A landmark legal case may finally put a stop to almost half a century of bizarre medical procedures in the United States, where children's genitals have been surgically altered to fit a standardized definition of the proper sizes for penises and clitorises.
South Carolina couple Mark and Pam Crawford adopted their son M.C. when he was 19 months old, after he had been the ward of the state for a few months. Before his adoption, M.C.'s doctors and social workers decided that the infant's penis was too small or ambiguous, and determined that the best course of action was plastic surgery that would make his genitals look female. There was absolutely no medical cause for the surgery. It was purely cosmetic. Now, M.C. is 8 years old and has told his parents that he wants to be a boy. But before he was able to make this decision, doctors had surgically altered him in a way that has already caused him grief and confusion.
The Crawfords are suing the South Carolina Department of Social Services, Greenville Hospital, and Medical University of South Carolina for gross negligence and medical malpractice. According to CNN:
The suit says the surgery violated the 14th Amendment, which says that no state shall "deprive any person of life, liberty, or property without due process of law."
The thing that's truly appalling about this case is that M.C.'s experiences are all too common.
According to many doctors during the twentieth century, a medically acceptable clitoris at birth measures .02 to .09 cm, while a medically acceptable penis at birth is 2.5 to 4.5 cm. But there are as many as 1 in 2,000 babies born every year whose genitals exist in that 1.0 to 2.4 cm gray area, or who have ambiguous testicles and labia. These babies are called intersexed. Their ambiguous genitals often result from the fact that clitorises and penises develop from the same tissues in the womb, as do labia and testicles. Plus, there is a lot of natural variation in size and shape anyway.
A note on terminology: Humans cannot be hermaphrodites, which are defined scientifically as animals that are capable of both impregnating and being impregnated.
When intersex babies are born, or when babies' genitals are injured, it has been common medical practice to treat these children as if they have a medical problem that needs fixing. But only a small number of intersex children have medical problems. Most are just slightly outside the range of the typical, no different from kids born with big noses or really short fingers. But in the mid-twentieth century, it became medical "common sense" that children would be traumatized by growing up with genitals that don't match the norm. As a result, girls with large clitorises were given clitoridectomies, and boys with small penises were given reconstructive surgery and raised as girls.
These days, the common sense is changing fast. Now, many doctors would tell parents of intersex children that the child will naturally choose a gender as they grow up (M.C., for example, seems to have chosen his before reaching the age of 8). Parents may choose a temporary gender for the child until he or she is old enough to choose. But mostly, the parents have to be patient and let the kid just be a kid without assigning them a "boy or girl" status — and certainly before giving them life-altering surgery. The Crawfords' lawsuit, if successful, will likely cement this treatment into standard medical practice.
These surgeries are an issue that intersex people have been dealing with for a long time. It has taken decades of activism to reach a point where parents were willing to sue medical professionals for altering their infants' genitals without any medical reason.
On Autostraddle, Claudia writes about why this case is important to intersex people:
Intersex isn't a medical condition . . . It's about bodies that have a combination of sex traits traditionally considered "male" or "female" in the same body. The clinical procedures in question are not those that track health or provide any sort of medical benefit for the child; the genital surgeries, (vaginal) dilation procedures, and other treatments that parents and clinicians give proxy consent to are cosmetic. They're performed to make their child's external genitals look "normal" (as though there is one way genitals should naturally look), to remove internal gonads kids assigned M/F "shouldn't" have, to sculpt intersex bodies into something that more closely approximates societal beauty standards as to what our most private of parts should look like.
This case is really important because it clearly argues that parents and doctors shouldn't get consent proxy to decide whether intersex children should have these cosmetic procedures. Since they're not medically relevant, only intersex persons themselves should decide what we want to do with our bodies.
You can read the tragic story of one boy who was given a sex-reassignment surgery at birth in the incredible book As Nature Made Him: The Boy Who Was Raised as a Girl. In the meantime, if you want to learn more about the lawsuit, you can go to the Advocates for Informed Choice website. They are a legal organization that advocates for intersex children.