*129 WHO DECIDES? GENITAL-NORMALIZING SURGERY ON INTERSEXED INFANTS

Alyssa Connell Lareau [FNa1]

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A. INTERSEXUALITY IS NOT A MEDICAL CONDITION THAT NEEDS TO BE TREATED

Most commentators acknowledge that the "intersex problem" is a psychosocial rather than a medical emergency. [FN42] As biology professor Anne Fausto-Sterling stated: "[T]hough certain disease states may accompany some forms of intersexuality, and may require medical intervention, intersexual conditions are not themselves diseases." [FN43] Put simply, "ambiguous genitalia are not diseased. They just look different." [FN44] Similarly, a pediatric surgeon admitted that "surgeons *136 are a bit guilty of ... taking the simplistic view that there was something obviously wrong [with an infant presenting ambiguous genitals] and therefore needed surgical correction, and the sooner you did it the better." [FN45]

No intersex activist contends that genital surgery should not be performed if it is required in order to save the child's life or substantially improve the child's physical wellbeing. [FN46] Instead, the dispute is about cosmetic genital surgery performed for social and psychological reasons. Social and psychological concerns regarding both the parents and the child are not sufficient to justify irreversible medical surgery. Moreover, these social and psychological concerns are based upon questionable premises.

An initial justification asserted for immediate genital surgery is to preserve the psychological wellbeing of the parents by putting them "more at ease" with their child's genitalia. [FN47] However, it is not clear that the parents' comfort level should be considered at all when making medical decisions for the child. [FN48] Moreover, genital-normalizing surgery does not resolve all the difficulties involved in raising an intersexed child in our society. Parents need to understand that "[w]hether surgery is performed or not, the intersexed person's genitals will be different in appearance and in function from other people's genitals." [FN49] Some researchers have found that while surgery makes parents feel more comfortable, counseling can serve the same purpose without the disadvantages of irreversible surgery. [FN50]

Furthermore, as seen in the case of John/Joan, there is a chance that the child will reject the assigned gender. In some cases, a child's rejection of the assigned sex after irreversible surgery can lead to familial angst more severe than the awkwardness parents may feel with a child's ambiguous genitals. [FN51] Thus, even if parental discomfort is credited as an important variable, surgery will not completely resolve this issue; furthermore, less drastic alternatives, such as extensive familial counseling, are available.

The second justification for early surgery--that surgery is necessary for the *137 child's psychological benefit--is similarly problematic. Under this justification, parents see themselves as sparing their child from a society where intersex children are rejected and taunted by their peers for being different. [FN52] However, parents should not authorize unnecessary irreversible surgeries because society is uncomfortable with any departure from sexual dimorphism. [FN53] Children who have genital-normalizing surgery but do not conform to their assigned gender's stereotypes can still experience social trauma. [FN54] Almost every child will experience some kind of social trauma as a part of growing up. Even if there were documented evidence that genital-normalizing surgery made life easier for intersexed children, it would be unclear that surgical alteration of children was the appropriate response to bullying. [FN55]

In response to this argument, some clinicians argue that children should not be forced to "wait for society to be taught to act differently." [FN56] The difficulty with this logic is elucidated by Professor Alice Dreger's interesting analogy: "We still live in a nation where dark-skinned people have a harder time than light-skinned people do. But would [a surgeon] suggest we work on technologies to 'fix' dark skin? Would we call people who refuse to lighten their children cruel Luddites?" [FN57] When a child's race, religion, height, weight, or other features deviate from society's social norms, the child's social life is more difficult. Allowing parents to consent to procedures that "correct" these features approaches a modern day eugenics movement. A physician would be shocked if parents came to her and demanded that their extremely tall daughter's legs be *138 surgically cut down to make it easier for her to "fit in" at school; why should surgically altering the appearance of her genitalia be any different?

In addition, there is evidence that the surgical treatment model actually contributes to intersexuals' "feelings of freakishness." [FN58] Dandara Hill, a woman who was born with a large clitoris, remembers the treatment she received:
There were always men in white coats parading through the exam room to look at my 'private parts.' They often

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