INTERSEX IN IRELAND
These surgeries are irreversible. Once a team of doctors has reduced an intersex person’s clitoris to a size that medical professionals find more acceptable, it is impossible to undo that decision and restore the genitalia to their previous state or to repair any lost or damaged sensation. It is important to note that the infant will not be in a position to discuss their loss of sensation or nerve damage until they reach sexual maturity. Even then, their surgically reduced clitoris will be all that they are familiar with. They will not be in a position to compare it with having an unaltered clitoris. Dr Costigan admits that “results from some of the earlier surgeries weren’t as good as hoped.” However, what guarantee is there that today’s IGM surgeries performed by HSE surgeons are not the “weren’t as good as hoped” surgeries of tomorrow?
A 2020 study [12] , the first national study in the United States of intersex adults, found high rates of disability and that more than one third of participants had previously attempted suicide, which is considerably higher than amongst the general population. As Irish intersex adults ourselves, we have no reason to believe that circumstances are better in Ireland. Irish mental health professionals [13] have described mental healthcare as being in a state of emergency for the general population, let alone intersex people who are potentially at an elevated risk of attempted suicide. For intersex people assigned the wrong sex at birth, they are left to contend with what has been described as the worst transgender healthcare in Europe [14] , along with the violence and discrimination that many transgender people face in Ireland. This year, Spain joined Greece, Germany, Iceland, Portugal and Malta in banning binary affirming surgeries on intersex children. While these laws are not perfect, they are massive leaps forward that recognise the bodily autonomy of the intersex person and their right not to be irreversible altered to meet the standards of a team of medical professionals that they will likely never again encounter once the intersex child has left their “care”. It is time that Ireland join Spain, Greece, Germany, Iceland, Portugal and Malta in ending IGM and addressing the needs of those intersex people harmed by outdated medical practices. It is time that the HSE start listening to intersex people rather than acting in what they believe are the best interests of intersex people. It is time that intersex people are included in RSE and Irish culture more generally rather than being forced to hide in the shadows because of ignorance, stigma and outdated medical practices. Acknowledgements: The INIA Innovative Training Network is supported by a grant from the European Commission’s Marie Skłodowska-Curie Actions program under project number 859869. This article reflects only the views of the author, and the Agency is not responsible for any use that may be made of the information it contains.
These binary-affirming procedures would be illegal in Ireland under any other circumstances. The HSE describe FGM [5] (Female Genital Mutilation) as “the partial or total removal of the external female genitalia, or any practice that purposely changes or injures the female genital organs for non-medical reasons. The practice is internationally recognised as a human rights violation of women and girls”. Because binary affirming surgeries are performed on intersex children for non-medical but rather cosmetic reasons, intersex activists refer to them as Intersex Genital Mutilation, or IGM for short. FGM law in Ireland [6] states that “it shall not be a defence to proceedings
By Adeline Whittney Berry
My name is Addy. I am a member of Intersex Ireland, Ireland’s only Intersex led support and advocacy group.
I am also a researcher who looks at the needs and experiences of older intersex people across Europe as part of the INIA project [1] . This work allows me the opportunity to compare the lives of older intersex people in Ireland with those of older intersex people in Europe and elsewhere. Intersex Ireland is proud to be an active member of OII Europe, the umbrella organisation of European human rights based and intersex-led organisations and part of the vibrant international intersex community. Intersex is an umbrella term used to describe a wide number of naturally occurring chromosomal, gonadal or genital variations that don’t fit neatly into strict medical binary definitions of what might be considered male or female. According to experts [2] including the United Nations, intersex people make up as much as 1.7% of the Earth’s population. Sometimes intersex traits are visible at birth, others not until puberty and sometimes not at all, only to be discovered post-mortem. Since at least the 1960s, it has been common practice around the world, including in Ireland, to perform binary affirming surgery and hormonal interventions on intersex children based on the work of disgraced psychologist Dr John Money. It was Dr Money’s belief that when a child is born with ambiguous genitalia, it was important to assign the child as either male or female before performing irreversible surgery to cement that decision. Intersex children were often assigned female at birth [3] as those surgeries were considered easier to perform. These procedures have been described by the UN Special Rapporteur [4] as a form of torture that infringe on the human rights of intersex people. “Children who are born with atypical sex characteristics are often subject to irreversible sex assignment, involuntary sterilization, involuntary genital normalizing surgery, performed without their informed consent, or that of their parents, ‘in an attempt to fix their sex’, leaving them with permanent, irreversible infertility and causing severe mental suffering,”.
for an offence under this section for the accused person to show that he or she believed that the act concerned was consented to by the girl concerned or her
Intersex adults who attempt to address issues they struggle with often encounter medical professionals with little knowledge or understanding about
parents or guardian, or the woman concerned, as the case may be, or required or permitted for customary or ritual reasons”. However, these harmful surgeries, performed for “customary” rather than medical reasons, continue unabated in Ireland. Research shows [8] that intersex people who undergo clitorectomies as children suffer many of the same negative effects as children subjected to FGM. Another study [9] found that “Those who had undergone clitoral surgery were significantly less likely to report experience of orgasm compared with those who had not had surgery”.
intersex or intersex issues. This is in part because of how decades of binary- affirming surgeries and hormonal procedures have served to hide both atypical genitalia and intersex people from society, resulting in under-representation in culture, RSE and medical education for intersex people. This leaves intersex people at the mercy of medical knowledge and practices [10] that have not kept pace with progress. A 2021 report [11] by the Department of Children, Equality, Disability, Integration and Youth found that there is a paucity of research on intersex youth in Ireland but that international studies suggest circumstances might be quite dire.
[8] Minto, C. L., Liao, L. M., Woodhouse, C. R., Ransley, P. G., & Creighton, S. M. (2003). The effect of clitoral surgery on sexual outcome in individuals who have intersex conditions with ambiguous genitalia: a cross-sectional study. The Lancet.
[9] Ismail, I., & Creighton, S. (2005). Surgery for intersex. Reviews in Gynaecological Practice, 5(1), 57-64. [10] Berry, A. W., & Monro, S. (2022). Ageing in obscurity: a critical literature review regarding older intersex people. Sexual and Reproductive Health Matters, 30(1).
[11] www.gov.ie/pdf/?file=https:// assets.gov.ie [12] Rosenwohl-Mack, A., Tamar- Mattis, S., Baratz, A. B., Dalke, K. B., Ittelson, A., Zieselman, K., & Flatt, J. D. (2020). A national study on the physical and mental health of intersex adults in the US.
[13] www.breakingnews.ie/ireland/ mental-health-problems-in-ireland- have-gone-from-a-crisis-to-an- emergency[14] https://gcn.ie/ireland- worst-eu-trans-healthcare/
[1] https://www.intersexnew.co.uk/ [2] OHCHR. (2017). Intersex. UN Free & Equal. [3] Woodhouse, C. R. J. (2004). Intersex surgery in the adult. [4] www.ohchr.org/sites/default/ files/Documents/HRBodies/ HRCouncil/RegularSession/ Session22/
[5] www.hse.ie/eng/about/who/ primarycare/socialinclusion/ domestic-violence/female- genital-mutilation-fgm/ [6] www.irishstatutebook.ie/ eli/2012/act/11/section/2 [7] www.irishexaminer.com/lifestyle
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