The Hamburg hearing on 21 June 2018 concerning operations on children with variations in sex characteristics

On 21 June 2018, a hearing on “Operations on Children with Variations in Physical Sex Characteristics” took place at the Hamburg City Hall in response to the major interpellation (Drs. 21/9670). Hamburg Parliament’s Science Committee invited four people to provide information: Prof. Dr Konstanze Plett, lawyer and co-author of the constitutional complaint the “Third Option”, Ursula Rosen, representative of the association “Intersexuelle Menschen e. V.”, Dr Michaela Katzer from the Merseburg University of Applied Sciences and Dr Katinka Schweizer from the Institute for Sex Research and Forensic Psychiatry at the University Medical Centre Hamburg-Eppendorf.

During the well-attended three-hour hearing, people signalled a great deal of interest in the topic. The expert respondents agreed that operations on the genitals of children which are not for reasons of medical emergency should not be performed, in order to preserve the child’s right to physical integrity. You can find a report on the hearing under this link to the Tageszeitung newspaper (taz, 26 June 2018).

“The topic is complex and requires a lot of familiarisation with all its facets,” Schweizer stressed. There is a great deal of uncertainty about which forms of variation count as intersex and diverse sex development (DSD). For example, so-called hypospadias, in which the urethra ends at the underside of the penis, is mistakenly not included, explained Ursula Rosen. And should you operate on a child with hypospadias merely so that the child is able to stand up when it urinates? How important is this for the identity of an adolescent, and can one speak here of a “medically necessary” intervention? Such and other issues were addressed by the Committee. Despite the new AWMF (Association of the Scientific Medical Societies in Germany) guidelines (2016), which call for extreme restraint in irreversible, non-essential surgery on children, the speakers agreed that legislation is needed to regulate this. If the guidelines are not adhered to and an operation should take place after all, who will file a complaint? “The parents will not complain, as they would no doubt be for the surgical intervention, and the children are often too young,” says Plett. Rosen referred to another problematic aspect: There is a danger that gender-normalising, non-essential operations may be justified by other concepts.

At the end of the event, policymakers were called upon to make changes – to improve the counselling and support for parents of intersex children so as to avoid operations that would later be regretted. Medical diagnostics and education should be accompanied by psychosocial and peer-to-peer counselling. What is necessary is independent advisory structures for the future, a look into the past, and a reappraisal of Hamburg’s history in dealing with intersex.