History of Intersex Surgery

The history of intersex surgery is intertwined with the development of the specialities of pediatric surgery, pediatric urology, and pediatric endocrinology, with our increasingly refined understanding of sexual differentiation, with the development of political advocacy groups united by a human qualified analysis, and in the last decade by doubts as to efficacy, and controversy over when and even whether some procedures should be performed.

Ambiguous genitalia has been considered a birth defect throughout recorded history. Single cases were described by doctors sporadically over the centuries. Some of our modern ideas of birth defects can be traced to French anatomist Isidore Geoffroy Saint-Hilaire (1805–1861), who pioneered the field of teratology. Since the 1920s surgeons have attempted to correct an increasing variety of birth defects. Success has often been partial and surgery is often associated with minor or major, transient or permanent complications. Techniques in all fields of surgery are frequently revised in a quest for higher success rates and lower complication rates. Some surgeons, well aware of the immediate limitations and risks of surgery, feel that significant rates of imperfect outcomes are no scandal (especially for the more severe and disabling birth defects). Instead they see these negative outcomes as a challenge to be overcome by improving the techniques. Genital reconstruction evolved within this tradition, but in the last decade, nearly every aspect of this perspective has been called into question.