Intersex medical interventions

1213:

often performed during the surgery to confirm function of the sensory nerves. Clitoral reduction is rarely done except in combination with vaginoplasty when substantial virilization is present. Potential problems: The degree to which the goal of preserving sexual sensations is attained is a subject of controversy regarding the necessity of such treatments, and lack of firm evidence of good outcomes. The success of more contemporary approaches was challenged by Thomas in 2004: "confidence in the superiority of modern surgery is almost certainly misplaced as the crucial components of current clitoral reduction surgery are not fundamentally different from those used in specialist centres 20 years ago".

586: 1648: 1577:... outcomes from clitoroplasty identify problems related to decreased sexual sensitivity, loss of clitoral tissue, and cosmetic issues ... Feminising as opposed to masculinising genitoplasty requires less surgery to achieve an acceptable outcome and results in fewer urological difficulties... Long term data on sexual function and quality of life among those assigned female as well as male show great variability. There are no controlled clinical trials of the efficacy of early (less than 12 months of age) versus late surgery (in adolescence and adulthood), or of the efficacy of different techniques" 1782: 1847:

successful psychological outcome for the patient and might require psychological support when the patient is trying to distinguish a gender identity. The Swiss National Advisory Commission on Biomedical Ethics states that, where "interventions are performed solely with a view to integration of the child into a family and social environment, then they run counter to the child's welfare. In addition, there is no guarantee that the intended purpose (integration) will be achieved."

32: 1798:

stated to be based on probabilities of cancer risk may be encapsulating treatment decisions based on other factors, such as the desire to conduct normalising surgery… Treating cancer may be regarded as unambiguously therapeutic treatment, while normalising surgery may not. Thus basing a decision on cancer risk might avoid the need for court oversight in a way that a decision based on other factors might not. The committee is disturbed by the possible implications of this..."

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questions of necessity as they reflect parental, social, and cultural concerns. There remains no clinical consensus or clear evidence regarding surgical timing, necessity, type of surgical intervention, degree of difference warranting intervention and evaluation method. Such surgeries are the subject of significant contention, including community activism, and multiple reports by international human rights and health institutions and national ethics bodies.

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outward some of the buried components of the corpora so that the penis protrudes more. The girth is augmented with transplantation of the patient's fat. This procedure is designed to preserve erectile and sexual function without surgically altering the urethra. This type of surgery is not performed on children and primarily produces a small increase in the size of a normal penis, but would be less likely to produce a major functional change in a severe

1924:, a US professor of Clinical Medical Humanities and Bioethics, argues that little has changed in actual clinical practice in recent years. Creighton and others in the UK have found that there have been few audits of the implementation of the 2006 statement, clitoral surgeries on under-14s have increased since 2006, and "recent publications in the medical literature tend to focus on surgical techniques with no reports on patient experiences". 1155: 1630:

surgical procedures are sources of concerns. There is no evidence regarding the effect of surgically treated or non-treated DSDs during childhood for the individual, the parents, society or the risk of stigmatization... Physicians working with these families should be aware that the trend in recent years has been for legal and human rights bodies to increasingly emphasize preserving patient autonomy.

1204:

it fell into disfavor in the last 15 years. Potential surgical problems: Unfortunately the subsequent sensations were not always pleasant, and erection could be painful. Adults who had a clitoral recession in early childhood often report reduced capacity for enjoyment of sexual intercourse, though similar women who had not had surgery also report a high rate of sexual dysfunction.

1195:, like phalloplasty, is a term that encompasses any surgical reconstruction of the clitoris, such as removal of the corpora. Clitoral recession and reduction can both be referred to as clitoroplasty. Potential surgical problems: Major complications can include scarring, contractures, loss of sensation, loss of capacity for orgasm, and unsatisfactory appearance. 891:

leaving an opening (a "fistula") proximal to the intended urethral opening. Sometimes a second operation is successful, but some boys and men have been left with chronic problems with fistulas, scarring and contractures that make urination or erections uncomfortable, and loss of sensation. It is increasingly recognized that long-term outcomes are poor.

1229:) exist, and the outer virilization is modest, surgery involves separating the fused labia and widening the vaginal introitus. With greater degrees of virilization, the major challenge of the procedure is to provide a passage connecting the outer vaginal opening to the cervix which will stay wide enough to allow coitus. XY girls or women with partial 1495:...interventions have lasting effects on the development of identity, fertility, sexual functioning and the parent-child relationship. The parents' decisions should therefore be marked by authenticity, clarity and full awareness, and based on love for the child, so that they can subsequently be openly justified vis-à-vis the child or young adult. 977:

ventral side of the shaft. In a complete chordee the phallus is "tethered" downward to the perineum by skin. A more severe chordee is often accompanied by a hypospadias and sometimes by severe undervirilization: a perineal "pseudovaginal pouch" and bifid ("split") scrotum with an undersized penis. This combination, referred to as

1246:

complication and the chief reason that a revision may be required when a girl is older. When a neovagina is made from a segment of bowel, it tends to leak mucus; when made with a skin graft, lubrication is necessary. Less common complications include fistulas, uncomfortable scarring, and problems with urinary continence.

1035:

Construction of a narrow tube lined with mucosa (a urethra) is a similar challenge. Minor revisions of the skin are rarely followed by problems. More complicated reconstruction may result in scarring and contracture, which can distort the shape or curvature of the penis, or interfere with erections or make them painful.

1270:. If the gonads are relatively "normal" testes, but the child is to be assigned and raised as female, (e.g., for intersex conditions with severe undervirilization, or major malformations involving an absent or unsalvageable penis) they must be removed before puberty to prevent virilization from rising testosterone. 1639:

commentary stated that the purpose of the 2006 Consensus Statement was to validate existing practices, "The authoritativeness and "consensus" in the Chicago statement lies not in comprehensive clinician input or meaningful community input, but in its utility to justify any and all forms of clinical intervention."

2466:

Mouriquand, Pierre D. E.; Gorduza, Daniela Brindusa; Gay, Claire-Lise; Meyer-Bahlburg, Heino F. L.; Baker, Linda; Baskin, Laurence S.; Bouvattier, Claire; Braga, Luis H.; Caldamone, Anthony C.; Duranteau, Lise; El Ghoneimi, Alaa; Hensle, Terry W.; Hoebeke, Piet; Kaefer, Martin; Kalfa, Nicolas; Kolon,

1973:

When an individual is born with atypical genitalia that pose no physical risk, treatment should focus not on surgical intervention but on psychosocial and educational support for the family and child. Cosmetic genitoplasty should be deferred until children are old enough to voice their own view about

1815:

have occurred in partially or completely virilized genetic males who were reassigned and raised as females. This is the management practice that has been most thoroughly undermined in recent decades, as a result of a small number of spontaneous self-reassignments to male. Reducing the likelihood of a

1764:

and clitoris, with a "cotton tip applicator" and extended tests with a biothesiometer, a medical device used to measure sensitivity thresholds. Values were recorded. The authors note that there are no control data "for assessment of the viability and function of the clitoris in unaffected women." The

1751:

A 2007 paper by Yang, Felsen and Poppas provided what the authors believe is the first study of clitoral sensitivity after clitoris reduction surgery, but the research was itself the subject of ethical debate. Postoperative patients aged older than five years were "considered candidates" for clitoral

1525:

and others examined outcomes from early surgeries in individuals with XY variations, at one patient centre. The study has been used to support claims that "the majority of women... have clearly favored genital surgery at an earlier age" but the study was criticized by Baratz and Feder in a 2015 paper

1491:

It is important to bear in mind and also to point out to the parents that a diagnosis does not in itself entail any treatment or other medical measures, but serves initially to provide an overview of the situation and a basis for subsequent decisions, which may also take the form of watchful waiting.

1101:

is surgery intended to enlarge a small penis. Early attempts in the 1950s and 1960s involved constructing a tube of non-erectile flesh extending a small penis but the penis did not function. In recent years a small number of urologists have been offering an augmentation procedure that involves moving

890:

or in urogenital opening) is more challenging, may be done in stages, and has a significant rate of complications and unsatisfactory outcomes. Potential surgical problems: For severe hypospadias (3rd degree, on perineum) constructing a urethral tube the length of the phallus is not always successful,

3785:

Gorduza, Daniela; Tardy-Guidollet, Véronique; Robert, Elsa; Gay, Claire-Lise; Chatelain, Pierre; David, Michel; Bretones, Patricia; Lienhardt-Roussie, Anne; Brac de la Perriere, Aude; Morel, Yves; Mouriquand, Pierre (2014). "Late prenatal dexamethasone and phenotype variations in 46,XX CAH: Concerns

1868:

Additionally, parents are not often consulted on the decision-making process when choosing the sex of the child, and they may be advised to conceal information from their child. The Intersex Society of North America stated that "For decades, doctors have thought it necessary to treat intersex with a

1772:

Loss of sexual function and sensation remains a concern in a submission by the Australasian Paediatric Endocrine Group to the Australian Senate in 2013. Clinical decision-making has prioritized perceived advantages from infant clitoral reduction surgery over the potential disadvantages of reduced or

1576:

It is generally felt that surgery that is carried out for cosmetic reasons in the first year of life relieves parental distress and improves attachment between the child and the parents. The systematic evidence for this belief is lacking. ... information across a range of assessments is insufficient

1479:

A 2006 clinician "Consensus Statement on Intersex Disorders and Their Management" attempted to prioritise psychosocial support for children and families, but it also supports surgical intervention with psychosocial rationales such as "minimizing family concern and distress" and "mitigating the risks

1337:

are normally formed. Severe bladder exstrophy or cloacal exstrophy in genetic males often renders the phallus widely split, small, and unsalvageable. The scrotum is also widely split, though testes themselves are usually normal. From the 1960s until the 1990s, many of these infants were assigned and

1277:

are a special case: if there is any degree of responsiveness to testosterone, they should be removed before puberty. On the other hand, if androgen insensitivity is complete, the testes may be left to produce estradiol (via testosterone) to induce breast development, but there is a slowly increasing

976:

is the cutting of ventral penile skin and connective tissue to free and straighten the penis. A mild chordee, manifest as a well-formed penis "bent" downward by subcutaneous connective tissue, may be an isolated birth defect easily repaired by releasing some of the inelastic connective tissue on the

1846:

deemed too large or penis is reduced/removed), or feelings of freakishness and unacceptability, which may have been avoided without the surgery. Studies have revealed how surgical intervention has had psychological effects, affecting well-being and quality of life. Genital surgeries do not ensure a

1806:

Gender identity and sexuality in intersex children have been problematized, and subjective judgements are made about the acceptability of risk of future gender dysphoria. Medical professionals have traditionally considered the worst outcomes after genital reconstruction in infancy to occur when the

1797:

or monitored carefully. In a major Parliamentary report in Australia, published in October 2013, the Senate Community Affairs References committee was "disturbed" by the possible implications of current practices in the treatment of cancer risk. The committee stated: "clinical intervention pathways

1487:

The initial aim of counselling and support is therefore to create a protected space for parents and the newborn, so as to facilitate a close bond. In addition, the parents need to be enabled to take the necessary decisions on the child's behalf calmly and after due reflection. In this process, they

1203:

involves the repositioning of the erectile body and glans of the clitoris farther back under the symphysis pubis and/or skin of the preputium and mons. This was commonly done from the 1970s through the 1980s to reduce protrusion without sacrificing sensation. Outcomes were often unsatisfactory, and

785:

intended to make genitalia more like those of typical XX-females. There are multiple techniques or approaches for each procedure. Some of these are needed for variations in degrees of physical difference. Techniques and procedure have evolved over the last 60 years. Some of the different techniques

748:

Both sets of rationales may be the subject of debate, particularly as the consequences of surgical interventions are lifelong and irreversible. Questions regarding physical health include accurately assessing risk levels, necessity and timing. Psychosocial rationales are particularly susceptible to

4567:

Creighton, Sarah; Ransley, Philip; Duffy, Patrick; Wilcox, Duncan; Mushtaq, Imran; Cuckow, Peter; Woodhouse, Christopher; Minto, Catherine; Crouch, Naomi; Stanhope, Richard; Hughes, Ieuan; Dattani, Mehul; Hindmarsh, Peter; Brain, Caroline; Achermann, John; Conway, Gerard; Liao, Lih Mei; Barnicoat,

1735:

editorial in 2015 stated that parents are unduly influenced by medicalized information, may not realize that they are consenting to experimental treatments, and regret may be high. Research has suggested that parents are willing to consent to appearance-altering surgeries even at the cost of later

1629:

There is still no consensual attitude regarding indications, timing, procedure and evaluation of outcome of DSD surgery. The levels of evidence of responses given by the experts are low (B and C), while most are supported by team expertise... Timing, choice of the individual and irreversibility of

1446:

describes the trait as "compatible with normal life expectancy", and "often undiagnosed". Behrmann and Ravitsky find social concepts of sex, gender and sexual orientation to be "intertwined on many levels. Parental choice against intersex may thus conceal biases against same-sex attractedness and

1212:

was developed in the 1980s to reduce size without reducing function. Lateral wedges of the erectile tissue of the clitoris are removed to reduce the size and protrusion. The neurovascular tissue is carefully spared to preserve function and sensation. Nerve stimulation and sensory responses are now

1859:

Photographs of intersex children's genitalia are circulated in medical communities for documentary purposes, and individuals with intersex traits may be subjected to repeated genital examinations and display to medical teams. Problems associated with experiences of medical photography of intersex

1715:

Infant vaginoplasties should not be done because most people who have had them performed report some degree of difficulty with sexual function; even though we have no evidence that adult sexual function will be better if surgery is deferred, the outcomes could not be worse than they currently are

1358:

can be equally difficult when this has been disrupted as well. Functional problems can warrant a temporary or long-term colostomy. The added challenge for the most severely affected genetic females, and for genetic males who are being raised as females, is construction of a neovagina. Scarring is

1114:

where a normal penis is buried in suprapubic fat. In most cases, when the fat is depressed with the fingers, the penis is seen to be of normal size. This is common in overweight boys before the penile growth of puberty. Surgical techniques have been devised to improve it. The most common problems

1245:

as a female. One method is to use a segment of colon, which provides a lubricated mucosal surface as a substitute for the vaginal mucosa. Another is to line the new vagina with a skin graft. Potential surgical problems: Stenosis (narrowing) of the constructed vagina is the most common long-term

1607:

In a study in Lübeck conducted between 2005 and 2007 ... 81% of 439 individuals had been subjected to surgeries due to their intersex diagnoses. Almost 50% of participants reported psychological problems. Two thirds of the adult participants drew a connection between sexual problems and their

1586:

Data presented in recent years suggests that little has changed in practice. Creighton and others in the UK have found that there have been few audits of the implementation of the 2006 statement, clitoral surgeries on under-14s have increased since 2006, and "recent publications in the medical

1507:

Recognition that medicalization and stigmatisation of intersex people result in significant trauma and mental health concerns. In view of ensuring the bodily integrity and well-being of intersex people, autonomous non-pathologising psycho-social and peer support be available to intersex people

1638:

and Ellen Feder criticized that omission, stating that issues have barely changed in two decades, with "lack of novel developments", while "lack of evidence appears not to have had much impact on physicians' confidence in a standard of care that has remained largely unchanged." Another 2016

1034:

is a general term for any reconstruction of the penis itself, especially for more unusual types of injuries, deformities, or birth defects. The principal difficulty is that erectile tissue is not easily constructed and this limits the surgeon's ability to make more than minor size changes.

1728:

Parents are frequently considered able to consent to feminizing or masculinizing interventions on their child, and this may be considered standard for the treatment of physical disorders. However this is contested, particularly where interventions seek to address psychosocial concerns. A

1087:

are saline-filled plastic ovoids implanted in the scrotum. They have no function except to provide the appearance and feel of testes. Several sizes are available, but most are implanted in adolescence to avoid repeated procedures to implant larger sizes at puberty. Prostheses made of

1183:. This procedure was the most common clitoral surgery performed prior to 1970, but was largely abandoned by 1980 because it usually resulted in loss of clitoral sensation. Potential surgical problems: The primary effect of this surgery is a drastic reduction in ability to experience 1282:

must be directly examined; atypical gonads with Y line or potential testicular function should be removed but in rare instances a surgeon may try to preserve the ovarian part of an ovotestis. Potential surgical problems: A lifetime of hormone replacement will be required, to avoid

1022:. Surgical repair for this is primarily a phalloplasty. Potential surgical problems: Surgery for the more severe degrees of cloacal exstrophy is extensive and usually multistage. A variety of potential problems and complications can occur, including need for long-term colostomy or 981:, is in the spectrum of ambiguous genitalia due to a number of conditions. Scarring and contracture are occasional complications, but most unsatisfactory outcomes occur when a severe hypospadias needs to be repaired as well. Long-term complications can include fistulas between 4851:"Georgiann Davis (2011), "DSD is a Perfectly Fine Term": Reasserting Medical Authority through a Shift in Intersex Terminology, in PJ McGann, David J. Hutson (ed.) Sociology of Diagnosis (Advances in Medical Sociology, Volume 12), Emerald Group Publishing Limited, pp.155-182" 2467:

Thomas F.; Manzoni, Gianantonio; Mure, Pierre-Yves; Nordenskjöld, Agneta; Pippi Salle, J. L.; Poppas, Dix Phillip; Ransley, Philip G.; Rink, Richard C.; Rodrigo, Romao; Sann, Léon; Schober, Justine; Sibai, Hisham; Wisniewski, Amy; Wolffenbuttel, Katja P.; Lee, Peter (2016).

4523:

Minto, Catherine L; Liao, Lih-Mei; Woodhouse, Christopher R. J.; Ransley, Phillip; Creighton, Sarah M (April 12, 2003). "The effect of clitoral surgery on sexual outcome in individuals who have intersex conditions with ambiguous genitalia: a cross-sectional study".

1236:

The most challenging surgery with the highest complication rate is construction of an entirely new vagina (a "neovagina"). The most common instance of this is when a child will be assigned and raised as a female despite complete virilization, as with Prader 5

1147:. In the 21st century, feminizing surgery to support reassignment of XY infants with non-ambiguous micropenis has been largely discontinued, and surgical reassignment of XY infants with exstrophy or other significant variations or injuries is diminishing. See 1488:

should not be subjected to time or social pressures. Parents' rapid requests for medical advice or for corrective surgery are often a result of initial feelings of helplessness, which need to be overcome so as to permit carefully considered decision-making.

1860:

children have been discussed along with their ethics, control and usage. "The experience of being photographed has exemplified for many people with intersex conditions the powerlessness and humiliation felt during medical investigations and interventions".

2320: 1612:

A 2016 Australian study of persons born with atypical sex characteristics found that "strong evidence suggesting a pattern of institutionalised shaming and coercive treatment of people". Large majorities of respondents opposed standard clinical protocols.

1850:

Opponents of all "corrective surgery" on atypical sex characteristics suggest to change social opinion regarding the desirability of having genitalia that look more average, rather than perform surgery to try to make them more like those of other people.

1534:

if surgery were performed later, or (3) that significant technical improvements that were expected to improve outcomes had occurred in the 13 or 14 years between when they underwent early childhood surgery and when it might have been deferred until after

1917:

The Council of Europe argues that secrecy and shame have perpetuated human rights abuses and a lack of social understanding of the reality of intersex people. It calls for respect for "intersex persons' right not to undergo sex assignment treatment".

1517:

Specialists at the Intersex Clinic at University College London began to publish evidence in 2001 that indicated the harm that can arise as a result of inappropriate interventions, and advised minimising the use of childhood surgical procedures.

915:. Potential surgical problems: The most complicated aspect of closure involves moving the urethra to the phallus if it is not already there (i.e., repairing a perineal hypospadias). Fistulas, scarring, and loss of sensation are the main risks. 641:

has been characterized by controversy due to reports that surgery can compromise sexual function and sensation, and create lifelong health issues. The medical interventions can be for a variety of reasons, due to the enormous variety of the

1092:

are no longer available due to safety and perception-of-safety concerns. Potential surgical problems: Foreign body reactions, rarely with infection or erosion of scrotal skin, are minimal but constitute the most significant complication.

1949:

In April 2015, Malta became the first country to recognize a right to bodily integrity and physical autonomy, and outlaw non-consensual modifications to sex characteristics. The Act was widely welcomed by civil society organizations.

6188:

Machado P. S.; Costa A. B.; Nardi H. C.; Fontanari A. M. V.; Araujo I. R.; Knauth D. R. (2015). "Follow-up of Psychological Outcomes of Interventions in Patients Diagnosed with Disorders of Sexual Development: A Systematic Review".

1881:

described current surgical interventions as experimental, stating that clinical confidence in constructing "normal" genital anatomies has not been borne out, and that medically credible pathways other than surgery do not yet exist.

1608:

history of surgical treatment. Participating children reported significant disturbances, especially within family life and physical well-being – these are areas that the medical and surgical treatment was supposed to stabilize.

1708:

Genital surgery should be handled differently than other birth defect surgery; this is a type of surgery that parents should not be empowered to make decisions about because they will be under social pressure to make "bad"

5824: 900:

may involve comprehensive surgical repair of the genito-urinary area, usually during the first seven years of life, including reconstruction of the urethra, closure of the penile shaft and mobilisation of the corpora.

2585: 1379:

was published in the Journal of Child and Adolescent Psychopharmacology. It examined the use of "prenatal hormone screening or treatment for the prevention of homosexuality" using research conducted on foetuses with

2328: 1668:

Management practices for intersex conditions have evolved over the last 60 years. In recent decades surgical practices have become the subject of public and professional controversy, and evidence remains lacking.

1388:

describe how later research constructs "low interest in babies and men – and even interest in what they consider to be men's occupations and games – as "abnormal", and potentially preventable with prenatal dex ".

1341:

Potential surgical problems: Surgery for the more severe degrees of cloacal exstrophy is extensive and usually multistage. A variety of potential problems and complications can occur, including need for long-term

3236:

Minto CL, Liao LM, Woodhouse CR, Ransley PG, Creighton SM (2003). "The effect of clitoral surgery on sexual outcome in individuals who have intersex conditions with ambiguous genitalia: a cross-sectional study".

661:

recognized, for the first time, a right for intersex persons not to undergo sex-assignment treatment and Malta became the first country to prohibit involuntary or coerced modifications to sex characteristics.

5962:

Consortium on the Management of Disorders of Sex Differentiation. 2006. Clinical Guidelines for the Management of Disorders of Sex Development in Childhood. Rohnert Park: Intersex Society of North America.

5383:

Cools, Martine; Koen van Aerde; Anne-Marie Kersemaekers; Marjan Boter; Stenvert L. S. Drop; Katja P. Wolffenbuttel; Ewout W. Steyerberg; J. Wolter Oosterhuis; Leendert H. J. Looijenga (September 2005).

4254:

Creighton, Sarah M.; Minto, Catherine L.; Steele, Stuart J. (July 14, 2001). "Objective cosmetic and anatomical outcomes at adolescence of feminising surgery for ambiguous genitalia done in childhood".

2353: 4617:

Crouch, Naomi S.; Minto, Catherine L.; Liao, Lih-Mei; Woodhouse, C R J; Creighton, Sarah M. (2004). "Genital sensation after feminizing genitoplasty for congenital adrenal hyperplasia: a pilot study".

2225: 6098:

Lee, Peter A.; Nordenström, Anna; Houk, Christopher P.; Ahmed, S. Faisal; Auchus, Richard; Baratz, Arlene; Baratz Dalke, Katharine; Liao, Lih-Mei; Lin-Su, Karen; Looijenga, Leendert H.J.; Mazur, Tom;

5525:; Cavicchia-Balmer, Yvonne; Huber, Johannes (August 2013). "Shaping Parents: Impact of Contrasting Professional Counseling on Parents' Decision Making for Children with Disorders of Sex Development". 2406:

2253: 1463:. This revised code now specifically includes intersex people who do not identify with their sex assigned at birth and experience clinically significant distress or impairment, using the language of 5495: 1974:

whether to undergo the surgery. Those whose oath or conscience says “do no harm” should heed the simple fact that, to date, research does not support the practice of cosmetic infant genitoplasty.

1634:

A 2016 paper on "Surgery in disorders of sex development (DSD) with a gender issue" repeated many of the same claims, but without reference to human rights norms. A commentary to that article by

6082:

Human Rights Commission of the City and County of San Francisco, and Marcus de María Arana. A Human Rights Investigation Into The Medical "Normalization" Of Intersex People. San Francisco, 2005.

1014:(the two embryonic parts unjoined). The penis often cannot be salvaged, although the testes can be retained. Repair may involve closure of the bladder, closure of the anterior abdominal wall, 869:. Potential surgical problems include maintaining the blood supply. If vessels cannot be stretched into the scrotum, or are separated and cannot be reconnected, a testis will die and atrophy. 1350:. Creating a functional urethra is difficult and poor healing, with scarring, stricture, or fistula can require a vesicostomy to prevent urinary incontinence. Construction of a functional 1969:, calling for a rethink of early genital surgeries on children with intersex traits. The statement reflected on the history of such interventions, their rationales and outcomes, stating: 2287: 786:

have been devised to reduce complications associated with earlier techniques. There remains a lack of consensus on surgeries, and some clinicians still regard them as experimental.

7574: 3101: 2923: 6227: 2150: 829:

account for a significant portion of cases but these are rare in North America and Europe. Masculinizing surgery for completely virilized individuals with XX sex chromosomes and

1064: 940: 5816: 2621: 4906: 2568: 2089: 1018:(temporary or permanent) with reconstruction of the rectum. If the halves of the phallus cannot be joined, they may be removed. The smallest defect in this spectrum is an 4570:"Regarding the Consensus Statement on 21-Hydroxylase Deficiency from the Lawson Wilkins Pediatric Endocrine Society and The European Society for Paediatric Endocrinology" 267: 7427: 1556:

is atypical." The term has been controversial and not widely adopted outside clinical settings: the World Health Organization and many medical journals still refer to

5857: 1807:

person develops a gender identity discordant with the sex assigned as an infant. Most of the cases in which a child or adult has voluntarily changed sex and rejected

1793:

In the cases where nonfunctional testes are present, or with partial androgen insensitivity syndrome, there is a risk that these develop cancer. They are removed by

250: 4663:; Migeon, C.J.; Berkovitz, G.D.; Gearhart, J.P.; Dolezal, C.; Wisniewski, A.B. (2004). "Attitudes of Adult 46,XY Intersex Persons to Clinical Management Policies". 2354:"OII-Europe applauds Malta's Gender Identity, Gender Expression and Sex Characteristics Act. This is a landmark case for intersex rights within European law reform" 1831:, but they may make different choices with non-medicalized information. However, there is no evidence that surgeries help children grow up psychologically healthy. 5740: 2246: 1752:

sensitivity testing, and 10 of 51 patients were tested, with 9 undergoing extended vibratory sensory testing. The initial tests were performed on the inner thigh,

1572:

argue that the term DSD was designed to "reinstitutionalise" medical authority over intersex bodies. On surgical rationales and outcomes, the article stated that:

5907: 4921: 1946:

won the first successful case brought against a surgeon for non-consensual surgical intervention. The Regional Court of Cologne, Germany, awarded her €100,000.

5386:"Morphological and Immunohistochemical Differences between Gonadal Maturation Delay and Early Germ Cell Neoplasia in Patients with Undervirilization Syndromes" 2357: 1359:

extensive and the lower torso disfigured even with the best outcomes. Finally, it has become apparent that some XY males (without intersex conditions) who are

5943: 5875: 2209: 1106:. Potential surgical problems include reabsorption of the fat, scarring resulting in interference with erectile function, and issues with physical sensation. 1816:

gender "mismatch" is also a claimed advantage of deferring reconstructive surgery until the patient is old enough to assess gender identity with confidence.

2663: 7567: 5479: 1869:

concealment-centered approach, one that features downplaying intersex as much as possible, even to the point of lying to patients about their conditions."

1233:

will have a blind vaginal pouch of varying degrees of depth. Sometimes this can be dilated to a usable depth. Sometimes surgery is performed to deepen it.

5781: 4004: 3485:

Alizai NK, Thomas DF, Lilford RJ, Batchelor AG, Johnson N (1999). "Feminizing genitoplasty for congenital adrenal hyperplasia: what happens at puberty?".

1842:), genital surgery may lead to negative consequences for sexual functioning in later life (such as loss of sensation in the genitals, for example, when a 1026:. In many cases a functional penis cannot be created. Scarring is often extensive and the lower torso severely disfigured even with fairly good outcomes. 6921: 3223:

Statement of the British Association of Pediatric Surgeons Working Party on the Surgical Management of Children Born with Ambiguous Genitalia. July 2001.

2629: 1055:. The most common scenario is accidental discovery of persistent Müllerian derivatives or a small uterus during abdominal surgery of a normal boy for 1006:

is a major birth defect involving inadequate closure and incomplete midline fusion of multiple pelvic and perineal organs as well as the front of the

5289:

Yang, Jennifer; Felsen, Diane; Poppas, Dix P. (October 2007). "Nerve Sparing Ventral Clitoroplasty: Analysis of Clitoral Sensitivity and Viability".

1544:

In 2006, an invited group of clinicians met in Chicago and reviewed clinical evidence and protocols, and adopted a new term for intersex conditions:

6415: 3947:"Cognitive outcome of offspring from dexamethasone-treated pregnancies at risk for congenital adrenal hyperplasia due to 21-hydroxylase deficiency" 1936: 81: 5606:

Bean, E. J.; Mazur, T.; Robinson, A. D. (2009). "Mayer-Rokitansky-Küster-Hauser Syndrome: Sexuality, Psychological Effects, and Quality of Life".

7560: 6102:; Mouriquand, Pierre; Quigley, Charmian A.; Sandberg, David E.; Vilain, Eric; Witchel, Selma; and the Global DSD Update Consortium (2016-01-28). 2687: 2410:; Mouriquand, Pierre; Quigley, Charmian A.; Sandberg, David E.; Vilain, Eric; Witchel, Selma; and the Global DSD Update Consortium (2016-01-28). 4162: 3208:"Statement of the British Association of Paediatric Surgeons Working Party on the Surgical Management of Children Born with Ambiguous Genitalia" 2321:"Making depathologization a matter of law. A comment from GATE on the Maltese Act on Gender Identity, Gender Expression and Sex Characteristics" 817:

Orchiopexy and hypospadias repair are the most common types of genital corrective surgery performed in infant boys. In a few parts of the world

6260: 5969:

Consortium on the Management of Disorders of Sex Differentiation. 2006. Handbook for Parents. Rohnert Park: Intersex Society of North America.

5341: 3644: 3520:

Lobe TE, Woodall DL, Richards GE, Cavallo A, Meyer WJ (1987). "The complications of surgery for intersex: changing patterns over two decades".

2183: 1278:

risk of cancer in adult life. Streak gonads without a Y chromosome cell line need not be removed but will not function. Finally, the gonads in

1426:

recommending that deselection of embryos and foetuses on grounds of intersex status should not be permitted. It quoted research by Professors

6791: 4167: 1415: 1123:

In the last 50 years, the following procedures were most commonly performed to make the genitalia more typically female: virilization due to

653:

issues. Intersex organizations, and human rights institutions increasingly question the basis and necessity of such interventions. In 2011,

2004: 1423: 4833: 4240: 2705: 7490: 7475: 3717: 1483:

In 2012, the Swiss National Advisory Commission on Biomedical Ethics argued strongly in favour of improved psychosocial support, saying:

2919: 2293: 1063:, or bowel disease. Removal would not involve genital surgery. A rarer indication would be that of a completely virilized XX child with 7328: 6236: 3207: 2159: 572: 6046:

Houk C. P.; Hughes I. A.; Ahmed S. F.; Lee P. A. (2006). "Summary of Consensus Statement on Intersex Disorders and Their Management".

3280:

Chase, C (1996). "Re: Measurement of pudendal evoked potentials during feminizing genitoplasty: technique and applications (letter)".

7254: 4025: 3555:

Manuel M, Katayama PK, Jones HW (1976). "Jr. 1976 The age of occurrence of gonadal tumors in intersex patients with a Y chromosome".

2618: 1705:

Any surgery not absolutely necessary for physical health should be postponed until the person is old enough to give informed consent.

1225:, can be fairly simple or quite complex, depending on the initial anatomy. If a normal internal uterus, cervix and upper vagina (the 7552: 6315: 4898: 7417: 3007:"Surgical Repair of Late Complications in Patients Having Undergone Primary Hypospadias Repair during Childhood: A New Perspective" 2087:

Submission 88 to the Australian Senate inquiry on the involuntary or coerced sterilisation of people with disabilities in Australia

2086: 978: 790: 7440: 6914: 5116:

Dayner, Jennifer E.; Lee, Peter A.; Houk, Christopher P. (October 2004). "Medical Treatment of Intersex: Parental Perspectives".

1819:

Human rights institutions question such approaches as being "informed by redundant social constructs around gender and biology".

3831:"Prenatal Dexamethasone Treatment of Children at Risk for Congenital Adrenal Hyperplasia: The Swedish Experience and Standpoint" 7809: 7452: 6846: 6393: 5581:"What evidence is there that you can grow up psychologically healthy with intersex genitals (without "normalizing" surgeries)?" 4040: 1907:

access to justice and reparation for unnecessary medical treatment, as well as inclusion in equal treatment and hate crime law.

637:, primarily for the purposes of making a person's appearance more typical and to reduce the likelihood of future problems. The 507: 59: 1904:

unnecessary "normalising" treatment of intersex persons, and unnecessary pathologisation of variations in sex characteristics.

6781: 6304: 5775: 5489: 4934: 3153:

Casale AJ, Beck SD, Cain MP, Adams MC, Rink RC (1999). "Concealed penis in childhood: a spectrum of etiology and treatment".

2948: 2747:

Liao, Lih-Mei; Wood, Dan; Creighton, Sarah M (28 September 2015). "Parental choice on normalising cosmetic genital surgery".

2715: 2657: 1766: 432: 335: 7825: 1702:

If outcome is less than satisfactory, early surgery leaves a person wondering if they would have been better off without it.

1052: 7955: 7447: 6786: 6573: 6533: 6410: 6380: 6015: 5850: 2024: 1690:

Assuming infant surgery is successful, there is no barrier to engaging in normal sexual activities, and less distortion of

437: 245: 205: 76: 47: 2381: 7290: 789:

Some children receive a combination of procedures. For example, a child regarded as a severely undervirilized boy with a

465: 5983: 5737: 2247:"Nuremberg Hermaphrodite Lawsuit: Michaela "Micha" Raab Wins Damages and Compensation for Intersex Genital Mutilations!" 7457: 6907: 6359: 6033: 4061:

Behrmann, Jason (2013). "Queer Liberation, Not Elimination: Why Selecting Against Intersex is Not "Straight" Forward".

4817: 7184: 6314:

Zillén, Kavot; Garland, Jameson; Slokenberga, Santa; Committee on Bioethics of the Council of Europe (January 2017).

6280: 5953: 5917: 5650: 5576: 5367: 4940: 2219: 2066: 1419: 1266:, the gonads or streaks must be removed because they are nonfunctional but have a relatively high risk of developing 935:, the gonads or streaks must be removed because they are nonfunctional but have a relatively high risk of developing 6229:

On the management of differences of sex development. Ethical issues relating to "intersexuality".Opinion No. 20/2012

5885: 2152:

On the management of differences of sex development. Ethical issues relating to "intersexuality".Opinion No. 20/2012

7432: 7121: 7106: 6430: 2324: 96: 2861:"Congenital Adrenal Hyperplasia: Review from a Surgeon's Perspective in the Beginning of the Twenty-First Century" 1720:

Others argue that the key questions are not ones of early or late surgery, but questions of consent and autonomy.

1158:

Licence to Lie and to Mutilate: "even the most enthusiastic proponents of prophylactic castration" - treatment of

6756: 6632: 6622: 2943:. Palgrave Studies in Literature, Science and Medicine Series. Springer International Publishing AG. p. 68. 2643: 1274: 1230: 1159: 1136: 407: 274: 257: 5712: 2645:

Promoting and Protecting Human Rights in relation to Sexual Orientation, Gender Identity and Sex Characteristics

670:

The goals of surgery vary with the type of intersex condition but usually include one or more of the following:

7950: 7945: 7905: 7374: 7156: 6930: 6766: 6751: 6538: 6455: 6291: 5762: 4001: 1773:

distorted sexual sensation. Human rights institutions stress the informed consent of the individual concerned.

1748:

Reports published in the early 1990s state that 20-50% of surgical cases result in a loss of sexual sensation.

1687:

Surgery in infancy avoids asking adolescent to make a decision that is stressful and difficult even for adults.

1468: 1381: 1238: 1124: 830: 802: 657:

won the first successful case brought against a surgeon for non-consensual surgical intervention. In 2015, the

565: 417: 402: 210: 180: 114: 6469: 6403: 5580: 1403: 1398: 1372: 1363:

and raised as females have not developed a female gender identity and have sought reassignment back to male.

127: 69: 3592:"Discordant sexual identity in some genetic males with cloacal exstrophy assigned to female sex after birth" 1187:. The appearance is not very normal. Regrowth of unwanted erectile tissue has sometimes presented problems. 7595: 7354: 7239: 7229: 6696: 6691: 6675: 6658: 6583: 6464: 1999: 1500: 1464: 923:(also referred to as "orchiectomy") removal of the gonads. This is done in three circumstances. (1) If the 818: 643: 347: 342: 322: 305: 240: 122: 1647: 7756: 7422: 7364: 6716: 6670: 6653: 6484: 5242:"The Surgical Management of Infants and Children with Ambiguous Genitalia: Lessons learned from 25 years" 4020:

A. F. Radicioni, A. Ferlin, G. Balercia, D. Pasquali, L. Vignozzi, M. Maggi, C. Foresta, A. Lenzi (2010)

1989: 1659: 1530:(1) not having surgery at all might be an option; (2) they might have had lower rates of reoperation for 1148: 1097: 638: 585: 367: 317: 300: 147: 3887:"Prenatal Dexamethasone for Congenital Adrenal Hyperplasia: An Ethics Canary in the Modern Medical Mine" 1712:

By mid-adolescence or later, persons may decide that their atypical genitalia do not need to be changed.

7733: 7583: 7323: 6971: 6819: 6726: 6648: 6627: 6313: 2602: 2522: 1939:

and Special Rapporteur on Torture have all published reports calling for changes to clinical practice.

1338:

raised as females, with fashioning of a vagina and gonadectomy as part of the perineal reconstruction.

475: 377: 295: 287: 262: 4920:

Jones, Tiffany; Hart, Bonnie; Carpenter, Morgan; Ansara, Gavi; Leonard, William; Lucke, Jayne (2016).

3118:

Schober JM, Carmichael PA, Hines M, Ransley PG (2002). "The ultimate challenge of cloacal exstrophy".

2678: 1913:

respecting self-determination in gender recognition, through expeditious access to official documents.

7940: 7884: 7582: 7004: 6966: 6961: 6868: 6776: 6771: 6741: 6721: 6701: 6568: 6268: 5800:

Discrimination and violence against individuals based on their sexual orientation and gender identity

4172: 4048: 2054: 1932: 1596: 1443: 1313:. Cloacal exstrophy in a genetic female usually requires major surgical reconstruction of the entire 558: 544: 427: 422: 392: 372: 352: 230: 5435:

Furtado P. S.; et al. (2012). "Gender dysphoria associated with disorders of sex development".

5333: 4105: 3641: 7587: 7407: 7096: 6951: 6761: 6746: 6736: 6731: 6711: 6706: 6388: 4387: 4348: 1900:

highlights several areas of concern in relation to intersex surgeries and other medical treatment:

412: 397: 387: 382: 362: 357: 54: 3742:(2008). "Mind the Gaps: Intersex and (Re-productive) Spaces in Disability Studies and Bioethics". 1834:

Unlike other aesthetic surgical procedures performed on infants, such as corrective surgery for a

7485: 7412: 7338: 7129: 7022: 6578: 4388:"Cosmetic and anatomical outcomes following feminising childhood surgery for intersex conditions" 1552:. The new term refers to "congenital conditions in which development of chromosomal, gonadal, or 1355: 1351: 690: 235: 132: 6317:

The Rights of Children in Biomedicine: Challenges posed by scientific advances and uncertainties

5162:(October 2015). "The Rights of LGBTI Children under the Convention on the Rights of the Child". 1401:

to select against intersex traits was the subject of 11 papers in the October 2013 issue of the

7777: 7134: 7116: 7071: 6956: 6665: 6588: 6511: 6352: 6225: 4830: 4202: 2721: 2148: 1652: 312: 174: 6293:

Eliminating forced, coercive and otherwise involuntary sterilization, An interagency statement

5764:

Eliminating forced, coercive and otherwise involuntary sterilization, An interagency statement

3713: 2523:"Childhood surgery for ambiguous genitalia: glimpses of practice changes or more of the same?" 1411:

arising from prenatal testing, as well prenatal hormone treatment to prevent intersex traits.

7910: 7787: 7751: 7313: 7300: 6976: 6435: 6398: 6376: 4716:"Misrepresentation of Evidence Favoring Early Normalizing Surgery for Atypical Sex Anatomies" 2938: 2469:"Surgery in disorders of sex development (DSD) with a gender issue: If (why), when, and how?" 1994: 1891: 1765:

ethics of these tests have been criticized by bioethicists, and subsequently defended by the

1663: 1083: 650: 646:. Some disorders, such as salt-wasting disorder, can be life-threatening if left untreated. 101: 64: 43: 7618: 4850: 3829:

Hirvikoski, Tatja; Nordenström, Anna; Wedell, Anna; Ritzén, Martin; Lajic, Svetlana (2012).

3211: 1943: 1131:; genital variations in infants with XY or mixed chromosomes to be raised as girls, such as 911:

a boy may have a "pseudovaginal pouch" or a single urogenital opening in the midline of the

654: 7915: 7782: 7610: 7534: 7379: 7214: 6946: 6809: 6543: 6099: 4771: 4660: 4347:

Minto, Catherine L.; Creighton, Sarah; Mrcog, Md; Woodhouse, Christopher (August 1, 2001).

3942: 3669: 2407: 1781: 1522: 1439: 1279: 956: 714: 694: 497: 460: 215: 5023:"The human rights of intersex people: addressing harmful practices and rhetoric of change" 793:

may have midline urogenital closure, third degree hypospadias repair, chordee release and

8: 7234: 7174: 7091: 6938: 5205:

Newman, Kurt (1992). "Functional Results in Women Having Clitoral Reduction as Infants".

3450:

Schnitzer JJ, Donahoe PK (2001). "Surgical treatment of congenital adrenal hyperplasia".

1984: 1587:

literature tend to focus on surgical techniques with no reports on patient experiences".

993: 634: 630: 137: 2641: 833:

is even rarer. An early procedure was performed by London surgeon Thomas Brand in 1779.

7671: 7628: 7480: 7369: 7275: 7076: 6999: 6254: 6214: 6171: 6146: 6104:"Global Disorders of Sex Development Update since 2006: Perceptions, Approach and Care" 6071: 6039: 5941: 5558: 5511:(2002). Rethinking the Meaning and Management of Intersexuality. Sexualities, 159–180." 5460: 5266: 5241: 5187: 4809: 4748: 4715: 4696: 4642: 4549: 4500: 4475: 4425:

Minto, Catherine L; Liao, K.Lih-Mei; Conway, Gerard S; Creighton, Sarah M (July 2003).

4324: 4299: 4280: 4227: 4144: 4086: 3979: 3946: 3919: 3886: 3767: 3616: 3591: 3432: 3384: 3359: 3340: 3262: 3205:

Rangecroft L, Brain C, Creighton S, Di Ceglie D, Ogilvy-Stuart A, Malone P, Turnock R.

3093: 3041: 3006: 2895: 2860: 2836: 2801: 2782: 2649: 2596: 2412:"Global Disorders of Sex Development Update since 2006: Perceptions, Approach and Care" 2242: 2207: 2177: 1259: 1132: 928: 718: 5382: 5129: 4676: 4537: 4443: 4426: 4403: 4364: 4268: 3533: 3498: 3463: 3293: 3250: 3166: 3131: 2983: 1508:

throughout their life (as self-required), as well as to parents and/or care providers.

7686: 7676: 7638: 7623: 7249: 7169: 6887: 6841: 6563: 6345: 6300: 6276: 6206: 6187: 6176: 6133: 6125: 6063: 5949: 5771: 5748: 5693: 5688: 5671: 5646: 5623: 5550: 5542: 5485: 5452: 5417: 5363: 5314: 5306: 5271: 5257: 5222: 5218: 5191: 5179: 5141: 5133: 5098: 5090: 5070: 5052: 5044: 4997: 4989: 4930: 4801: 4753: 4735: 4688: 4680: 4634: 4630: 4599: 4591: 4541: 4505: 4456: 4448: 4407: 4368: 4329: 4272: 4232: 4136: 4128: 4078: 4037: 3984: 3966: 3924: 3906: 3882: 3860: 3852: 3811: 3803: 3759: 3695: 3656: 3621: 3572: 3568: 3537: 3502: 3467: 3424: 3389: 3332: 3328: 3297: 3254: 3170: 3135: 3085: 3046: 3028: 2987: 2944: 2900: 2882: 2841: 2823: 2774: 2766: 2711: 2653: 2547: 2521:

Creighton, Sarah M.; Michala, Lina; Mushtaq, Imran; Yaron, Michal (January 2, 2014).

2498: 2490: 2441: 2433: 2283: 2215: 2115: 2062: 1928: 1897: 1761: 1385: 1297: 1291: 1144: 1128: 1003: 999: 878:

may be a single-stage procedure if the hypospadias is of the first or second degree (

658: 225: 6218: 6075: 5562: 5464: 4700: 4553: 4148: 4090: 3771: 3436: 3344: 3266: 3097: 2917: 2786: 1226: 1048: 7772: 7681: 7633: 7511: 7506: 7402: 7386: 6613: 6198: 6166: 6158: 6115: 6085: 6055: 5990:. Council of Europe Committee on Social Affairs, Health and Sustainable Development 5683: 5615: 5534: 5444: 5407: 5397: 5360:

Galileo's Middle Finger: heretics, activists, and the search for justice in science

5298: 5261: 5253: 5214: 5171: 5159: 5125: 5082: 5034: 5018: 4981: 4876: 4813: 4793: 4775: 4743: 4727: 4672: 4646: 4626: 4581: 4533: 4495: 4487: 4438: 4399: 4360: 4319: 4311: 4284: 4264: 4222: 4214: 4120: 4070: 3974: 3958: 3914: 3898: 3842: 3795: 3751: 3685: 3611: 3603: 3564: 3529: 3494: 3459: 3416: 3379: 3371: 3324: 3289: 3246: 3162: 3127: 3077: 3036: 3018: 2979: 2890: 2872: 2831: 2813: 2758: 2581: 2537: 2480: 2423: 1927:

Institutions like the Swiss National Advisory Commission on Biomedical Ethics, the

1737: 1460: 5175: 3081: 2970:

Glassberg, KI (1999). "Editorial: gender assignment and the pediatric urologist".

2680:

Violencia contra Personas Lesbianas, Gays, Bisexuales, Trans e Intersex en América

1241:, or (in the past) when a genetic male infant with a severely defective penis was 7691: 7333: 7270: 7204: 7164: 7146: 7014: 6899: 6226:

Swiss National Advisory Commission on Biomedical Ethics NEK-CNE (November 2012).

6011: 6003: 5846: 5838: 5797: 5744: 5086: 4985: 4837: 4770: 4074: 4044: 4008: 3799: 3648: 3315:

Thomas, D F M (2004). "Gender assignment: background and current controversies".

3005:

Barbagli, Guido; Sansalone, Salvatore; Djinovic, Rados; Lazzeri, Massimo (2012).

2625: 2542: 2485: 2468: 2149:

Swiss National Advisory Commission on Biomedical Ethics NEK-CNE (November 2012).

2093: 1962: 1954: 1684:

Genital surgery performed before the age of memory is less emotionally traumatic.

1561: 1431: 1318: 982: 739: 6290:

World Health Organization; OHCHR; UN Women; UNAIDS; UNDP; UNFPA; UNICEF (2014).

5761:

World Health Organization; OHCHR; UN Women; UNAIDS; UNDP; UNFPA; UNICEF (2014).

5481:

Resilient Individuals: Sexual Orientation, Gender Identity & Intersex Rights

4022:

Consensus statement on diagnosis and clinical management of Klinefelter syndrome

989:

and skin or other cavities, or between urethra and perineum. Loss of sensation.

955:. (3) Gonadectomy can be performed in the equally rare instance of a child with 7718: 7666: 7648: 7643: 6598: 6425: 5908:"'Stunning victory' as US Surgeons General call for an end to intersex surgery" 5738:

Resolution 1952/2013, Provision version, Children's right to physical integrity

5619: 5302: 4315: 3642:

Bioethics Forum blog – Preventing Homosexuality (and Uppity Women) in the Womb?

3375: 2107: 1910:

access to information, medical records, peer and other counselling and support.

1812: 1808: 1553: 1360: 1306: 1302: 1267: 1242: 1056: 936: 886:

is otherwise normal. Surgery for third-degree hypospadias (urethral opening on

858: 846: 733: 529: 91: 6331: 5039: 5022: 4731: 4491: 4124: 3902: 3755: 2282: 1965:, three former Surgeons General of the United States published a paper at the 849:) is the second most common surgery performed on infant male genitalia (after 649:

Interventions on intersex infants and children are increasingly recognized as

7934: 7900: 7723: 7529: 7244: 7063: 7031: 7026: 6994: 6558: 6548: 6506: 6496: 6474: 6202: 6129: 6029: 6007: 5912: 5842: 5812: 5546: 5508: 5310: 5183: 5137: 5094: 5048: 4993: 4864: 4739: 4684: 4595: 4452: 4411: 4372: 4132: 3970: 3910: 3856: 3807: 3763: 3739: 3032: 2886: 2827: 2770: 2551: 2494: 2437: 1958: 1828: 1565: 1427: 1191: 1051:

derivatives would need to be removed from a child being raised as a boy: see

963:

can be removed. A lifetime of hormone replacement will be required, to avoid

455: 220: 169: 159: 6289: 5817:"Malta passes law outlawing forced surgical intervention on intersex minors" 5760: 5448: 2877: 2818: 1375:

to prevent intersex traits. In 1990, a paper by Heino Meyer-Bahlburg titled

1309:. Simple bladder exstrophy in a genetic female does not usually involve the 7801: 7541: 7524: 6856: 6851: 6501: 6491: 6210: 6180: 6162: 6137: 6067: 6059: 5697: 5627: 5554: 5456: 5421: 5355: 5318: 5145: 5102: 5056: 5001: 4965: 4880: 4805: 4779: 4757: 4692: 4638: 4603: 4586: 4569: 4545: 4509: 4460: 4386:

Creighton, Sarah; Minto, Catherine L.; Steele, Stuart J. (August 1, 2001).

4349:"Long term sexual function in intersex conditions with ambiguous genitalia" 4333: 4276: 4236: 4218: 4140: 4082: 3988: 3928: 3878: 3864: 3815: 3699: 3690: 3674:"What Causes Low Rates of Child-Bearing in Congenital Adrenal Hyperplasia?" 3673: 3652: 3625: 3506: 3471: 3393: 3336: 3258: 3174: 3139: 3089: 3050: 2991: 2904: 2845: 2778: 2676: 2577: 2570:

Intersex Issues in the International Classification of Diseases: a revision

2502: 2445: 2316: 2119: 1921: 1839: 1794: 1786: 1757: 1753: 1691: 1635: 1569: 1284: 1263: 1217: 1208: 1199: 1167: 1110: 1076: 1060: 1039: 1030: 1007: 964: 952: 932: 908: 850: 822: 806: 794: 684: 629:, hormonal and other medical interventions performed to modify atypical or 517: 512: 164: 154: 6144: 6045: 5942:

Australian Senate; Community Affairs References Committee (October 2013).

5412: 5275: 5226: 4200: 3714:"American Journal of Bioethics, 13:10, 51-53. Retrieved 11 September 2013" 3576: 3541: 3428: 3420: 3301: 3023: 2208:

Australian Senate; Community Affairs References Committee (October 2013).

7854: 7846: 7359: 7318: 7285: 7053: 7046: 6861: 6022: 5522: 5402: 5385: 4476:"Managing intersex, Most vaginal surgery in childhood should be deferred" 4106:"Classifying Intersex in DSM-5: Critical Reflections on Gender Dysphoria" 3847: 3830: 3607: 2802:"Should the Genitoplasty of Girls with CAH be Done in One or Two Stages?" 1966: 1347: 1250: 1176: 1023: 1011: 919: 883: 873: 522: 502: 4867:(2011). "The Intersex Enchiridion: Naming and Knowledge in the Clinic". 4427:"Sexual function in women with complete androgen insensitivity syndrome" 3962: 1467:. This move was criticised by intersex advocacy groups in Australia and 1434:, and by Jason Behrmann and Vardit Ravitsky. It quotes research showing 738:

to reduce effects of atypical genitalia on psychosexual development and

7869: 7859: 7728: 7519: 7219: 7209: 7141: 6814: 6608: 6593: 6089: 5880: 3407:

Rink RC, Adams MC (1998). "Feminizing genitoplasty: state of the art".

3066:"Should Surgery for Hypospadias Be Performed Before an Age of Consent?" 1140: 1103: 1019: 895: 837: 798: 605: Physical integrity and bodily autonomy on intersex not legislated 470: 6445: 6120: 6103: 5538: 4797: 3941: 2762: 2642:

Asia Pacific Forum of National Human Rights Institutions (June 2016).

2428: 2411: 31: 7879: 7308: 7196: 7036: 6836: 6553: 4659: 4002:

Submission on the ethics of genetic selection against intersex traits

1835: 1776: 1343: 1115:

post-surgery are recurrence with continued weight gain and scarring.

1015: 960: 853:). The surgeon moves one or both testes, with blood vessels, from an 678: 492: 5945:

Involuntary or coerced sterilisation of intersex people in Australia

5716: 3065: 2211:

Involuntary or coerced sterilisation of intersex people in Australia

931:

testes or streak gonads and at least some of the boy's cells have a

781:

intended to make genitalia more like those of typical XY-males, and

729:

to alleviate parental distress over the atypical genital appearance.

7874: 7710: 7591: 7280: 7224: 7081: 7041: 6368: 5984:"PACE - Doc. 13297 (2013) - Children's right to physical integrity" 4969: 2918:

Weill Cornell Medical College, Department of Urology (2016-01-21).

2382:"Surgery and Sterilization Scrapped in Malta's Benchmark LGBTI Law" 1843: 1681:

Tissue is more elastic and heals better according to many surgeons.

1557: 1531: 1435: 1408: 1322: 1314: 1172: 1089: 1079:

by early adolescence. Risks are simply those of abdominal surgery.

939:. (2) In rare instances when an XX child has completely virilizing 912: 907:

closure of any midline opening at the base of the penis. In severe

887: 826: 599: Regulatory suspension of non-consensual medical interventions 22: 5713:"How common is intersex? | Intersex Society of North America" 5584: 5520: 5477: 5073:(August 2014). "Patient advocate responds to DSD surgery debate". 4616: 4163:"OII Australia and OII Aotearoa submission on the DSM-5 and SOC-7" 2465: 2025:"Intersex Genital Mutilation – IGM: The Fourteen Days of Intersex" 1698:

Argued or putative advantages of surgery in adolescence or later:

7864: 6527: 5798:

United Nations High Commissioner for Human Rights (May 4, 2015),

5575: 3828: 3659:(2010), at Hastings Center Bioethics Blog, retrieved 18 May 2012. 2749: 1827:

Parents may be advised that without surgery, their child will be

1740:

states that parents have no right to consent to such treatments.

1730: 1326: 1154: 1010:

and lower abdominal wall. The penis and scrotum are often widely

971: 879: 862: 854: 626: 199: 5976: 3004: 7701: 7658: 7086: 6826: 5970: 5964: 5672:"Medical photography: ethics, consent and the intersex patient" 4011:, Organisation Intersex International Australia, 29 April 2014. 3945:; Dolezal, C.; Haggerty, R.; Silverman, M.; New, M. I. (2012). 3786:

about current protocols and benefits for surgical procedures".

3784: 1330: 1310: 1222: 1184: 1072: 1044: 986: 948: 866: 842: 700: 593: Legal prohibition of non-consensual medical interventions 534: 482: 5670:

Creighton, Sarah; Alderson, J; Brown, S; Minto, Cathy (2002).

2096:, Australasian Paediatric Endocrine Group (APEG), 27 June 2013 1550:

Consensus Statement on Intersex Disorders and their Management

1262:

testes or streak gonads and at least some of the cells have a

801:

performed. A child regarded as a severely virilized girl with

7743: 6091:

Fixing Sex: Intersex, Medical Authority, and Lived Experience

5876:"These Doctors Want Us To Stop Pathologizing Intersex People" 3117: 2940:

Life, Death, and Consciousness in the Long Nineteenth Century

2108:"Ambiguous Genitalia and Disorders of Sexual Differentiation" 1456: 1334: 1255: 1180: 1068: 944: 924: 865:. If the inguinal canal is open it must be closed to prevent 704: 665: 4346: 3484: 2520: 6831: 6337: 5669: 4566: 1621:

A 2016 follow-up to the 2006 Consensus Statement, termed a

998:

is among the most complex of the surgeries described here.

487: 4051:

Genomic resource centre, undated, retrieved 22 April 2014.

3519: 2677:

Comisión Interamericana de Derechos Humanos (2015-11-12),

805:(CAH) may undergo both a partial clitoral recession and a 6267: 6147:"Consensus statement on management of intersex disorders" 6145:

Lee P. A.; Houk C. P.; Ahmed S. F.; Hughes I. A. (2006).

4784: 4522: 4203:"Consensus statement on management of intersex disorders" 4201:

Lee P. A.; Houk C. P.; Ahmed S. F.; Hughes I. A. (2006).

3235: 2930: 2053: 1672: 1459:

included a change from using gender identity disorder to

539: 6332:

Intersex surgeries: is it right to assign sex to a baby?

4919: 4424: 2650:

Asia Pacific Forum of National Human Rights Institutions

1642: 6097: 5975:

Council of Europe, and Commissioner for Human Rights. "

4418: 3877: 3064:

Carmack, Adrienne; Notini, Lauren; Earp, Brian (2015).

2405: 2203: 2201: 2199: 2197: 2195: 2193: 959:

virilized enough to raise as male, in which ovaries or

744:

to improve the potential for adult sexual relationships

4574:

The Journal of Clinical Endocrinology & Metabolism

3835:

The Journal of Clinical Endocrinology & Metabolism

3678:

The Journal of Clinical Endocrinology & Metabolism

1377:

Will Prenatal Hormone Treatment Prevent Homosexuality?

1325:, symphysis pubis, and both the vaginal introitus and 2703: 1392: 6002: 5948:. Canberra: Community Affairs References Committee. 5837: 4474:

Creighton, Sarah; Minto, Catherine (December 2001).

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6016:"Re-Thinking Genital Surgeries on Intersex Infants" 5851:"Re-Thinking Genital Surgeries on Intersex Infants" 3554: 3192:. London and New York: Academic Press. p. 273. 3152: 2800:González, Ricardo; Ludwikowski, Barbara M. (2014). 2799: 2630:

Office of the UN High Commissioner for Human Rights

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6929: 6320:. Committee on Bioethics of the Council of Europe. 2936: 2241: 1854: 1777:Decision-making on cancer and other physical risks 1480:of stigmatization and gender-identity confusion". 7590:congenital anomalies of the genitalia, including 5605: 4028:, December 2010, Volume 33, Issue 11, pp 839-850. 3063: 2746: 1677:Argued or putative advantages of infant surgery: 1503:published in 2013 sought, amongst other demands: 1118: 7932: 5478:Australian Human Rights Commission (June 2015). 5288: 5013: 5011: 3449: 2516: 2514: 2512: 1937:Office of the High Commissioner for Human Rights 1785:Intersex banner reading "End Intersex Surgery," 1743: 882:opening on glans or shaft respectively) and the 5332:Dreger, Alice; Feder, Ellen K (June 16, 2010). 4923:Intersex: Stories and Statistics from Australia 2686:, Comisión Interamericana de Derechos Humanos, 2114:, Treasure Island (FL): StatPearls Publishing, 2106:Mehmood, Khawar T.; Rentea, Rebecca M. (2024), 710:to close open wounds or exposed internal organs 5705: 5608:Journal of Pediatric and Adolescent Gynecology 5484:. Sydney: Australian Human Rights Commission. 4970:"Still ignoring human rights in intersex care" 4473: 4392:Journal of Pediatric and Adolescent Gynecology 4353:Journal of Pediatric and Adolescent Gynecology 3668: 3589: 2619:Report of the UN Special Rapporteur on Torture 2347: 2345: 2286:; Commissioner for Human Rights (April 2015), 1539: 7568: 6915: 6353: 5977:Human Rights and Intersex People, Issue Paper 5811: 5434: 5348: 5115: 5008: 4831:An Interview with Dr. Tiger Howard Devore PhD 4168:Organisation Intersex International Australia 3351: 3201: 3199: 2563: 2561: 2509: 2289:Human rights and intersex people, Issue Paper 2105: 1416:Organisation Intersex International Australia 566: 5325: 5069: 4840:, We Who Feel Differently, February 7, 2011. 3231: 3229: 2614: 2612: 2311: 2309: 2005:(DoDI) 6130.03, 2018, section 5, 13f and 14m 1736:adult sexual sensation. Child rights expert 1424:National Health and Medical Research Council 7491:Timeline of reproductive rights legislation 7476:Birth control movement in the United States 5514: 5331: 4963: 4857: 4714:Baratz, Arlene B.; Feder, Ellen K. (2015). 4713: 3357: 3190:Testicular Feminization. In: Intersexuality 3057: 2376: 2374: 2342: 1526:for neglecting to inform respondents that: 1418:made a submission on genetic selection via 7575: 7561: 7329:Reproductive endocrinology and infertility 6922: 6908: 6360: 6346: 6259:: CS1 maint: location missing publisher ( 5831: 5233: 5198: 4957: 3196: 3113: 3111: 2742: 2740: 2738: 2697: 2558: 2461: 2459: 2457: 2455: 2401: 2399: 2397: 2395: 2351: 2182:: CS1 maint: location missing publisher ( 2144: 2142: 2140: 2138: 2136: 2134: 2082: 2080: 2078: 1651:ILGA conference 2018, group photo to mark 1623:Global Disorders of Sex Development Update 1221:, the construction or reconstruction of a 1127:; genital variations due, for example, to 666:Purposes of genital reconstructive surgery 573: 559: 6170: 6119: 5791: 5687: 5643:Intersex and Identity, the Contested Self 5411: 5401: 5265: 5063: 5038: 5017: 4913: 4899:"Malta Bans Surgery on Intersex Children" 4892: 4890: 4843: 4747: 4585: 4499: 4442: 4323: 4297: 4226: 4097: 4026:Journal of Endocrinological Investigation 3978: 3918: 3846: 3689: 3615: 3406: 3383: 3226: 3040: 3022: 2969: 2894: 2876: 2835: 2817: 2609: 2541: 2484: 2427: 2306: 2049: 2047: 2045: 1801: 1616: 1067:(Prader stage 5) being raised as a male; 5805: 5471: 5282: 5158: 4304:Journal of the Royal Society of Medicine 4060: 2998: 2670: 2371: 1780: 1646: 1512: 1153: 979:pseudovaginal perineoscrotal hypospadias 791:pseudovaginal perineoscrotal hypospadias 752: 584: 6273:Sexual health, human rights and the law 5754: 5731: 5665: 5663: 5428: 4929:. Cambridge, UK: Open Book Publishers. 3637: 3635: 3108: 2858: 2735: 2704:German Ethics Council (February 2012). 2635: 2452: 2392: 2131: 2075: 2059:Sexual health, human rights and the law 1872: 1822: 1595:A 2014 civil society submission to the 1474: 7933: 7810:Congenital absence of the vas deferens 5640: 5502: 5354: 5239: 5204: 4896: 4887: 4863: 4196: 4194: 4192: 4190: 3738: 3583: 3314: 3308: 3187: 2315: 2237: 2235: 2042: 1885: 1673:Comparing early against late surgeries 1373:prenatal testing and hormone treatment 1071:and uterus must be removed to prevent 947:can be removed before puberty to stop 7556: 6903: 6341: 6275:. Geneva: World Health Organization. 5905: 5873: 5569: 4824: 4103: 3279: 3273: 2278: 2276: 2274: 2272: 2270: 2061:. Geneva: World Health Organization. 1767:Office for Human Research Protections 1643:Controversies and unsettled questions 1581: 1560:traits or conditions. Academics like 1171:amputation or removal of most of the 5827:from the original on 14 August 2015. 5660: 5634: 5344:from the original on March 22, 2016. 5338:Hastings Center Bioethics Forum Blog 4155: 3720:from the original on 11 October 2014 3632: 1366: 4909:from the original on July 18, 2015. 4187: 2232: 1723: 1590: 1499:A joint international statement by 1450: 1430:, Jeff Nisker, associate professor 466:Genital modification and mutilation 13: 7826:Persistent Müllerian duct syndrome 2920:"Genitoplasty - Treatment Options" 2267: 1568:, and clinical psychologists like 1407:. There is widespread evidence of 1393:Genetic selection and terminations 1053:persistent Müllerian duct syndrome 825:synthesis, or even rarer forms of 767:genetic selection and terminations 30: 14: 7967: 7185:self-report sexual risk behaviors 6325: 5874:Weiss, Suzannah (June 30, 2017). 5577:Intersex Society of North America 5130:10.1097/01.ju.0000138519.12573.3a 4677:10.1097/01.ju.0000117761.94734.b7 4300:"Editorial: Surgery for Intersex" 4063:The American Journal of Bioethics 3951:European Journal of Endocrinology 2937:Cogan, L.; O'Connell, M. (2022). 2256:from the original on May 11, 2016 1864:Secrecy and information provision 1420:preimplantation genetic diagnosis 1399:preimplantation genetic diagnosis 1254:is removal of the gonads. If the 813:Masculinizing surgical procedures 779:masculinizing surgical procedures 7255:Precocious puberty and pregnancy 6882: 6881: 6444: 6431:Sex characteristics (legal term) 5906:Power, Shannon (June 29, 2017). 5899: 5863:from the original on 2017-07-28. 5787:from the original on 2016-11-09. 5689:10.1046/j.1464-410X.2002.02558.x 5498:from the original on 2015-07-03. 5258:10.1097/00000658-199206000-00011 4820:from the original on 2014-09-11. 4631:10.1111/j.1464-410x.2004.04572.x 4568:Angela; Perry, Les (July 2003). 4243:from the original on 2009-08-03. 3329:10.1111/j.1464-410x.2004.04709.x 3104:from the original on 2018-01-04. 2926:from the original on 2017-08-19. 2859:Piaggio, Lisandro Ariel (2014). 2666:from the original on 2017-01-15. 2591:from the original on 2016-08-11. 2325:Global Action for Trans Equality 2228:from the original on 2015-09-23. 1501:intersex community organizations 1371:There is widespread evidence of 97:Sex characteristics (legal term) 7375:Sexually transmitted infections 6108:Hormone Research in Paediatrics 5867: 5599: 5376: 5152: 5109: 4897:Dreger, Alice (April 3, 2015). 4764: 4707: 4653: 4610: 4560: 4516: 4467: 4379: 4340: 4291: 4247: 4054: 4031: 4014: 3995: 3935: 3871: 3822: 3778: 3732: 3706: 3662: 3590:Reiner WG, Gearhart JP (2004). 3548: 3513: 3478: 3443: 3400: 3181: 3146: 2963: 2911: 2852: 2793: 2693:from the original on 2016-01-07 2416:Hormone Research in Paediatrics 1855:Medical photography and display 1599:cited data from a large German 1287:and enable sexual functioning. 1231:androgen insensitivity syndrome 1160:androgen insensitivity syndrome 1137:androgen insensitivity syndrome 967:and enable sexual functioning. 7906:Progestin-induced virilization 6931:Sexual and reproductive health 5527:The Journal of Sexual Medicine 5164:Nordic Journal of Human Rights 2099: 2017: 1382:congenital adrenal hyperplasia 1125:congenital adrenal hyperplasia 1119:Feminizing surgical procedures 1065:congenital adrenal hyperplasia 1047:. It is rare that a uterus or 941:congenital adrenal hyperplasia 803:congenital adrenal hyperplasia 783:feminizing surgical procedures 770:treatment for gender dysphoria 611:Intersex medical interventions 1: 5935: 5176:10.1080/18918131.2015.1128701 4538:10.1016/s0140-6736(03)12980-7 4444:10.1016/S0015-0282(03)00501-6 4404:10.1016/S1083-3188(01)00112-7 4365:10.1016/S1083-3188(01)00111-5 4269:10.1016/s0140-6736(01)05343-0 3891:Journal of Bioethical Inquiry 3744:Journal of Bioethical Inquiry 3534:10.1016/s0022-3468(87)80119-7 3499:10.1016/s0022-5347(05)68986-0 3464:10.1016/s0889-8529(08)70023-9 3294:10.1016/s0022-5347(01)65736-7 3251:10.1016/s0140-6736(03)12980-7 3167:10.1016/s0022-5347(01)68114-x 3132:10.1016/s0022-5347(05)65455-9 3082:10.1080/00224499.2015.1066745 2984:10.1016/s0022-5347(01)61676-8 1877:In 2015, an editorial in the 1744:Sensation and sexual function 1548:(DSD) in the journal article 1404:American Journal of Bioethics 677:to improve the potential for 7355:Disorders of sex development 6676:International Intersex Forum 6465:Disorders of sex development 6367: 6191:Journal of Health Psychology 5219:10.1016/0022-3468(92)90308-t 5207:Journal of Pediatric Surgery 5087:10.1016/j.jpurol.2014.03.019 5075:Journal of Pediatric Urology 4986:10.1016/j.jpurol.2016.05.017 4974:Journal of Pediatric Urology 4171:. 2012-06-06. Archived from 4075:10.1080/15265161.2013.828131 3800:10.1016/j.jpurol.2014.02.003 3788:Journal of Pediatric Urology 3569:10.1016/0002-9378(76)90160-5 2543:10.1080/19419899.2013.831214 2486:10.1016/j.jpurol.2016.04.001 2473:Journal of Pediatric Urology 2352:OII Europe (April 1, 2015). 2000:Disorders of sex development 1601:Netzwerk DSD/Intersexualität 1546:Disorders of sex development 1465:disorders of sex development 1301:is needed regardless of the 819:5-alpha-reductase deficiency 673:Physical health rationales: 644:disorders of sex development 619:intersex genital mutilations 323:International Intersex Forum 123:Disorders of sex development 7: 7956:Social problems in medicine 7757:Unilateral ovarian agenesis 7365:Reproductive system disease 6671:Intersex Day of Remembrance 6534:Civil society organizations 5362:. New York: Penguin Press. 5027:Reproductive Health Matters 4780:"Sex, health, and athletes" 4720:Archives of Sexual Behavior 4298:Creighton, Sarah M (2001). 4113:Archives of Sexual Behavior 4104:Kraus, Cynthia (May 2015). 1990:History of intersex surgery 1978: 1660:History of intersex surgery 1540:Chicago consensus statement 1149:history of intersex surgery 1098:Penile augmentation surgery 639:history of intersex surgery 318:Intersex Day of Remembrance 206:Civil society organizations 10: 7972: 7734:Sertoli cell-only syndrome 7324:Obstetrics and gynaecology 6628:Sex verification in sports 6100:Meyer-Bahlburg, Heino F.L. 5715:. Isna.org. Archived from 5620:10.1016/j.jpag.2008.11.006 5390:J. Clin. Endocrinol. Metab 5303:10.1016/j.juro.2007.05.097 4316:10.1177/014107680109400505 3452:Endocrinol Metab Clin N Am 3376:10.1177/014107680109400505 2408:Meyer-Bahlburg, Heino F.L. 1889: 1657: 1384:(CAH). Dreger, Feder, and 841:for repair of undescended 263:Sex verification in sports 7893: 7885:Penoscrotal transposition 7845: 7838: 7818: 7800: 7765: 7742: 7709: 7700: 7657: 7609: 7602: 7499: 7468: 7395: 7347: 7299: 7263: 7240:Pregnant patients' rights 7195: 7155: 7105: 7062: 7013: 7005:Pre-conception counseling 6987: 6962:Abortion-rights movements 6937: 6877: 6869:Sex differences in humans 6802: 6684: 6641: 6520: 6454: 6442: 6375: 6269:World Health Organization 6032:(editor) (October 2009). 5040:10.1016/j.rhm.2016.06.003 4732:10.1007/s10508-015-0529-x 4492:10.1136/bmj.323.7324.1264 4125:10.1007/s10508-015-0550-0 4049:World Health Organization 3903:10.1007/s11673-012-9384-9 3756:10.1007/s11673-007-9073-2 2055:World Health Organization 1933:World Health Organization 1931:, the Council of Europe, 1597:World Health Organization 1444:World Health Organization 725:Psychosocial rationales: 683:to provide an outlet for 7783:Mixed gonadal dysgenesis 7126:Gamete Cryopreservation 6972:Circumcision controversy 6952:Compulsory sterilization 6389:Compulsory sterilization 6203:10.1177/1359105315572454 3943:Meyer-Bahlburg, H. F. L. 3670:Meyer-Bahlburg, H. F. L. 2530:Psychology and Sexuality 2388:. Reuters. 1 April 2015. 2010: 1298:bladder exstrophy repair 691:urinary tract infections 55:Compulsory sterilization 7486:Social hygiene movement 7339:Transgender health care 6235:. Berne. Archived from 5641:Preves, Sharon (2003). 5449:10.1038/nrurol.2012.182 4480:British Medical Journal 4431:Fertility and Sterility 3323:(Supplement 3): 47–50. 3070:Journal of Sex Research 2878:10.3389/fped.2013.00050 2865:Frontiers in Pediatrics 2819:10.3389/fped.2013.00054 2806:Frontiers in Pediatrics 2707:Intersexuality, Opinion 2158:. Berne. Archived from 1447:gender nonconformity." 1356:external anal sphincter 1179:, erectile tissue, and 1135:, partial and complete 757:Interventions include: 7778:Ovotesticular syndrome 7314:Genitourinary medicine 7117:In vitro fertilization 7072:Hormonal contraception 6957:Contraceptive security 6847:Non-binary recognition 6666:Intersex Awareness Day 6589:Ancient Greek religion 6512:Sexual differentiation 6163:10.1542/peds.2006-0738 6060:10.1542/peds.2006-0737 5291:The Journal of Urology 5118:The Journal of Urology 4881:10.3366/soma.2011.0026 4665:The Journal of Urology 4661:Meyer-Bahlburg, H.F.L. 4587:10.1210/jc.2003-030127 4219:10.1542/peds.2006-0738 3691:10.1210/jcem.84.6.5718 3360:"Surgery for intersex" 2601:: CS1 maint: others ( 1976: 1802:Gender identity issues 1790: 1655: 1653:Intersex Awareness Day 1632: 1617:2016 Global DSD Update 1610: 1579: 1537: 1510: 1497: 1438:rates of up to 88% in 1409:pregnancy terminations 1275:androgen insensitivity 1163: 943:(Prader stage 5), the 617:), sometimes known as 607: 508:Non-binary recognition 313:Intersex Awareness Day 175:Sexual differentiation 35: 7951:Intersex and medicine 7946:Gynecological surgery 7911:Pseudohermaphroditism 7788:XY gonadal dysgenesis 7752:XX gonadal dysgenesis 6977:Intersex human rights 6539:Fictional characters‎ 6480:Medical interventions 6436:Yogyakarta Principles 6421:Medical interventions 5356:Dreger, Alice Domurat 5240:Newman, Kurt (1991). 3421:10.1007/s003450050055 3188:Hauser, G.A. (1963). 2245:(December 17, 2015). 1995:Intersex human rights 1971: 1892:Intersex human rights 1784: 1716:after infant surgery. 1664:Intersex human rights 1658:Further information: 1650: 1627: 1605: 1574: 1528: 1513:Outcomes and evidence 1505: 1485: 1436:pregnancy termination 1227:Müllerian derivatives 1157: 1084:Testicular prostheses 753:Types of intervention 707:with high risk levels 689:to prevent or reduce 588: 211:Fictional characters‎ 143:Medical interventions 102:Yogyakarta Principles 87:Medical interventions 34: 7916:True hermaphroditism 7611:Uterine malformation 7535:tax on childlessness 7291:Genital modification 7215:Unintended pregnancy 6947:Reproductive Justice 5988:www.assembly.coe.int 5403:10.1210/jc.2005-0139 4772:Rebecca Jordan-Young 3848:10.1210/jc.2012-1222 3608:10.1056/nejmoa022236 3358:Creighton S (2001). 3161:(3 Part 2): 1165–8. 2029:OII Intersex Network 1873:Alternative pathways 1823:Stigma and normality 1523:Heino Meyer-Bahlburg 1475:Psychosocial support 1280:true hermaphroditism 957:true hermaphroditism 773:psychosocial support 498:Anti-gender movement 268:at the Olympic Games 7235:Pregnancy from rape 7092:Intrauterine device 6521:Society and culture 4532:(9365): 1252–1257. 4486:(7324): 1264–1265. 4038:Gender and Genetics 3963:10.1530/EJE-11-0789 3881:; Feder, Ellen K.; 3557:Am J Obstet Gynecol 3024:10.1155/2012/705212 3011:Advances in Urology 1985:Intersex healthcare 1886:Human rights issues 951:development and/or 635:sex characteristics 631:ambiguous genitalia 194:Society and culture 7672:Vaginal hypoplasia 7629:Unicornuate uterus 7619:Müllerian agenesis 7481:History of condoms 7370:Sexual dysfunction 7276:Sexual orientation 7230:Options counseling 7077:Male contraception 7000:Genetic counseling 6642:History and events 6040:Ashgate Publishing 6004:Elders, M Joycelyn 5839:Elders, M Joycelyn 5743:2015-07-21 at the 5587:on 8 December 2006 5521:Streuli, Jürg C.; 4836:2016-03-04 at the 4043:2014-04-06 at the 4007:2014-10-06 at the 3883:Tamar-Mattis, Anne 3655:, Ellen K. Feder, 3647:2016-04-02 at the 2624:2016-08-24 at the 2386:The New York Times 2243:Zwischengeschlecht 2092:2015-09-23 at the 1944:Christiane Völling 1791: 1656: 1582:Changing practices 1209:Clitoral reduction 1200:Clitoral recession 1164: 1133:gonadal dysgenesis 905:Urogenital closure 761:surgical treatment 699:to reduce risk of 655:Christiane Völling 608: 36: 7928: 7927: 7924: 7923: 7834: 7833: 7796: 7795: 7687:Cloacal exstrophy 7677:Imperforate hymen 7639:Bicornuate uterus 7624:Cervical agenesis 7550: 7549: 7250:Teenage pregnancy 6967:Genital integrity 6897: 6896: 6842:Non-binary gender 6810:Children's rights 6685:Rights by country 6564:Intersex and LGBT 6470:Genetic diagnosis 6416:Malta declaration 6411:Legal recognition 6306:978-92-4-150732-5 6197:(10): 2195–2206. 6121:10.1159/000442975 6035:Critical Intersex 5777:978-92-4-150732-5 5749:Council of Europe 5719:on 22 August 2009 5676:BJU International 5539:10.1111/jsm.12214 5491:978-1-921449-71-0 5246:Annals of Surgery 5160:Sandberg, Kirsten 5019:Carpenter, Morgan 4964:Feder, Ellen K.; 4936:978-1-78374-208-0 4903:The Stranger SLOG 4798:10.1136/bmj.g2926 4774:; Peter Sonksen; 4619:BJU International 4263:(9276): 124–125. 4175:on 6 October 2014 3740:Holmes, M. Morgan 3657:Anne Tamar-Mattis 3317:BJU International 2950:978-3-031-13363-3 2763:10.1136/bmj.h5124 2717:978-3-941957-50-3 2659:978-0-9942513-7-4 2429:10.1159/000442975 2319:(April 8, 2015). 2284:Council of Europe 1929:Australian Senate 1898:Council of Europe 1838:(as opposed to a 1809:sex of assignment 1762:vaginal introitus 1367:Hormone treatment 1303:sex of assignment 1292:Cloacal exstrophy 1145:bladder exstrophy 1129:cloacal exstrophy 1004:cloacal exstrophy 1000:Bladder exstrophy 909:undervirilization 764:hormone treatment 659:Council of Europe 583: 582: 461:Children's rights 336:Rights by country 226:Intersex and LGBT 128:Genetic diagnosis 82:Malta declaration 77:Legal recognition 7963: 7941:Urologic surgery 7843: 7842: 7773:Gonadal agenesis 7707: 7706: 7682:Vaginal adenosis 7634:Uterus didelphys 7607: 7606: 7577: 7570: 7563: 7554: 7553: 7512:Two-child policy 7507:One-child policy 7387:Gender dysphoria 6924: 6917: 6910: 6901: 6900: 6885: 6884: 6574:Military service 6448: 6362: 6355: 6348: 6339: 6338: 6321: 6310: 6298: 6286: 6264: 6258: 6250: 6248: 6247: 6241: 6234: 6222: 6184: 6174: 6141: 6123: 6086:Katrina Karkazis 6079: 6026: 6020: 6012:Carmona, Richard 5999: 5997: 5995: 5959: 5929: 5928: 5926: 5925: 5920:on July 12, 2017 5916:. Archived from 5903: 5897: 5896: 5894: 5893: 5884:. Archived from 5871: 5865: 5864: 5862: 5855: 5847:Carmona, Richard 5835: 5829: 5828: 5815:(2 April 2015). 5809: 5803: 5802: 5795: 5789: 5788: 5786: 5769: 5758: 5752: 5751:, 1 October 2013 5735: 5729: 5728: 5726: 5724: 5709: 5703: 5701: 5691: 5667: 5658: 5656: 5638: 5632: 5631: 5603: 5597: 5596: 5594: 5592: 5583:. Archived from 5573: 5567: 5566: 5533:(8): 1953–1960. 5518: 5512: 5506: 5500: 5499: 5475: 5469: 5468: 5432: 5426: 5425: 5415: 5405: 5396:(9): 5295–5303. 5380: 5374: 5373: 5352: 5346: 5345: 5334:"Bad Vibrations" 5329: 5323: 5322: 5297:(4): 1598–1601. 5286: 5280: 5279: 5269: 5237: 5231: 5230: 5202: 5196: 5195: 5156: 5150: 5149: 5124:(4): 1762–1765. 5113: 5107: 5106: 5071:Tamar-Mattis, A. 5067: 5061: 5060: 5042: 5015: 5006: 5005: 4961: 4955: 4954: 4952: 4951: 4945: 4939:. Archived from 4928: 4917: 4911: 4910: 4894: 4885: 4884: 4861: 4855: 4854: 4847: 4841: 4828: 4822: 4821: 4776:Katrina Karkazis 4768: 4762: 4761: 4751: 4726:(7): 1761–1763. 4711: 4705: 4704: 4671:(4): 1615–1619. 4657: 4651: 4650: 4614: 4608: 4607: 4589: 4580:(7): 3454–3456. 4564: 4558: 4557: 4520: 4514: 4513: 4503: 4471: 4465: 4464: 4446: 4422: 4416: 4415: 4383: 4377: 4376: 4344: 4338: 4337: 4327: 4295: 4289: 4288: 4251: 4245: 4244: 4230: 4198: 4185: 4184: 4182: 4180: 4159: 4153: 4152: 4119:(5): 1147–1163. 4110: 4101: 4095: 4094: 4058: 4052: 4035: 4029: 4018: 4012: 3999: 3993: 3992: 3982: 3939: 3933: 3932: 3922: 3875: 3869: 3868: 3850: 3841:(6): 1881–1883. 3826: 3820: 3819: 3782: 3776: 3775: 3750:(2–3): 169–181. 3736: 3730: 3729: 3727: 3725: 3716:. October 2013. 3710: 3704: 3703: 3693: 3684:(6): 1844–1847. 3666: 3660: 3639: 3630: 3629: 3619: 3587: 3581: 3580: 3552: 3546: 3545: 3517: 3511: 3510: 3482: 3476: 3475: 3447: 3441: 3440: 3404: 3398: 3397: 3387: 3355: 3349: 3348: 3312: 3306: 3305: 3277: 3271: 3270: 3245:(9365): 1252–7. 3233: 3224: 3222: 3220: 3219: 3210:. Archived from 3203: 3194: 3193: 3185: 3179: 3178: 3150: 3144: 3143: 3115: 3106: 3105: 3076:(8): 1047–1058. 3061: 3055: 3054: 3044: 3026: 3002: 2996: 2995: 2967: 2961: 2960: 2958: 2957: 2934: 2928: 2927: 2915: 2909: 2908: 2898: 2880: 2856: 2850: 2849: 2839: 2821: 2797: 2791: 2790: 2744: 2733: 2732: 2730: 2729: 2720:. Archived from 2701: 2695: 2694: 2692: 2685: 2674: 2668: 2667: 2639: 2633: 2632:, February 2013. 2616: 2607: 2606: 2600: 2592: 2590: 2582:Morgan Carpenter 2575: 2565: 2556: 2555: 2545: 2527: 2518: 2507: 2506: 2488: 2463: 2450: 2449: 2431: 2403: 2390: 2389: 2378: 2369: 2368: 2366: 2365: 2356:. Archived from 2349: 2340: 2339: 2337: 2336: 2327:. Archived from 2313: 2304: 2303: 2302: 2301: 2292:, archived from 2280: 2265: 2264: 2262: 2261: 2251: 2239: 2230: 2229: 2205: 2188: 2187: 2181: 2173: 2171: 2170: 2164: 2157: 2146: 2129: 2128: 2127: 2126: 2103: 2097: 2084: 2073: 2072: 2051: 2040: 2039: 2037: 2036: 2021: 1738:Kirsten Sandberg 1724:Parental consent 1591:Patient outcomes 1521:A 2004 paper by 1461:gender dysphoria 1451:Gender dysphoria 1075:development and 1043:is removal of a 861:position to the 719:fecal continence 604: 598: 592: 575: 568: 561: 19: 18: 7971: 7970: 7966: 7965: 7964: 7962: 7961: 7960: 7931: 7930: 7929: 7920: 7889: 7830: 7814: 7792: 7761: 7738: 7696: 7692:Vaginal atresia 7653: 7598: 7581: 7551: 7546: 7495: 7464: 7437:United Kingdom 7391: 7343: 7334:Sexual medicine 7295: 7271:Gender identity 7259: 7205:Maternal health 7191: 7151: 7147:fertility fraud 7108: 7101: 7058: 7009: 6983: 6933: 6928: 6898: 6893: 6873: 6798: 6680: 6637: 6516: 6450: 6449: 6440: 6371: 6366: 6328: 6307: 6296: 6283: 6252: 6251: 6245: 6243: 6239: 6232: 6157:(2): e488–500. 6018: 5993: 5991: 5982: 5956: 5938: 5933: 5932: 5923: 5921: 5904: 5900: 5891: 5889: 5888:on July 1, 2017 5872: 5868: 5860: 5856:. Palm Center. 5853: 5836: 5832: 5810: 5806: 5796: 5792: 5784: 5778: 5767: 5759: 5755: 5745:Wayback Machine 5736: 5732: 5722: 5720: 5711: 5710: 5706: 5668: 5661: 5653: 5639: 5635: 5604: 5600: 5590: 5588: 5579:(24 May 2006). 5574: 5570: 5519: 5515: 5507: 5503: 5492: 5476: 5472: 5443:(11): 620–627. 5433: 5429: 5381: 5377: 5370: 5353: 5349: 5330: 5326: 5287: 5283: 5238: 5234: 5203: 5199: 5157: 5153: 5114: 5110: 5068: 5064: 5016: 5009: 4962: 4958: 4949: 4947: 4943: 4937: 4926: 4918: 4914: 4895: 4888: 4862: 4858: 4849: 4848: 4844: 4838:Wayback Machine 4829: 4825: 4769: 4765: 4712: 4708: 4658: 4654: 4615: 4611: 4565: 4561: 4521: 4517: 4472: 4468: 4423: 4419: 4384: 4380: 4345: 4341: 4296: 4292: 4252: 4248: 4213:(2): e488–500. 4199: 4188: 4178: 4176: 4161: 4160: 4156: 4108: 4102: 4098: 4059: 4055: 4045:Wayback Machine 4036: 4032: 4019: 4015: 4009:Wayback Machine 4000: 3996: 3940: 3936: 3876: 3872: 3827: 3823: 3783: 3779: 3737: 3733: 3723: 3721: 3712: 3711: 3707: 3672:(1 June 1999). 3667: 3663: 3649:Wayback Machine 3640: 3633: 3588: 3584: 3553: 3549: 3518: 3514: 3483: 3479: 3448: 3444: 3405: 3401: 3356: 3352: 3313: 3309: 3278: 3274: 3234: 3227: 3217: 3215: 3206: 3204: 3197: 3186: 3182: 3151: 3147: 3116: 3109: 3062: 3058: 3003: 2999: 2968: 2964: 2955: 2953: 2951: 2935: 2931: 2916: 2912: 2857: 2853: 2798: 2794: 2745: 2736: 2727: 2725: 2718: 2702: 2698: 2690: 2683: 2675: 2671: 2660: 2640: 2636: 2626:Wayback Machine 2617: 2610: 2594: 2593: 2588: 2573: 2567: 2566: 2559: 2525: 2519: 2510: 2464: 2453: 2404: 2393: 2380: 2379: 2372: 2363: 2361: 2360:on May 22, 2015 2350: 2343: 2334: 2332: 2331:on July 4, 2015 2314: 2307: 2299: 2297: 2281: 2268: 2259: 2257: 2249: 2240: 2233: 2222: 2206: 2191: 2175: 2174: 2168: 2166: 2162: 2155: 2147: 2132: 2124: 2122: 2104: 2100: 2094:Wayback Machine 2085: 2076: 2069: 2052: 2043: 2034: 2032: 2023: 2022: 2018: 2013: 1981: 1963:Richard Carmona 1955:Joycelyn Elders 1894: 1888: 1875: 1866: 1857: 1825: 1804: 1779: 1746: 1726: 1675: 1666: 1645: 1619: 1593: 1584: 1562:Georgiann Davis 1542: 1515: 1477: 1453: 1442:even while the 1432:Georgiann Davis 1414:In April 2014, 1395: 1369: 1329:. However, the 1121: 1111:Concealed penis 1002:or more severe 815: 755: 740:gender identity 668: 606: 602: 600: 596: 594: 590: 579: 550: 549: 545:Sex differences 451: 443: 442: 338: 328: 327: 291: 280: 279: 195: 187: 186: 118: 107: 106: 50: 17: 12: 11: 5: 7969: 7959: 7958: 7953: 7948: 7943: 7926: 7925: 7922: 7921: 7919: 7918: 7913: 7908: 7903: 7897: 7895: 7891: 7890: 7888: 7887: 7882: 7877: 7872: 7867: 7862: 7857: 7851: 7849: 7840: 7836: 7835: 7832: 7831: 7829: 7828: 7822: 7820: 7816: 7815: 7813: 7812: 7806: 7804: 7798: 7797: 7794: 7793: 7791: 7790: 7785: 7780: 7775: 7769: 7767: 7763: 7762: 7760: 7759: 7754: 7748: 7746: 7740: 7739: 7737: 7736: 7731: 7726: 7721: 7719:Cryptorchidism 7715: 7713: 7704: 7698: 7697: 7695: 7694: 7689: 7684: 7679: 7674: 7669: 7667:Vaginal septum 7663: 7661: 7655: 7654: 7652: 7651: 7649:Arcuate uterus 7646: 7644:Uterine septum 7641: 7636: 7631: 7626: 7621: 7615: 7613: 7604: 7600: 7599: 7580: 7579: 7572: 7565: 7557: 7548: 7547: 7545: 7544: 7539: 7538: 7537: 7532: 7527: 7522: 7514: 7509: 7503: 7501: 7497: 7496: 7494: 7493: 7488: 7483: 7478: 7472: 7470: 7466: 7465: 7463: 7462: 7461: 7460: 7455: 7453:teen pregnancy 7445: 7444: 7443: 7435: 7430: 7425: 7420: 7415: 7410: 7405: 7399: 7397: 7393: 7392: 7390: 7389: 7384: 7383: 7382: 7372: 7367: 7362: 7357: 7351: 7349: 7345: 7344: 7342: 7341: 7336: 7331: 7326: 7321: 7316: 7311: 7305: 7303: 7297: 7296: 7294: 7293: 7288: 7283: 7278: 7273: 7267: 7265: 7261: 7260: 7258: 7257: 7252: 7247: 7242: 7237: 7232: 7227: 7222: 7217: 7212: 7207: 7201: 7199: 7193: 7192: 7190: 7189: 7188: 7187: 7179: 7178: 7177: 7167: 7161: 7159: 7153: 7152: 7150: 7149: 7144: 7139: 7138: 7137: 7132: 7124: 7119: 7113: 7111: 7103: 7102: 7100: 7099: 7094: 7089: 7084: 7079: 7074: 7068: 7066: 7060: 7059: 7057: 7056: 7051: 7050: 7049: 7044: 7034: 7029: 7019: 7017: 7011: 7010: 7008: 7007: 7002: 6997: 6991: 6989: 6985: 6984: 6982: 6981: 6980: 6979: 6974: 6964: 6959: 6954: 6949: 6943: 6941: 6935: 6934: 6927: 6926: 6919: 6912: 6904: 6895: 6894: 6892: 6891: 6878: 6875: 6874: 6872: 6871: 6866: 6865: 6864: 6859: 6854: 6849: 6844: 6839: 6829: 6824: 6823: 6822: 6812: 6806: 6804: 6800: 6799: 6797: 6796: 6795: 6794: 6784: 6782:United Kingdom 6779: 6774: 6769: 6764: 6759: 6754: 6749: 6744: 6739: 6734: 6729: 6724: 6719: 6714: 6709: 6704: 6699: 6694: 6688: 6686: 6682: 6681: 6679: 6678: 6673: 6668: 6663: 6662: 6661: 6656: 6645: 6643: 6639: 6638: 6636: 6635: 6630: 6625: 6620: 6619: 6618: 6617: 6616: 6611: 6603: 6602: 6601: 6599:Hermaphroditus 6596: 6581: 6576: 6571: 6566: 6561: 6556: 6551: 6546: 6541: 6536: 6531: 6524: 6522: 6518: 6517: 6515: 6514: 6509: 6504: 6499: 6494: 6489: 6488: 6487: 6477: 6472: 6467: 6461: 6459: 6452: 6451: 6443: 6441: 6439: 6438: 6433: 6428: 6426:Sex assignment 6423: 6418: 6413: 6408: 6407: 6406: 6396: 6394:Discrimination 6391: 6385: 6383: 6373: 6372: 6365: 6364: 6357: 6350: 6342: 6336: 6335: 6334:- video on BBC 6327: 6326:External links 6324: 6323: 6322: 6311: 6305: 6287: 6281: 6265: 6223: 6185: 6142: 6114:(3): 158–180. 6095: 6083: 6080: 6043: 6027: 6008:Satcher, David 6000: 5980: 5979:", April 2015. 5973: 5971:DSD Guidelines 5967: 5965:DSD Guidelines 5960: 5954: 5937: 5934: 5931: 5930: 5898: 5866: 5843:Satcher, David 5830: 5804: 5790: 5776: 5753: 5730: 5704: 5659: 5651: 5633: 5614:(6): 339–346. 5598: 5568: 5513: 5501: 5490: 5470: 5437:Nat. Rev. Urol 5427: 5413:1854/LU-848324 5375: 5368: 5347: 5324: 5281: 5232: 5197: 5170:(4): 337–352. 5151: 5108: 5081:(4): 788–789. 5062: 5007: 4980:(6): 436–437. 4956: 4935: 4912: 4886: 4865:Holmes, Morgan 4856: 4842: 4823: 4763: 4706: 4652: 4625:(1): 135–138. 4609: 4559: 4515: 4466: 4437:(1): 157–164. 4417: 4378: 4359:(3): 141–142. 4339: 4310:(5): 218–220. 4290: 4246: 4186: 4154: 4096: 4053: 4030: 4013: 3994: 3957:(1): 103–110. 3934: 3897:(3): 277–294. 3870: 3821: 3794:(5): 941–947. 3777: 3731: 3705: 3661: 3631: 3582: 3563:(3): 293–300. 3547: 3522:J Pediatr Surg 3512: 3493:(5): 1588–91. 3477: 3442: 3415:(3): 212–218. 3399: 3350: 3307: 3288:(3): 1139–40. 3272: 3225: 3195: 3180: 3145: 3107: 3056: 2997: 2978:(4): 1308–10. 2962: 2949: 2929: 2910: 2851: 2792: 2734: 2716: 2696: 2669: 2658: 2634: 2608: 2584:(eds.). 2014. 2557: 2508: 2479:(3): 139–149. 2451: 2422:(3): 158–180. 2391: 2370: 2341: 2305: 2266: 2231: 2220: 2189: 2130: 2098: 2074: 2067: 2041: 2015: 2014: 2012: 2009: 2008: 2007: 2002: 1997: 1992: 1987: 1980: 1977: 1953:In June 2017, 1915: 1914: 1911: 1908: 1905: 1890:Main article: 1887: 1884: 1874: 1871: 1865: 1862: 1856: 1853: 1824: 1821: 1803: 1800: 1778: 1775: 1745: 1742: 1725: 1722: 1718: 1717: 1713: 1710: 1706: 1703: 1696: 1695: 1688: 1685: 1682: 1674: 1671: 1644: 1641: 1618: 1615: 1592: 1589: 1583: 1580: 1554:anatomical sex 1541: 1538: 1514: 1511: 1476: 1473: 1452: 1449: 1397:The ethics of 1394: 1391: 1368: 1365: 1268:gonadoblastoma 1143:, cloacal and 1120: 1117: 1057:cryptorchidism 1049:Müllerian duct 937:gonadoblastoma 847:cryptorchidism 821:or defects of 814: 811: 775: 774: 771: 768: 765: 762: 754: 751: 746: 745: 742: 736: 734:sex of rearing 730: 723: 722: 711: 708: 697: 687: 681: 667: 664: 601: 595: 589: 581: 580: 578: 577: 570: 563: 555: 552: 551: 548: 547: 542: 537: 532: 530:Medical ethics 527: 526: 525: 520: 515: 510: 505: 500: 495: 485: 480: 479: 478: 468: 463: 458: 452: 449: 448: 445: 444: 441: 440: 435: 433:United Kingdom 430: 425: 420: 415: 410: 405: 400: 395: 390: 385: 380: 375: 370: 365: 360: 355: 350: 345: 339: 334: 333: 330: 329: 326: 325: 320: 315: 310: 309: 308: 303: 292: 286: 285: 282: 281: 278: 277: 272: 271: 270: 260: 255: 254: 253: 243: 238: 233: 228: 223: 218: 213: 208: 203: 196: 193: 192: 189: 188: 185: 184: 177: 172: 167: 162: 157: 152: 151: 150: 140: 135: 130: 125: 119: 113: 112: 109: 108: 105: 104: 99: 94: 92:Sex assignment 89: 84: 79: 74: 73: 72: 62: 60:Discrimination 57: 51: 42: 41: 38: 37: 27: 26: 15: 9: 6: 4: 3: 2: 7968: 7957: 7954: 7952: 7949: 7947: 7944: 7942: 7939: 7938: 7936: 7917: 7914: 7912: 7909: 7907: 7904: 7902: 7901:Clitoromegaly 7899: 7898: 7896: 7892: 7886: 7883: 7881: 7878: 7876: 7873: 7871: 7868: 7866: 7863: 7861: 7858: 7856: 7853: 7852: 7850: 7848: 7844: 7841: 7837: 7827: 7824: 7823: 7821: 7817: 7811: 7808: 7807: 7805: 7803: 7799: 7789: 7786: 7784: 7781: 7779: 7776: 7774: 7771: 7770: 7768: 7764: 7758: 7755: 7753: 7750: 7749: 7747: 7745: 7741: 7735: 7732: 7730: 7727: 7725: 7724:Polyorchidism 7722: 7720: 7717: 7716: 7714: 7712: 7708: 7705: 7703: 7699: 7693: 7690: 7688: 7685: 7683: 7680: 7678: 7675: 7673: 7670: 7668: 7665: 7664: 7662: 7660: 7656: 7650: 7647: 7645: 7642: 7640: 7637: 7635: 7632: 7630: 7627: 7625: 7622: 7620: 7617: 7616: 7614: 7612: 7608: 7605: 7601: 7597: 7593: 7589: 7585: 7578: 7573: 7571: 7566: 7564: 7559: 7558: 7555: 7543: 7540: 7536: 7533: 7531: 7530:child benefit 7528: 7526: 7523: 7521: 7518: 7517: 7515: 7513: 7510: 7508: 7505: 7504: 7502: 7498: 7492: 7489: 7487: 7484: 7482: 7479: 7477: 7474: 7473: 7471: 7467: 7459: 7458:birth control 7456: 7454: 7451: 7450: 7449: 7448:United States 7446: 7442: 7439: 7438: 7436: 7434: 7431: 7429: 7426: 7424: 7421: 7419: 7416: 7414: 7411: 7409: 7406: 7404: 7401: 7400: 7398: 7394: 7388: 7385: 7381: 7378: 7377: 7376: 7373: 7371: 7368: 7366: 7363: 7361: 7358: 7356: 7353: 7352: 7350: 7346: 7340: 7337: 7335: 7332: 7330: 7327: 7325: 7322: 7320: 7317: 7315: 7312: 7310: 7307: 7306: 7304: 7302: 7298: 7292: 7289: 7287: 7284: 7282: 7279: 7277: 7274: 7272: 7269: 7268: 7266: 7262: 7256: 7253: 7251: 7248: 7246: 7245:Prenatal care 7243: 7241: 7238: 7236: 7233: 7231: 7228: 7226: 7223: 7221: 7218: 7216: 7213: 7211: 7208: 7206: 7203: 7202: 7200: 7198: 7194: 7186: 7183: 7182: 7180: 7176: 7173: 7172: 7171: 7168: 7166: 7163: 7162: 7160: 7158: 7154: 7148: 7145: 7143: 7140: 7136: 7133: 7131: 7128: 7127: 7125: 7123: 7120: 7118: 7115: 7114: 7112: 7110: 7104: 7098: 7097:Sterilization 7095: 7093: 7090: 7088: 7085: 7083: 7080: 7078: 7075: 7073: 7070: 7069: 7067: 7065: 7064:Contraception 7061: 7055: 7052: 7048: 7045: 7043: 7040: 7039: 7038: 7035: 7033: 7032:Birth spacing 7030: 7028: 7027:childlessness 7024: 7023:Childfreeness 7021: 7020: 7018: 7016: 7012: 7006: 7003: 7001: 6998: 6996: 6995:Sex education 6993: 6992: 6990: 6986: 6978: 6975: 6973: 6970: 6969: 6968: 6965: 6963: 6960: 6958: 6955: 6953: 6950: 6948: 6945: 6944: 6942: 6940: 6936: 6932: 6925: 6920: 6918: 6913: 6911: 6906: 6905: 6902: 6890: 6889: 6880: 6879: 6876: 6870: 6867: 6863: 6860: 6858: 6855: 6853: 6850: 6848: 6845: 6843: 6840: 6838: 6835: 6834: 6833: 6830: 6828: 6825: 6821: 6818: 6817: 6816: 6813: 6811: 6808: 6807: 6805: 6801: 6793: 6790: 6789: 6788: 6787:United States 6785: 6783: 6780: 6778: 6775: 6773: 6770: 6768: 6765: 6763: 6760: 6758: 6755: 6753: 6750: 6748: 6745: 6743: 6740: 6738: 6735: 6733: 6730: 6728: 6725: 6723: 6720: 6718: 6715: 6713: 6710: 6708: 6705: 6703: 6700: 6698: 6695: 6693: 6690: 6689: 6687: 6683: 6677: 6674: 6672: 6669: 6667: 6664: 6660: 6657: 6655: 6652: 6651: 6650: 6647: 6646: 6644: 6640: 6634: 6631: 6629: 6626: 6624: 6621: 6615: 6612: 6610: 6607: 6606: 6604: 6600: 6597: 6595: 6592: 6591: 6590: 6587: 6586: 6585: 6582: 6580: 6577: 6575: 6572: 6570: 6567: 6565: 6562: 6560: 6557: 6555: 6552: 6550: 6549:Gender system 6547: 6545: 6542: 6540: 6537: 6535: 6532: 6529: 6526: 6525: 6523: 6519: 6513: 6510: 6508: 6507:Quigley scale 6505: 6503: 6500: 6498: 6497:Phall-O-Meter 6495: 6493: 6490: 6486: 6483: 6482: 6481: 6478: 6476: 6475:Hermaphrodite 6473: 6471: 6468: 6466: 6463: 6462: 6460: 6457: 6453: 6447: 6437: 6434: 6432: 6429: 6427: 6424: 6422: 6419: 6417: 6414: 6412: 6409: 6405: 6402: 6401: 6400: 6397: 6395: 6392: 6390: 6387: 6386: 6384: 6382: 6378: 6374: 6370: 6363: 6358: 6356: 6351: 6349: 6344: 6343: 6340: 6333: 6330: 6329: 6319: 6318: 6312: 6308: 6302: 6295: 6294: 6288: 6284: 6282:9789241564984 6278: 6274: 6270: 6266: 6262: 6256: 6242:on 2015-04-23 6238: 6231: 6230: 6224: 6220: 6216: 6212: 6208: 6204: 6200: 6196: 6192: 6186: 6182: 6178: 6173: 6168: 6164: 6160: 6156: 6152: 6148: 6143: 6139: 6135: 6131: 6127: 6122: 6117: 6113: 6109: 6105: 6101: 6096: 6093: 6092: 6087: 6084: 6081: 6077: 6073: 6069: 6065: 6061: 6057: 6054:(2): 753–57. 6053: 6049: 6044: 6041: 6037: 6036: 6031: 6030:Morgan Holmes 6028: 6024: 6017: 6014:(June 2017). 6013: 6009: 6005: 6001: 5989: 5985: 5981: 5978: 5974: 5972: 5968: 5966: 5961: 5957: 5955:9781742299174 5951: 5947: 5946: 5940: 5939: 5919: 5915: 5914: 5913:Gay Star News 5909: 5902: 5887: 5883: 5882: 5877: 5870: 5859: 5852: 5849:(June 2017). 5848: 5844: 5840: 5834: 5826: 5822: 5821:Star Observer 5818: 5814: 5813:Star Observer 5808: 5801: 5794: 5783: 5779: 5773: 5766: 5765: 5757: 5750: 5746: 5742: 5739: 5734: 5718: 5714: 5708: 5699: 5695: 5690: 5685: 5681: 5677: 5673: 5666: 5664: 5654: 5652:0-8135-3229-9 5648: 5644: 5637: 5629: 5625: 5621: 5617: 5613: 5609: 5602: 5586: 5582: 5578: 5572: 5564: 5560: 5556: 5552: 5548: 5544: 5540: 5536: 5532: 5528: 5524: 5517: 5510: 5509:Morgan Holmes 5505: 5497: 5493: 5487: 5483: 5482: 5474: 5466: 5462: 5458: 5454: 5450: 5446: 5442: 5438: 5431: 5423: 5419: 5414: 5409: 5404: 5399: 5395: 5391: 5387: 5379: 5371: 5369:9781594206085 5365: 5361: 5357: 5351: 5343: 5339: 5335: 5328: 5320: 5316: 5312: 5308: 5304: 5300: 5296: 5292: 5285: 5277: 5273: 5268: 5263: 5259: 5255: 5252:(6): 644–53. 5251: 5247: 5243: 5236: 5228: 5224: 5220: 5216: 5212: 5208: 5201: 5193: 5189: 5185: 5181: 5177: 5173: 5169: 5165: 5161: 5155: 5147: 5143: 5139: 5135: 5131: 5127: 5123: 5119: 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Retrieved 2031:. 2012-02-25 2028: 2019: 1972: 1952: 1948: 1941: 1926: 1922:Alice Dreger 1920: 1916: 1895: 1878: 1876: 1867: 1858: 1849: 1840:cleft palate 1833: 1826: 1818: 1805: 1795:orchidectomy 1792: 1789:27 June 2020 1787:Berlin Pride 1771: 1758:labia minora 1754:labia majora 1750: 1747: 1731: 1727: 1719: 1697: 1692:psychosexual 1676: 1667: 1636:Alice Dreger 1633: 1628: 1622: 1620: 1611: 1606: 1600: 1594: 1585: 1575: 1570:Tiger Devore 1549: 1545: 1543: 1529: 1520: 1516: 1506: 1498: 1494: 1490: 1486: 1482: 1478: 1454: 1413: 1402: 1396: 1386:Tamar-Mattis 1376: 1370: 1340: 1317:, including 1296: 1290: 1289: 1285:osteoporosis 1272: 1264:Y chromosome 1249: 1248: 1235: 1218:Vaginoplasty 1216: 1215: 1207: 1206: 1198: 1197: 1190: 1189: 1175:, including 1168:Clitorectomy 1166: 1165: 1122: 1109: 1108: 1096: 1095: 1082: 1081: 1077:menstruation 1061:appendectomy 1040:Hysterectomy 1038: 1037: 1031:Phalloplasty 1029: 1028: 992: 991: 970: 969: 965:osteoporosis 953:menstruation 933:Y chromosome 918: 917: 904: 903: 894: 893: 872: 871: 851:circumcision 836: 835: 823:testosterone 816: 807:vaginoplasty 795:phalloplasty 788: 782: 778: 776: 756: 747: 724: 685:menstruation 672: 669: 651:human rights 648: 622: 618: 614: 610: 609: 518:Third gender 513:Queer theory 408:South Africa 179: 165:Prader scale 155:Orchidometer 142: 86: 65:Human rights 48:legal issues 44:Human rights 7855:Hypospadias 7428:Philippines 7360:Infertility 7319:Gynaecology 7286:Transgender 7054:Sperm theft 7047:foster care 6862:Transgender 6767:Switzerland 6752:New Zealand 6623:Researchers 6458:and biology 6023:Palm Center 5645:. Rutgers. 5591:25 November 3364:J R Soc Med 1967:Palm Center 1829:stigmatized 1469:New Zealand 1348:vesicostomy 1251:Gonadectomy 1024:vesicostomy 920:Gonadectomy 874:Hypospadias 713:to improve 695:obstruction 523:Transgender 418:Switzerland 403:New Zealand 258:Researchers 133:Definitions 117:and biology 7935:Categories 7870:Micropenis 7860:Epispadias 7729:Monorchism 7520:baby bonus 7516:Financial 7396:By country 7220:childbirth 7210:Obstetrics 7142:Sperm bank 6815:Disability 6654:of surgery 6633:Television 6609:Androgynos 6594:Aphroditus 6569:Literature 6246:2015-07-19 6151:Pediatrics 6048:Pediatrics 5936:References 5924:2017-06-30 5892:2017-06-30 5881:Refinery29 4950:2016-08-29 4526:The Lancet 4398:(3): 142. 4257:The Lancet 4207:Pediatrics 3218:2004-08-28 3017:: 705212. 2956:2023-01-20 2728:2016-10-03 2364:2015-07-03 2335:2015-07-03 2300:2018-01-04 2260:2015-12-21 2169:2015-07-19 2125:2024-03-12 2112:StatPearls 2035:2019-06-12 1709:decisions. 1361:reassigned 1273:Testes in 1260:dysgenetic 1243:reassigned 1141:micropenis 1104:micropenis 1020:epispadias 929:dysgenetic 896:Epispadias 838:Orchiopexy 799:orchiopexy 633:and other 503:Non-binary 471:Disability 301:of surgery 290:and events 275:Television 231:Literature 138:Healthcare 7880:Diphallia 7433:Singapore 7348:Disorders 7309:Andrology 7197:Pregnancy 7181:Research 7037:Parenting 6988:Education 6837:Androgyny 6697:Australia 6692:Argentina 6554:Guevedoce 6530:(antonym) 6255:cite book 6130:1663-2818 5723:21 August 5547:1743-6095 5311:0022-5347 5192:147310957 5184:1891-8131 5138:0022-5347 5095:1477-5131 5049:0968-8080 4994:1477-5131 4792:: g2926. 4740:0004-0002 4685:0022-5347 4596:0021-972X 4453:0015-0282 4412:1083-3188 4373:1083-3188 4179:6 October 4133:0004-0002 3971:0804-4643 3911:1176-7529 3857:0021-972X 3808:1477-5131 3764:1176-7529 3724:6 October 3033:1687-6369 2887:2296-2360 2828:2296-2360 2771:1756-1833 2757:: –5124. 2597:cite book 2552:1941-9899 2495:1477-5131 2438:1663-2818 2178:cite book 1942:In 2011, 1935:, and UN 1836:cleft lip 1694:identity. 1344:colostomy 1016:colostomy 985:or upper 961:ovotestes 855:abdominal 679:fertility 493:Androgyny 348:Australia 343:Argentina 202:(antonym) 7875:Aphallia 7839:External 7711:Testicle 7603:Internal 7592:intersex 7423:Pakistan 7301:Medicine 7281:Intersex 7264:Identity 7225:Abortion 7107:Assisted 7082:Safe sex 7042:adoption 7015:Planning 6888:Category 6803:See also 6792:military 6717:Colombia 6659:timeline 6605:Judaism 6584:Religion 6456:Medicine 6369:Intersex 6271:(2015). 6219:24498085 6211:25721455 6181:16882788 6138:26820577 6088:(2008). 6076:46508895 6068:16882833 5858:Archived 5825:Archived 5782:Archived 5741:Archived 5698:11849163 5628:19589707 5563:17767717 5555:23742202 5496:Archived 5465:22294512 5457:23045263 5422:15998778 5358:(2015). 5342:Archived 5319:17707043 5146:15371809 5103:24909610 5057:27578341 5002:27349148 4907:Archived 4834:Archived 4818:Archived 4806:24776640 4778:(2014). 4758:25808721 4701:25087899 4693:15017234 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