Thousands of babies around the world are born each year without a sex-specific chromosome count, and that may have male or female genitalia – or a mix of both. Germany's top ethics board is deciding if such 'intersexuals' should
When Diana Hartmann was born in 1965, doctors couldn't answer the question: "Boy or girl?" The child was healthy, but, said the doctors, its sex was "unclear." Diana was somewhere on the scale between the two poles of man and woman. The doctors decided Diana should be a boy, but her mother saw a little girl in the infant – hence the name Diana. The doctors wanted to operate; her mother refused.
Hartmann's case isn't unique: every year, it is estimated that between 80 and 120 "intersexual" children are born in Germany. They don't have a sex-specific chromosome count, their hormones function differently than those of most people, and they may have male or female genitalia – or a mix of both. In a society where so much is dealt with based on firm distinctions between both genders, uncertainty in this regard causes a great deal of confusion among parents, doctors, and the authorities.
Since December 2010, the German National Ethics Council, mandated by the federal government, has been considering how they could ensure that these children live with dignity. They have been consulting with experts from the medical, legal and social science communities, as well as intersexuals themselves, and are due to publish their report in the coming weeks.
The two main issues are whether a "third sex" should be introduced, and whether operations to make intersexuals male or female should be performed – and, if so, at what age and under what conditions. In the past, intersexual children were operated on in their first year, the assumption being that to assign them to the male or female sex early on would prevent trauma down the line. The practice continues to this day.
Professor Olaf Hiort of the Schlweswig-Holstein University Clinic, a specialist in sexual development, believes guidelines need to be drawn up and special centers established to provide both guidance and information for doctors and the parents of intersexual children.
Medical historian Ulrike Klöppel of Berlin's Humboldt University points out that research up to now has been based on people born intersexual but then operated on to become male or female. "It should have been the other way round," she says. "The question should have been: ‘Do intersexuals who haven't been operated on have a poorer life experience?"" Klöppel believes that concerns should focus on what they believe would be helpful in their lives: "That would be scientific. The way things are now, it only goes in one direction and leaves no room for evidence against the prevailing approach."
Diana Hartmann also believes more information would be crucial – not for the purposes of medical treatment but to open up the subject of sex, sexuality and intersexuality. Nearly everybody, she believes, has some kind of problem with their appearance or their sexuality – "nobody can say ... I'm absolutely normal." That's why she has a lot of reservations on the subject of introducing a "third sex." Hartmann worries that it could just lead to yet further isolation for intersexual people. "Who belongs to a third sex? Who belongs to a first one, or a second one?"
Presently under German law, a child's particulars including gender – boy or girl – have to be registered within a week after birth. There can be extensions in exceptional cases, but not until a child reaches puberty. For this reason, many favor introducing a third box to check next to male/female – but what should it read?
Medical historian Klöppel would like to see the requirement to list sex dropped, or at least postponed so that everybody can decide for themselves what sex they want to be. For his part, Olaf Hiort thinks that it would make sense to determine under which conditions a division into two genders makes sense -- and when it doesn't.
"Is the baby healthy?" is usually the first question asked after a birth. But the second one – "Boy or girl?" – might be phrased differently in the future. Or be dropped altogether.
Read the full story in German by Danielle Bengsch
Photo - kristin_a
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