The UN Committee Against Torture has called it ‘inhuman treatment’. The Scottish government has repeatedly promised to hold a consultation on it, but without result. Now a new analysis of the way that non-therapeutic surgeries on intersex/VSC children are carried out in Scotland has raised fresh questions about why nothing has been done.
Across much of the world, including Scotland, intersex people and others with VSC (variation of sex characteristics) are frequently subjected to genital examinations, ‘masculinising’ and ‘feminising’ genital surgery, and hormone treatments, when they are below the age of medical consent. Such treatments can cause loss of sensation, infertility, and lasting pain. The UN Committee on the Rights of the Child has previously called on the UK to ‘ensure that no one is subjected to unnecessary medical or surgical treatment during infancy or childhood’ and to ‘guarantee bodily integrity, autonomy and self-determination’.
New research examines the legal framework
Describing them as ‘procedures carried out for cosmetic or cultural reasons, rather than to actually medically benefit the individual,’ researcher Cameron Kadar examined the way in which Scots law has historically treated these surgeries. He also examined the present day legal framework surrounding them.
“Specifically, I looked at the medical law in Scotland regarding the best interests of the child, and the reasons why non therapeutic surgery is carried out in the first place,” he explained. “There is no proven medical benefit to such surgeries. The overall rationale for them arrived from ideas posited by New Zealand sexologist John Money in the 1960s – that the surgeries have to facilitate the social acceptance of the child, which can minimise any gender doubts that the child may have, and provide the capacity for penal-vaginal intercourse.”
Describing this as being problematic in itself, he also noted that it stems from an assumption that children will or should grow up to be heterosexual.
Scotland has established consensus guidelines stating that any such surgery should be delayed until children are old enough to consent, rather than the decision belonging to their parents, but Kadar warned that there is no substantive evidence to suggest that these guidelines are being followed.
“If the state has not legislated, especially with a medical topic, the individuals who compose of the state don’t have the medical expertise. So when we get things which are diagnosable or medically defined, those medical definitions themselves aren’t usually contested by the state. In Scotland, the state is doing nothing about this. And doctors are the same. While the law hasn’t changed, they’re going to try and follow these procedures. So I think we’re kind of caught at the start. Neither party is willing to change its behaviour because its opinion is dependent on the other party.”
Noting that other countries have already taken action, he said “Scotland has not legislated on this issue but it is within our competency, as far as the devolved government is concerned. If we do not, we will be left behind.
“This is a debate essentially about a child not having to bear the weight of social assimilation, the child not being alienated within changing rooms just because his body looks different. That doesn’t mean that his body is wrong, or if there’s anything unnatural about him. Education, social policy, communications within the medical community, all of this needs to really stack up to mitigate the harms which these people are currently facing.”
Human rights “sorely lacking”
“I/VSC equality and human rights in Scotland are sorely lacking and rarely, if at all, recognised appropriately by policy makers or by the public sector,” said Rebecca Crowther of the Equality Network. “For people with a VSC or who are intersex their existence is rarely acknowledged outside of a medical context, which can be harmful.
“It was intended that the new Relationships Sexual Health and Parenting Guidance for Scottish schools would be updated to cover diverse sex characteristics and variations in bodies – this would be a positive step for the awareness, and for the support of young people with a VSC – however even if this had materialised, this would not be enough.”
She noted that the lack of public awareness around these issues “begets violence, persecution, shame and intolerance,” adding “When we enable a society that recognises and celebrates these differences we remove the impetus and supposed reasoning for these harmful interventions.”
“Due to culture, the instinctive reaction of many parents is just to ‘fix’ their child in a way which shows that they’re like other children,” said Kadar. “I think they feel pressure to make that decision because they’re confronted by all these exclusionary binary ideals of how intersex is an abnormality that requires medical intervention out of social necessity, despite there being no medical benefits.”
He noted that the treatment of ‘normalising’ surgeries on Scottish I/VSC children is clearly anomalous because another form of genital alteration carried out on children for purely social reasons is treated very differently.
“This country has outlawed FGM for decades and there’s barely any distinction.”