History of the Surgery Intersex
Intersex surgery is a unique kind of surgery that is done to rectify birth deficiencies or the injuries caused by genitalia. Its primary purpose is to make the appearance of an individual normal and also to cease the chances of future problems. Usually, it is thought that it is a newer concept but in reality, the surgery of intersex has got a definite old history like all other aspects of medication. The surgery was pioneered between 1930 and 1960 by some urologists. In that era appearance of external genitalia was the main focus for this surgery and at that time most of the patients were adults. By the 1960s surgeons realized that it was possible to carry out this surgery for the infants as well and they found it quite appropriate to do the surgery at the time of birth so that infants would grow up normally having full attributes of one gender. In the era of 1980s, there were some complications discovered in the surgery of infants and in 1990 it was defamed as well. The recent history of intersex surgery has been attributed to controversy after the publication of several reports that surgery showed that surgery has been failed to obtain desired results in many cases and it is still not decided what time of life either infancy, adolescence, or adulthood is suitable for the surgery.
Intersex sexual development may go astray at any time in the sexual development phase of a fetus. Normally female fetuses have a 2 X chromosome (xx) karyotype while a normal male fetus will be comprised of an X and Y chromosome. The maternal ovum will always provide an X and the sex chromosome provided by the sperm may be an X or Y, thus determining the genetic sex. As the embryo develops after the first weeks of conception, anatomical structures which will become the internal and external genitals are still undifferentiated and identical in the female and male embryos. These structures that form regardless of sex are the gonadal ridges, and internal ducts (Mulllenian and Wolffian ducts). The formation of the sexual organs is determined by the presence or lack of the Y chromosome. When there is a Y chromosome, a gene located on it induces the gonadal ridge to become testes. In the absence of a Y chromosome, the gonadal ridge will develop into ovaries. Around seven weeks post-conception, in an embryo with the XY karyotype, testosterone produced by the Leydig cells of the testes make the Wolffian ducts form into the epididymis, seminal, vesicles, prostate, vans deferens and urethra and the Mullerian ducts regress. In an embryo composed of an XX karyotype, the Wolffian ducts regress, and the Mullerian ducts develop into the uterus, fallopian tubes, and the superior part of the vagina. In the absence of androgens (hormones linked to male sexual characteristics), male genitalia will not form. One of the main reasons why ambiguous genitalia may form is as a consequence of insufficient or high-level exposure to androgens (Kettenis & Pfäfflin 2003). Since discrepancies in sexual development may be internal or external, instances of discovery vary from the time of birth to puberty or lack thereof. At birth, an intersexual infant of the 46 XX karyotype may possess an enlarged clitoris, clitoris the size of a penis, fused labia giving the appearance of the empty scrotum as genitalia, whereas, an infant with the 46 XY karyotype may possess a small penis, penis the size of a clitoris, fused or split scrotum, hypospadias (urethral opening located at perineum). Parents may choose sexual reassignment surgery for their intersexual infant at this time but may decide against the surgery for precautionary reasons that may be presented at a later age. If there is no apparent genital ambiguity at birth, sexual discrepancies are discovered at later ages through certain syndromes which may surface as gynecomastia, Klinefelter, or Tuner syndrome. The deviations from the typical route may thus occur in any phase of sexual differentiation, may become manifest at any age, maybe complete or incomplete, and may have an impact on one or more physical sex characteristics (Kettenis & Pfäfflin 2003).
To reduce the likelihood that a child will develop a strong desire to avoid having intimate relationships with others, parents should allow a child to decide whether or not they want corrective genital surgeries. This could also be avoided by having the parents openly discussing their intersex conditions with them (SOURCE), which in turn would normalize the topic and make it so the child feels comfortable enough to ask their parents questions, taking away the secrecy commonly found when parents opt for early genital surgery. Additionally, parents could find their child a therapist to deter any loss of self-confidence when they discover how different they are from the general population
A benefit of waiting for the child to grow and decide for themselves if they want corrective genital surgeries, such as vaginoplasties, is that the child feels more comfortable in their skin regardless of the decision they make. Parents who prefer early surgery often avoid discussing their child’s intersex condition with them, causing the child to feel like an outcast, or like a freak. As they grow older, they prefer to avoid intimate relationships for fear that their significant other will reject them because of their anatomy.
When parents openly discuss their child’s condition with them, the child is less likely to feel like an outcast. They come to realize that they are not the only ones with intersex conditions, which in turn diminishes the feelings of feeling like a freak. They may even feel more comfortable asking their parents or doctors questions about their condition or corrective surgeries if they have not had any up to this point.
As the child becomes more comfortable discussing their condition with their parents or doctors, their intersex condition becomes normalized to them. A sort of systematic desensitization occurs in which they do not feel shame when talking about their intersex condition with others. Once again, this helps to boost the child’s self-esteem about their intersex status and avoid feelings of being an outcast.
When the child is old enough to decide for themselves whether they want surgeries or not, it is important to discuss the benefits and consequences of getting corrective surgeries to normalize their genitals. They must be aware of the fact that many individuals with adrenal hyperplasia who get vaginoplasties are not satisfied with their new vaginas (Slijper 2003). Similarly, those who get clitoral reductions often lose sensation in their clitoris, making sex less pleasurable (Minto, Liao, Woodhouse, Ransley, Creighton, 2003). On the opposite end though, corrective surgery may make one feel more comfortable seeking out a sexual partner. Other times, it is impossible to have sex because the individual may have a shallow vagina, common in patients with adrenal hyperplasia (Minto, et al. 2003). In these cases, corrective surgery may be required.
If the child still feels like an outcast or grows up continuing to avoid intimate relationships, therapy may be a viable option. In therapy, the patient may grow to feel more comfortable in their own skin, and if they are yet to have surgery, the therapist may help them reach a decision. With their new confidence, they may begin to look for sexual partners, or at least feel more comfortable looking for one.
Upon being born intersex the major issue is the decision of whether or not to have corrective surgery done. Many times parents choose whether or not the doctor performs the corrective surgery on the infant so that they can raise the child “normally”. However, these surgeries often have negative consequences associated with them, such as loss of sexual functioning and feeling in one’s genitals (Thorn, 2014). Infant corrective surgery has shown to be one of the worst things to do because the parents are avoiding the issue and the child usually feels that they are not ‘normal’. Two out of the five solutions that were discussed involved postponing and talking about corrective surgery with the intersex individual as they become a teenager or a young adult. With these two solutions the intersex individual gets the option to make their own decisions on how they will be seen to the general public, they will get to understand their disorder, their parents will have an open relationship with them, and most importantly they get to decide whether or not they want corrective surgery.
Parents discussing the child’s condition openly with them throughout their life and having therapy sessions for both the parents and intersex individuals are both extremely important for their mental health and confidence. Numerous intersex individuals whose parents did not talk openly with them about their condition report feeling shame and isolation as a child that grew to feelings of betrayal as a young adult (Group for the Advancement of Psychiatry, 2007). They may distance themselves from family and avoid developing relationships, whether intimate or not. Therapy for parents helps them to cope with their child’s intersex condition, so that they will develop a healthy relationship with the child, without thoughts of embarrassment or shame running through their or their child’s mind. Therapy is highly recommended for intersex individuals throughout their life since they first must cope with the discovery of this condition, then they will have many different questions as they go through puberty, in young adulthood as they try to develop intimate relationships, and finally if they plan to have children. Lastly, many intersex individuals choose to live as to the last solution, without any sort of corrective surgery, since this type of corrective surgery is mainly cosmetic and not focused on optimum functioning. Although the abnormality of their external genitalia may be embarrassing for them to expose to their partner if they keep an open relationship about their condition it should not create any obstacles to having an intimate relationship.
Overall, the research in this paper shows that the intersex condition is not an issue that is new to civilization but instead is slightly more common than believed. It is an abnormality that occurs because of an inhibition of either testosterone
Group for the Advancement of Psychiatry. 2007. LGBT Mental Health Syllabus:
Psychological and Psychotherapy Issues. Retrieved from http://www.aglp.org/gap/7_intersex/#psychology
Kinsman, Kat. “Intersex dating: Finding love across the intersection.” CNN. Cable News Network, 1 Jan. 1970. Web. 12 Oct. 2014. <http://www.cnn.com/2014/04/15/living/intersex-dating-relate/index.html>.
Kettenis, P. T., & Pfäfflin, F. (2003). Transgenderism and intersexuality in childhood and adolescence making choices. Thousand Oaks, Calif.: SAGE Publications.
Minto, C., Liao, L., Woodhouse, C., Ransley, P., & Creighton, S. (2003). The effect of clitoral surgery on sexual outcome in individuals who have intersex conditions with ambiguous genitalia: a cross-sectional study. Lancet, 361(9365), 1252-1257.
Slijper, F. E. (2003). Clitoral surgery and sexual outcome in intersex conditions. Lancet, 361(9365), 1236
Thorn, E. D. (2014), Drop the Knife! Instituting policies of Nonsurgical Intervention for Intersex Infants. Family Court Review, 52: 610–621. DOI: 10.1111/fcre.12110