Editorials

Managing intersex

BMJ 2001; 323 doi: http://dx.doi.org/10.1136/bmj.323.7324.1264 (Published 01 December 2001) Cite this as: BMJ 2001;323:1264

Most vaginal surgery in childhood should be deferred

  1. Sarah Creighton, consultant gynaecologist,
  2. Catherine Minto, gynaecology research fellow
  1. Elizabeth Garrett Anderson and Obstetric Hospital, University College London Hospitals, London WC1E 6DH
  2. Academic Unit of Obstetrics and Gynaecology, University College London, London WC1E 6AU

    For over 40 years doctors have been in the impossible situation of making momentous decisions for intersex children, without well founded scientific principles and with little more to guide them than a personal hunch that they were doing the “right thing for the child.” Despite rapid advances in understanding sexual differentiation and increased accuracy of diagnosis, the clinical management of intersex has changed little. Recently the medical profession has been confronted by the powerfully critical voices of intersex consumer groups (www.cah.org.uk/; www.isna.org/; www.medhelp.org/www/ais). With a serious deficiency of any evidence base, emotive debates on ethics, and clinical concerns over the long term consequences of interventions, it is time to stand back and rethink every aspect of this management.14

    Intersex conditions consist of a blending or mix of the internal and external physical features usually classified as male or female—for example, an infant with ambiguous genitalia or a woman with XY chromosomes. Actual prevalence figures are unknown, with population estimates of 0.1% to 2%, though figures can be distorted by varying definitions of intersex.5 When intersex is recognised in infancy, doctors decide if the …

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