Talk:Intersex medical interventions

message: 1. abnormal is an objective term that is used to describe any deviation from usual; substituting several words that together are less clear is not an improvement of either style or truth. 
2. Your substitution suggests a politically motivated denial of simple fact in order to push a specific opinion on a recently advocated but unproven management approach. I have tried to do justice to the controversy, but have tried to present your view as one of several different perspectives since at present we have neither social consensus nor long-term outcome evidence of superiority. Would you describe cosmetic surgery to remove a blood vessel malformation of the skin a procedure to "make the skin more socially acceptable"? You might in some contexts, but not in the intro to an encyclopedia article. 
3. I added a sentence in the controversies section to represent what I suspect is your viewpoint: Within the last decade, some people have raised the question of whether surgery to correct abnormal genitalia should be done at all. Opponents of all "corrective surgery" on abnormal genitalia suggest we should be attempting to change social opinion regarding the desirability of having genitalia that look more average, rather than performing surgery to try to make them more like other peoples'.
Is this a fair representation? Alteripse 00:45, 13 Nov 2004 (UTC)
thread_title: Abnormal

message: A couple of user:cherylchase's recent changes are excellent (especially the point that perhaps doctors and parents consider a gender identity change the worst outcome). However, a couple are not. The listing of goals is not the place to make unsubstantiatable accusations of "unclear thinking". You may disagree with the goals as is, and should be, clearly explained in the article, but the surgeons who do the surgery and the parents and patients who consent to it can usually formulate exactly what outcomes they are wishing for. There is rarely anything unclear about the intentions of surgery. I have attempted to make it very clear that some of the purposes are controversial this can even be emphasized further as one perspective on this issue, though not as the only perspective on this issue. Much less controversial is the fact that not all the goals (e.g., sexual function) are achieved in a large proportion of cases. This is explicitly stated, and elaborated even further in the article on history of intersex surgery. May I suggest going a piece at a time about the things you would like to change, and explaining on talk page? That is the usual custom here for articles with content that may be controversial. Thanks. alteripse 22:45, 3 May 2006 (UTC)
thread_title: recent changes

message: "abnormal" is a term that describes larger than usual penises, and smaller than usual clitorises. But these deviations from usual do not create a wish for surgery on the part of parents or doctors. There's a useful clue in that lack of symmetry about what is prompting surgery. Cherylchase 17:00, 5 May 2006 (UTC)
thread_title: "abnormal"

message: "Opponents of all 'corrective surgery' on abnormal genitalia suggest we should be attempting to change social opinion regarding the desirability of having genitalia that look more average, rather than performing surgery to try to make them more like other peoples" is not quite right. I think that coming to some agreement first on what are the rationales for surgery will let us make more progress on an accurate characterization of the views of opponents of all appearance-altering surgeries.
I'm going to discuss here the earliest articulated rationale for surgery. The rationales have shifted over the years; we can discuss later rationales after this one.
The famous 1955 papers by Money, Hampson, and Hampson say that there are two reasons why early surgery to normalize the appearance of the genitalia is necessary. First, the child could not develop a gender identity concordant with the sex assigned unless the genitals had an appearance congruent to the sex assigned, and that this should happen before the child is 18 months old. Second, the articles say that gender identity is socially determined, largely through interaction with the parents. Thus, the parents must believe that the child has a "true sex" which the doctors have uncovered and which is congruent with the sex assigned. Unless the genitals have an appearance normal for the sex assigned, the parents will not believe that is the true sex, and they will not be able to interact with the child in such a way as to cause the child to develop a concordant gender identity.
This theory is no longer very popular. It is contradicted by many cases in which children (born with or without intersex anomalies) developed gender identity discordant with the sex assigned, as well as an extensive history of people who developed a socially acceptable gender identity despite growing up with ambiguous genitalia and without surgery. The most famous case of discordant gender id is recounted in (Colapinto 2000). The phenomenon of transsexuality is also relevant; these individuals develop discordant gender identity despite completely normal genital appearance. A summary of information about individuals who have done well despite growing up with ambiguous genitalia and no surgery is available at ISNA's FAQ. 
Surprisingly, Money himself is the author of some of this information. His first encounter with an intersexed person is described on page 4 of the Prologue to his collection "Venuses Penuses" (sic).
At Harvard, I probably would have gone down the mainstream of clinical psychology of the time except for the coincidence of a case presentation in the Fall of 1949 by George Gardner MD for Social Relations Course 281A, Clincal Problems of Child Guidance, at the Judge Baker Guidance Center in Boston. The case was one of hermaphroditism in a child who had grown up always as a boy despite having been born with, instead of a penis, an organ the size and form of a clitoris. At puberty, he feminized in physique. It is now known in retrospect that his case was one of the androgen-insensitivity syndrome. Psychologically he was a boy and could not entertain the idea of reassignment as a girl. Even though not too much could be achieved by way of surgery and hormone treatment, he was permitted to continue living as a boy. He has since married and become a father by adoption, and has achieved professional recognition in the world of medicine.
Money's 1952 PhD dissertation contains discussion of numerous published cases for the period:
The findings are somewhat disconcerting, for one would not have been surprised had the paradox of hermaphroditism been a fertile source of psychosis and neurosis.. The evidence, however, shows that the incidence of the so-called functional psychoses in the most ambisexual of the hermaphrodites—those who could not help but be aware that they are sexually equivocal—was extraordinarily low.
There are also vingettes of people in (Young 1937) who seemed to be doing quite well without surgery, and who refused Young's offer of surgery.
Money, J., J. G. Hampson, et al. (1955). "Hermaphroditism: Recommendations Concerning Assignment of Sex, Change of Sex, and Psychologic Management." Bulletin of Johns Hopkins Hospital 97(4): 284-300.
	
Money, J., J. G. Hampson, et al. (1955). "An Examination of Some Basic Sexual Concepts: The Evidence of Human Hermaphroditism." Bulletin of the Johns Hopkins Hospital 97(4): 301-319.
	
Money, J., J. G. Hampson, et al. (1955). "Sexual incongruities and psychopathology: The evidence of human hermaphroditism." Bulletin of the Johns Hopkins Hospital 97(4): 43-57.
Colapinto, J. (2000). As Nature Made Him : The Boy Who Was Raised As a Girl. New York, Harper Collins.
Dreger, A. D. (1998). Hermaphrodites and the Medical Invention of Sex. Cambridge, Harvard University Press.
	
http://www.isna.org/faq/healthy
Money, John. 1952. Hermaphroditism: An Inquiry into the Nature of a Human Paradox. Doctoral Dissertation, Harvard University, Cambridge (444 pages). Can be ordered directly from Harvard University’s Widener Library for about $100.
Young, H. H. (1937). Genital Abnormalities, Hermaphroditism, and Related Adrenal Diseases. Baltimore, Williams and Wilkins.
	
Cherylchase 17:00, 5 May 2006 (UTC)
thread_title: rationales for appearance-altering surgery

message: I don't think that Money's theory is "an out-of-fashion psychological rationale for it that no one under 50 even remembers". In (Kessler 1998), Suzanne Kessler reports on assumptions and attributions of meaning revealed in interviews she carried out with six doctors who worked with intersex children in New York. These were three men, three women, one clinical geneticist, two peds endos, one endo, one psychoendocrinologist (guess we know who that is), and one urologist. The represent four different medical centers, no two of them collaborate on research or work together on a team. They all had extensive clinical experience with various intersex syndromes, and some are internationally known researchers in the field of intersexuality. They were selected based on their prominence in the field, and in such a way as to cover four different centers. All were interviewed in the spring of 1985, in their offices.
All six specialists told Kessler that management of intersexed chases is based upon the theory of gender proposed by Money in 1955 and elaborated in 1972. From the transcribed interviews:
I think we [physicians] have been raised in the Money theory. (an endocrinologist)
We always approach the problem in a similar way and it's been dictated, to a large extent, by the work of John Money and Anke Erhardt because they are the only people who have published, at least in medical literature, any data, any guidelines. . . .  And I don't know how effective it is. (another endo)
Kessler on the pervasiveness of the Money theory:
Contradictory data were not mentioned by any of the six physicians, and have not reduced these physicians' belief in the theory's validity. Although only one of the physicians interviewed has published with Money, they all essentially concur with his views and give the impression of a consensus that is rarely encountered in science. The one physician who raised some questions about Money's philosophy and the gender theory on which it is based has extensive experience with intersexuality in a nonindustrialized culture where the infant is managed differently with no apparent harm to gender development. Even though psychologists fiercely argue issues of gender identity and gender role development, doctors who treat intersexed infants seem untouched by these debates. There are still, in the late 1990s, few renegade voices within the medical establishment. Why Money has been so single handedly influential in promoting his ideas about gender is a question worthy of a separate substantial analysis.
I don't believe that the Money rationale for early genital surgery fell out of favor until after the David Reimer story hit Rolling Stone in 1997. The story was known earlier (Diamond was presenting it in Fall 1995, and ISNA published an account of Diamond's presentation). 
I'm not ignoring your question about how best to represent the argument of opponents of surgery. First I would like to demonstrate that rationales for surgery have been guesses, not evidence-based, and that as each rationale has fallen out of fashion, a different rationale has taken its place, and not through a process involving scientific thinking.
Cherylchase 06:15, 6 May 2006 (UTC)
replies: text: Actually, the bit about cultural influence brings up the point about comparisons with Female Genital Cutting (I believe that is the current PC term). I realize that a lot of this article is dealing with birth defects, but the parts about surgical "reinforcement" (for the lack of a better term) of the sex of rearing should probably make some mention of this. Like with FGC, the "benefits" in those cases are cultural and social acceptance, as well as the cascade that derives from this. While I don't have any sources handy, I have seen this point raised by several people; I suspect Ms/Mrs Chase might know of a decent source we might quote on this. Zuiram 16:45, 31 March 2007 (UTC)
replies: text: I am not sure I understand your point. May I remind you that our preference for a normal upper lip instead of a cleft upper lip is "cultural" also? I don't think anyone should question that improved "cultural and social acceptance" has always been the principal reason that surgeons and parents have put infants through surgery to correct socially significant differences from body norms, and is typically the main reason adults undergo most surgery on their external sexual parts. alteripse 12:23, 1 April 2007 (UTC)

text: You are badly and sadly misinformed. Doctors do not "mislead" parents into sex assignment. Parents have assigned sex to infants at birth for all of human history and certainly do not need doctors to do it. These days, as well as in the 1960s, doctors assist parents to assign sex when it isnt obvious by inspection, and i have no idea on what grounds you describe that as "misleading parents". And you have it exactly backwards when you claim that underdeveloped countries dont have gender dichotomies; that is racist nonsense of the worst 18th century "noble savage" variety. Go to any international medical meeting on this topic and you will hear heart-wrenching stories about the cruelty and ignorance of how these conditions are handled by parents and societies in the third world. Look at the european pediatric literature on the difficulties of dealing with middle eastern patients with these disorders, or the australian literature on dealing with south asians. Underdeveloped countries are not beacons of enlightenment on this topic--- many are just a colonization removed from infanticide, an older and far more "natural" way to deal with ambiguous genitalia than surgery. alteripse (talk) 02:40, 16 December 2009 (UTC)
thread_title: Money theory remained dominant until less than a decade ago

message: Intersex surgery is surgery performed to correct birth defects or early injuries of the genitalia, primarily for the purposes of making the appearance more normal and to reduce the likelihood of future problems. 
::1) If it's just injuries, why is it called "intersex surgery". That doesn't make sense.
::2) Is it fair to call them 'birth defects'? What about calling it 'anomalous genitals' or some other formulation. --Obi-Wan Kenobi (talk) 03:39, 20 June 2013 (UTC)
replies: text: Unwanted by whom? I think the use of the term birth defect is a bit pejorative here. Can you show reliable sources that call anomalous genitalia "birth defects"?--Obi-Wan Kenobi (talk) 21:40, 20 June 2013 (UTC)
replies: text: How about the NIH and National Library of Medicine? http://www.nlm.nih.gov/medlineplus/ency/article/003269.htm
Like most people who try to force their opinions about the right way to think about sex on everyone else, you have no clue, do you? Severe forms of this are devastating to parents, preclude the kind of physical sexual relations most people enjoy, are often associated with problems of urinary or bowel function, and sometimes carry risk of death or other disability. If you would actually read the references to the article, you would have learned that most of the people who have them grow up dissatisfied with their genitalia even if not operated on. But god forbid we acknowledge someone might not want to be born this way! Are you really such a fool that you cannot distinguish a person from a condition? Or do you have such contempt for these people that you think that if we all pretend it's just a "difference", not a "defect", it won't bother them? alteripse (talk) 22:53, 20 June 2013 (UTC)

text: Please cool down with the you have no clue", "Are you really such a fool", etc. You've been around long enough to know better. Let's focus on the facts and the article, and not the person. Between us all, we can get a cited, accurate lede - Alison ❤ 23:15, 20 June 2013 (UTC)
replies: text: "Unwanted by whom?"-- sorry but "clueless" is charitable. Few editors are more tedious and unlikely to improve an article than self-righteous adolescent language police trying to force their POV about sex on everyone else, and unable to distinguish respect for people and recognition that a problem with the body can actually be a problem with the body. If there is some other way to construe his comments, please explain and I will try to understand it. alteripse (talk) 23:59, 20 June 2013 (UTC)
thread_title:  issue with lede 

message: The article should discuss the constitutional rights of intersexuals such as myself. No gender-corrective surgery should be performed on an infant or individual under the age of 18, unless they have the ability consent to it. I was assigned the male gender, but even though I would've been an intersexed woman without it, and because I am still masculine, I would've wanted a choice!   — Preceding unsigned comment added by 12.154.105.53 (talk) 08:49, 23 July 2017 (UTC)
thread_title:  Constitutional Rights for Intersexuals

message: has just added a flag regarding tone of some materials, including rhetorical questions that have been in the article for over a decade (see here, for example, from September 2004). In reviewing the article, I felt that, while they might not be encyclopedic according to current standards, they do help to show the issues, and removing or modifying them causes other problems. Modifying them in the way that Maplestrip has done, fails to improve the tone, and makes the wording more complex. More care is needed. Trankuility (talk) 10:02, 29 October 2016 (UTC)
replies: text: The way I modified some of them was somewhat of an experiment, and I personally do think it's an improvement, but I agree that more work needs to be put into it if we want to improve it. There's a reason I didn't touch the most offending section. I don't believe these kinds of rhetorical questions are proper in an encyclopedia. It communicates the right ideas, but it does so in a way that's just unheard of for a work like this. People go to an encyclopedia to find answers or to read the opinions of experts, not to be asked morality and value questions themselves. I think the best way to handle this situation is to give the viewpoints of all sides; the pros and cons of any proposed actions. I don't think rhetorical questions are needed to explain that many aspects of this topic are subjective and a personal value call. ~Mable (chat) 10:12, 29 October 2016 (UTC)
replies: text: I do not agree that the changes are an improvement. I also take issue with the question of balance. In considering the viewpoints of all sides, it is necessary to note that this is a contentious area in both pediatric medicine and human rights fields. Clinical reviews are already cited, expressing the current balance of perspectives within pediatric specialisms - and the available evidence. From a human rights perspective, the issues are increasingly clear. Last week, multiple international human rights institutions issued a joint statement that is very clear. The current sources are all verifiable, as they should be. It is neither necessary nor appropriate to explain that many aspects of this topic are subjective in a way that implies that different value calls are equally valid. Trankuility (talk) 10:27, 29 October 2016 (UTC)
replies: text: Even more reason to stray away from asking rhetorical questions. With a rhetorical question without explanation, you indicate that it could go one way or the other and that both sides of the argument have about equal value. It is impossible to balance the article properly without indicating what the current consensus is among high-profile human rights activists and medical experts. Of course, my edit to change "what do you think" to "it is unsure which is better" does not improve this aspect. It's just a change in tone. We should have "according to x, y, and z, this is the way to go". You know, to simplify greatly here. ~Mable (chat) 11:36, 29 October 2016 (UTC)
replies: text: On refection, I agree that removing them would be ideal. The changes to date have been deliberately slow and incremental, and erring on the side of caution retaining older material. But your changes have altered the character of the questions. For example, changing "Do any advantages of infant clitoral reduction surgery outweigh the potential disadvantages of reduced or distorted sexual sensation?" to "It is subjective whether any advantages of infant clitoral reduction surgery outweigh the potential disadvantages of reduced or distorted sexual sensation" changes a rhetorical statement that is, in fact, answered by the clinical and human rights materials, into a statement that ignores or overrides the clinical and human rights materials, and the "subjective" part of that statement is possibly WP:OR. The same is true of changing "How much weight should be given to the cosmetic argument that there is value in making genitals more typical for sex of rearing?" to "It is unknown how much weight should be given to the cosmetic argument that there is value in making genitals more typical for sex of rearing." In my view, the human rights and clinical material should not be overridden by those statements. The changes should be reverted for now. Trankuility (talk) 12:26, 29 October 2016 (UTC)
replies: text: I'll revert those changes - that's not a problem. But this is pretty much how I read these rhetorical questions: apparently, the encyclopedia isn't sure either. Something like "Research has been done in order to find out whether ..." could work too, if that's what is meant to be communicated. ~Mable (chat) 12:59, 29 October 2016 (UTC)
thread_title:  Tone issues and longstanding rhetorical questions 

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thread_title:  External links modified 

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thread_title:  External links modified 

message: The map is not up to date. For example,  it excludes a jurisdiction in India where IGM was banned. Should we remove the map until it has been updated? Prcc27 (talk) 10:33, 29 May 2020 (UTC)
thread_title:  Map 

message: I was wondering if the recent edit means that, conversely, the current version conflates treatments specifically for newborns with treatments that aren't for newborns. Admittedly I know very little about the subject, but I would like to help improve the accuracy of the article if I can. Cheers. DN (talk) 20:57, 11 January 2024 (UTC)
thread_title:  Conflation in the lead 

message: Hi everyone,
I am requesting that we change this page from IMI, so instead I would title it Treatment of Disorders of Sexual Development. or even management of DSD words.
There are a few reasons why I am considering we should make the change.
1) Intersex is somewhat a medically outdated term since 2006, the chicago consensus recommends the usage of "disorders of sexual development" as the chicago consensus term is more inclusive to all conditions that fall under this umbrella rather than the outdated intersex term.
2) medical intervention might be a misleading term, whereas treatment is a bit more neutral i think. management is also okay
3) treatment / management of DSD seems to be a middle ground term that physicians are using nowadays
https://www.massgeneral.org/children/disorders-of-sexual-development/diagnosis-treatment
https://link.springer.com/chapter/10.1007/978-3-662-54256-9_18
https://www.researchgate.net/publication/301253426_Diagnosis_and_Treatment_of_Disorders_of_Sexual_Development
Just my opinion Philipbrochard (talk) 07:57, 24 March 2024 (UTC)
thread_title:  Rename this IMI page to Treatment of DSD 

message: Brazil, Colombia and Germany have all passed legislation banning unnecessary surgeries on intersex todlers. Tigunikas (talk) 17:40, 12 May 2024 (UTC)
thread_title:  Missing countries