Intersexuality - Dealing with Intersexuality

Continuing Changes - Current Guidelines

A few years ago, the American biologist Milton Diamond and the Canadian psychiatrist Keith Sigmundson proposed new guidelines for the medical management of intersexes, from birth through adolescence into adulthood. These guidelines were the result of intensive discussions among biologists, physicians, psychologists, lawyers and various intersex support groups. For doctors, this is a brief summary of the main points:

• In each case of atypical sex organs, make every effort to establish the probable cause.
• From the very beginning, inform and counsel the parents, and protect their confidentiality.
• Where cause and prognosis are clear, make the appropriate sex assignment as early as possible.
• In less obvious cases, base the sex assignment not on the physical appearance at birth, but on the most likely eventual outcome for the child after puberty.
• In very difficult cases, make the best decision possible at the time, but explain to the family that the child may later “switch genders”, i.e. develop another sexual self-identification.
• As long as there is no final diagnosis, delay entering the child’s sex in official records. Some indeterminate phrase like “Infant Jones” or “Baby Brown” may be used as well as gender-neutral first names like “Terry”, “Kim”, “Francis”, etc.
• Perform no major surgery for cosmetic reasons alone; only for conditions related to the child’s future health. Explain this decision to the parents who may want their baby to "look normal." Even if the external sex organs remain obviously atypical, a satisfying life in adulthood may very well be possible. Indeed, most intersex conditions do not need any surgery at all.
• Keep the door open for future consultation. Both parents and child may need occasional or regular counseling as the years go by.
• Be an authority, but avoid being authoritarian. Provide the best available information, but remember: Only the client can make the final decision about her or his sexual identity.
• Put the family in touch with a support group.

For the full text of the guidelines, click here.
For some legal aspects of “normalizing surgery”, click here.