History of Intersex Surgery - Rise of Infant Surgery and "nurture Over Nature"

Rise of Infant Surgery and "nurture Over Nature"

By the 1960s, the young specialties of pediatric surgery and pediatric urology at children's hospitals were universally admired for bringing infant birth defect surgery to new levels of success and safety. These specialized surgeons began to repair wider varieties of birth defects at younger ages with better results. Earlier correction reduced the social "differentness" of a child with a cleft lip, or club foot, or skull malformation, or could save the life of an infant with spina bifida.

Genital corrective surgeries in infancy were justified by (1) the belief that genital surgery is less emotionally traumatic if performed before the age of long-term memory, (2) the assumption that a firm gender identity would be best supported by genitalia that "looked the part," (3) the preference of parents for an "early fix," and (4) the observation of many surgeons that connective tissue, skin, and organs of infants heal faster, with less scarring than those of adolescents and adults. However, one of the drawbacks of surgery in infancy was that it would be decades before outcomes in terms of adult sexual function and gender identity could be assessed.

In North American and European societies, the 1960s saw the beginning of the "sexual revolution," characterized by increased public interest and discussion about sexuality, recognition of the value of sexuality in people's lives, the separation of sexuality from reproduction by increasing availability of contraception, the lessening of many social barriers and inhibitions related to sexual behavior, and social acknowledgment of women's sexuality. It was the era when feminism made it politically incorrect to question the social learning theory of gender identity: the main differences between boys and girls resulted from being taught to be differently. Genes and hormones were thought not to have a strong influence on any aspect of human psychosexual development, gender identity, or sexual orientation.

The 1970s and 1980s were perhaps the decades when surgery and surgery-supported sex reassignment were most uncritically accepted in academic opinion, in most children's hospitals, and by society at large. In this context, enhancing the ability of people born with abnormalities of the genitalia to engage in "normal" heterosexual intercourse as adults assumed increasing importance as a goal of medical management. Many felt that a child could not become a happy adult if his penis was too small to insert in a vagina, or if her vagina was too small to receive a penis.

By 1970, surgeons still considered it "easier to make a hole than a pole," but had abandoned "barbaric" clitorectomies in favor of "nerve sparing" clitoral recession and promised orgasms when the girls grew up. Pediatric endocrinology, surgery, child psychology, and sexuality textbooks recommended sex reassignment for a male whose penis was irreparably malformed or "too small to stand to urinate or penetrate a vagina," because the surgeons claimed to be able to construct vaginas where none existed. The majority of these genetic males who were reassigned and surgically converted had cloacal exstrophy-type malformations or extreme micropenis (typically less than 1.5 cm). In 1972 John Money published his influential text (Money, 1972) on the development of gender identity, and reported successful reassignment at age 22 months of a boy (David Reimer) who had lost his penis to a surgical accident. This experiment proved not to be as successful as Money claimed. David Reimer grew up as a girl, but never identified as one. At the age of 14, David decided to live his life as a male, revealing the truth behind Money's 'success'.