Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Sex is better than gender
- Jed Rowe (3 December 2001)
-
Shining a light on Intersex and bringing it's treatment into the New Milennium
- Melissa Cull (8 December 2001)
-
A Light in the Darkness
- George Hill (18 December 2001)
-
Mental Health is important in Intersex Dsiorder
- Adrian Sutton (19 December 2001)
-
Intersex experience with Indian endocrinologists
- Sridhar R Gumpeny, 15-12-16 Krishnanagar, Visakhapatnam 530 002, India (22 December 2001)
|
|
|||
|
Jed Rowe, Consultant Geriatrician Moseley Hall Hospital, Birmingham B13 8JL
Send response to journal:
|
It seems ironic that an editorial on intersex should use the grammatical term gender rather than sex. With three genders the term is best reserved for latin nouns or the like and its use here has the pejorative implication that some might be designated neuter. |
|||
|
|
|||
|
Melissa Cull, Adrenal Hyperplasia Network Founder, CAHG Secretary & Adult Support Co-ordinator 17 Newton Road, Lichfield, Staffordshire, WS13 7EF. Tel: 01543 252961 Fax: 01543 411 761
Send response to journal:
|
It is excellent to see surgery for ambiguous genitalia / intersex being openly discussed with recent articles in New Scientist 1. Papers by Creighton, SM et al 2,3,4 and the feature by Melton, L 5 prove what patients have been saying for years – surgery can and does cause damage to sexual function. This research is long overdue and most welcomed by patients and parents. I fully concur that cosmetic genital surgery needs to be reassessed. Parents and patients need to have all the facts explained before opting for irreversible genital surgery. This is especially so in the changing NHS that is aiming to be more patient lead. Also with the importance of fully informed consent (particularly after the Bristol and Alderhay scandals), often lacking with ambiguous genitalia / intersex as surgery is often done on children before they can give consent. If parents are to make these decisions they need the full facts or they will end up with feelings of extreme guilt for damaging their child’s sexual function by having early surgery. Ambiguous genitalia / intersex isn’t something to be ashamed of; being more open can only help people lead better lives. More research is needed into whether leaving surgery until adolescence will have psychological effects compared to early infant surgery as is current practice in the thought that it re-enforces gender identity. This gives rise to the necessity for ‘Multidisciplinary Treatment Centres’ to treat the conditions with a more holistic approach encompassing surgery, endocrinology and psychology. The BAPU Conference 2000 and the Tavistock and Portland “Gender Identity and Intersex” 2000 conference brought together professionals and patient support groups to present their views. Universities have also invited patient groups to speak to medical students to learn from the patient the effect of lives of the intersexed. Support groups are professional and not as previously envisaged as “disgruntled doctor haters”, work closely with the medical profession to improve treatment, raise awareness and support patients. Patients only have the opportunity to air their views with the media who can often distort important issues. When Doctors come to our conferences and take time to listen to patients, parents and support groups, they learn more about how conditions affect patients compared to the few minutes of consultation. Patients too are more likely to open up and talk to doctors that take an interest in how conditions affect people’s quality of life and everyday living. 1. The Gender Police, Phillips H. New Scientist. 2001; 2290:38-41 2. Objective Cosmetic and Anatomical Outcomes at Adolescence of Feminising Surgery for Ambiguous Genitalia Done in Childhood. Creighton SM, Minto CL, Steele SJ. Research letters. Lancet 2001; 358:124-125. 3. Surgery for Intersex, Creighton SM. Journal of the Royal Society of Medicine. Volume 94 May 2001. Section of Obstetrics & Gynaecology. 2001; 94:218-220 4. Managing Intersex, Creighton SM, Minto CL. BMJ. 1 December 2001; 323:1264-1265 5. New Perspectives on the Management of Intersex. Melton L. Lancet 30 07 2001; 357:2110 |
|||
|
|
|||
|
George Hill, NOCIRC of Louisiana Port Allen, Louisiana 70767-0088
Send response to journal:
|
|
|||
|
|
|||
|
Adrian Sutton, Consultant Child Psychiatrist The Winnicott Centre, 195 Hathersage Road, Manchester M13 0JE
Send response to journal:
|
Managing Intersex
Creighton & Minto’s1 editorial highlights the complexity of the constellation of intersex conditions and the ‘need to rethink our approach to the management’. They particularly emphasise the importance of listening to the people who are their patients and the importance of managing them in multidisciplinary teams. My own clinical work with children, teenagers and their families in this arena has highlighted that they are group of patients who need to be understood as being at greater risk of mental health problems because of the particular emotional and relationship complications consequent upon the condition2 . The associated complexity begins at the point of recognition that there is an intersex disorder and sets in train psychological processes, within professionals as well as in parents, which themselves need to be managed3 . I have also argued from experience in psychoanalytic psychotherapy and psychiatric management of these children and their families that the very nature of the condition makes it harder for professionals to manage their own thinking and responses when treating these young people as their lives unfold5. The management relies as much upon what have been described as capabilities as on competences4. I therefore agree wholeheartedly with the authors’ recommendation for multidisciplinary team management. Such teams need to include mental health specialists able to make formal psychiatric assessments when required. They also need to be skilled in consultation to other professionals, assisting them in their decision-making processes where powerful conscious and unconscious mechanisms are set in motion by the very nature of the condition being treated. 1. Creighton S, Minto C. Managing Intersex BMJ 2001;323: 1264 -5. 2. Sutton A & Whitaker J. Intersex Disorder in Childhood and Adolescence: gender identity, gender role, sex assignment, and general mental health. In Di Ceglie D & Freedman D eds. A Stranger in My Own Body London, Karnac Books. 1998 3. Nelki J & Sutton A. Emotional aspects of gynaecological problems presenting at birth. In Garden AS. ed. Paediatric & Adolescent Gynaecology. London, Sydney & Auckland. Arnold. 1998 4. Sutton A. ‘Lesley": the struggle of a teenager with an intersex disorder to find an identity- its impact on the "I" of the beholder’ Case Study D. In eds Di Ceglie D & Freedman DManaging Intersex Creighton & Minto 2001 BMJ 323: 1264-5 |
|||
|
|
|||
|
Sridhar R Gumpeny, Consultant Endocrine and Diabetes Centre, 15-12-16 Krishnanagar, Visakhapatnam 530 002, India
Send response to journal:
|
The editorial ‘Managing intersex’ (1) shows that we are bound by soft evidence masquerading as hard data. For a variety of reasons, many Indian children with intersex are often not managed according to what textbooks say. These individuals form 2.5% to 12.5% of patients at endocrine centers from different parts of the country (2). Our clinical experience in managing persons with ambiguous genitalia is discordant from what standard textbooks say. The 18-month age limit for gender assignment is often the exception. Many present late. In our computerized database (3), only one among 12 individuals with ambiguous genitalia was referred before the age of five years (2). The oldest was married and had been living with his spouse for two years. If biology and biochemistry isn’t all there is to sex and gender, social and psychological aspects must be important. In India we often consider whether an impotent man is better than an infertile woman. I reckon there is a large pool of ‘untreated’ individuals who can provide answers to these questions. Reference: (1) Creighton S, Minto C. Managing intersex. BMJ 2001;323:1264-5 (2) Sridhar GR. Socio-psychological aspects of artificial sex change. J Assoc Physicians India 1999;47:1217-8 (3) Sridhar GR, Venkat Yarabati. Information technology and endocrine sciences in the new millennium. Indian J Endocrinol Metab 2000; 4:70-80 |
|||