Hundreds of children undergo surgery in Quebec to normalize their genitals. Little girls are going to have surgeries to reduce the size of their lips or to open a sealed vagina. Little boys are going to have an operation so that they can “pee standing up”.
Since 2015, more than 1,385 surgeries have been performed on children under 14 years of age with variation in sexual development; 838 of them on children under two years old, according to figures from the Régie de l’assurance maladie du Québec obtained by intersex activist Janic Bastien under the Access to Information Act. “One case is too much”, deplores the latter.
However, if these surgeries are legal in Canada, they are increasingly contested, and several countries are considering banning them. They are even considered human rights violations by several organizations, including the United Nations Human Rights Council.
Monique, 65, was born with one extra chromosome. “The doctors told my parents that they didn’t know if I was a boy or a girl, but that they were going to fix it. They told them to keep it a secret and to raise me like a boy, ”said the lady who requested anonymity to preserve her privacy.
Monique had surgery at birth: her only ovary was removed, her vagina closed and a penis built. She grew up in the skin of Robert (fictitious name): “I spent part of my life fighting against myself”, says the lady who has consulted in psychology practically all her life.
Robert and Monique have coexisted for a long time. When she was 50, her parents told her she was a hermaphrodite, a term that has since been replaced by intersex. “At that point, I told myself that Monique would live and I decided to come back as I was when I was born. “
Genital mutilation?
At the time, the assignment of sex was common. Since the 1990s, intersex people around the world have decried these unwanted operations, which they describe as “genital mutilation”. They campaign to have them banned and ask doctors to wait until the child is able to make an informed decision about his own body before having an operation to “normalize” his genitals. Today, medicine has evolved, admit intersex activists, but surgeries are no more legitimate, they say. “Doctors mutilate much better than before,” quips Hélène Beaupré, worker and coordinator of intersex projects at Interligne, a support group for LGBTQ + people.
Doctor Mohamed El-Sherbiny, pediatric urologist at the Montreal Children’s Hospital (MUHC), believes that we have to make a difference. He specifies that, in some cases, these operations are medically necessary to avoid possible health problems, such as urinary tract infections or cancer. “Each case is different,” he says. That is why, if we put all cases in the same basket and we talk about genital mutilation, it is totally inappropriate. “
He recognizes that at the time, the doctors “made several interventions without giving all the information to the parents”, but that the standards evolved. “Performing irreversible surgeries goes against children’s rights, because if this child later decides to choose a sex other than the one assigned to him, something that could have been of use to him will have already been taken away. . This led to a movement in the profession to put a stop to irreversible surgeries. “
Thus, he explains, depending on the specific case of the child, doctors will rely on the scientific literature to know the sex that the child is likely to choose later and proceed, if necessary, to operations. reversible. In cases where there is no scientific consensus, doctors will suggest that parents wait for the child to develop.
“Pee standing up”
According to RAMQ figures, the most frequent intervention on the genitals of children is the repair of hypospadias. These are boys whose urinary meatus does not open at the end of the glans, but rather on the penis itself or at the level of the scrotum. In many cases, the penis has a more or less pronounced curvature. This represents 618 of the 838 surgeries performed on children under two years of age since 2015 and three quarters of operations among 3 to 13 year olds.
For doctors, hypospadias does not fall under the category of variations in sexual development, because, in their opinion, the sex of the child is clear. But on the side of activists, we believe that it is part of intersexuality since it is about different genitals that we push to normalize.
The duty met four parents of children in this situation. They claim to have been well informed by the medical team and not to have been pressured. It was explained to them that they could wait until the child was able to make a decision on his own. But by specifying that the child would not have any memory of this painful experience if they decided to have him operated before the age of two years.
An argument that the Dr El-Sherbiny confirms, also evoking the risk of confusion for the child. “If we let the child decide in adolescence, we have to imagine the impact that this will have for him. He acknowledges that in many cases the main reason parents have is so that the boy can “pee standing up” and “for cosmetic reasons”.
Parents who want to do well
When she learned that her son had hypospadias, Valérie initially thought about waiting until he was old enough to decide. “But, being a boy, my husband said to himself that, when he was a teenager, it might be difficult for his self-esteem and that we were better off doing it right away, while he ‘will not account for it. “
She candidly admits that she was not aware that militants are decrying these operations. She finds that “weird” because it is a decision made for the well-being of the child and which is up to the parents.
Another mother, who requested anonymity, opted for her son’s operation because her husband himself was treated as a child for the same and is very happy about it today. The brother of this one has very bad memories of his pain in erection and during the surgery as a teenager.
Erica (not her real name) has chosen not to have her son operated on, part of whose penis is stuck to the testicles. She fears complications, such as fistulas, small holes that often reappear after the operation and that must be closed afterwards. She is worried that her son will have to be operated on many times over time if she consents to a first surgery.
Removal of testicles and clitoroplasties
The second most common operation is orchiectomy, according to RAMQ figures. It consists of removing testicles. According to Dr. El-Sherbiny, the majority of these operations are performed on boys who are not intersex, but who are born with testicles that have not descended or are not functioning. These are then removed when there is a risk of cancer.
In some, much rarer cases, children will be born with female external organs and internal testes. In such cases, doctors usually wait until the child is certain of their gender before performing such an operation, says Dr.r El-Sherbiny.
“Traditionally, this surgery was linked to the summons,” says activist Janic Bastien. If we were making little girls, we didn’t want to keep internal testicles because we feared that puberty development would go in a different direction. Today, doctors will usually cite cancer risk. “
Other operations can be counted on the fingers of one hand. Since 2015, fewer than five clitoroplasties have been performed on children. The information from the RAMQ does not allow us to know under what circumstances it was made. For his part, the Dr Mohamed El-Sherbiny says he does not do this type of surgery on young children and recommends waiting until the child reaches the age of legal consent, which is 14 years old.
There are also a few rare vaginoplasties. For the creation of a non-existent vagina, the doctor waits until the child is 14 years old. But in some cases, the vagina is there, but sealed. He can then proceed. “It’s a reversible operation, and we can undo it easily if the child later decides to be a boy,” says Dr.r El-Sherbiny.
Plasty of the vaginal lips, to reduce the volume, has also been an infrequent operation (under five) since 2015 in children under 2 years old, but there are 30 in children aged 3 to 13 years.
Virilized female organs
Little girls with congenital adrenal hyperplasia (HCS) are born with virilized sex organs because they have been exposed to a large amount of testosterone in the mother’s womb. They have developed a clitoris that looks like a micropenis, swollen or fused lips. Parents often opt for surgery during childhood. In boys, the genitals are not affected. In extreme cases, girls and boys can die from it if they do not take medication for it.
According to the Dr Mohamed El-Sherbiny, most girls in this situation will grow up like women. But not all of them. “For milder cases, there is nothing in the literature that tells us that it would be better to wait to have surgery, especially when it only involves opening the lips. But it becomes less obvious when the patient is severely masculinized, and I personally would be more hesitant to perform surgery in such a case. “
This condition is often referred to as an intersex condition. But several, like Lise (fictitious name), reject this qualification altogether. “My daughter is not intersex, she is a girl who has been exposed to a hormonal imbalance, period. It is not so much the intersex designation that repels her as the militant discourse. “I don’t understand how the operation that was performed on my daughter would be genital mutilation… I find that terminology so violent. “
Last year, while in Ontario, the Quebecer decided to have her eight-month-old daughter operated on to separate the urethra from the vagina and reduce the size of the swollen lips that looked like testicles. But although her daughter’s clitoris is larger than average, the doctors recommended not to touch it, and she agreed. It compares it to the socially accepted corrective operation of a cleft lip or fused fingers. “Why would it be any different because it’s in his pants?” “
What if his daughter asks him questions later? “I will tell him that we made the decision we thought was best at the time and show him the studies that were available at the time of his birth. “
About ten years old, Geneviève (fictitious name), had his daughter who suffered from HCS operated on. She claims to have chosen an aesthetic reconstruction procedure for her daughter because she would have liked it done for her. She wanted to keep him from feeling “different” as a teenager. Recently, she asked her daughter what she was feeling: “She said to me: ‘I’m happy, it’s done!’. “
If all parents are convinced that they made the right choice for their children, activists believe that they lack information on intersex realities. Activist Hélène Beaupré concludes: “My dream would be to create an association of parents of intersex children and to support parents who have questions to equip them in decision-making. “