What evidence is there that you can grow up psychologically healthy with intersex genitals (without "normalizing" surgeries)?

A lot of people think that doctors do “normalizing” surgeries on infants and children with intersex because, if they didn’t, those children would grow up to be very damaged psychologically. In fact, there’s virtually no documented evidence for that.1

Yup, you heard us right: there’s virtually no evidence of people with “uncorrected” intersex genitals suffering increased rates of psychological illness or social ostracization.

In fact, we do have lots of evidence that people who grow up with “uncorrected” intersex genitals do OK. Here’s some of it:

A 1937 book, Genital Abnormalities, Hermaphroditism, and Related Adrenal Diseases (Baltimore: Williams and Wilkins) recorded the lives of dozens of adults with “sexual ambiguity,” very few of whom were seeking “corrective” surgery. Most were fine with their physical differences. Ironically, the author of that book, Hugh Hampton Young, was a famous surgeon at Johns Hopkins University, the very place that ultimately launched the “optimum gender of rearing” (concealment-centered) model that insisted you had to do “normalizing” surgery on very young children. If the Hopkins team had read Young’s work, maybe they would have thought twice about how necessary infant genital surgeries really are.

But probably not. Because the very man at Hopkins leading the charge for infant surgeries had himself shown, through extensive research, that people with “uncorrected” intersex have lower rates of psychopathology than the general population. That man was John Money. For his Ph.D. dissertation in psychology at Harvard University in 1952, Money researched hundreds of people with intersex. And yes, he found that they had lower rates of psychopathology than the general population. His theory was that they learned good coping skills. You can read about this in Money’s dissertation (never published, but you can order it from Harvard University’s Widener Library for about $100) or read the summary of it in John Colapinto’s book, As Nature Made Him.

In spite of the fact that the Hopkins surgery-based system for treating intersex spread all over the world, some people slipped through, growing up with intersex genitals intact. All the ones we know about did OK. In our video, Hermaphrodites Speak!, Hida Viloria tells about how she is glad she never had “corrective” surgery. Hida also testified at the San Francisco Human Rights Commission’s open hearing on intersex. Hale Hawbecker—whose parents went against medical advice to sex re-assign him at birth—reports the same in chapter 11 of Intersex in the Age of Ethics. Also take a look at chapters 7 and 9 in that same book for autobiographies of two women who grew up with large clitorises.

As early as 1989, a peer-reviewed study published in the Journal of Urology showed that boys with “micropenis” could do well if raised without surgery and with honesty. Reilly (whose married name is Justine Schober and who is now member of our Medical Advisory Board) and Woodhouse “interviewed and examined 20 patients with the primary diagnosis of micropenis in infancy” and concluded that “[A] small penis does not preclude normal male role and a micropenis or microphallus alone should not dictate a female gender reassignment in infancy.” More particularly, these doctors found that when parents “were well counseled about diagnosis they reflected an attitude of concern but not anxiety about the problem, and they did not convey anxiety to their children. They were honest and explained problems to the child and encouraged normality in behavior. We believe that this is the attitude that allows these children to approach their peers with confidence.” (See Justine M. Reilly and C. R. J. Woodhouse, “Small Penis and the Male Sexual Role,” Journal of Urology, 142 (1989): 569-571.)

This, again, accords with what we know happened to people before the era of enforced infant “normalizing” surgeries. In Hermaphrodites and the Medical Invention of Sex, historian Alice Dreger documents many cases of French and British people who, before the age of surgical “correction”, fared well socially. Some of them sought advice and information from medical doctors, but very few sought “corrective” surgeries.

There has always been sex variation, and there have not been widespread suicides of or assaults on people with variations that could easily be labeled intersex. In his 1949 book, Human Sex Anatomy (Baltimore: The Williams and Wilkins Company), Robert Latou Dickenson demonstrated how adult women and men have widely varied forms of genital anatomy.

So, what’s the evidence that children with intersex actually need “normalizing” genital surgeries—surgeries that risk their heath, continence, fertility, sensation, and life? We’re waiting to see it.

1 Among doctors, there are lots of rumors that fly around that, if you don’t surgically “fix” a child with intersex genitals, she or he will commit suicide, but they’re just that: unsubstantiated rumors. Dr. William Reiner talks about that in our video, The Child with an Intersex Condition: Total Patient Care. The only case of suicide by an “uncorrected” person with intersex that we know of was that of Herculine Barbin, but it isn’t at all clear why s/he committed suicide; on that point, see Alice Dreger’s Hermaphrodites and the Medical Invention of Sex, p. 19.

Building a world free of shame, secrecy, and unwanted sexual surgeries since 1993
Copyright © ISNA 1993-2008