The intersex community is fighting for the end of nonconsensual surgical interventions performed on intersex children.

Meanwhile, when Florida’s Republican Gov. Ron DeSantis signed Senate Bill 254 to ban trans youth from receiving gender-affirming care in May, he explained that he sought to permanently outlaw the “mutilation of minors.” It was a part of his “let kids be kids” campaign, which aimed to separate children from LGBTQ “confusing concepts.”

Being intersex means there are a variety of conditions a person is born with where the reproductive or sexual anatomy do not align with the medical binary of female and male, be it related to genitalia, hormones, chromosomes, or other factors. For many intersex people, doctors who intervene by performing genital surgery on them as kids have been detrimental to their adulthood.

Still, trans youth are simultaneously facing a relentless attack regarding receiving care for their dysphoria.

Last year marked the fourth consecutive record-breaking year for anti-trans legislation in the U.S. with a fivefold increase in bills targeting healthcare, according to Trans Legislation Tracker, who regularly monitors legislation aimed to limit the rights of the trans community. In only our fourth week into the new year, over 320 bills in several states have been introduced on the legislative floor, targeting LGBTQ people—especially trans healthcare.

Despite talking points like DeSantis’ that frame trans healthcare for trans youth as a form of mutilation, studies have shown that trans children and teens who aren’t provided with proper healthcare resort to self-mutilation to change their anatomy. And doctors have confirmed that mental health in trans and nonbinary youth improve greatly when provided with gender-affirming care.

Intersex children face nonconsensual surgical intervention as kids

The most pressing issue for the intersex community is the continued performance of genital and reproductive system surgery on children born with intersex variations, and the main concern is that they simply lack the ability to be in control of the intense and personal decision.

“When these surgeries are performed on intersex people, it’s usually done in infancy—before the age of two—and the purpose is almost never to meet a true and urgent medical need, but rather to make adults more comfortable by making the intersex child’s body conform to a more typical understanding of what it means to be ‘male’ or ‘female,’” said Sylvan Fraser, legal and policy director of interACT, the world’s largest intersex advocacy group.

The risks of these surgeries include neurotoxic effects of anesthesia, irreversible nerve damage, infertility, future sexual dysfunction, chronic urinary complications and post-traumatic stress disorder, Fraser explains. Surgeries include gonadectomy, a surgery that removes what would develop as testes, ovaries or either, as well as clitoral reductions, vaginoplasties and extensive, multi-stage penile surgeries that are performed at major hospitals in every region of the U.S.

While the Biden administration made history in being the first in the U.S. to acknowledge intersex people and their right to bodily autonomy, “the legal landscape regarding intersex rights is highly decentralized,” said Sharon Preves, the program director of Public Health Sciences and professor of sociology at Hamline University in Minnesota. Preves, who is also the author of Intersex and Identity: the Contested Self, explains that there have been attempts to pass legislation to ban “nonconsensual cosmetic surgery on infants and children” in a few states, though none have yet passed.

“These bills have thus far not made it out of committee and have been stopped by pediatric urologists and endocrinologists who continue to argue that such interventions are ‘for the sake of the child’ and that to not intervene would cause irreparable social harm and alienation, dooming the child to a life of social isolation and misery.”

In addition to the damage these procedures cause intersex people, activists claim that the conservative reckoning around gender in recent legislation sessions is more so a reflection of Republican political mobilization.

‘Anti-gender’ agendas to mobilize conservative voters

Terry Schilling, the president of American Principles Project, a social conservative advocacy group told The New York Times last April that religious and conservative organizations needed to find a topic candidates felt comfortable speaking on, “and we threw everything at the wall,” he said.

What has stuck, to their surprise—especially amongst parents—was the issue of trans identities amongst young people. The framing of parent’s rights was used widely after.

There’s a great deal of ignorance around intersex children because “the reason that [Republicans] were able to pass legislation in the U.S. is because people did not have an awareness of the violations that befall intersex children,” said Sean Saifa Wall, a queer intersex activist currently based in England for the Marie Skłowdoska-Curie fellow at the University of Huddersfield, studying the erasure of intersex people from social policy in Ireland and England.

Last month, the civil rights nonprofit Southern Poverty Law Center (SPLC) identified over 60 organizations pushing anti-LGBTQ disinformation in their report. Researchers of their report highlighted “concerning parallels between the Right’s obsession with regulating trans bodies [...] and the rhetoric of white nationalism.”

“All of what we had talked about publicly as intersex activists was used to weaponize against trans kids. And in doing so, continue to harm intersex kids, [which] has been facilitated because people do not know what happens to intersex children,” Wall said.

Where does the intersex community fit in the affirmation debate?

In the slew of anti-trans gender-affirming care bans last year, many bills explicitly provide exceptions that would impact surgical procedures performed on intersex children.

“[The bills] are simultaneously singling out and stigmatizing intersex youth by making a specific exception in a majority of these bills for surgeries on minors with a so-called “disorder of sex development,” said Fraser, who adds that the intention of ‘protecting vulnerable children’ is “bitterly ironic” given that trans youth are framed to be “protected” from services they actively seek, “whereas intersex children actually are vulnerable to serious harm as a result of the non-consensual and unnecessary medical interventions that these bills adamantly refuse to regulate.”

David Rubin, associate professor in the Women’s, Gender, and Sexuality Studies at the University of South Florida and author of Intersex Matters tells Reckon that the liberation of trans and intersex communities are intertwined.

He explains that “this glaring contradiction alerts us to the fact that anti-trans bills contain an implicit anti-intersex animus. In other words, the fight for access to gender affirmative healthcare has to include explicit opposition to non-consensual intersex childhood surgeries.”

Additionally, Wall adds that the issue runs deeper in history, where intersex people could consult doctors to address different aspects of their sex variations before surgeries became customary practice in the 1950s. “When we look at the roots of medicine—which is rooted in colonization, which is rooted in eugenics, which is rooted in anthropological classification—doctors have systemically denied trans people gender-affirming care,” they said.

Even in 1966, when John Money established a Gender Identity Clinic at Johns Hopkins University, he saw more intersex patients than trans patients. The issue at large, Wall explains, is that intersex people are a threat to the gender binary.

A looming fear of what lies beyond the gender binary

Rubin explains that at the heart of today’s anti-trans bills that claim to protect kids “juridically validate medical violence” against intersex people, all in the name of “preserving an ideological sex binary.”

Heteronormativity, Fraser adds, drives many of these surgeries to uphold a “desirable” male or female body (in heterosexual adult relationships) that are projected onto infants and young children who may not necessarily grow up to be straight or cis in the first place, let alone prefer to keep their natal sex characteristics in order to prevent the risks from surgery.

For Wall, it all stems from one issue: far-right, authoritarian political ideology.

“U.S. has promoted fascism in the global community and installed dictators who have led fascist murderous regimes in Central and South America, the Caribbean, Africa and Asia, [and more],” he said. When zooming out in the greater historical moment, it is about maintaining the gender binary, but also the regulation and controlling of women’s bodies—from the criminalization of poor women to women of color who want to exercise their right to abortion.

“I think it’s important for us to zoom out, because I think what we do is that we get really committed to the silos,” he said. What feels important for Wall is for people to not be on the sidelines under the guise that intersex issues are separate from everybody else. “It really requires people to step up and be curious about themselves, to really question themselves.”