Boy or Girl? Probably!

[El Greco]

Even if only because a large body part is easier to operate on than a small one. Am I wrong about this?

There is no way to answer that in a definite way. Every case is different, but the results of an operation can be predicted rather well. When the result of the operation is expected to be the same, an early operation is preferable since the child will have no memory of it.

What dictates the time of an operation in such cases, is the frequently coexistent urological problems. In a male with hypospadias for example, an operation is always performed asap simply because they don't want the child to have to sit in order to pee when it goes to school.

 

[Earthborn]

Every case is different, but the results of an operation can be predicted rather well.

Someone's gender identity later in life cannot be predicted so easily and kids are turned into one sex or another, possibly removing the tissue that fits their identity best.

When the result of the operation is expected to be the same, an early operation is preferable since the child will have no memory of it.

A child may not have any memory of it, but it does end up with an often insensitive non-functional sexual organ for the rest of its life, and it may need several other operations later on.

What dictates the time of an operation in such cases, is the frequently coexistent urological problems.

Of course any urological problems should be corrected as soon as possible. Nobody is disputing that. The issue here is: why go any further?

simply because they don't want the child to have to sit in order to pee when it goes to school.

So having to sit down to pee is a urological problem? Geez!

 

[El Greco]

Please, read more carefully what I write.

Someone's gender identity later in life cannot be predicted so easily and kids are turned into one sex or another, possibly removing the tissue that fits their identity best.

I didn't say that gender identity can be predicted. I said that the results of an operation can be predicted. As for the gender, in most cases it is an easy choice for the doctor since there are extremely few cases where genitalia of bothe sexes are developed equally well.

A child may not have any memory of it, but it does end up with an often insensitive non-functional sexual organ for the rest of its life, and it may need several other operations later on.Of course any urological problems should be corrected as soon as possible. Nobody is disputing that. The issue here is: why go any further?

Because most times the correction of serious urological problems requires the reconstruction or amputation of genitalia.

So having to sit down to pee is a urological problem? Geez!

Second strawman in the same post. What I said is that hypospadias is an urological problem. Didn't I ? Let me read my post again. Yes, I did.

As for sitting down to pee, it is indeed both an urological and a devastating psychological problem if you are a MALE, as I clearly stated in my previous post.

If you understand better what I'm saying now, I'd be happy to browse Smith's General Urology which I have right here for any other clarification.

 

[BillyJoe]

Okay, so tell me... What is it?

If the operations were perfect and people ended up with normal looking and functional genitalia, then maybe yes: that might be possible. It would mean that some of them could live normal lives and not need to ever make such a decision.

The problem is, these operations are far from perfect.

Sorry, I thought we were considering situations in which operations are needed and deciding whether they should be performed during childhood or adulthood.

Yes, that is what I'm saying. Even if only because a large body part is easier to operate on than a small one. Am I wrong about this?

Not having much success googling for the timing of surgery for hermaphroditism. I found the following which perhaps supports your view.... Unilateral Cleft Nasal Repair: Timing

Some surgeons believe that early nasal surgery (1) interferes with growth, resulting in nasal hypoplasia; (2) introduces scars, making secondary correction difficult; (3) damages infantile cartilage; and (4) makes repair technically harder because of the small size of the nose and immature cartilage (LaRossa, 1993).

Still, that is Cleft Nasal Repair and the opinion of "some surgeons"

 

[Earthborn]

As for the gender, in most cases it is an easy choice for the doctor

An easy choice? Have you been paying attention? Real intersexed people don't think it is an easy choice (even for themselves)!

since there are extremely few cases where genitalia of bothe sexes are developed equally well.

This is true, but irrelevant.

Because most times the correction of serious urological problems requires the reconstruction or amputation of genitalia.

I doubt that. And even if true, it doesn't seem necessary to me to 'lock' someone into a specific gender.

As for sitting down to pee, it is indeed both an urological and a devastating psychological problem if you are a MALE, as I clearly stated in my previous post.

It is not a urological problem and if it causes a psychological problem it is only because of the gender segregation in society.

Instead of adressing the real societal issues let's chop of pieces of babies until they fit into our culture.

I'd be happy to browse Smith's General Urology which I have right here for any other clarification.

Okay, so how often is intersexuality accompanied with urological problems, and how are those problems defined?

 

[Earthborn]

That doesn't really explain it, does it?

Whatever the reason, I am sure the problem could be solved with more privacy, which would be a good idea for a number of other reasons too.

Sorry, I thought we were considering situations in which operations are needed and deciding whether they should be performed during childhood or adulthood.

No, we are talking about early childhood sex(re)assignment, not medically necessary surgery.

Not having much success googling for the timing of surgery for hermaphroditism. I found the following which perhaps supports your view.... Unilateral Cleft Nasal Repair: Timing Still, that is Cleft Nasal Repair and the opinion of "some surgeons"

Now imagine that happening on body parts that are packed with bloodvessels and nervous tissue and that waits 12 years before it really begins to grow.

 

[El Greco]

It is not a urological problem and if it causes a psychological problem it is only because of the gender segregation in society.

So, sitting down to pee when you are a male with hypospadias is not an urological problem ? Ok, I'll do my best to convince the hundrends of thousands of urologists around the world who believe it is

Okay, so how often is intersexuality accompanied with urological problems, and how are those problems defined?

This is again extremely general. With "intersexuality" we usually refer to many more conditions than the ones we could operate on, like Klinefelter syndrome where male genitalia are almost normal.

Other cases (like cloacal exstrophy) are always having numerous urological problems where multiple surgeries and sex assignment are mandatory.

But what's important to understand is that most cases of hermaphrodites are not truly ambiguous, meaning that in the majority of cases have to do with a boy gone wrong (undervirilized males) or a girl gone wrong (virilized females). Early operation is decided simply because it is only possible for such individuals to function as a certain sex (I'm talking in the physiological level, if a man decides he wants to be a woman or vice versa, this is another story).

In the most common cause of hermaphroditism, Congenital Adrenal Hyperplasia, we have XX individuals capable of having children of their own. So, reconstructive surgery is usually performed very early because in the vast majority of cases these individuals could only function as women.

In cases of true hermaphroditism and when no health concerns are present, the parents can decide to wait until puberty so that the child can decide for him/herself. Then of course, they don't know how to raise the child. How are they going to dress it, how are they going to answer questions, how are they going to deal with problems in school etc.

 

[El Greco]

Instead of adressing the real societal issues let's chop of pieces of babies until they fit into our culture.

This is an outrageous comment to make in response to my refering to hypospadias. It shows that you are completely ignorant. Would correcting a heart defect in an infant be classified as "chopping babies" ?

 

[Earthborn]

Would correcting a heart defect in an infant be classified as "chopping babies" ?

If the heart defect is threatening the life or health of the child, it is necessary and then 'chopping babies' maybe justified because the alternative is far worse.

This is not usually the case with hypospadias:

Our discussions with men who have had hypospadias surgery lead us to believe that the physical damage and emotional trauma of genital surgery are frequently far worse than the hypospadias itself.

From here

So, reconstructive surgery is usually performed very early because in the vast majority of cases these individuals could only function as women.

So allow them to function as women, without 'reconstructive' surgery just because their genitalia look different.

But what's important to understand is that most cases of hermaphrodites are not truly ambiguous, meaning that in the majority of cases have to do with a boy gone wrong (undervirilized males) or a girl gone wrong (virilized females).

Yes, this is true. It is also irrelevant. No matter whether they are truly ambiguous or not, intersexed people are more likely to change their assigned gender later on. And even if they don't transition, the surgery in early childhood is often unnecessary.

How are they going to dress it, how are they going to answer questions, how are they going to deal with problems in school etc.

Those are societal problems, which can't be solved with surgery. All parents can do is chose a gender the best they can, tell their child that there is nothing wrong if it choses a different one, and these parents and child should get all the support they need.

 

[Earthborn]

[No message]

 

[El Greco]

Originally quoted by Earthborn
Our discussions with men who have had hypospadias surgery lead us to believe that the physical damage and emotional trauma of genital surgery are frequently far worse than the hypospadias itself.

"Intersex Society" ? I'd guess they would be rather biased, right ? Let's look at this (from here):

In the more severe cases of unusual sexual development, the Intersex Society of North America have made a strong statement that the issue of surgery should be left until the individual concerned is old enough to choose for themselves what to do about their ambiguous sexual development. While I would support this view in principle, I don't think any responsible pediatrician or parent would leave an unambiguously male child who had a correctable moderate-to-severe hypospadias to suffer the psychological effects of this difference as he grew up. A more difficult question arises where the hypospadias is mild. Should surgery be performed purely for cosmetic reasons? Such a penis is likely to be fully functional and capable of delivering enjoyable sex to its owner. If it is also going to be capable of delivering sperm into a partner, the risks of surgery may be unjustifiable. On the other hand, I have met several men with mild hypospadias who have not had operations to correct it, and for whom associated issues like torsion of the penis, issues of size (small penis size, that is), the psychological effects of changing at school, peeing alongside other men in public restrooms, and generally feeling 'different' have been devastating, and have ultimately prevented them from establishing successful intimate relationships, whether they identified themselves as gay or straight.

(bold mine)

Not correcting severe hypospadias is like not seperating five fused fingers at birth because the child may like it better this way when it grows up. With mild hypospadias the decision is more difficult but if you visit any support group you will see that parents and doctors are actually taking all these things under consideration and don't act as butchers, no matter how "Intersex Society" would like to depict them.

 

[El Greco]

So allow them to function as women, without 'reconstructive' surgery just because their genitalia look different.

I won't even start answering this. Please, do visit a support site for CAH and read some stories, study some cases and feel the agony of the parents, instead of repeating inapplicable generalities.

 

[BillyJoe]

Earthborn

That doesn't really explain it, does it?

I thought the smilie meant you understood, sorry.
But I don't know that I want to describe the effects on a male of sharing showering facilities with females, after all, I hardly know you.

BillyJoe
(I see Greco has taken up the serious discussion so I leave that to him)

 

[davefoc]

Over the years I have read several articles on this issue.

They have all more or less supported Earthborn's view. They have interviewed adults who have had been altered surgically early on and those who hadn't. It seems like the ones who had not had the surgery were dealing with it better than those who had.

The number that I recall from those articles is that some form of mixed sex occurs about 1 in 10,000 births.

It seems from reading El Greco's posts that the situation is more complicated than I realized from reading those articles. Based on what I got from those articles I would definitely be in Earthborn's camp when it came to a child with significant sexual ambibuity, but if the child was clearly a male or clearly a female and all that was required was surgery to correct deformities I would be very open to a discussion of the advantages of doing the surgery early rather than later.

As to mixed locker rooms, I wonder. It seems that Earthborn's link is arguing for more privacy in locker rooms. So I guess she's suggesting that locker rooms be changed to something like the situation in coed dorms.

My daughter is attending college and I was fairly uncomfortable with the whole coed dorm and coed bathroom thing, but I also felt that somehow it was working and that I just needed to accept that.

The other way to interpret Earthborn's question about shared locker rooms is that she is advocating that people of different sexes become comfortable with being with each other naked in public. I have been to nude beaches and one of the things I noticed was that complete nudity seemed to be less sexually stimulating than seeing women in bikinis as at normal beaches.

So it's not completely clear to me that western customs regarding dress are necessary to prevent uncontrolled promiscuity as I think BillyJoe was suggesting with his question. I think that someday I'd like to investigate this whole issue further with Earthborn but she and my wife might not understand my scientific curiosity about the issue though.

 

[El Greco]

davefoc, I don't support obligatory sex assignment in any way, especially when the ambiguity is mind-boggling. But these are really very few cases. There are several organizations of very unfortunate activists who have had terrible experiences with early and/or unnecessary operations and they sure deserve their opinions to be taken seriously. This doesn't mean I am going to adopt any position sustaining that all early operations -except urgent life-saving ones- are butchering. For every victim of unnecessary operation there are probably many more people who have been able to forget their mishaps and start a new life. The vast majority of parents and doctors want the best for the children and will explore all possible ways to deal with the problem. Depicting them as insensitive butchers who think only of their social status is at least unfair.

 

[Earthborn]

I won't even start answering this. Please, do visit a support site for CAH and read some stories, study some cases and feel the agony of the parents, instead of repeating inapplicable generalities.

I did. I remain unconvinced that surgery is the correct way of dealing with genitalia that look different than normal. Of course I sympathize with the parents, and can understand that they want to normalize their children as much as possible. The problem in my mind is that it doesn't normalize them, but instead pathologize them more than necessary.

if the child was clearly a male or clearly a female and all that was required was surgery to correct deformities I would be very open to a discussion of the advantages of doing the surgery early rather than later.

The problem as I see it is that such surgery is far from perfect, is purely cosmetic and the problems that people experience if they aren't operated on (or even if they are) are societal and not medical.

There are of course no absolutes in the medical area. If the normalizing surgery is easy and relatively risk free, it might be a good idea. I think the surgeons need to show the evidence that it is.

The other way to interpret Earthborn's question about shared locker rooms is that she is advocating that people of different sexes become comfortable with being with each other naked in public.

Heck no! That's quite the opposite of what I am arguing. In basically all social situations there is a 'pecking' order. If people meet eachother naked, they will almost certainly judge eachother's bodies, which will mean that people without perfect genitals will suffer.

What I am arguing is that when public restrooms or showers are designed, they should be designed with a maximum of privacy, just like most people (including men) prefer them anyway. Give everyone a little private room, and you don't need gender segregation. Makes everybody happy.

 

[sorgoth]

I think that if I had seen nude women every day, if I considered it normal, it wouldn't be nearly as sexually stimulating as it is for me now.

 

[BillyJoe]

dave,

I have been to nude beaches and one of the things I noticed was that complete nudity seemed to be less sexually stimulating than seeing women in bikinis as at normal beaches.

Really?

I'm not really doubting you because I've never been to a nude beach but I'm sure I rather see some women in bikinis (at the very least) rather than naked but I'm equally sure I'd prefer to see some other women nude rather than clothed (even if just in a bikini). But that's just me I guess.

billyjoe

 

[BillyJoe]

Earthborn,

IThe problem as I see it is that such surgery is far from perfect, is purely cosmetic and the problems that people experience if they aren't operated on (or even if they are) are societal and not medical.

I missed that bit in your previous post. I understand what you mean by it being a societal rather than a medical problem but, I think perhaps it's a bit of both.

What I am arguing is that when public restrooms or showers are designed, they should be designed with a maximum of privacy, just like most people (including men) prefer them anyway. Give everyone a little private room, and you don't need gender segregation. Makes everybody happy.

Do you mean a totally enclosed room for both changing and showering? Go in totally clothed and dirty, come out totally clothed and clean?
Yes, this could work - maybe double brick walls, though, because even the sound of a woman showering could be a little stimulating for some.

Billyjoe.

 

[BillyJoe]

I think that if I had seen nude women every day, if I considered it normal, it wouldn't be nearly as sexually stimulating as it is for me now.

Are you also promoting a societal change?