Press Release:: 4/10 Children Treated for Intersex Develop Psychological Disorders

Classification: News

Press Release: 1 May 1998

Four out of ten children treated for intersexuality develop psychological disorders, according to a Dutch team which followed 59 children. In a recent issue of Archives of Sexual Behavior, FME Slijper et al report on treatment of psychological problems in a population of 59 children with a variety of intersex conditions. 44 were assigned female; 5 male. All those with ambiguous genitalia were subjected to genital surgery.1 The abstract notes that “Despite the sex assignment, genital organ correction soon after birth, psychological counseling of parents and intensive psychotherapy of children, general psychopathology developed equally (39%) in all four groups [ie, CAH assigned female, those with testes or ovotestes and ambiguous genitalia assigned female, those with testes and female genitals assigned female, and those with testes and ambiguous genitalia assigned male].”

In what seems to this reviewer a shocking lapse of responsibility on the part of authors and editors or peer reviewers, Slijper et al mention Diamond and Sigmundson’s enlightened guidelines for management of intersexuality in such a way as to utterly misrepresent their work and to dismiss it. “Diamond is of the opinion that sex assignment and genital surgery should be delayed until the child can decide for itself. This means the child should neither be raised as a boy nor a girl, but as an intersex person,” asserts Slijper et al.2 But Diamond’s paper, though it counsels against irreversible and medically unnecessary surgery on infants, consists in the main of extensive and detailed guidelines for how to decide which sex to assign to a large number of intersex etiologies. Diamond even emphasizes “In rearing, parents must be consistent in seeing their child as either a boy or a girl; not neuter.” This reader suspects that Slijper et al have never read Diamond.

In light of the swelling population of former patients who condemn genital surgeries as sexually mutilating, it is unfortunate that this paper does not present information on the patients’ sexual behavior or their satisfaction with sexual function. They do note, however, that early vaginoplasty and requisite vaginal dilation appeared to lead to severe psychological problems, because they were experienced as a violation of bodily integrity. They also found that surgeons seemed to have much more positive evaluations of surgical results than did patients or even parents—genital anomalies were not rendered invisible by surgery. Slijper et al conclude with a call for a reconsideration of the sex assignment in children born with ambiguous external genitalia and testes or ovotestes. Unfortunately, they reject the notion of allowing patients to decide for themselves what genital surgery, if any, is best. In considering assigning a larger number of infants with ambiguous genitals male, they immediately move to an optimistic evaluation of prospects for phalloplasty on infants.

1 Slijper, Froukje M. E., Stenvert L. S. Drop, Jan C. Molenaar, and Sabine M. P. F. de Muinck Keizer-Schramer. 1998. Long-term psycho-logical evaluation of intersex children. Archives of Sexual Behavior 27 (2):125-144.

2 Diamond, Milton, and H. Keith Sigmundson. 1997. Management of Intersexuality: Guidelines for dealing with persons with ambiguous genitalia. Archives of Pediatrics and Adolescent Medicine 151:1046-1050.