Today the World Health Organization has published a major and long-awaited report on sexual health, human rights and the law.
It contains a specific section on intersex people, as well as other stigmatized social groups including lesbians and gay men, and transgender people. The report notes that, over the last three decades,
there has been a rapid increase in the documentation and understanding of the nature of discrimination and inequality related to sexuality and sexual health. This includes information about the marginalization, stigmatization and abuse of those perceived as having socially unacceptable sexual practices or characteristics (e.g. being HIV-positive, engaging in same-sex sex, being a sexually active adolescent, a sex worker, a transgender or intersex person, or any combination of these), and the toll that such discrimination takes on people’s health. Many documented cases involve violations of human rights, such as the rights to health, life, equality and non-discrimination, privacy, and to be free from inhuman and degrading treatment, among others. The achievement of sexual health is thus closely associated with the protection of human rights.
Section 3.4.9 on intersex people reads, in full:
Intersex people may face discrimination and stigma in the health system, in many cases being subjected to lack of quality of care, institutional violence and forced interventions throughout their lifetime (178, 262, 263).
A major concern for intersex people is that so-called sex normalizing procedures are often undertaken during their infancy and childhood, to alter their bodies, particularly the sexual organs, to make them conform to gendered physical norms, including through repeated surgeries, hormonal interventions and other measures. As a result, such children may be subjected to medically unnecessary, often irreversible, interventions that may have lifelong consequences for their physical and mental health, including irreversible termination of all or some of their reproductive and sexual capacity. Medical procedures may sometimes be justified in cases of conditions that pose a health risk or are considered life-threatening. Such procedures, however, are sometimes proposed on the basis of weak evidence, without discussing and considering alternative solutions (178, 262, 264–270).
Increasingly, concerns are being raised by intersex people, their caregivers, medical professionals and human rights bodies that these interventions often take place without the informed consent of the children involved and/or without even seeking the informed consent of their parents (178, 262, 264, 270–273). Parents often consent to medical intervention for their children in circumstances where full information is lacking and without any discussion of alternatives (263, 274).
According to human rights standards, intersex persons should be able to access health services on the same basis as others, free from coercion, discrimination and violence (29, 107, 242). Human rights bodies and ethical and health professional organizations have recommended that free and informed consent should be ensured in medical interventions for people with intersex conditions, including full information, orally and in writing, on the suggested treatment, its justification and alternatives (178, 264, 275).
These organizations have also recommended that medical and psychological professionals should be educated and trained about physical, biological and sexual diversity and integrity, and that they should properly inform patients and their parents of the consequences of surgical and other medical interventions and provide additional support (91, 176, 264, 268, 271, 276). It has also been recommended that investigation should be undertaken into incidents of surgical and other medical treatment of intersex people without informed consent and that legal provisions should be adopted in order to provide remedies and redress to the victims of such treatment, including adequate compensation (91, 264).
We thank the contributors to the report, and in particular Mauro Cabral of GATE.