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In the February 2005 issue of Journal of Pediatric and Adolescent Gynecology, gynecologist Sarah Creighton and pediatric urologist Walid Farhat offer competing views on whether feminizing genital surgeries should be performed early or it should be delayed until the patient is old enough to consent to it.
Creighton, while admitting that evidence is still inconclusive, insist that the "review of the current liteerature does not support the use of feminizing infant genitoplasty as an effective treatment for stable gender or psychosexual development." Creighton points out that young girls have no use for "functional" vagina until they start menstruation or having intercourse, and argues that by delaying the vaginoplasty we could reduce the total number of operations needed to achieve vaginal length, while reducing risk of stenosis and give patients greater control over their lives. Regarding clitoral reduction/recession surgeries, Creighton stops short of arguing against it but stresses that families need to be aware of the damages clitoral surgeries may cause to the child's sexual functioning.
Farhat on the other hand argues that there is not enough evidence for "recommending a systematic policy change at this stage." Farhat discusses that there are non-medical reasons for the early intervention, such as "lessening the mental anguish of the parents about their anomalous child" and "the assumption that the child may not remember being born with a genital anomaly." "Both these assumptions have yet to be proven," admits Farhat, but there are some things seriously wrong with these assumptions as reasons for early intervention even if they were proven to be true.
First, surgeries on a child should only be performed if doctors feel that it is in the best interest of the child. That the procedure might help someone other than the patient does not justify performing such invasive and irreversible surgery on the child. Mental anguish experienced by the parents is a real clinical concern, and it should be dealt as a psychological need rather than a justification to alter the child's genitalia.
Second, the idea it is better to keep the child in the dark about the condition they were born with seems like a plan to deprive patients from learning about our own bodies and managing our health with all the knowledge that we can find. In fact, it's a return to the 1950s when secrecy and deception were endorsed as a treatment protocol in dealing with intersex patients under the belief that ignorance is a bliss. One of the most significant victories for the intersex movement has been that medical associations such as American Academy of Pediatrics no longer openly advocate for secrecy and deception--but some doctors still think that secrecy is a good practice, apparently.
In the end, Farhat states "we recommend that assignment of gender be done on an individual basis." Of course, the actual practice should always be done on an individual basis. But we are recently finding out that when doctors say "on an individual basis" in regards to intersex treatment, they don't really mean "on the basis of individual patients' needs and circumstances." What they actually mean is "on the basis of what patients' parents want and need." But why is it always about the parents? If any surgeries were to happen, we'd like it to be because the best available evidence suggested that surgery is in the best interest of the child, at least in the minds of the doctors performing it, and not simply because parents demanded it.
Source:
Creighton SM (2005). "Early intervention of CAH surgical management." Journal of Pediatric and Adolescent Gynecology. 18(1):63-66.
Farhat WA (2005). "Early intervention of CAH surgical management." Journal of Pediatric and Adolescent Gynecology. 18(1):66-9.
Posted by Emi on Jun 2, 2005