Treatment of intersex children

Parents face many ethical dilemmas, but one of the most difficult (and controversial) can be when parents have an intersex child: a child who has a disorder of sexual development (DSD). Collectively, there are more than 60 conditions that can cause DSDs.

While each affects the body differently, they can cause a person with male or female chromosomes to have genitalia that appears to be of the opposite gender or is ambiguous. These conditions can make it difficult to identify a baby as male or female and have sparked controversy over what truly makes a person male or female.

Although surgical treatments are available, treatment decisions are difficult for parents and doctors because the issue isn’t purely medical—there are ethical and personality components involved that might not be immediately apparent. For example, some parents may choose to assign a particular gender to a newborn who displays both male and female genitals. The goal is to provide a child with a gender identity and to avoid growing up uncertain of gender and sexual development. There is a chance, however, that the parents and their doctors will assign the child the “wrong” gender or one they won’t identify with as they grow older. Because of this possibility, some medical experts and parents argue that a child should be allowed to choose a gender when the child is older.

If treatment will be pursued, there are medications that can help regulate hormones and surgery to remove abnormal sex organs or construct/re-construct sex organs. Treatment often involves many specialists, including child psychology, genetics, pediatric endocrinology, pediatric urology, nursing, and social work.

Medications

Some children with DSD may require medications to correct hormone or electrolyte imbalances. This is true for congenital adrenal hyperplasia, one of the most common DSD types. This condition affects the body’s ability to produce electrolyte-regulating hormones while also overproducing male hormones.

Surgery

Surgery options can include removal of “excess” or malformed sexual organs, such as removing an ovary in a child with a male gender assignment or testes in a child with a female gender assignment. Such removal is not always medically necessary. However, some malformed sexual organs can increase the risk for certain cancer types.

Other surgeries are intended for cosmetic or reconstructive purposes. This includes surgeries that may make ambiguous sexual organs more closely resemble a male or female. While the organs may physically appear more like a man or woman’s, they may not always be functioning or retain the same sensitivity. Sometimes these surgeries require repeat operations to achieve the desired result.

Support groups for intersex children and parents of intersex children are available nationwide as a means to help families dealing with these difficult decisions and conditions.

Reviewed by Dr. Sara Connolly, January 2020