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Intersex is about so much more than identity politics

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Hanne Gaby Odiele

Hanne Gaby Odiele

Hanne Gaby Odiele

The Belgian model Hanne Gaby Odiele has revealed that she is intersex. She says she has done this to break the "taboo" about this subject and to help professionals and parents understand that children with this condition should not be forced to have surgery without their consent.

What is intersex? In the past it was called hermaphroditism, but more recently is referred to as a disorder with sexual development. It is a condition in which there is a discrepancy between the genetic make up of the child and their sex organs. A child might have the genetic make up of male (XY chromosomes) or female (XX) chromosomes, but their sexual organs do not match.

For example, genetic males may not have a penis or genetic females may lack ovaries and a uterus and instead have testicles. The most common cause is adrenogenital syndrome, a condition in which the female foetus is exposed to high levels of male hormones secreted by the adrenal glands, causing her masculinisation. This occurs in about one in 15,000 newborns.

Genetic conditions such as adrenogenital insensitivity syndrome and Klinefelter syndrome (xxy chromosomes) are also causal.

The treatment traditionally began as early as possible with surgery and the gender of the genitalia was assigned, usually, rather than that of the chromosomes. This approach was based on the work of Dr John Money, an American psychologist at Johns Hopkins Hospital specialising in gender identity. He advanced the idea that gender was socially and not biologically determined; nurture was stronger than nature.

Therefore if children had surgery early and there was no ambiguity in the parents about the child's gender, then the outcome would be good. He is famous for the case of David Reimer, one of the most famous patients in medical history. As a baby he underwent a circumcision that destroyed his penis in a botched operation. His parents were advised to take him to Money for assistance in changing his gender to female, so that he could lead a healthy sex life as an adult woman. His name was changed to Brenda. He had surgery to provide a vagina and was brought up as a girl with continuing input from Money, part of which was to supervise his.

Money reported this case in various medical journals calling it the Joan/John Case, claiming the operation to have been a success and providing support for his position regarding gender. Society bought into the belief that gender was indeed a malleable social construct, a view that is now commonplace. Tragically, Brenda had many mental health problems growing up and at 14 learnt the truth - that she was born male. She immediately underwent reassignment back to her original gender and got married. However he continued to be dogged by depression and at the age of 38 David (formerly Brenda) Reimer shot himself.

While David did not have an intersex problem, his case may have contributed to the change in medical opinion regarding early surgery. It is now advised that it be delayed for as long as is healthy physically and psychologically, while also involving the child in the decision where feasible.

Yet questions continue to be discussed and debated among professionals dealing with these cases. The fundamental one is which is the correct sex to select - that based on the organs, or on the chromosomes? How damaging psychologically is it to wait until it becomes more obvious from the child's behaviour and personality which sex "fits" best?

How will this influence sexual orientation - most of those with congenital adrenal hyperplasia, the most common cause, are heterosexual, but there has been an increase in those who are bisexual or same sex attracted.

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Intersex should not be confused with gender identity disorder (trans) where the person has congruent genes and sexual organs but feels and believes they are incongruent. They insist that they are of a particular biological sex but that they function as and are of a gender that is different. For this they can undergo gender reassignment surgery, although their needs are very different from those who are intersex.

It is unclear why Ms Odiele made this statement now since there have been some cases (Christiane Volling in Germany) before the courts asserting that non-consensual surgery violates the rights of this group.

Malta, in 2015, became the first country to ban non-consensual gender reassignment surgery and that same year the Council of Europe recognised the right of intersex people not to have reassignment surgery.

Whatever Odiele's motivation, this is clearly a profoundly complex condition with significant physical, psychological, social and ethical ramifications, demanding sensitive management by professionals, parents and wider society. It would be perverse if it were to be appropriated by those engaged in identity politics, now raging in the US and Europe.


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