It's time to defend intersex rights

When we can't even define what constitutes "normal", we shouldn't be performing surgeries on infants to make them conform to gender preconceptions, writes Morgan Carpenter.

The clitoris is the only part of any human body that's purely designed for pleasure. But is too much of a good thing a bad thing?

Research on what constitutes "normal" genitalia, for both men and women, is somewhat scarce - but labia reductions are becoming more common, and so a Dutch study in 2009 examined what doctors believe a normal labia looks like. It found that plastic surgeons were more likely to find larger labia minora "distasteful and unnatural, compared with general practitioners and gynaecologists". It also found that male doctors in each of those specialties were more inclined than women doctors to recommend surgery.

A cross-party Senate Standing Committee report released last month found such evidence "disturbing"; we can't objectively define "normal". The Senate committee goes further: "Normalising appearance goes hand in hand with the stigmatisation of difference."

The Senate Committee was investigating the medical treatment of intersex people - people who do not meet typical, biological definitions of male or female. Intersex refers to a range of at least 30 or 40 testable genetic, anatomical or hormonal types of sex difference. Intersex people, particularly those born with ambiguous genitalia, are at the pointy end of the debate about what constitutes "normal".

Unlike women who undergo labia surgery, intersex infants and children can't consent.

Germany has just created a new "indeterminate" classification on birth certificates for those same children. The ACT government is considering similar proposals. They create a whole other debate about normality, autonomy and consent. Most (but not all) intersex people identify as male or female, however different our bodies look. Adults should be free to make their own identification choices, but the German law affects people before they are of an age to make that choice. It places children at risk of being "outed" at school and, while surgeries continue there, it could even increase a tendency towards surgical intervention. The new classifications miss the point.

The standard medical policy in Australia has been to surgically 'correct' nonconforming genitalia in infancy or childhood. The aim is to make the person it belongs to appear more "normal". The Senate Committee says "normalisation surgery is more than physical reconstruction. The surgery is intended to deconstruct an intersex physiology and, in turn, construct an identity that conforms with stereotypical male and female gender categories".

These attempts to make intersex people appear normal come at a huge cost to the people concerned. Biologist Anne Fausto-Sterling describes how "penetration in the absence of pleasure takes precedence over pleasure in the absence of penetration". The Australian Paediatric Endocrine Group (APEG) acknowledges that post-surgical sexual function and sensation are of "particular concern".

The parliamentary inquiry was also disturbed by the possibility that doctors might recommend "therapeutic" sterilisations on the basis of cancer risk when a child's gonads do not match the sex they are assigned. Cancer risk has often been entangled with sex assignment and social factors in decision-making processes.

OII Australia told the Senate Committee that all of its individual members have experienced some form of coerced medical intervention. Some members were not told of their diagnoses, or their parents were badgered into making their children undergo normalising surgeries.

The Senate Committee has been highly critical of current practice, saying that while enormous medical "effort has gone into assigning and 'normalising' sex: none has gone into asking whether this is necessary or beneficial". In calmly restrained parliamentary language, they described this as "extremely unfortunate".

Whether too big or too small, when outcomes are contested and we can't even define what constitutes "normal", normalising surgeries on infants and children can't be justified. Australian intersex organisations have called for such surgeries to end, and the UN Special Rapporteur on Torture has even called for such surgeries to be outlawed, along with gay conversion therapy.

The Senate Committee has accepted that the status quo is not acceptable; 'normalising' surgical interventions on infants should be deferred until they are of an age to give consent themselves. It recommends the development of national standards, and legal oversight of all therapeutic and non-therapeutic surgeries on intersex infants.

The Senate Committee has changed the debate on the correct treatment of intersex differences. If adopted, its recommendations will effectively protect the rights of intersex children and future adults.

Coming on the back of intersex inclusion in new anti-discrimination legislation, improved access to Medicare, and federal gender recognition guidelines, these are hugely important developments that help end the stigmatisation of difference.

We should all feel good about what we've got, whatever our shape or size.

Morgan Carpenter is the president of Organisation Intersex International Australia, a community organisation that promotes human rights and bodily autonomy for intersex people. View his full profile here.