COVID-19: Intersex and “Essential” Medical Care

Celeste E. Orr proposes that the current crisis reveals what is truly essential medical care.

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Intersex people are facing unique challenges during the global COVID-19 crisis. The ongoing debates about what ought to be deemed essential and non-essential medical care during the pandemic offer us the opportunity to critically reflect on the supposed necessity of subjecting intersex infants and children to irreversible, non-consensual surgical interventions. These interventions are never essential for these intersex individuals.

Intersex activist organizations, like InterAct: Advocates for Intersex Youth, have published comprehensive resources specific to intersex people during the COVID-19 crisis, noting “Intersex people face unique barriers in healthcare. Since many intersex people have a history of medical trauma, seeking care for any reason can be stressful.” 

Intersex people are born with “unique variations in reproductive or sex anatomy. Variations may appear in a person’s chromosomes, genitals, or internal organs like testes or ovaries.” People with intersex variations defy the male-female sex binary.

Many intersex people have a history of medical trauma. The medical profession has an ongoing history of claiming that intersex variations are “emergencies” that require immediate, irreversible, “normalizing” surgical intervention in the hopes their anatomies will better approximate “male” or “female” sex. This intervention is presumably essential to one’s well-being and health. In fact, many medical professionals advise early surgeries, “usually ‘between 12 and 24 months of age’”.

According to intersex studies scholars, intersex activists and advocates, and many nongovernmental organizations, these irreversible surgeries are not necessary. Rather they are performed for cosmetic reasons on non-consenting infants and children, violate the Hippocratic Oath, and constitute interphobia, human rights violations, intersex genital mutilation, sexual assault, and torture. As I explain elsewhere, these procedures constitute medical malpractice and gratuitously disable intersex infants. Surgeries can result in, for example, sterilization, inability to orgasm or experience genital sensation, chronic infections, anesthetic neurotoxicity, incontinence, and post-traumatic stress disorder. In short, these procedures negatively impact a person’s life, health, and well-being profoundly. Nevertheless, these surgeries take place in Canada and across the globe because of cultural investments in the belief that all human beings must be exclusively male or female, in terms of both biology and identity.

Photo Credit: geralt. Image Description: Inscription Covid-19 with some related phrases on a colorful banner.

Given many intersex people’s histories of medical violence and trauma, many may be reluctant to seek medical care during the COVID-19 crisis. Many intersex people understandably distrust the medical industry. The resources offered up by InterAct are invaluable, and have left me wondering: what intersex “treatment” is being regarded as essential or not essential during the COVID-19 pandemic?

Since the COVID-19 crisis, non-essential medical care and surgeries have been postponed in Canada and around the globe. According to the World Health Organization, some essential services include: vaccinations, reproductive health care, mental health care, management of noncommunicable diseases, laboratory services, and blood bank services.

There are ongoing debates about what ought to be considered essential or non-essential medical care. For instance, there are debates about whether abortion is essential even though abortion “uses relatively few medical resources and is time-sensitive” and organizations like The American College of Obstetrics and Gynecologists deem abortion “an essential component of comprehensive health care” during the crisis. Banning or limiting access to abortion during this time, or any time, is about “control,” not safety.

There have been no formal statements concerning the medical management of intersex infants and children since the COVID-19 outbreak. This is not surprising, unfortunately. There is a culture of “silence” around intersex issues; there are no globally accepted medical guidelines concerning intersex medical care; and intersex infants and children have always been at risk because of the tendency of medical professionals to favour “normalizing” procedures.

Nonetheless, the pandemic is a reason to delay these surgeries because they are not actually imperative to one’s health or well-being. When the pandemic subsides, there is an opportunity for the medical community and general population to contest the supposed necessity of irreversible, non-consensual, cosmetic intervention on intersex individuals.

So many folks have already noted we cannot go back tobusiness as usualafter this pandemic. The pandemic clearly reveals that “business as usual” places various populations and the environment in danger. As fewer intersex infants and children are subjected to the cosmetic surgical knife during the pandemic, we must ensure that we do not go back to subjecting intersex infants and children to cosmetic procedures being “business as usual” post-pandemic.

I am not undermining the work medical professionals are doing right now. They are in great danger, risking their lives for the global community without enough resources. I am also not claiming that only essential medical care ought to be available to people when the pandemic subsides. However, I am inviting everyone to think critically about, reflect on, and actively oppose the supposed essential nature of these non-consensual, irreversible, cosmetic interventions on intersex infants and children.

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Celeste E. Orr is a Visiting Assistant Professor in the Gender and Sexuality Studies Department at St. Lawrence University.