I 

118TH CONGRESS 

2D SESSION H. R. 10426 

To amend part E of title IV of the Social Security Act to require States 

to prohibit genital surgery on foster children with variations in sex 

characteristics who are under six years of age as a condition of receiving 

grants under such part. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 16, 2024 

Ms. GARCIA of Texas (for herself, Mr. POCAN, Mr. TAKANO, Mr. TORRES of 

New York, Ms. BONAMICI, Ms. CHU, Mr. FROST, Mr. GARCI ́A of Illinois, 

Mr. GREEN of Texas, Ms. JACOBS, Ms. JAYAPAL, Ms. LEE of California, 

Ms. LEE of Pennsylvania, Mrs. LEE CARTER, Ms. MCCLELLAN, Mr. 

MCGOVERN, Mrs. MCIVER, Ms. PINGREE, Ms. PRESSLEY, Mr. QUIGLEY, 

Mrs. RAMIREZ, and Ms. TLAIB) introduced the following bill; which was 

referred to the Committee on Ways and Means 

A BILL 

To amend part E of title IV of the Social Security Act 

to require States to prohibit genital surgery on foster 

children with variations in sex characteristics who are 

under six years of age as a condition of receiving grants 

under such part. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Protect Intersex Chil5 dren Act’’. 


ssavage on LAPJG3WLY3PROD with BILLS
2 

•HR 10426 IH

1 SEC. 2. PREAMBLE. 

2 (a) The Congress opposes all forms of prejudice, bias, 

3 and discrimination, and affirms its commitment to the 

4 dignity and autonomy of all people, including those born 

5 with variations in their physical sex characteristics. The 

6 Congress especially notes the importance of protecting 

7 children within the guardianship of the foster care system. 

8 (b) ‘‘Variations in physical sex characteristics’’ is an 

9 umbrella term used to describe a wide range of natural 

10 bodily variations in traits including genitals, gonads, hor11 mone function, and chromosomal patterns, and may be re12 ferred to as ‘‘difference of sex development’’ or ‘‘intersex’’. 

13 (c) People born with variations in their physical sex 

14 characteristics are a part of the fabric of the Nation’s di15 versity and are equally entitled to dignity and bodily au16 tonomy. 

17 (d) People born with variations in their physical sex 

18 characteristics are regularly subjected in infancy, without 

19 their consent, to surgeries to change the appearance or 

20 function of those variations, even though performing such 

21 surgeries may result in lasting harm and therefore does 

22 not serve the child’s best interests. 

23 (e) Not all persons with variations in their physical 

24 sex characteristics will need or desire the surgeries that 

25 may be recommended or performed on them in infancy. 

26 People born with variations in their physical sex characterVerDate Sep 11 2014 20:50 Jan 24, 2025 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H10426.IH H10426

ssavage on LAPJG3WLY3PROD with BILLS
3 

•HR 10426 IH

1 istics should be free to choose whether to undergo sur2 geries that impact not only their bodily autonomy but also 

3 their reproductive and sexual health. 

4 (f) The Congress recognizes that leading pediatric 

5 hospitals have begun to institute partial bans on these sur6 geries on patients with variations in their physical sex 

7 characteristics who are too young to participate in a mean8 ingful discussion of the implications of these surgeries, 

9 and therefore cannot meaningfully assent or consent to 

10 them, but the prohibition on non-consensual surgical pro11 cedures on pediatric patients with differences in sex char12 acteristics should not be construed to apply to, regulate, 

13 or prohibit surgical procedures provided to transgender 

14 patients, with the consent of the patients, by skilled and 

15 knowledgeable surgeons. 

16 (g) Therefore, the Congress calls upon the States to 

17 hold health professionals responsible for safeguarding the 

18 bodily autonomy of people born with variations in their 

19 physical sex characteristics and ensuring patient-centered 

20 care that conforms with best practices in the medical pro21 fession by ending the practice of performing specified sur22 geries on such children when they are under the age of 

23 six and the surgery is not required to address an imme24 diate risk to life, as provided. 


ssavage on LAPJG3WLY3PROD with BILLS
4 

•HR 10426 IH

1 SEC. 3. FINDINGS. 

2 The Congress finds the following: 

3 (1) Individuals with variations in their physical 

4 sex characteristics may present with differences in 

5 genital anatomy, internal reproductive structures, 

6 chromosomes, or hormonal variations. An estimated 

7 1.7 percent of babies are born with genetic, physio8 logical, or anatomical variations that can cause their 

9 physical sex characteristics to not conform to the ex10 pectations for a typical male or female baby. The 

11 vast majority of babies born with these variations do 

12 not require surgical intervention related to their 

13 physical sex characteristics immediately, if at all. 

14 (2) Beginning in the 1950s physicians in the 

15 United States began performing irreversible and in16 voluntary surgeries (often referred to as genital-nor17 malizing surgeries) on infants with variations in 

18 their physical sex characteristics without medical 

19 justification. 

20 (3) According to available public records, at 

21 least about 80 percent of these irreversible surgeries 

22 occur on infants under the age of 2, with even high23 er figures reported in published medical studies. A 

24 literature review of genital surgery conducted on 

25 children with variations in their physical sex charac26 teristics published in the Journal of Steroid BioVerDate Sep 11 2014 20:50 Jan 24, 2025 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H10426.IH H10426

ssavage on LAPJG3WLY3PROD with BILLS
5 

•HR 10426 IH

1 chemistry and Molecular Biology found that between 

2 2005 and 2012 the average age of patients was 11.2 

3 months old and the median age was 9.9 months at 

4 initial surgery. 

5 (4) These surgeries, which include unnecessary 

6 infant vaginoplasties, clitoral reductions and reces7 sions, and removal of gonadal tissues, are often per8 formed before a child can even speak or stand, 

9 meaning the individual is excluded from the decision 

10 whether to undergo these irreversible procedures. 

11 (5) There is evidence that these surgeries cause 

12 severe psychological and physiological harm when 

13 performed without the informed consent of the indi14 vidual. These harms may include scarring, chronic 

15 pain, urinary incontinence, loss of sexual sensation 

16 and function, sterilization, depression, post-trau17 matic stress disorder, suicidality, and surgical en18 forcement of incorrect gender assignment. 

19 (6) Three former United States Surgeons Gen20 eral who served in both Republican and Democratic 

21 Administrations, Dr. Joycelyn Elders, Dr. David 

22 Satcher, and Dr. Richard Carmona, issued a state23 ment calling for a moratorium on medically unneces24 sary surgeries on intersex children too young to par25 ticipate in the decision, noting that, ‘‘Cosmetic 


ssavage on LAPJG3WLY3PROD with BILLS
6 

•HR 10426 IH

1 genitoplasty should be deferred until children are old 

2 enough to voice their own view about whether to un3 dergo the surgery. Those whose oath or conscience 

4 says ‘do no harm’ should heed the simple fact that, 

5 to date, research does not support the practice of 

6 cosmetic infant genitoplasty.’’. 

7 (7) A number of domestic and international 

8 human rights organizations have conducted thorough 

9 inquiries into genital surgeries on infants with vari10 ations in their physical sex characteristics and have 

11 concluded that performing these procedures, inex12 tricably without the consent of the infants, is cruel 

13 and catastrophic, as follows: 

14 (A) The United Nations Special 

15 Rapporteur on Torture and Other Cruel, Inhu16 man or Degrading Treatment or Punishment 

17 explained in 2013, ‘‘children who are born with 

18 atypical sex characteristics are often subject to 

19 irreversible sex assignment, involuntary steri20 lization, involuntary genital normalizing sur21 gery, [or] performed without their informed 

22 consent . . . ‘in an attempt to fix their sex,’ 

23 leaving them with permanent, irreversible infer24 tility and causing severe mental suffering.’’. 


ssavage on LAPJG3WLY3PROD with BILLS
7 

•HR 10426 IH

1 (B) The United Nations High Commis2 sioner for Human Rights explained in 2015 

3 that non-consensual ‘‘medically unnecessary 

4 surgeries and other invasive treatment of 

5 intersex babies and children . . . are rarely dis6 cussed and even more rarely investigated or 

7 prosecuted. . . . The result is impunity for the 

8 perpetrators; lack of remedy for victims; and a 

9 gap between legislation and the lived realities of 

10 intersex people.’’. 

11 (C) The World Health Organization ex12 plained in 2015, that children with variations in 

13 their physical sex characteristics have been 

14 ‘‘subjected to medically unnecessary, often irre15 versible, interventions that may have lifelong 

16 consequences for their physical and mental 

17 health, including irreversible termination of all 

18 or some of their reproductive and sexual capac19 ity. . . . Human rights bodies and ethical and 

20 health professional organizations have rec21 ommended that free and informed consent 

22 should be ensured in medical interventions for 

23 people with intersex conditions, including full 

24 information, orally and in writing, on the sugVerDate Sep 11 2014 20:50 Jan 24, 2025 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H10426.IH H10426

ssavage on LAPJG3WLY3PROD with BILLS
8 

•HR 10426 IH

1 gested treatment, its justification and alter2 natives.’’. 

3 (D) Physicians for Human Rights has 

4 ‘‘call[ed] for an end to all medically unneces5 sary surgical procedures on intersex children 

6 before they are able to give meaningful consent 

7 to such surgeries.’’. 

8 (E) Human Rights Watch concluded that 

9 these surgeries, when performed without con10 sent, are ‘‘often catastrophic, the supposed ben11 efits are largely unproven, and there are gen12 erally no urgent health considerations at stake. 

13 Procedures that could be delayed until intersex 

14 children are old enough to decide whether they 

15 want them are instead performed on infants 

16 who then have to live with the consequences for 

17 a lifetime.’’. 

18 (8) In 2005, the San Francisco Human Rights 

19 Commission performed an investigation into this 

20 topic and issued an in-depth report, recommending 

21 that ‘‘ ‘normalizing’ interventions should not occur in 

22 infancy or childhood. Any procedures that are not 

23 medically necessary should not be performed unless 

24 the patient gives their legal consent.’’. 


ssavage on LAPJG3WLY3PROD with BILLS
9 

•HR 10426 IH

1 (9) Intersex advocacy groups led by individuals 

2 with variations in their physical sex characteristics 

3 themselves advocate for the postponing or banning 

4 of these surgeries. Those subjected to surgery to 

5 alter their variations in sex characteristics at a 

6 young age express despair over the fact that they 

7 were unable to make these decisions for themselves, 

8 publishing about their experiences in major news 

9 outlets: ‘‘I know firsthand the devastating impact 

10 [these non-consensual surgeries] can have, not just 

11 on our bodies but on our souls. We are erased before 

12 we can even tell our doctors who we are. Every 

13 human rights organization that has considered the 

14 practice has condemned it, some even to the point of 

15 recognizing it as akin to torture.’’. 

16 (10) The United States Department of State 

17 has acknowledged Intersex Awareness Day under the 

18 Obama, Trump, and Biden Administrations by rec19 ognizing the harm of these surgeries. In 2017, the 

20 Department released a statement recognizing that 

21 ‘‘at a young age, intersex persons routinely face 

22 forced medical surgeries without free or informed 

23 consent. These interventions jeopardize their phys24 ical integrity and ability to live freely.’’. 


ssavage on LAPJG3WLY3PROD with BILLS
10 

•HR 10426 IH

1 (11) Physicians who have participated in these 

2 surgeries have also expressed remorse that their 

3 training did not properly prepare them to respect 

4 the bodily autonomy of people born with variations 

5 in their physical sex characteristics. As a Stanford6 educated urologist explains: ‘‘I know intersex women 

7 who have never experienced orgasm because clitoral 

8 surgery destroyed their sensation; men who under9 went a dozen penile surgeries before they even hit 

10 puberty; people who had . . . vaginas created that 

11 scarred and led to a lifetime of pain during inter12 course . . . the psychological damage caused by 

13 [non-consensual] intervention is just as staggering, 

14 as evidenced by generations of intersex adults deal15 ing with post-traumatic stress disorder, problems 

16 with intimacy and severe depression. Some were 

17 even surgically assigned a gender at birth, only to 

18 grow up identifying with [a different] gender.’’. 

19 (12) When the life of an infant born with vari20 ations in their physical sex characteristics is threat21 ened and medical attention cannot be safely de22 ferred, therapeutic treatment options should remain 

23 available to children, families, and medical profes24 sionals to ensure that the imminent risk to life is ad25 dressed. In such cases, where surgical intervention 


ssavage on LAPJG3WLY3PROD with BILLS
11 

•HR 10426 IH

1 cannot be deferred and the infant lacks agency to 

2 advance the infant’s own interests, clinical ethicists 

3 may be consulted or included in decision-making to 

4 serve as a proxy for the interests of the infant and 

5 to ensure that the infant’s long-term well-being is a 

6 primary consideration in decision-making. 

7 (13) The United States should serve as a model 

8 of competent and ethical medical care and has a 

9 compelling interest in protecting the physical and 

10 psychological well-being of children, including those 

11 born with variations in their physical sex character12 istics. 

13 SEC. 4. STATES REQUIRED TO PROHIBIT SPECIFIED SUR14 GERIES ON FOSTER CHILDREN WITH VARI15 ATIONS IN SEX CHARACTERISTICS WHO ARE 

16 UNDER 6 YEARS OF AGE, AS A CONDITION OF 

17 PARTICIPATION IN THE FEDERAL FOSTER 

18 CARE AND ADOPTION ASSISTANCE PROGRAM. 

19 (a) STATE PLAN REQUIREMENT.—Section 471 of the 

20 Social Security Act (42 U.S.C. 671) is amended— 

21 (1) in subsection (a)— 

22 (A) by striking ‘‘and’’ at the end of para23 graph (36); 

24 (B) by striking the period at the end of 

25 paragraph (37) and inserting ‘‘; and’’; and 


ssavage on LAPJG3WLY3PROD with BILLS
12 

•HR 10426 IH

1 (C) by adding at the end, the following: 

2 ‘‘(38) provides that the State shall have in ef3 fect the laws and procedures described in subsection 

4 (f), which shall specify appropriate penalties and en5 forcement mechanisms described in subsection (f)(3) 

6 to ensure compliance with the laws and proce7 dures.’’; and 

8 (2) by adding at the end the following: 

9 ‘‘(f) STATE LAWS AND PROCEDURES TO PROHIBIT

10 GENITAL SURGERY ON FOSTER CHILDREN BORN WITH

11 VARIATIONS IN THEIR PHYSICAL SEX CHARACTERISTICS

12 WHO ARE UNDER 6 YEARS OF AGE.— 

13 ‘‘(1) IN GENERAL.—The laws and procedures 

14 described in this subsection are laws and procedures 

15 which prohibit a physician who is licensed to provide 

16 medical care under State law from performing any 

17 of the following surgical procedures on a foster child 

18 who has not attained 6 years of age and who is an 

19 individual born with variations in their physical sex 

20 characteristics, unless the surgical procedure is to 

21 address an immediate risk to life: 

22 ‘‘(A) Clitoroplasty, clitoral reduction, or 

23 clitoral recession, including corporal-sparing 

24 procedures. 

25 ‘‘(B) Gonadectomy. 


ssavage on LAPJG3WLY3PROD with BILLS
13 

•HR 10426 IH

1 ‘‘(C) Vaginoplasty, urogenital sinus mobili2 zation, or vaginal exteriorization. 

3 ‘‘(D) Phallectomy, penectomy, or 

4 phalloplasty. 

5 ‘‘(2) DEFINITIONS.—In paragraph (1): 

6 ‘‘(A) INDIVIDUAL BORN WITH VARIATIONS

7 IN THEIR PHYSICAL SEX CHARACTERISTICS.— 

8 The term ‘individual born with variations in 

9 their physical sex characteristics’ means an in10 dividual born with physical traits, including 

11 genitals, gonads, hormone function, or chromo12 somal patterns, that vary from stereotypical no13 tions regarding the development, appearance, or 

14 function of sex characteristics. 

15 ‘‘(B) SURGICAL PROCEDURE TO ADDRESS

16 AN IMMEDIATE RISK TO LIFE.—The term ‘sur17 gical procedure to address an immediate risk to 

18 life’ means a surgical procedure— 

19 ‘‘(i) to remove tissue that is malig20 nant; 

21 ‘‘(ii) to create an opening to allow 

22 urine or feces to exit the body where an 

23 opening is underdeveloped or not present; 

24 ‘‘(iii) to reposition internal organs 

25 that formed outside of the body; 


ssavage on LAPJG3WLY3PROD with BILLS
14 

•HR 10426 IH

1 ‘‘(iv) that is required to treat com2 plications of a previous surgery and cannot 

3 be delayed without increasing physical 

4 health risks to the patient; or 

5 ‘‘(v) that is necessary to preserve life 

6 in the event of a medical emergency. 

7 ‘‘(3) ENFORCEMENT.— 

8 ‘‘(A) IN GENERAL.—The relevant licensing 

9 entity of the State shall consider a violation of 

10 a State law or procedure described in para11 graph (1) to be unprofessional conduct, and 

12 shall discipline any violator of such a law or 

13 procedure accordingly. 

14 ‘‘(B) CONCURRENT AUTHORITY.—The rel15 evant department of health or regulatory body 

16 of a State shall have concurrent authority to 

17 initiate proceedings to address violations of a 

18 State law or procedure described in paragraph 

19 (1). 

20 ‘‘(4) RULE OF INTERPRETATION.—This sub21 section shall not be interpreted to require a State to 

22 impose liability on a hospital at which a violation of 

23 a State law or procedure described in paragraph (1) 

24 occurs.’’. 

25 (b) EFFECTIVE DATE.— 


ssavage on LAPJG3WLY3PROD with BILLS
15 

•HR 10426 IH

1 (1) IN GENERAL.—The amendments made by 

2 subsection (a) shall take effect on the 1st day of the 

3 1st calendar quarter that begins 1 year or more 

4 after the date of the enactment of this Act, and shall 

5 apply to payments under part E of title IV of the 

6 Social Security Act for calendar quarters beginning 

7 on or after such date. 

8 (2) DELAY PERMITTED IF STATE LEGISLATION

9 REQUIRED.—If the Secretary of Health and Human 

10 Services determines that State legislation (other 

11 than legislation appropriating funds) is required in 

12 order for a State plan developed pursuant to part E 

13 of title IV of the Social Security Act to meet the ad14 ditional requirements imposed by the amendments 

15 made by subsection (a), the plan shall not be re16 garded as failing to meet any of the additional re17 quirements before the 1st day of the 1st calendar 

18 quarter beginning after the 1st regular session of 

19 the State legislature that begins 1 year or more 

20 after the date of the enactment of this Act. For pur21 poses of the preceding sentence, if the State has a 

22 2-year legislative session, each year of the session is 

23 deemed to be a separate regular session of the State 

24 legislature. 

Æ 


ssavage on LAPJG3WLY3PROD with BILLS