Jamaican Intersex (ambiguous genitalia) baby case a cause for concern part 2 #learning moment

See part one HERE

A reminder - What is the difference between a TRANS, transsexual or transgender person & an intersex person? INTERSEX is not a part of transgender because intersex is not about gender. Intersex is about anatomical differences in sex. Also the word ‘hermaphrodite’ is no longer an acceptable term in discussing such issues since 2005. Sadly a sociologist who hosts a show on Nationwide had fun using the term disparagingly. She is the same sociologist who featured in this previous post: Aphrodite’s P.R.I.D.E Jamaica, APJ tackles gender identity, transgender misconceptions & an ignorant sociologist ......

now to pressing matters:

So part two of the series regarding little baby ‘Angel’ and the associated ambiguous genitalia issue garnered several comments on social media where it was shared on CVM TV’s Inspire Jamaica Facebook page. The feature has been growing on the minds of Jamaicans as the stories carried therein as very positive and host Kerlene Brown has certainly grown since her appearance on television several years ago; Miss Brown obviously did some research on the matter as she also raised the issue of the timing of the surgery whether it should occur at puberty or not; my beef is not with the show itself but the decision by the goodly consulting gynaecologist & endocrinologist Dr Gabay to rush to surgery as he suggests when baby ‘Angel’ get to 18 months after the birth. Bear in mind the mother though while seemingly obedient to the suggestion has not said a full yes based on the interview. This entry is in no way questioning the competencies of persons such as Dr Gabay but the principle if not ethics regarding addressing sex and gender specific to ambiguous genitalia.

There seems to be mixed positions on whether to take the early surgery route versus waiting until after puberty. Some experts suggest it maybe too late in some cases as developmental trends may preclude such reassignment surgery or post hormonal treatment courses.

also see: Chilean officials oppose “normalization” surgery for intersex children! 2016 (OII)

The push by intersex activists worldwide but especially in the United States, Australia and Canada have all pushed that early surgery is not the way to go and that issues to do with chromosomal changes can occur even after initial tests may shoe XX as in this case and a uterus but no undescended testicles suggesting male features or the lack thereof. I still suggest that no surgery be done to little ‘Angel’ and allow the baby to develop to puberty (age 18 as our age of majority) and then allow the adult person to make a decision based on more test now that they have matured.

Intersex Issues and the International Classification Of Diseases

The ICD revision and reform process has a key relevance for the intersex movement. Diagnostic categories play a central role in expressing scientific understandings, establishing medical approaches, informing clinical protocols, defining surgical, hormonal and other treatments. Diagnostic categories defining intersex bodies reify differences between stereotypical female and male bodies on the one hand, considered to be healthy, and bodies that vary from female and male standards on the other hand, considered to be “disordered”, Or “abnormal”. Current Classifications therefore contribute to stigma and discrimination against intersex people; they endow appropriateness to medical attempts to “fix” Or “normalize”

Intersex bodies through surgical and hormonal means. They play a direct role in determining how intersex bodies are treated in society at large.

Everywhere in the world, people born with intersex traits are subjected to “normalizing” procedures, including clitoridectomies, labioplasties, vaginoplasties, gonadectomies, hypospadias “repair”, and treatment with steroids or sex hormones.

Many of these procedures are performed during infancy and early childhood when intersex individuals cannot provide their informed consent. Intersex babies, infants, children and adolescents are also subjected to related practices in medical settings, such as continued exposure. In different parts of the world, treatments also include socio--‐legal measures, including a lack of birth certificates; at least in this case according to part 1 of the video the mother explained the process she was told that she could get the changes made at the Registrar General Department, RGD. Most of these treatments have lifelong consequences: they produce sterility, genital insensitivity and impaired sexual function, chronic pain, chronic bleeding, and chronic infections, post--‐surgical depression, and trauma (in many cases associated with the experience of rape), massive internal and external scarring, metabolic imbalances.

These procedures have been internationally denounced as institutionalized forms of genital mutilation.

They reproduce and reinforce the cultural sense of intersex bodies as disordered and shameful; they produce coercive social environments. Such a hint came through loudly when the goodly doctor spoke to the possible embarrassment by the parent(s) and inquisitive family members where lies are told to cover up or deflect the scrutiny. Given what we now know I believe persons can be allowed to mature with the right psycho-social interventions and some medical monitoring but not medicalizations as seen before.

Vaginoplasties are another common feminizing treatment, performed on girls affected by CAH, by complete or partial Androgen Insensitivity Syndrome, or by Mayer Rokitansky Kuster Hauser Syndrome.

Vaginoplasties, as well as other associated genitoplasties, seems to be the recommended course in this specific case and which are also performed to feminize intersex bodies when an infant has been assigned female at birth –for example, in cases of penile agenesis. Early surgical interventions are known to have significant negative consequences:

In children with ambiguous genitalia assigned female, vaginoplasty is commonly performed during the first year of life even though the child will not menstruate for a further 10 or so years and is unlikely to be sexually active until after puberty.

High rates of introital stenosis of up to 100% have been demonstrated as well as frequent requirements for repeated reconstructive surgery in adolescence before tampon use or intercourse. Given that there is no available data to suggest early infant vaginoplasty has a better long-term outcome than a later delayed surgery, vaginoplasty in infancy is, then, chiefly to create a reassuring appearance for parents and clinicians’.

Vaginoplasties usually require regular follow--‐up treatment through dilation, a procedure that has been repeatedly identified as an experience comparable with rape by intersex people forced to undergo it after non--‐consensual interventions, or following interventions where consent was not fully informed. The latter cases are characterized by inadequate or incomplete access to proper information regarding follow up treatment and long--‐lasting consequences.

Dense scarring and the closing of the vagina opening are common complications [in addition to] chronic pain during intercourse, excessive vaginal secretion and total closure of the vagina”, complicated by other factors “including poor communication, inadequate follow--‐up, humiliating encounters with health professionals including medical photography, poor treatment outcome, and inadequate psychological support.

Given the occurrence of long term failures, long--‐term follow up is rare, for example, because pediatric urologists do not follow patients into adulthood, and because patients “have been shown to be reluctant to seek further medical advice despite significant distress”; clinicians acknowledge that such data are necessary “to provide an honest and meaningful account” of results.

Given the limitations of such data, a “common weakness of the existing literature is that most studies have been based on surgeon impressions of outcome, as opposed to patient satisfaction”

Other concerns
Prenatal Treatment

Dexamethasone, a steroid, is used to prevent homosexuality and physical “virilization”in infants with CAH assigned female. This is defended as a means of preventing post--‐natal elective surgical treatments, and is considered to be of greater benefit than established cognitive and physical risks to the children exposed to such treatment. Dexamethasone treatment does not address the more critical issue of salt wasting associated with CAH, an issue which may necessitate urgent medical attention to ensure the health of an infant. Genital variation is seen as a social emergency.

Sterilization

Sterilization is a consequence of treatment rationales related to tumor risk. The fertility of persons with intersex variations is not valued in the same way as that of other persons – and sterilizations may not be viewed as such if a child’s capacity for fertility does not match a gender assignment or reassignment removing a person’s only route to biological parenthood.

I hope some gentile persuasion can be brought to bear on this and a rushed decision is not enter into on the part of the mother for this baby; Dr Gabay did say in the video that the department which he is a part sees on average five to six cases per year.

What isn’t intersex ?

A point from OII Australia with whom I totally support:

INTERSEX is not a sexual orientation. Although nearly all intersex have a sexual orientation, we are no different to other people in this. It is unknown if our intersex influences our sexual orientation and intersex resist efforts by researchers who seek to link the two. We do this because we hold the view that it is a back door way to find the gay gene. We hold the view that this effort is essentially homophobic.

Peace & tolerance

H