OII’s Objections to the APA DSM-V Committee’s Proposals on Intersex
- We believe that the term ‘disorder of sex development’ (DSD) is not the best way to refer to intersex, intersex people or any medical issues they experience.
- When an intersex person rejects an assignment made on their behalf at or near birth, or puberty, we do not regard them as having any sort of identity disorder, or gender incongruence.
- When a person prefers to identify as intersex, and does not want to conform to any clear gender, we do not regard them as having any sort of identity disorder, or gender incongruence.
- In situations where an individual rejects an earlier assignment made without their consent, we regard this as being due to an erroneous earlier assignment, and thereby any problems arising from that as iatrogenic rather than as a psychological disorder or incongruence. When no consent was sought from an individual, when it becomes possible for that person to exercise their choice to reverse such an error, this cannot be considered a disorder or incongruence.
- We see no need to further medicalize and stigmatize intersex people by referring to them as necessarily disordered (DSD), and where mistakes in assignment have been made, we see no value in medicalizing and stigmatizing them further by applying another form of disorder called ‘gender incongruence’.
- We ask that the same standards applied in the situation for homosexuality starting with the DSM-II revision be applied to intersex; we request that the DSM-V committee recognize that intersex and all intersex expressions of gender identity are part of normal human variation, and that treatment be confined to those genuine medical issues facing intersex people, and issues they themselves seek medical assistance with.
- In the case of children where there is some doubt as to which gender assignment will offer the best outcome, once a decision has been made on their behalf, they should be dealt with in a sensitive and flexible way that will allow them to express their own preferences as they get older, and that should be managed in a way that can most effectively accommodate their own choices and decisions. With an awareness of the potentially disastrous consequences of altering children’s genitals surgically prior to an age when they can make informed consent, we call for the minimum of non-essential medical treatment and assignment relating to their gender role, presentation and sex characteristics, until they are in a position to decide upon an appropriate gender (or some other arrangement) for themselves.
- To summarize: If an intersex child is assigned a gender without their consent, when they come to exercise their own choice for assignment, this cannot be considered a psychological disorder, or gender incongruence.