History of Intersex Surgery - Infant Surgery Falls From Favor

Infant Surgery Falls From Favor

By 1990, biological factors were being reported for a wide variety of human behaviors and personality characteristics. The idea that culture accounted for all the differences between men and women seemed as obsolete as psychotherapy for homosexuality.

A more abrupt and sweeping re-evaluation of reconstructive genital surgery began about 1997, triggered by a combination of factors. One of the major factors was the rise of patient advocacy groups that expressed dissatisfaction with several aspects of their own past treatments. The Intersex Society of North America was the most influential and persistent, and has advocated postponing genital surgery until a child is old enough to display a clear gender identity and consent to the surgery. Recommendations from these voices ranged from the unexceptionable (ending shame and secrecy, and providing more accurate information and counseling) to the radical (assigning a third sex or no sex at all to intersex infants). The idea that possession of abnormal genitalia in and of itself does not constitute a medical crisis was stressed.

However, physicians involved in intersex care had embarrassingly little long-term outcome data with which to refute them. In 1997 a patient account was published which could not be ignored. David Reimer's tragic story, told in both popular and medical publications, was widely interpreted by the public and many physicians as a cautionary tale of medical hubris, of the folly of attempting to foil nature with nurture, of the importance of early hormones on brain development, and the risks and limitations of surgery. Some clinicians proposed a moratorium on pediatric sex reassignment, particularly of undervirilized males as females, due to a lack of data that rearing or appearance of genitalia play a major part in gender identity development. Those clinicians encouraged delaying surgery until elected by adolescents in order to preserve sexual sensitivity.

Similar controversy occurred in Europe and Latin America. In 1999 Colombia's constitutional court limited the ability of parents to consent to genital surgery for infants with intersex conditions. A number of advocacy groups argue against many forms of genital surgery in childhood. In 2001, British surgeons argued for deferring vaginoplasty until adulthood on grounds of poor outcomes for women who were operated on as infants.