Intersex Management in the United States and Non-Western Cultures

Abstract

In Western nations, there is growing agreement about ethical approaches to clinical intersex management. At the same time, as Western-trained physicians increasingly encounter intersex patients in other parts of the world, new ethical tensions arise. Which cultural values are fair parameters for gender-assignment decision-making, particularly in cultural milieus where there is social and economic inequality between the sexes? How can physicians uphold universal bioethical principles while remaining culturally sensitive? Physicians have a primary commit- ment to patient beneficence and universal human rights, requiring physicians to promote concordance between the child’s assigned gender and his or her likely future gender identity. Ultimately, the potential patient distress posed by gender dysphoria fundamentally outweighs the influence of local cultural factors such as economics, gender politics, and homophobia.

Gender identity: A psychosocial primer for providing care to patients with a disorder/difference of sex development and their families [individualized care for patients with intersex (Disorders/differences of sex development): Part 2]

“…In most societies, expressed gender plays a role in resource allocation, including income and inheritance. Gender also often impacts division of labor, rules of conduct, educational attainment, health, political empowerment, and initiation of and freedom in relationship building (particularly, marriage) [24,25]. The influence of gender on these arenas likely depends on a number of factors, e.g.…”

“…Religious background also may posit a strong influence on a family's perspective related to sex assignment and change. In some faith traditions, gender influences access to spiritual activities, and some religions have very strong negative views on sex assignment change [24,25,30]. Furthermore, some religions include systems of law that will influence sex reassignment.…”

Mechanical sex, science, security: Intersex medical violence, Thomas Hobbes and John Money’s invention of gender

“…Yet it is precisely these medical interventions, which are nowadays common worldwide (Tell, 2015), that have been described by intersex people and activists as causing 'horrific physical and emotional scars' (Davis, 2015: 5) 3 through 'pathologization, shame, and deceit' (Orr, 2022: 3) and as 'human rights violations' (Carpenter, 2016: 74) imprinting a lifelong sense of being a 'freak' (Walsh, 2015: 120). Even though intersex traits rarely, if ever, cause medical issues by themselves (Davis, 2015;Dreger, 1999;Holmes, 2009;Kessler, 1998;Preves, 2003;Reis, 2021), they are nonetheless overwhelmingly construed as 'emergencies' (Karkazis, 2008: 96) requiring immediate medical intervention for the ostensible sake of the intersex person's health and well-being.…”

“… 14. Ironically, contemporary Saudi hospitals seem to follow Western rather than Islamic medical practice (Tell, 2015: 10). …”