The Congress finds the following:
(1)
Individuals with variations in their physical sex characteristics may present with differences in genital anatomy, internal reproductive structures, chromosomes, or hormonal variations. “Intersex” refers to the variety of different physical indicators that create those differences. As many as 1.7 percent of babies are born with physical sex characteristics which do not conform to the expectations for a typical male or female. The vast majority of babies born with these variations do not require surgical intervention related to their physical sex characteristics immediately, if at all.
(2)
Beginning in the 1950s physicians in the United States began performing irreversible surgeries (often referred to as genital-normalizing surgeries) on infants with variations in their physical sex characteristics without medical justification.
(3)
As many as two-thirds of these irreversible surgeries occur on infants under the age of two. A literature review of genital surgery conducted on children with variations in their physical sex characteristics published in the Journal of Steroid Biochemistry and Molecular Biology found that between 2005 and 2012 the average age of patients was 11.2 months old and the median age was 9.9 months at initial surgery.
(4)
These surgeries, which include unnecessary infant vaginoplasties, clitoral reductions and recessions, and removal of gonadal tissues, are often performed before a child can even speak or stand, meaning the individual is excluded from the decision whether to undergo these irreversible procedures.
(5)
There is evidence that these surgeries cause severe psychological and physiological harm when performed without the informed consent of the individual. These harms may include scarring, chronic pain, urinary incontinence, loss of sexual sensation and function, sterilization, depression, post-traumatic stress disorder, suicidality, and incorrect gender assignment.
(6)
A number of domestic and international human rights organizations have conducted thorough inquiries into genital surgeries on infants with variations in their physical sex characteristics and have concluded that these procedures are cruel and catastrophic, as follows:
(A)
The United Nations Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment explained in 2013, “children who are born with atypical sex characteristics are often subject to irreversible sex assignment, involuntary sterilization, involuntary genital normalizing surgery, performed without their informed consent, or that of their parents, “in an attempt to fix their sex,” leaving them with permanent, irreversible infertility and causing severe mental suffering.”.
(B)
The United Nations High Commissioner for Human Rights explained in 2015, “medically unnecessary surgeries and other invasive treatment of intersex babies and children … are rarely discussed and even more rarely investigated or prosecuted. … The result is impunity for the perpetrators; lack of remedy for victims; and a gap between legislation and the lived realities of intersex people.”.
(C)
The World Health Organization explained in 2015, that children with variations in their physical sex characteristics have been “subjected to medically unnecessary, often irreversible, interventions that may have lifelong consequences for their physical and mental health, including irreversible termination of all or some of their reproductive and sexual capacity. … Human rights bodies and ethical and health professional organizations have recommended that free and informed consent should be ensured in medical interventions for people with intersex conditions, including full information, orally and in writing, on the suggested treatment, its justification and alternatives.”.
(D)
Physicians for Human Rights has “call[ed] for an end to all medically unnecessary surgical procedures on intersex children before they are able to give meaningful consent to such surgeries.”.
(E)
Human Rights Watch concluded that these surgeries are “often catastrophic, the supposed benefits are largely unproven, and there are generally no urgent health considerations at stake. Procedures that could be delayed until intersex children are old enough to decide whether they want them are instead performed on infants who then have to live with the consequences for a lifetime.”.
(7)
Intersex advocacy groups led by individuals with variations in their physical sex characteristics themselves advocate for the postponing or banning of these surgeries, as follows:
(A)
Those subjected to surgery to alter their variations in sex characteristics at a young age express despair over the fact that they were unable to make these decisions for themselves, publishing about their experiences in major news outlets: “I know firsthand the devastating impact [these surgeries] can have, not just on our bodies but on our souls. We are erased before we can even tell our doctors who we are. Every human rights organization that has considered the practice has condemned it, some even to the point of recognizing it as akin to torture.”.
(B)
Young people born with variations in their physical sex characteristics who have been able to participate in these life-altering decisions are thriving, such as a young California resident with variation of sex characteristics who was not forced to undergo surgery in infancy and instead participated in the decision at the age of 16. They told reporters that for them, surgery “was the right choice, but that’s very much an anomaly for intersex people. … The important thing was that I was old enough to make that decision for myself.”.
(8)
The United States Department of State has acknowledged Intersex Awareness Day in both 2016 and 2017 by recognizing the harm of these surgeries. In both years the Department released statements recognizing that “at a young age, intersex persons routinely face forced medical surgeries without free or informed consent. These interventions jeopardize their physical integrity and ability to live freely.”.
(9)
In light of ongoing advocacy by the intersex community, in 2005 the San Francisco Human Rights Commission performed an investigation into this topic and issued an in-depth report, recommending that ““normalizing” interventions should not occur in infancy or childhood. Any procedures that are not medically necessary should not be performed unless the patient gives their legal consent.”.
(10)
Physicians who have participated in these surgeries have also expressed remorse that their training did not properly prepare them to respect the bodily autonomy of people born with variations in their physical sex characteristics. As a Stanford-educated urologist explains: “I know intersex women who have never experienced orgasm because clitoral surgery destroyed their sensation; men who underwent a dozen penile surgeries before they even hit puberty; people who had false vaginas created that scarred and led to a lifetime of pain during intercourse … the psychological damage caused by intervention is just as staggering, as evidenced by generations of intersex adults dealing with post-traumatic stress disorder, problems with intimacy and severe depression. Some were even surgically assigned a gender at birth, only to grow up identifying with the opposite gender.”.
(11)
When the physical health of an infant born with variations in their physical sex characteristics is threatened and medical attention cannot be safely deferred, all therapeutic treatment options should remain available to children, families, and medical professionals to ensure that the imminent physical danger is addressed.
(12)
The United States should serve as a model of competent and ethical medical care and has a compelling interest in protecting the physical and psychological well-being of children, including those born with variations in their physical sex characteristics.