O&G Magazine, the magazine of the Royal Australian & New Zealand College of Obstetricians and Gynaecologists (RANZCOG) published a special issue on LGBTQIA people for December 2018. The magazine contains articles on intersex people by Morgan Carpenter and Dr Jenny Beale, and other relevant, important articles including on health screening by Dr Kimberley Ivory and developments in Aotearoa New Zealand by Dr Elizabeth Kerekere.
Morgan Carpenter (co-executive director of IHRA) has written on the medical needs of intersex people, including:
simple concerns with transparency, accountability and respect. Current medical practices give rise to serious concerns and they need to change to bring them into line with human rights norms that Australia is obliged to meet.20 Many of us lack trust in healthcare providers, particularly people with a history of unwanted interventions and medical display. All of us hope to find practitioners who are willing to listen and be gentle when we need healthcare. Please consider reaching out to us if you are interested in taking referrals, or if you are involved in developing or updating educational resources or curricula.
Dr Jenny Beale comments on the current Australian Human Rights Commission inquiry into protecting the rights of people born with variations in sex characteristics in the context of medical interventions, and states:
Historically, healthcare for individuals with intersex variations was paternalistic and often surrounded by secrecy. Non-disclosure of the variation occurred and surgical and medical treatments were not always fully explained. This is no longer acceptable practice. Full disclosure of information and openness with patients and parents is considered vital.
Early (often in infancy) ‘normalising’ genital surgery for atypical genitalia has been the traditional practice of some medical professionals and still occurs in many centres today. This is a controversial topic and intersex advocates have been vocal in expressing their concern regarding non-medically necessary early surgery. In some parts of the world, there has been a move to delay surgery until the individual is old enough to be involved in the decision-making process… Autonomy of the individual (including the child and future adult) should be respected, with ongoing support offered to optimise quality of life and wellbeing.
Dr Kimberley Ivory states, in relation to screening programs:
Intersex people are born with physical or biological sex characteristics that are more diverse than stereotypical definitions for male or female bodies. While there are many underlying anatomical and physiological causes of intersex conditions, the clinician needs to understand that the intersex person who presents to them may need cervical screening, prostate examinations or mammograms; some people may need a combination of these.
The Darlington Statement states that ‘national screening programs and computerised systems must recognise the needs of people born with intersex variations.’ The clinician must be prepared to screen the organs that are present to reduce cancer risk.
Dr Elizabeth Kerekere states on developments in Aotearoa New Zealand:
The assault on the bodily integrity of many intersex people starts at birth and some intersex variations may not become apparent until a person is trying to conceive. Ethical, medical and human rights concerns have been raised11 about medical and surgical practices on intersex infants and children, when they are too young to provide informed consent. The need to repeal these so-called ‘genital normalising’ practices is urgent. The work of the Intersex Roundtable has led to establishing a national intersex clinical network through the Paediatric Society of New Zealand. This world-first network will collect accurate population data and produce medical guidelines for ensuring the bodily integrity of intersex children.
Intersex adults tackle comparable barriers to those who are trans or gender diverse when trying to access general medical care or surgical support. Activists and largely unfunded non-governmental organisations continue to provide guidelines, support and advice to agencies.
We commend the full issue and thank RANZCOG for engaging with these authors and publishing it.
Carpenter, Morgan. 2018. ‘What Do Intersex People Need from Doctors?’ O&G Magazine 20 (4): 32–33. https://www.ogmagazine.org.au/20/4-20/what-do-intersex-people-need-from-doctors/.
Beale, Jenny. 2018. ‘Intersex: Variations in Sex Characteristics’. O&G Magazine 20 (4): 29–31. https://www.ogmagazine.org.au/20/4-20/intersex-variations-in-sex-characteristics/.
Ivory, Kimberley. 2018. ‘LGBTQIA Gynaecological Screening’. O&G Magazine 20 (4): 38–40. https://www.ogmagazine.org.au/20/4-20/lgbtqia-gynaecological-screening/.
Kerekere, Elizabeth. 2018. ‘Takatapui’. O&G Magazine 20 (4): 41–42. https://www.ogmagazine.org.au/20/4-20/takatapui/.