Sexual Assault in Medical Contexts

Celeste Orr considers routine sexual assault of people with intersex traits.


Recently, former U.S. gymnastics doctor, Larry Nassar, pleaded guilty to 7 counts of first-degree sexual misconduct and was sentenced to prison. However, over 160 survivors testified against him. Nassar’s institutional power and highly regarded medical position protected him for so many years. Although Nassar pleaded guilty, he maintained that he “was a good doctor” because his treatments worked. This statement suggests that he doesn’t seem to fully recognize that the sexual abuse he committed was sexual abuse because it occurred in a medical context. This case prompted me to reflect on the sexual violence many intersex people are subjected to in medical contexts.

Sexual violence towards intersex people is ignored by the mainstream, white-washed #MeToo movement. In fact, it’s not readily recognized as sexual violence at all because of the institutional power medical professionals wield over intersex variations, professionals who have worked to “maintain their exclusive jurisdiction over intersex traits.”

There are so many intersex activists and intersex studies scholars out there reporting stories of sexual violence, assault at the hands of (or prescribed by) medical professionals. However, such violence is not centered in conversations about sexual assault. In part, this is because the medical context in which these abuses occur and the assumed expertise we associate with doctors function as institutional protection to those who commit (or prescribe) the act of assault. The context, in a very important sense, renders the assault invisible and prevents so many from recognizing it as sexual violence.

Image Description: Examination table with a pillow. Paper is pulled over the table and it is ready for the next patient. There is a scale the the left of the examination table and a garbage can and counter to the right. A magazine rack is mounted on the wall behind the examination table.

Intersex activist Emi Koyama explains that various routine medical practices and procedures enacted on intersex infants, children, and adolescents constitute “ritualistic sexual abuse of children.” Two examples are the unnecessarily displaying of intersex children’s genitals to numerous other doctors and students, as if their bodies were side-shows to gawk at, and the dilating of intersex children’s surgically created vaginas with dildo-like instruments. Koyama suggests that adult intersex people’s stories often resemble those of people who have survived childhood sexual abuse, whereby there is trust violation, lack of honest communication, and punishment for asking questions or telling the truth.

As mentioned, in some cases, intersex children are routinely penetrated by a hard instrument to help ‘dilate’ the vagina so that it won’t close off. Some medical professionals dilate children themselves. Claudia Astorino, intersex activist and writer, further explains and documents her own experiences of repeated unnecessary genital examinations and vaginal dilation:

I had a dilation procedure performed for almost every exam I had with intersex doctors from the time I was 8 until I was 16 […]. I absolutely hated these procedures. I mean, imagine a man as old as your father or your grandfather, who you don’t know, inserting a medical dildo into you each time you saw him, knowing that you can’t question the doctor’s orders and just accept that you have to undergo these uncomfortable procedures for your health. Imagine a decade or so later, realizing that these procedures did nothing to track your health, and have everything to with grown men feeling good about the fact that you could fuck some dude someday like a ‘normal girl.’ That all those traumatizing procedures weren’t actually medically relevant at all, and it was actually within my right to refuse those examinations.

In addition to the fact that Astorino’s account clearly documents repeated sexual assault, it also draws attention to the fact that these assaults occur because of the dominant interphobic, cissexist, heteronormative, phallogocentric cultural preoccupation with females having vaginas that can “accommodate” a “normal” sized penis. The medical context and the fact that dilation is presented as medically necessary mask the sexual assault as a routine medical procedure. This is referred to by some intersex activists as “institutionalized sexual abuse.”

Yet, these acts are never included in mainstream conversations about sexual assault because the medical protocol or prescription is the act itself.

Intersex people who confront their doctors about the resulting harm and trauma are often told, “you don’t know what you’re talking about.”

Medical professionals performing these procedures do not believe that they are sexual abusing intersex children and they deny the abuse. The problem is that those who have the power to determine what counts as abuse also have the power to ignore the claims of sexual abuse.

Tarana Burke, founder of the #MeToo campaign, states: “No matter how much I keep talking about power and privilege, they keep bringing it back to individuals.” Rather than individualizing assault and implying that there are just a lot of “bad apples” out there, we must focus on the power, privilege, and institutional protections that enable systematic abuse of marginalized and culturally devalued people. In doing so, we need to include intersex people’s voices in discussions about systemic (medical) sexual abuse.


Celeste Orr is a Ph.D. Candidate at the University of Ottawa in the Institute of Feminist and Gender Studies.

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