Genital Surgery On Intersexed Children

This letter was sent from Cheryl Chase, Exec. Dir., Intersex Society of North America to a judge in Columbia, South America.

7 February 1998

Mr. Rodrigo Uprimny
Corte Constitucional
Calle 72 No 7-96
Bogotá
COLOMBIA SOUTH AMERICA


Dear Mr. Uprimny,

Thank you for providing the opportunity to comment on this case. As I understand the case, physicians have asked for the Court to either approve performing genital surgery on a six year old intersexed child, or to wait and allow the child to make any decisions about surgery herself, when she is old enough to evaluate risks and benefits. Apparently the surgery contemplated is clitoral reduction, vaginoplasty (to create or deepen a vagina), or both. In a previous case regarding an emasculated boy, the Court determined that all choices involving sexual identity must be made directly by the person, and not by the parents.

We argue, in keeping with the Court's previous determination, that only the child has the right to make decisions regarding her sexual identity and cosmetic genital surgery. To impose surgery on her would subject her to an unnecessary risk of irreversible harm and violate her human rights.

During the past several years, there has been an explosion of new scholarly work which considers medical management of intersex children, and the surrounding psychosocial issues. Based upon that work, a growing consensus of surgeons, psychologists, psychiatrists, and ethicists argue against early genital surgery on intersex children (Diamond 1996; Diamond and Sigmundson 1997b; Dreger 1997a; Dreger 1998 forthcoming-a; Drescher 1997; Kessler 1998 forthcoming; Schober 1998). It would be a pity for the Court to create a precedent insulating doctors from any liability for harm caused by performing non-consensual genital surgery on children precisely at the moment when scholarly opinion is changing. It would be even more ironic for the Court at this moment to reverse its previous opinion, and negate the right of a child to make for herself all decisions regarding her sexual identity.

Given the fact that genital surgery is not medically necessary, that it is irreversible and potentially harmful, that there is growing controversy among medical intersex specialists, and that the child can always choose surgery if she wishes when she is old enough to give informed consent, to impose surgery now would violate the first principle of medicine: "Primum, non nocerum" (First, do no harm).

Please refer also to enclosed Declarations from Cheryl Chase (Director of the Intersex Society), Justine Schober M.D. (pediatric urological surgeon), Alice Dreger Ph.D. (narrative ethicist), and Lisset Barcellos Cardenas (a Peruvian woman subjected to nonconsensual genital surgery at age 12). All of these argue that cosmetic genital surgery should never be performed without the express informed consent of the patient. Also enclosed is a letter in the original Spanish from Ms. Barcellos to her doctor in Lima, insisting that this practice is harmful, unethical, and must be stopped.

Letter | page 1, 2, 3, 4, 5, 6

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