were violated, I feel like my rights were violated. It was medical bullying.”
In addition to the lasting trauma these surgeries can cause intersex people, such practices can constitute violations of the human right to bodily integrity.
Countries have a responsibility to uphold and protect the human rights of their people in all areas, including in the administration of healthcare and the use of a human rights-centered approach to the treatment of intersex individuals. This responsibility includes not performing non-emergency interventions that are invasive and irreversible until the individual can meaningfully participate in the decision-making process.
For too long, intersex children have faced surgeries to make them fit a subjective gender binary, and far too many intersex adults have had to live with the consequences:
“I have been operated on, it’s too late for me, but if I stay silent it’s like I support surgeries and I can only change things if I speak up.” D from Germany, who underwent five genital operations.
Intersex rights are human rights. We must stand with all people fighting for intersex rights.
*gender: socially constructed characteristics of people commonly predicated on their biological sex — what it means to be “masculine” or “feminine.” This varies from society to society and can change or be changed. When individuals or groups do not “fit” established gender norms, they often face stigma, discriminatory practices, or social exclusion.
*gender binary: the gender binary is the classification of gender into two distinct and opposite categories based on two distinct and opposite categories of sex identity (male/female) and two corresponding categories of gender (“masculine”/“feminine”).
*gender stereotypes: generalizations about what it means to be “masculine” or “feminine” (how one “acts like a man” or “woman”)
*gender identity: each person’s deeply felt internal and individual experience of gender, which may or may not correspond with the sex assigned at birth
*Sex characteristics: Primary sex characteristics include sex chromosomes (e.g. XX, XY, X, XXY), external genitalia (e.g. glans penis, scrotum, foreskin, perineum, clitoris, labia, vulva, perineal urethra), gonads (e.g. ovaries, testes), hormones (e.g. estrogen, progesterone, testosterone) and internal reproductive organs (e,g, uterus, ovaries, fallopian tubes, prostate). Secondary Sex Characteristics develop later in life, usually during puberty and relate to hormone development and the growth of the individual. They include: facial and body hair, the menstrual cycle, breast development, height, muscle distribution and body fat.
*hetero-normative/heteronormative: the belief that people that heterosexuality is the “normal” or normative sexual orientation.