History of intersex surgery

The history of intersex surgery is intertwined with the development of the specialities of pediatric surgery, pediatric urology, and pediatric endocrinology, with our increasingly refined understanding of sexual differentiation, with the development of political advocacy groups united by a human qualified analysis, and in the last decade by doubts as to efficacy, and controversy over when and even whether some procedures should be performed.

Prior to the medicalization of intersex, Canon and common law referred to a person's sex as male, female or hermaphrodite, with legal rights as male or female depending on the characteristics that appeared most dominant. The foundation of common law, the Institutes of the Lawes of England described how a hermaphrodite could inherit "either as male or female, according to that kind of sexe which doth prevaile." Single cases have been described by legal cases sporadically over the centuries. Modern ideas of medicalization of intersex and birth defects can be traced to French anatomist Isidore Geoffroy Saint-Hilaire (1805–1861), who pioneered the field of teratology.

Since the 1920s surgeons have attempted to "fix" an increasing variety of conditions. Success has often been partial and surgery is often associated with minor or major, transient or permanent complications. Techniques in all fields of surgery are frequently revised in a quest for higher success rates and lower complication rates. Some surgeons, well aware of the immediate limitations and risks of surgery, feel that significant rates of imperfect outcomes are no scandal (especially for the more severe and disabling conditions). Instead they see these negative outcomes as a challenge to be overcome by improving the techniques. Genital reconstruction evolved within this tradition. In recent decades, nearly every aspect of this perspective has been called into question, with increasing concern regarding the human rights implications of medical interventions.

Genital reconstructive surgery was pioneered between 1930 and 1960 by urologist Hugh Hampton Young and other surgeons at Johns Hopkins Hospital in Baltimore and other major university centers. Understanding of intersex conditions was relatively primitive, based on identifying the type of gonad(s) by palpation or by surgery. Since ability to determine even the type of gonads in infancy was limited, sex of assignment and rearing were determined mainly by the appearance of the external genitalia. Most of Young's intersex patients were adults seeking his help with physical problems of genital function.

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