Boston Children’s Hospital Will No Longer Perform Two Types Of Intersex Surgery On Children

A top pediatric hospital in Boston has agreed to stop performing certain types of genital surgeries on intersex children if they are too young to meaningfully consent.

The decision came from the Boston Children’s Hospital’s behavioral health, endocrinology, and urology program. A spokesperson for the hospital told the 19th that it “will not perform clitoroplasty or vaginoplasty in patients who are too young to participate in a meaningful discussion of the implications of these surgeries unless anatomical differences threaten the physical health of the child.”

Every year, almost 1.7 percent of people are born intersex or are born with sexual or reproductive anatomy that doesn’t align into the binary of male or female. Some people develop these anatomical traits in adolescence or childhood, while others are born with them.

Over the years, the standard medical protocol was to use surgery and hormonal therapy to try to change intersex children’s physical appearance. Clitoroplasties, the surgical creation of a clitoris (which can involve reducing its size), and vaginoplasty, which involves constructing a vagina, are the two such surgeries.

Even though the surgeries are legal worldwide, activists have been protesting these practices for decades, they have been condemned by the United Nations, Amnesty International, and Human Rights Watch.

Activists say Boston’s Children’s Hospital could reflect a turning point, in July, Ann and Robert H. Lurie Children’s Hospital of Chicago took a similar move and suspended intersex surgeries.

Pidgeon Pagonis, the co-founder of the Intersex Justice Project, said “One hospital was cool, but people might be like, ‘Oh, that’s an anomaly.’ Now that there are two hospitals, people in the community are going to feel more ability to pressure their hospitals to do the same.” He said that in other major cities like New York, Seattle, Philadelphia, Los Angeles, and Oklahoma City, advocates are pushing for similar changes.

New York City Human Rights Commissioner Carmelyn Malalis and former health commissioner Oxiris Barbot also have spoken out against performing intersex surgeries on children.

Still, The hospital hasn’t considered dropping other intersex surgeries, including gonadectomies, which constitute the removal of certain reproductive glands, or phalloplasties, which enlarges the penises.

“Vaginoplasties and clitorectomies are very destructive, and it’s very welcome news,” Pagonis said. “But it means there’s still more work to do.”

Some of the consequences of intersex surgeries include loss of sexual sensation, incontinence, fertility problems, and pain during intercourse. Some of the physical consequences of intersex surgeries can have a lifelong psychological impact.

IJP co-founder Sean Saifa Wall mentioned that there are some circumstances when surgery can provide benefits, like if a child is unable to pass urine, but that isn’t likely. In a 2017 report authored by three former U.S. Surgeons General, they noted little benefit to conducting genital surgery on children.

Wall said, “the level of hypervigilance, of just trauma, the emotional and mental health trauma is lifelong.” He added, “we can lessen the potential psychological and physical trauma.”

Wall said he hopes Boston’s shift spurs change, not only from other hospitals but from insurance companies and lawmakers as well, so that it is not mandatory for activists to pressure their individual medical providers.

Recently, state lawmakers in California, New York and Connecticut have suggested bills to halt intersex surgeries, though none have become law.

“We need legislation with teeth,” Wall said. “We need legislation that is actually going to say that these surgeries cannot be done on children unless the medical providers can prove these surgeries are necessary.”

Boston Children's Hospital
Image Credit: Boston Children’s Hospital

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