Do No Harm: Intersex Surgeries and the Limits of Certainty

Do No Harm: Intersex Surgeries and the Limits of Certainty

The Southern Poverty Law Center and Advocates for Informed Choice have filed a lawsuit against the South Carolina Department of Social Services (SCDSS), Greenville Hospital System, the Medical University of South Carolina, and several medical personnel for allowing physicians to remove the atypical genitals of a 16-month-old toddler because that child, in the state’s custody at the time, was born with an intersex condition. M.C. had been identified male at birth, but his genitals were sufficiently indeterminate that surgeons removed his ambiguous phallus, a testis, and testicular tissue on one gonad, and surgically created an ostensible approximation of female genitals. The suit asserts that there was no medical need for this surgery, which was meant to permanently “fix” this child and turn him into an unequivocal girl, but it did him more harm than good. M.C., now eight years old, feels more like a boy, lives as a boy, and heartbreakingly has asked his mother, “When will I grow a penis?”

8-year-old M.C. identifies as a boy.*

This sad situation is reminiscent of another case in which the patient, also an orphan, had no parents to advocate on his behalf and underwent similar genital surgery for no medical reason. Frank, a seven-year-old boy was admitted to the Johns Hopkins Hospital in October 1925, diagnosed with undescended testicles and hypospadias, a condition where the urinary opening is underneath rather than at the tip of the penis. In addition, Frank had a short vagina, leading physicians to believe that he was actually a girl. When they did exploratory surgery they found an ovary on one side, confirming their suspicions. What was once seen as a boy’s penis was now seen as an enlarged clitoris. Doctors now considered Frank to be a girl, and they advised the orphanage to change his name from Frank to Frances and rear him as female. The fact that the child was an orphan probably made it easier for the doctors to convince his guardians that surgery was necessary, but even parents face overwhelming pressure when confronted with physicians’ seeming certainty over the correct course of action.

No surgery was performed initially on Frances. However, when Frances returned to the hospital two years later complaining that the “clitoral appendage” was annoying to her, doctors mentioned that she had a “terrible habit” of masturbating, and so they amputated it. A few years later, Frances returned, complaining of pain. She told her doctors that when she turned eighteen, she was going to learn a mechanical trade and live as a man. Worried about this seeming challenge to their previous decision, more tests were done, and it turned out that since Frances had some newly discovered testicular tissue, physicians agreed that perhaps he was really a man all along. As for his genitals, it was too late to alter them because the penis/clitoris had already been removed.

The Hippocratic Oath. Wikimedia

Frances changed his name to John, clearly stating that he wanted to live as a man, but that didn’t stop his doctor from speculating, “If implantation of ovaries ever becomes successful in the human should this be done?” One wants to scream “No!” at the case report; “Please, let John live his life as a man without any further medical scrutiny and unnecessary intervention.” Even though the doctor admitted that John seemed happily male, he still wondered about ovary implantation to force John to live as Frances against his own wishes. The mistake of the excised penis would then be negated, but at the expense of John’s inclination.

Many of the news sources surrounding the recent case of M.C. have reported that damaging surgeries such as these have been happening since the 1950s. While it is true that during the 1950s infant surgeries became standard protocol, interventionist surgeries to “repair” ambiguous genitals and to change people into the supposed “correct” gender began long before the 1950s. The earliest case I have found was in the 1840s, when a three-year-old girl’s undescended testes were removed because the physician was worried that when they matured, they might cause her to become sexually attracted to other women rather than to men. Throughout American history, fears of homosexuality have motivated intersex surgeries, as some physicians wanted to make sure that patients were certain of their sex so that they wouldn’t be attracted to the “wrong” sex.

What makes dealing with intersex especially complex is that parents are often asked to make decisions regarding their child’s body. Of course, parents want what is best for their children. They want them to be happy, and they want them to grow up without being teased or ridiculed for having an unusual body. Parents’ worries might be unfounded. M.C., for example, has recently told his classmates about his ordeal and has received nothing but support from his peers. Would parents consent to “normalizing” surgeries for their child if they were informed of likely negative consequences? Of course, there might be an underlying metabolic concern that needs careful medical attention, but often the issue is merely aesthetic or social. M.C.’s parents are asking, and we need to ask ourselves, if loss of sexual sensation, incontinence, scarring, sterilization, the emotional trauma of surgery, and the risk that the child might not want to live as the surgically-assigned gender are all worth the effort to superficially normalize bodies.

3 symbols
Three Symbols. Wikimedia

Since the late-twentieth century, attitudes towards these surgeries have begun to change, largely as a result of intersex activism that started in the 1990s. If, as a society, we felt more comfortable with difference, we might not be so eager to surgically repair bodies that don’t actually need repair. It is possible to choose a gender for a child born with ambiguous genitalia and still decline surgical intervention. If M.C.’s parents win their pathbreaking lawsuit, then perhaps physicians will have further incentive to hold off on irreparable surgeries until the children are old enough to have a say in what they want their bodies to look like.

Informed Consent. Flickr

*After careful consideration, Nursing Clio made the decision to publish pictures of M.C., which are prevalent throughout several other media sources. MC, and his parents, are very open and honest about his gender identity and his medical ordeal. It is their hope that by coming forward with their story, they can prevent this tragedy from happening to other children.

For Further Reading:

 – Elizabeth Reis, Bodies in Doubt: An American History of Intersex (Baltimore: Johns Hopkins University Press 2009), chapter 4.

– Hugh Hampton Young, Genital Abnormalities, Hermaphroditism and Related Adrenal Diseases (Baltimore: Williams and Wilkins, 1937), 84-91.

– Katrina Karkazis, Fixing Sex: Intersex, Medical Authority, and Lived Experience (Durham: Duke University Press, 2008).

Featured Image Caption: One and Two-day-old newborn babies listen to music with headphones at the 1st Private Hospital in eastern Slovak metropol of Kosice-Saca 11 August 2005. AFP PHOTO JOE KLAMAR, Flickr

Elizabeth Reis is a professor of gender and bioethics at the Macaulay Honors College at the City University of New York. She is the author of Bodies in Doubt: An American History of Intersex, which was recently published in a 2nd edition, and Damned Women: Sinners and Witches in Puritan New England. She is also the editor of American Sexual Histories: A Social and Cultural History Reader.

38 thoughts on “Do No Harm: Intersex Surgeries and the Limits of Certainty

    • Author gravatar

      Hello – My spouse (auntjanescreations) found a link to this site on WordPress and gave it to me. I was quite surprised to find so many interested in this subject. I would like to add something to Elizabeth Reis article. What happens to a child that is badgered by its parents and physician to have sexual assignment surgery, even at seven? The argument is the same that Ms. Reis wrote about. If you don’t have the surgery you will be ridiculed and bullied in school. A choice must be made because this is a binary world. Then what happens to the child that is surgically assigned a male body, put in male clothes, but is a girl inside? And, especially if the child believes that “he” is a boy now that the surgery has been done?

      The other children know that “he” is a girl no matter what “he“ is wearing. What’s it like to not just be the last chosen to play games, but not to be chosen at all and be ostracized, physically, and mentally abused? And, to have this follow “him” all the way to graduation from high school! I can tell you, it feels like dirt and it affects every aspect of your life. The fear of being discovered as a being intersex and really a girl eats into you, even to your senior years. I have found that the argument of; if you don’t have the surgery you will be ridiculed and bullied in school, turned out to be an absolute lie to me. I would give anything to be ridiculed for what I am, than what someone else wanted me to be and live my life out as ME. Thank you for your time, Ephie – an Intersex to male to female Transsexual.

      PS: What I am trying to emotionally say is that this part of the MD’s rational is not empirical. They are wannabes playing at being a psychologist with a knife and without a single study or unbiased follow-up to back them up.

    • Author gravatar

      This is an amazing story. Creating aesthetic penis is common hear for transgender cases, but this is the first I have heard of it in a situation like this.

    • […] who surround us help to facilitate this. I find no example more chilling than that outlined by Elizabeth Reis on Nurse Clio, which should give those who remain undecided sufficient food for […]

    • […] question of infant surgery has also been in the news recently. The lead intersex legal advocacy group in the U.S., Advocates […]

Comments are closed.