Indrajith Kamalanathan

When we discuss SDG number 5, Gender Equality, the conversation is mostly focused on the inequality of women and men. What come to mind are the wage gap or the different role distribution in society. But one quickly forgets that according to the latest research, the term gender is not limited to only male and female, as others like inter-, transsexuality and more have been added. However, surgeries on intersex children to create male or female features are still a common medical intrusion around the world, which can leave life-long physical and psychological damage on affected people.

The biological background

On one hand there are arguments for the binary sex identity in religious contexts, such as the Bible. God created two sexes, man and woman, Adam and Eve. “Adam was created with two bodies, one of which was cut away from him and formed Eve” (F. H. Bradley, Aphorisms, no. 94 (1930)).

On the other hand, there is society, which mainly believes in the binary terms because of obsolete genetic theory, which says that only the two chromosomes X and Y determine the sex. Men have the XY combination and women the XX. Every human embryo in the first weeks of its development has the potential to become a female or a male. Moreover, the old theories assumed that female development was based on a “passive program” while the male development was “active”, which determined the existence the Y-chromosome . However, more recent research arouses a much-varied image. It is concluded that the definition of the sex is much more complicated and that genes from the X-chromosome also contribute to it.

“These discoveries have pointed to a complex process of sex determination, in which the identity of the gonad emerges from a contest between two opposing networks of gene activity. (…) In the activity or amounts of molecules, the networks can tip the balance towards or away from the sex.” (Claire Ainsworth)

There is a complex balance between both systems and there are many genes on both chromosomes defining the outcome. This discovery completely changed the point of view in biological science.  Now, it is not only a turning on or off some gene on the Y chromosome, but it seems like a battle of the systems. Therefore, it is natural that combinations from both systems can result in an “intersex”, which has both female and male characteristics. These results explain the existence of intersexuality as a natural process and not as a disorder. Based on these theories, the opportunity for endless combinations of sexes is possible. “That’s often a very difficult problem because sex can be defined a number of ways.” (Arthur Arnold)

This is only the genetic part, and there are many more possibilities in the development of an identity, which are organized post systematically. Several sexes are determined by changes in response to hormonal signals and not only the genetixs. As an example, some people have Y-chromosomes and internal testes, but their external genitalia are female, which is why they develop as females.

Figure 13.1 – Illustration by Jonny Wan

Surgery on intersex children and the consequences

All the above raises the question: Why are these discoveries important?
In our society non-cisgender people don’t have the same rights as those perceived as normal. In this case, a lot of the intersexuality movements fight against the harmful surgery on intersex children. Even in the western world, such surgery is the standard medical intervention after the birth of an intersex baby, even if only 1.7 percent of the new-borns in the USA do not match the expectations of their assigned sex. United Nations for Human Rights have defined such surgery as a human rights violation and recommend the countries to ban this kind of mutilation. In a 2013 report, the United Nations special rapporteur on torture noted that:

“Children who are born with atypical sex characteristics are often subject to irreversible sex assignment, involuntary sterilization, involuntary genital normalizing surgery … leaving them with permanent, irreversible infertility and causing severe mental suffering. “

In conclusion, biologists construct a more various view of sex, but society has yet to catch up. In first case the discrimination and mutilation on intersex children and people must stop.

Figure 13.2 – End Intersex Surgery at Lurie Children’s Hospital

References

Claire Ainsworth. (2020, 18.02.2015). Sex redefined. Last call 31.03. Last Update 18.02.2015. Website: https://www.nature.com/news/sex-redefined-1.16943

Jorge Ponseti, Aglaja Stirn. (2019). How Many Sexes Are There and Is It Possible to Change Them?, Georg Thieme Verlag KG Stuttgart · New York. Website: https://www.thieme-connect.com/products/ejournals/pdf/10.1055/a-0978-7137.pdf

HRW. (2020, 25.07.2017). US: Harmful Surgery on Intersex Children. Last call 31.03. Last Update 25. 07. 2017. Website: https://www.hrw.org/news/2017/07/25/us-harmful-surgery-intersex-children