Friday, March 26, 2010

Position Statement on Genital Cutting

Organisation Intersex International
Position Statement on Genital Cutting

Intersex refers to atypical internal and/or external anatomical sexual characteristics, where features usually regarded as male or female may be mixed to some degree. This is a naturally occurring variation in humans. From the late 1950's onwards, starting in the USA, intersex infants and children were increasingly subject to cosmetic surgeries intended to ensure that their genital appearance and internal gonads conformed to that usually expected for their assigned gender. This also tended to entail hormone treatments aimed at conforming them to those associated with being "male" or "female."

From the early 1990’s to the present day, hundreds of intersex adults have come forward to say that they regard these medical practices as being extremely harmful to them, both physically and psychologically. Despite this high level of dissatisfaction, there has been little follow-up of adults who were treated this way as children, so without any clear understanding of outcomes, there is no real evidence upon which to justify this approach. On the contrary, the little evidence there is suggests that physiologically, functional outcome is poor. A study conducted in England of intersex people who electively chose to undergo such surgery as adults revealed that the large majority were dissatisfied; treatments resulted in physical pain and diminished sexual response, and were not able to provide them with the sense of normalcy which they hoped for.

There is no evidence that intersex variations alone will negatively impact the quality of life of the individuals who have them, nor that "normalizing" medical treatments are a solution. What evidence there is suggests the opposite; intersex adults who have not received unnecessary medical intervention have said they feel lucky to have "escaped" such treatments. They lack the psychological trauma from treatments imposed on others, and report satisfaction with their sexual response and their unique physical attributes. Such treatment is often justified from the assumption that intersex children and/or adults will be subjected to discriminatory behaviour because of their bodily differences; however, this is not necessarily correct, because their differences are sometimes only evident when naked, or not evident visually at all. Where differences are visible, this is no different than the situation of people from other minority groups. The solution to such challenges is not to alter the characteristics themselves, but to combat the prejudicial attitudes that stigmatise.

Cosmetic surgery on intersex genitals appears to harm intersex infants, children, and even adults, yet it still persists. As with male circumcision, it is often driven by parental desire to provide their children with bodies that conform to certain beliefs about how genitals should be. Also, the presumption that atypical sex anatomy will result in atypical sexual orientation and/or gender identity, homophobia and a fear of atypical gender presentation are seen by some intersex people as the motivation driving these surgeries. In many societies today, gender expression and sexual orientation are seen as a human right, and this is recognised by the UN. Performing unnecessary surgeries on infants and children in order to influence adult sexual orientation and/or gender identity outcomes should be seen as a human rights abuse. There is no evidence that sexual orientation or gender identity are affected by genital surgery one way or the other.

We seek recognition that all humans have the right to autonomy over their own bodies, including their genitals etc. Because infants and children are too young to assert their autonomy, they should not be subjected to unnecessary surgeries which may irrevocably harm them, and which they may not have chosen as adults. We recognise that cases requiring medical treatment for the maintenance of health or preservation of life should be managed as with any other situation where a child needs treatment. Intersex infants and children should be raised without cosmetic surgery and/or steroidal hormones until they are old enough to decide for themselves whether they wish to undergo these procedures and treatments or not.

We recommend avoidance of genital cutting, where possible, until a child can fully participate in decision making. This would be worked towards through communication between parents of intersex children, the children themselves, intersex adults, support groups, and clinicians who are sensitive to the needs of the child. Counselling should be available for those affected by the situation, to ensure they are fully informed and equipped to make the best decisions. Wider education about intersex as a human variation is also necessary; the cultural anxiety and social pressure that encourage surgery, hormone therapy and physical conformity need to be addressed. Through a process that includes education, communication, and counselling, then public shame will decrease, along with a reduction of cultural anxiety and social pressure, ultimately allowing people the liberty to maintain autonomy over their own bodies.

Online: Click here


  1. i still can't understand: is there any case, where it is not "possible" to "avoid[...] genital cutting [...] until a child can fully participate in decision making"?!

    why not simply demand a legal ban on "genital cutting" of intersexed kids, period, granting them the same rights female kids enjoy?

    cause else, in the end it will always be at the discretion of greedy doctors and selfish parents to say, oh, but it's just impossible to wait, because we say so!

  2. Dear Seelenlos,

    Unfortunately, there are cases where operations are required. I could not urinate often because of blockages. Therefore, intervention was required. So, what we are saying is that operations should only be done when they are really medically necessary. However, no genital cutting should ever be done just to normalize a child's body without informed consent.

  3. thanks again for specifying!

    however, i suppose for most people, the term "genital cutting", with its obvious connotation to "female genital cutting", clearly does not refer to medically indicated surgery, but in contrary to medically unnecessary "cosmetic" procedures.

    so, i'm still afraid the wording of your statement will send a wrong signal, allowing doctors and parents to define what's "necessary" in their eyes, and we all know where that ends.

    ok, i'm aware my insistance on very clear terms and definitions might appear a bit as nitpicking, but i think it's very important to make absolutely sure to close any backdoors for surgeons and unethically minded parents. because i think we all see time and time again how they only budge under massive pressure, and if so, immediately start looking out for loopholes.

    therefore, especially if it's about children and even more so if it's about toddlers, i'd like to ask you to take extra care when it comes to terminology, especially in public announcements, and always make extra sure to clearly distinguish between "cosmetic" procedures on the one side and actually medically indicated procedures on the other (against which of course i'm not opposed to either).

    thanks for your consideration, kind regards

  4. Dear Seelenlos,

    I do not think you are being nitpicky. Would you mind sending an email directly to me so that I will have your email address. That way I could help establish a dialog between you and the two main people who drafted this document. I really did not have any input in personally and I think it would be good for you to discuss this directly with Michelle from the UK and Hida from the USA. My email address is

    Kind regards,

  5. seelenloss - my son had moderate hypospadias with very severe chordee. He was in constant pain, and urination was starting to get difficult.

    He had genital reconstruction - consmesis is imperfect, but there's full functionality.
    Now he's old enough, we're discussing options with him. One of which is to leave well enough alone, but we'll finance any and all surgical changes he might desire.
    It's his body.