early medical interventions and the issue of consent under debate

Micro-penis, vagina shorter than the average and sometimes open to the urethra, absence of uterus, clitoris larger than average, urethra placed elsewhere than at the end of the glans (hypospade), vulva presenting the appearance of male external genitalia, hirsutism in girls, simultaneous presence of testicles and a vagina… These physical characteristics have in turn been used to refer to hermaphroditism, intersexuality, abnormalities in sexual development and, more recently, variations in genital development (GBV).

These manifestations, which can occur from birth to puberty, are described by the United Nations as follows: “Intersex people are those whose physical or biological characteristics, such as sexual anatomy, genitals, hormonal function, or chromosome pattern, do not match conventional definitions of masculinity and femininity. “

Difficult to have an overall figure on the prevalence of GBV consensus: from one birth in 4,000 to one in 50,000, “According to what we put in these variations”, explains Dr Claire Bouvattier, pediatric endocrinologist at the Kremlin-Bicêtre hospital (Val-de-Marne).

Blaise Meyrat, Swiss pediatric surgeon now retired, warns: “The subject is one of the most complex in pediatrics, from an ethical, societal, psychological and technical point of view. “ Today it is giving rise to a debate on the need or not to intervene early to “correct” these variations when the child cannot consent to it. But beyond that, some wonder: don’t these surgeries or hormonal treatments applied to intersex children come under the application of social and medical standards?

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The first operations on newborns began in the 1950s, thanks to technical progress after the Second World War, and were systematized from the 1970s. Today, interventions are variable and decided on a case-by-case basis. : construction of a vagina (vaginoplasty), urethral surgery, hormonal treatment to decrease or increase the level of certain hormones in order to virilize or feminize an individual, removal of the testes or ovaries (gonadectomy), reconstruction of a vulva (vulvoplasty)…

Manon (first name has been changed), 32, was born with male XY chromosomes and partial androgen insensitivity – her body does not fully respond to testosterone. When the testicles are born, she presents a “Small vaginal cavity” and virilized female external genitalia. Supported by a multidisciplinary team (doctors, psychologists, nurses) in an authorized center, she was assigned a daughter after a series of examinations (genetics, hormones, exploratory surgery): “The medical profession has often told me that I was a girl by default”, she remembers. At the age of 2, Manon undergoes castration, vaginoplasty and clitoral reduction.

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