Cheryl Chase's blog
Vaginal surgery generally requires a kind of post-operative care called “vaginal dilatation.” After surgery, the tissue tends to get smaller while healing. In order to keep the vaginal opening from closing up, the patient (or her mother or a doctor, in the case of an infant or child) is instructed to insert an object into the vagina, pressing against the scar tissue, on a regular basis.
When performed on a child, vaginal dilitation can be emotionally scarring for both child and parent. This is one reason why many experts recommend that vaginal surgery not be performed on children with DSDs (Disorders of Sex Development) — rather, it should be made available to patients who are at least adolescent, who can understand the reasons for the procedure, and who can do the necessary vaginal dilitations themselves (if the patient is not motivated to do this, then the surgery should obviously not be performed). The surgeon’s argument that vaginoplasty can be completed with a one-stage procedure on an infant has been roundly refuted — follow up surgery will almost always be required as the patient enters adolescence. Avoiding vaginal surgery on infants and children also allows for the patient (as an adolescent or adult) to try manual pressure dilation, which has been quite successful for many women who escaped vaginoplasty.
Today the San Francisco Human Rights Commission issued A Human Rights Investigation into the Medical ‘Normalization’ of Intersex People, declaring that the standard medical approach to intersex conditions leads pediatric specialists to violate their patients’ human rights.
“In issuing this report, the San Francisco Human Rights Commission has essentially declared me a human being,” said Cheryl Chase, Executive Director of ISNA. “They have agreed that I—and children born like me—deserve the same basic human rights as others.” Chase, who was born with mixed sex anatomy internally and externally, went on: “No longer should we be lied to, displayed, be injected with hormones for questionable purposes, and have our genitals cut to alleviate the anxieties of parents and doctors. Doctors’ good intentions are not enough. Practices must now change.”
On Jan. 18, 2005 NBC aired an episode (“Identity”) of Law & Order SVU closely mimicking David Reimer’s story (“the John/Joan case”) as a plot, right down to a vaporized penis, quotes like “easier to dig a hole than build a pole,” secrets and lies and a very unsavory representation of a doctor implicitly modeled after John Money. (Note that John Money is actually a psychologist, not a medical doctor.) If you see it pop up on the tv schedule in re-runs (often on the USA Network), check it out.
But does the Urology Department listen to the Psychiatry Department?
“For children with birth defects the most rational approach at this moment is to correct promptly any of the major urological defects they face, but to postpone any decision about sexual identity until much later, while raising the child according to its genetic sex. Medical caretakers and parents can strive to make the child aware that aspects of sexual identity will emerge as he or she grows. Settling on what to do about it should await maturation and the child’s appreciation of his or her own identity.”
Paul McHugh is University Distinguished Service Professor of Psychiatry at Johns Hopkins University.
The Casper Wyoming Star Tribune is carrying an article about Miki Ann Dimarco. Early this year, a U.S. District Court judge found that 438 days of confinement in Pod Three, a maximum security four-cell segregated area that is used to house the Wyoming Women’s Center worst inmates, was not cruel an unusual punishment. Dimarco was found guilty of passing six bad checks, totalling $742.85. That’s not why she was confined all alone for over a year. Rather, prison officials decided to segregate her when they discovered that she was intersexed.
Dusen, Matthew Van. 2004. Separate and Unequal. Casper Star Tribune, December 8. Available online.
Intersex children must be protected from temptation of parents to ‘fix’ them surgically.
December 01, 2004
By Wendell Roelf
A law on corrective surgery for children with ambiguous genitals - intersex children - was under consideration, the SA Human Rights Commission said yesterday.
“We are looking at the practice of surgery; do we need legislation to regulate this area, who should decide, when must the decision be taken?” said Judith Cohen, parliamentary officer for the commission.
The commission held a seminar on intersex children yesterday, asking whether gender “normalisation” surgery was in the best interests of the child.
The American Society of Plastic Surgeons, the largest organization of plastic surgeons, has not yet started tracking how many doctors are making “gynecologic cosmetic care” or “vaginal rejuvenation” their specialty, but notes that anecdotal evidence suggests demand for genital procedures is growing rapidly.
In her early 30s, Betsy Driver learned why she had never felt totally comfortable in her high school locker room.
When she four months old, Driver’s doctors removed her entire clitoris because it was unusually large for a baby girl, and, following doctor’s orders, her mother never told her. As a teenager, Driver never fully developed breasts and had to undergo a second surgery to reconstruct a vagina that was never there in the first place …
Llerena, Kim. 2004. Living in between, but no longer living in silence. Washington Square News, October 26.
Paediatric and Adolescent Gynaecology : A Multidisciplinary Approach. Essentially an intersex textbook with a significant emphasis on psychological care (and on issues such as psychological support) with chapters by clinical psychologists like Lih-Mei Liao, Julie Alderson and Polly Carmichael.
Balen, Adam H., Sarah M. Creighton, Melanie C. Davies, Jane MacDougall, and Richard Stanhope, eds. 2004. Paediatric and Adolescent Gynaecology : A Multidisciplinary Approach: Cambridge University Press.