Intersex surgeries are non-lifesaving procedures to change natural variations in genital appearance or reproductive anatomy. These are connected to ideas about gender and sexuality, and what “normal” looks like.
Intersex surgeries often come with serious lifelong emotional and physical consequences, high complication rates, and reduced sexual function. When done without the individual’s informed consent, the United Nations considers these surgeries as human rights violations.
Infant intersex surgeries violate principles of informed consent, bodily autonomy, and self-determination. They may also be prohibited by female genital cutting laws and regulations against forced sterilization. Even still, some doctors claim parental consent is enough to change the appearance or function of an intersex infant’s genitalia, including cosmetic alterations to the clitoris.
Many medical organizations agree that intersex people must be able to make decisions about their bodies, including the American Academy of Family Physicians, GLMA: Health Professional Advancing LGBTQ Equality, the American Counseling Association, and two state-level medical societies (Massachusetts and Michigan). The US Department of Health and Human Services released a report on Intersex Health Equity condemning medically unnecessary, nonconsensual intersex surgeries.
Below are research papers and further resources to understand the ethics of intersex surgery.
Books
- “Normalizing Intersex” – a special edition of the National Inquiry in Bioethics Journal (2016)
- Making Sense of Intersex: Changing Ethical Perspectives in Biomedicine (2014)
- Intersexuality and the Law (2012)
- Bodies in Doubt: An American History of Intersex (2012)
- Surgically Shaping Children: Technology, Ethics, and the Pursuit of Normality (2006)
- Intersex in the Age of Ethics (1999)
Featured Resource
Academic Papers and Resources
- Genital Modifications in Prepubescent Minors: When May Clinicians Ethically Proceed? (2024)
- Arguments for a ban on pediatric intersex surgery: A dis/analogy with Jehovah witness blood transfusion (2024)
- Conscientious Objection, Intersex Surgeries, and a Call for Perioperative Justice (2020)
- First Do No Harm: How Intersex Kids Are Hurt By Those Who Have Taken the Hippocratic Oath (2017)
- Re-Thinking Genital Surgeries on Intersex Infants (2017)
- From Intersex to Disorders of Sex Development: A Foucauldian Analysis of the Science, Ethics and Politics of the Medical Production of Cisgendered Lives (2016)
- Still ignoring human rights in intersex care (2016)
- Developmental, Sexual and Reproductive Neuroendocrinology: Historical, Clinical and Ethical Considerations (2011)
- Safety and Sanity in an Interdisciplinary Healthcare Team (2008)
- Changes in the Management of Children with Intersex Conditions (2008)
- David Reimer’s Legacy: Limiting Parental Discretion (2005)
- Ethical Concerns Related to Treating Gender Nonconformity in Childhood and Adolescence: Lessons From the Family Court of Australia (2005)
- Moving Toward an International Standard in Informed Consent: The Impact of Intersexuality and the Internet on the Standard of Care (2002)
- An Emerging Ethical and Medical Dilemma: Should Physicians Perform Sex Assignment on Infants with Ambiguous Genitalia? (2000)
- Using Bioethics Discourse To Determine When Parents Should Make Health Care Decisions For Their Children: Is Deference Justified? (2000)
- Ambiguous Sex’ Or Ambivalent Medicine? Ethical Issues in the Treatment of Intersexuality (1998)
- Informed Consent, Parental Permission, and Assent in Pediatric Practice (1995)
Other Articles
- When Emergency Pediatric Surgery Is Anything but (2017)
- Spare Intersex Kids Needless Surgeries (2017)
- Hypospadias Treatment Decisions (2016)
- Why Are Doctors Still Performing Genital Surgery on Infants? (2012)
- Normality Under the Knife: Women Who Have Congenital Adrenal Hyperplasia Should Not Have to Face Surgery on Their Genitalia to Make Them ‘Normal’ (2010)
- Consensus Statement on the Management of Intersex Disorders (2006)
Additional References to Cite
Thank you to interACT Board member Elizabeth Reis for providing the following list of additional resources:
Mouriquand, P. D., Gorduza, D. B., Gay, C. L., Meyer-Bahlburg, H. F., Baker, L., Baskin, L. S., . . . El Ghoneimi, A. (2016). Surgery in disorders of sex development (DSD) with a gender issue: If (why), when, and how? Journal of Pediatric Urology, 12(3), 139–149.
Dalke, K., Baratz, A., Greenberg, J.A. (2020). “Protecting Children with Intersex Traits: Legal, Ethical and Human Rights Considerations.” SSRN Scholarly Paper. Rochester, NY: Social Science Research Network, https://papers.ssrn.com/abstract=3626410. Peck, E., & Feder, E. K. (2017). Institutional evils, culpable complicity, and duties to engage in moral repair. Metaphilosophy, 48, 203–226.
Roen, K. (2008). “But we have to do something”: Surgical “correction” of atypical genitalia. Body & Society, 14, 47–66.
Roen, K. (2009). Clinical intervention and embodied subjectivity: Atypically sexed children and their parents. In M. Holmes (Ed.), Critical intersex (pp. 15–40). Ashgate. Roen, K., & Hegarty, P. (2018). Shaping parents, shaping penises: How medical teams frame parents’ decisions in response to hypospadias. British Journal of Health Psychology, 23, 967–981.
Timmermans, S., Yang, A., Gardner, M., Keegan, C. E., Yashar, B. M., Fechner, P. Y., . . . Sandberg, D. E. (2018). Does patient-centered care change genital surgery decisions? The strategic use of clinical uncertainty in disorders of sex development clinics. Journal of Health and Social Behavior, 59, 520–535.