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‘He needs to be a boy’: Unnecessary surgeries being performed on intersex children
Australian children born with ambiguous sex characteristics are being subjected to unnecessary surgeries with high complication rates because of outdated medical advice and pressure from distressed parents.
As Victoria prepares to become the first state to ban unnecessary surgeries for intersex minors, a new landmark report says some hospitals appear to keep no records justifying the surgical interventions.
Where records exist, they are often patchy and inconsistent, which elevates the risk of inadequate oversight, law reform group Equality Australia found.
The Missing Voice report, provided to this masthead ahead of its release on Monday, was compiled from more than 240 documents released by major public hospitals under freedom of information laws. Many medical records – including from Victoria – were so heavily redacted they could not be meaningfully analysed.
Of the 83 cases that could be scrutinised – which related to procedures in Sydney and Brisbane between 2018 and 2023 – nearly half featured cosmetic preferences as part of clinical deliberations, despite the children being too young to express their own wishes.
In some cases, cosmetic factors – the desire to make genitals look more “typical” to ease adult discomfort with bodily differences – was the primary factor behind children going under the knife.
Nearly one in five cases were justified – at least in part – on the need to reinforce the gender assigned to the child at birth. These surgeries can affect future reproductive function and sexual pleasure.
Advocates have long said surgeries that aren’t medically necessary should be delayed until the child is an adult.
Intersex individuals may have variations to their external genitalia – like a clitoris that resembles a penis or a scrotum that isn’t fused and resembles labia. They can also have variations in their chromosomes and hormone production, and have both ovarian and testicular tissue inside their bodies.
“Intersex” is a term used to describe innate sexual characteristics, not gender or sexual identity.
It is thought that about 1.7 per cent of the population is born with an intersex trait.
The release of Equality Australia’s report comes as Victoria considers becoming the first state to legislate an effective ban on surgeries for intersex minors when the interventions aren’t medically necessary. The ACT became the first Australian jurisdiction to ban such procedures two years ago.
Countries such as Spain, Portugal, Greece, Germany and Iceland have already banned unnecessary surgeries on intersex children.
The Victorian government pledged stronger safeguards for intersex minors in 2021. Two Labor sources, speaking on the condition of anonymity, said an announcement was imminent and reform would be discussed by cabinet on Monday.
Tougher safeguards are expected to be welcomed by intersex advocates, but face opposition from groups concerned about any dilution to parental rights.
Tony Briffa, the world’s first intersex public official, was born at a Melbourne hospital in the 1970s. Doctors would later discover that she was born with internal testes, which were removed when she was seven years old.
Briffa said she was 11 when doctors put her on female hormone replacement therapies – even though they would have known that her body would have converted the testosterone from her internal testes into oestrogen.
“But they didn’t want any ambiguity,” she told this masthead. “My parents were [also] told my testes had to be removed because they were a risk of cancer. That wasn’t the case.”
Briffa said her doctors were good people and that she doesn’t bear any ill will towards them – or her parents. However, she said the interventions left their mark.
“Every three months, having repeated genital examinations; having multiple doctors in the room, talking about you in the third person like you’re not there; learning you can’t have children. It has lifelong consequences.
“I had pneumonia this year. Even in my delirious state, I was adamant I didn’t want to go to hospital. I’ve got such horrible memories.”
Jade, who requested a pseudonym and uses she/her and they/them pronouns, was born in 2009 with indeterminate genitalia and a mix of male and female chromosomes.
Doctors removed a partially developed ovary when Jade was just six months old, and later removed their vagina and uterus at around 19 months of age, thinking the organs were the cause of constant urinary tract infections.
Jade, in an interview where their parents were present, told The Age that they felt like they now had a body “some doctor picked out for me”.
“It feels very cookie-cutter. It’s just not an easy experience to live through.”
Jade, who was born in regional Australia, said they wanted to speak about their experience to spread awareness about intersex variations.
“You hear about intersex and you think it’s this tiny, microscopic margin of people. It’s a very small percentage of the population, but our population is so big that it’s a large number of people.”
Jade’s mother, who requested anonymity to protect her teenager’s identity, said she and Jade’s father only wanted to do surgery that was medically necessary, but that it was difficult to challenge doctors.
“It was, ‘well, this needs to happen. He needs to be a boy. He needs to pee standing up.’ That’s what one urologist said. There was a real sense of urgency that it all needed to happen within the first year.”
Equality Australia legal director Heather Corkhill said the report showed intersex children remain at risk of surgeries that could be delayed until the age of consent – or avoided altogether – if stronger protections were put in place.
“The system is failing intersex children,” Corkhill said. “Hearing the stories of people who were harmed by surgeries done before they were old enough to speak for themselves is truly heartbreaking. We can and must do better – for parents who need clear information, for clinicians who deserve support in making difficult decisions, and for future generations of intersex children.”
Bioethicist Morgan Carpenter, an associate professor at the University of Sydney, said Equality Australia’s report was troubling.
“Children with intersex variations are still not being treated in line with community expectations and human rights standards,” Carpenter said.
“Without accountability and deterrents, this will not change.”
A Victorian government spokesperson acknowledged the significant work of Equality Australia and its report.
“We are working towards legal safeguards to protect people from unnecessary harm and trauma – and we’ll have more to say soon,” the spokesperson said.
Briffa commended the government’s commitment.
“People consider intersex variations like a defect. But it’s a variation – we can live fulfilling, happy lives,” she said.
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Broede Carmody is a health reporter for The Age. Previously, he was a state political reporter for The Age and the national news blogger for The Age and The Sydney Morning Herald.Connect via X or email.