operating room patient

photo credit: orthofeed.com

by Arlene B. Baratz, MD
Chair of Medical and Research Policy Committee:
InterACT- Advocates for Intersex Youth
Coordinator of Medical and Research Affairs:
Androgen Insensitivity Syndrome-Differences of Sex Development (AIS-DSD) Support Group

Regarding “Anesthesia and Developing Brains — Implications of the FDA Warning” by Andropoulos and Greene, Texas Children’s Hospital’s policy of careful decision-making regarding anesthesia for children under three, limiting use to “serious or life-threatening congenital conditions for which there are no alternative treatments… for which treatment cannot be delayed” (1) will help the 1 in 2000 healthy babies with intersex traits – differences of sex development (DSD)- who often undergo “normalizing” cosmetic genital surgery to avoid presumed future damage to “individual development, … parents, society and… risk of stigmatization.”(2) Emotionally-distressed families are vulnerable to presentations of surgery emphasizing vague harms, while minimizing controversies over timing and well-documented complications including multiple procedures, irreversible gender misassignment, impaired sexual function, and poor cosmesis. (3) Decisional regret often ensues when parents lacking psychoeducational alternatives choose surgery based on medicalized presentations. (4) In my experience as a physician, intersex parent and advocate, families are rarely informed of declarations by World Health Organization and United Nations (5) that unconsented childhood genitoplasty violates children’s human rights. We welcome discussions of evidence that genital difference is a threat justifying risks of anesthesia, surgery, and ignoring human rights.

  1. Andropoulos DB, Greene MF. Anesthesia and Developing Brains — Implications of the FDA Warning. New England Journal of Medicine.0(0):null. doi: doi:10.1056/NEJMp1700196. PubMed PMID: 28177852.
  2. Mouriquand PD, Gorduza DB, Gay CL, Meyer-Bahlburg HF, Baker L, Baskin LS, et al. Surgery in disorders of sex development (DSD) with a gender issue: If (why), when, and how? Journal of pediatric urology. 2016;12(3):139-49. doi: 10.1016/j.jpurol.2016.04.001. PubMed PMID: 27132944.
  3. Tamar-Mattis A, Baratz A, Baratz Dalke K, Karkazis K. Emotionally and cognitively informed consent for clinical care for differences of sex development. Psychology & Sexuality. 2013;5(1):44-55. doi: 10.1080/19419899.2013.831215.
  4. Streuli JC, Vayena E, Cavicchia-Balmer Y, Huber J. Shaping parents: impact of contrasting professional counseling on parents’ decision making for children with disorders of sex development. The journal of sexual medicine. 2013;10(8):1953-60. doi: 10.1111/jsm.12214. PubMed PMID: 23742202.
  5. Medical and Surgical Intervention of Patients with Differences in Sex
    Development [Internet]. 2016; 10/03/2016 [cited 2/21/2017]; [3]. Available from: http://glma.org/