Double standards, the medical approach, and self-determination: A discussion on intersex people
Is the medical framework for activism an appropriate or effective approach to securing self-determination and autonomy for intersex people? Not everyone is convinced.
I interviewed someone this week who works as an educator and advocate for intersex people here in Germany, and our conversation brought up quite a few points related to current discussions around trans health care, self-determination, and the medical approach to advocacy and social change.
We talked about the double standard of people who spread panic about genital surgeries on trans children –– which are not happening –– yet remain silent on the issue of intersex genital surgeries, often performed on infants and young children in an effort to make their external sex characteristics conform to societal expectations. There are reports (including an explainer on intersex people from the Cleveland Clinic) that show that these surgeries, which are often medically unnecessary, can cause scarring, infertility, and impaired sexual function later in life.
Of course, opinions are not entirely singular in the medical community or in the intersex community; a 2018 article by NBC News discusses the fact that sometimes, surgery is necessary to allow urinary function, and some intersex people are satisfied with the fact that their parents chose cosmetic surgery at birth.
Here in Germany, cosmetic surgeries for intersex children have actually been banned since 2021, though there are loopholes and ways to get around the ban. In the U.S., a lawmaker in California attempted to pass a ban in 2020, 2021, and again in 2022, but it has yet to pass. No other U.S. state currently limits surgical measures on intersex children.
But the main issue, as this educator/activist and I discussed, stems from the lack of autonomy given to these intersex children; their consent is not given for medical interventions and cosmetic surgeries, and it’s a violation of their human rights. The key here is that intersex activists want self-determination, much like trans activists in the U.S. and Germany.
Perhaps the most conceptually relevant part of our discussion (to my work) centered around the question of whether the medical approach to advocacy would work for intersex people.
When we look at the first German homosexual emancipation movement’s approach to medical advocacy, for example, activists and doctors alike focused on the argument that it was precisely because homosexuality was normal and natural that it should not be criminalized. Homophile activists in the 1950s and 1960s in West Germany used similar arguments: because we are normal, just like heterosexuals, we should not be punished for our identity.
And this first German movement’s pushes to decriminalize homosexuality were almost successful; the German parliament was considering decriminalization in the late 1920s, but when global markets crashed on Black Friday, the economic situation opened the door for radical political parties –– in this case, national socialism, which had been growing in influence for years beforehand –– and the changes never materialized. When the Nazis were elected to power, in fact, they strengthened legislation punishing homosexuality and persecuted thousands of homosexual men.
But seeing as intersex is such a medicalized (and often pathologized) issue, could the medical approach work here? We can look at natural variation in animals, just like Karl Heinrich Ulrichs did to confirm the “natural character of same-sex eroticism,” as Robert Beachy argues in Gay Berlin. We can deconstruct how we define sex –– is it just based on external genitalia at birth? If it’s more about chromosomes, why aren’t we testing every infant’s chromosomes? Is it about hormones, or secondary sex characteristics? –– and we can acknowledge the natural variations that occur in humans, from people with XXY chromosomes to people with hormonal variations.
Some, including the activist/educator to whom I spoke this week, are not convinced that the medical establishment will liberate intersex people. Others, including a social scientist and representative from a museum here in Germany, are skeptical about the medical approach as a whole, which implies a human-rights framework centered on proving the normality of queer and trans folks in an effort to gain rights, as opposed to a queer liberationist one, which focuses on the inherent worth of human beings.
And when we look to the past for hints about research into intersex people in Germany, we run into a major challenge: terminology. As I have mentioned, Geschlecht is a German word that incorporates aspects of gender, sex, and sexuality into one concept –– so when we’re looking at scientific arguments during the first homosexual emancipation movement, for example, that language does not always translate into today’s terms.
As someone who is not intersex, I cannot make the call on what framework to use. I think it makes for an interesting comparison between the homosexual/transvestite liberation attempted in the early 1900s, but ultimately, the medical system continues to cause harm to intersex people today. What I can do (and what we can all do) is listen to the voices of intersex groups in the U.S. and in Germany and back them in their calls for self-determination and autonomy, and we can encourage folks to include intersex people in their pushes for queer liberation.
Further reading:
Germany bans surgeries on intersex babies, but loopholes feared
Gay Berlin: Birthplace of a Modern Identity by Robert Beachy
'You can't undo surgery': More parents of intersex babies are rejecting operations
Intersex explainer by the Cleveland Clinic
"History isn't something you look back at and say it was inevitable, it happens because people make decisions that are sometimes very impulsive and of the moment, but those moments are cumulative realities." - Marsha P. Johnson