Should intersex infants be subject to “corrective” surgeries?

The Washington Post has published a long-form piece featuring a number of heart-rending stories about intersex persons. For those unfamiliar with intersex, it is term used to describe a variety of conditions which involve some physical disorder of sex development.

The Post article focuses on the debate about “corrective” surgeries for intersex infants. An older protocol pioneered by John Money favors such surgeries. Intersex activists are against them.

The thing that comes out so very clearly in the article is the emotional turmoil and uncertainty often suffered by intersex persons—especially those who underwent surgeries as infants that permanently impaired them in some way.

Our thinking about the intersex experience is ultimately a theological question. What the Bible teaches about our special creation as male and female, about the Fall, and about the new creation all figure into how Christians think about these things. Articles 5 and 6 in The Nashville Statement offer some guidance:

Article 5
WE AFFIRM that the differences between male and female reproductive structures are integral to God’s design for self-conception as male or female.
WE DENY that physical anomalies or psychological conditions nullify the God-appointed link between biological sex and self-conception as male or female.

Article 6
WE AFFIRM that those born with a physical disorder of sex development are created in the image of God and have dignity and worth equal to all other image-bearers. They are acknowledged by our Lord Jesus in his words about “eunuchs who were born that way from their mother’s womb.” With all others they are welcome as faithful followers of Jesus Christ and should embrace their biological sex insofar as it may be known.
WE DENY that ambiguities related to a person’s biological sex render one incapable of living a fruitful life in joyful obedience to Christ.

LGBT activists will often point to intersex conditions as evidence to disprove the male/female norm of scripture (Gen. 1:26-27; Matt. 19:4), and Article 5 rebuts that argument. Article 6, however, focuses on the fact that no disorder of sex development diminishes the dignity and worth of any person. All are special creations of God and are his image-bearers. Jesus knows them, loves them, and invites them to follow him.

But what about the surgeries that are the focus of The Washington Post piece? Although the issue is complicated, I agree with those who lean against such surgical interventions. I have a long section in my sexual ethics book about intersex. Here is an excerpt of my conclusions:

The phenomenon of intersex should call forth our compassion and our love for our neighbors who carry in their persons a painful reminder of the groaning creation. It should not call forth from us a revision of the binary ideal of Scripture…

How should parents deal with a child born with an intersex condition? There is no once-size-fits-all strategy, given the complexity of the possible conditions. Nevertheless, here are some guiding principles I would suggest for parents caring for a child with this condition. The first set of principles I would recommend are more theologically oriented. First, everyone needs know what the creation ideal of Scripture is. According to Genesis 1-2, man’s unfallen state is a clearly gendered state, and this is the norm. Second, the entrance of sin into the world and God’s subsequent curse means that all kinds of physical difficulties afflict the human condition. Disorders of sex development would be included in that. Third, the gospel of Jesus Christ not only frees from the penalty and power of sin in the present, it also promises eternal life in the future. That life involves the resurrection of our physical bodies. It means a renewal and restoration of what was lost in the Garden of Eden. In the resurrection, all disorders of sex development will be swept away, and intersex people will be healed and made whole. That hope of restoration should be held out to the child throughout his life even if some ambiguities about his condition remain unresolved.

Here are some principles I would suggest with respect to medical treatments. First, parents should be extremely reluctant about—if not altogether against—corrective surgery when the child is an infant. This is especially the case when the surgery would involve the modification of the child’s genitals or reproductive organs. Perhaps surgical procedures would be in order at some point during the child’s life, but do not rush a child into surgery simply out of a desire to make the child “normal.” Second, try to determine as soon as possible the chromosomal make-up of the child. If there is a Y chromosome present, that would strongly militate against raising the child as a female, regardless of the appearance of the genitals and other secondary sex characteristics. It would also suggest that medical treatments designed to make the child into a female are out of line. Third, understand that not all doctors and medical professionals share your biblical convictions. Worldviews affect the treatment of intersex conditions. Some doctors may view gender as a social construct and therefore would not let biological markers (such as a Y chromosome) determine the child’s gender. Fourth, parents need to take an active role in understanding the condition and pursuing treatment options in keeping with their biblical convictions.

What Is the Meaning of Sex?, pp. 180-82

If you are an intersex person and feel estranged from your own body, you need not feel estranged from Jesus. Jesus loves intersex persons. He knows what it is like for a person to suffer for no fault of his own. And he offers you hope and life. His powerful death and resurrection address not only your condition but the human condition and provides forgiveness and reconciliation to every sinner who receives Christ by faith. This message brings with it a promise of the renewal of all things in the age to come, which means that all of our broken bodies will one day be what God intended them to be. He knows every one of your tears and offers to wipe away every last one of them (Rev. 21:4). If you have felt your body to be a barrier to life and joy, it is no barrier to Jesus and to real life and real joy. They can be yours because of him.

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