Sex assignment

  (Redirected from Assigned male at birth)

Sex assignment (sometimes known as gender assignment) is the discernment of an infant's sex at birth.[1] A relative, midwife, nurse or physician inspects the external genitalia when the baby is delivered and, in more than 99.95% of births, sex is assigned without ambiguity.[2][3] Assignment may also be done prior to birth through prenatal sex discernment.[4]

The sex assignment at birth usually aligns with a child's anatomical sex and phenotype. The number of births where the baby is intersex—where they do not fit into typical definitions of male and female at birth—has been reported to be as low as 0.018%, but is often estimated at around 0.2%.[5][6][7] The number of births with ambiguous genitals is in the range of 0.02% to 0.05%.[3] These conditions may complicate sex assignment.[8] Other intersex conditions involve atypical chromosomes, gonads or hormones.[5][9] Reinforcing sex assignments through surgical or hormonal interventions is often considered to violate the individual's human rights.[10][11][12][13]

Traditionally assignment carries the implicit expectation that future gender identity will develop in alignment with the physical anatomy, assignment, and rearing.[14] In about 99.4% of cases, the child's gender identity will match their sex assignment.[15] If sex assignment and gender identity do not align, the person is transgender.[16][17][18][19] The sex assignment of an intersex individual may also contradict their future gender identity.[20]

TerminologyEdit

Sex assignment is the discernment of an infant's sex at birth.[21][22] Terms that may be related to sex assignment are:

Assigned male at birth (AMAB): a person of any age and irrespective of current gender whose sex assignment at birth resulted in a declaration of "male". Synonyms: male assigned at birth (MAAB) and designated male at birth (DMAB).[23][24]

Assigned female at birth (AFAB): a person of any age and irrespective of current gender whose sex assignment at birth resulted in a declaration of "female". Synonyms: female assigned at birth (FAAB) and designated female at birth (DFAB).[23][24]

Intersex, in humans and other animals, describes variations in sex characteristics including chromosomes, gonads, sex hormones, or genitals that, according to the UN Office of the High Commissioner for Human Rights, "do not fit typical binary notions of male or female bodies".[9] These may complicate the sex assignment of a newborn and can result a phenotypical sex assignment that is inconsistent with normal genotype.[8][20]

Transgender people have a gender identity, or gender expression, that differs from their assigned sex.[17][18][19] Transgender people are sometimes called transsexual if they desire medical assistance to transition from one sex to another.

Sex reassignment : a treatment program consisting of a combination of psychological, medical, and surgical methods intended to physically change a person's sexual characteristics.[citation needed]

Assignment in cases of infants with intersex traits, or cases of traumaEdit

Observation or recognition of an infant's sex may be complicated in the case of intersex infants and children and in cases of early trauma. In such cases, the infant may be assigned male or female, and may receive medical treatment to confirm that assignment. These medical interventions have increasingly been seen as a human rights issue due to their unnecessary nature and the potential for lifelong complications.[9][25]

Cases of trauma include the famous John/Joan case, where sexologist John Money claimed successful reassignment from male to female at age 17 months of a boy whose penis was destroyed during circumcision. However, this claim was later shown to be largely false. The subject, David Reimer, later identified as a man.[26]

The number of births with ambiguous genitals is in the range of 1 in 2,000 to 1 in 4,500 (0.05% to 0.02%).[3] Typical examples would be an unusually prominent clitoris in an otherwise apparently typical girl, or complete cryptorchidism in an otherwise apparently typical boy. In most of these cases, a sex is tentatively assigned and the parents told that tests will be performed to confirm the apparent sex. Typical tests in this situation might include a pelvic ultrasound to determine the presence of a uterus, a testosterone or 17α-hydroxyprogesterone level, and/or a karyotype. In some of these cases a pediatric endocrinologist is consulted to confirm the tentative sex assignment. The expected assignment is usually confirmed within hours to a few days in these cases.

Some infants are born with enough ambiguity that assignment becomes a more drawn-out process of multiple tests and intensive education of the parents about sexual differentiation. In some of these cases, it is clear that the child will face physical difficulties or social stigma as they grow up, and deciding upon the sex of assignment involves weighing the advantages and disadvantages of either assignment. Intersex activists have criticised "normalising" procedures performed on infants and children, who are unable to provide informed consent.[25]

HistoryEdit

In European societies, Roman law, post-classical canon law, and later common law, referred to a person's sex as male, female or hermaphrodite, with legal rights as male or female depending on the characteristics that appeared most dominant. Under Roman law, a hermaphrodite had to be classed as either male or female.[27] The 12th-century Decretum Gratiani states that "Whether an hermaphrodite may witness a testament, depends on which sex prevails".[28][29][30] The foundation of common law, the 16th Century Institutes of the Lawes of England, described how a hermaphrodite could inherit "either as male or female, according to that kind of sexe which doth prevaile."[31][32] Legal cases where sex assignment was placed in doubt have been described over the centuries.

With the medicalization of intersex, criteria for assignment have evolved over the decades, as clinical understanding of biological factors and diagnostic tests have improved, as surgical techniques have changed and potential complications have become clearer, and in response to the outcomes and opinions of adults who have grown up with various intersex conditions.

Before the 1950s, assignment was based almost entirely on the appearance of the external genitalia. Although physicians recognized that there were conditions in which the apparent secondary sexual characteristics could develop contrary to the person's sex, and conditions in which the gonadal sex did not match that of the external genitalia, their ability to understand and diagnose such conditions in infancy was too poor to attempt to predict future development in most cases.

In the 1950s, endocrinologists developed a basic understanding of the major intersex conditions such as congenital adrenal hyperplasia (CAH), androgen insensitivity syndrome, and mixed gonadal dysgenesis. The discovery of cortisone allowed survival of infants with severe CAH for the first time. New hormone tests and karyotypes allowed more confident diagnosis in infancy and prediction of future development.

Sex assignment became more than choosing a sex of rearing, but also began to include surgical treatment. Undescended testes could be retrieved. A greatly enlarged clitoris could be amputated to the usual size, but attempts to create a penis were unsuccessful. John Money and others controversially believed that children were more likely to develop a gender identity that matched sex of rearing than might be determined by chromosomes, gonads, or hormones. The resulting medical model was termed the "Optimal gender model".[33]

Challenges to requirements for sex assignmentEdit

In recent years, the perceived need to legally assign sex is increasingly being challenged by transgender, transsexual, and intersex people.[34][35] A report for the Dutch Ministry of Security and Justice states "Gender increasingly seems to be perceived as a ‘sensitive’ identity feature, but so far is not regarded, nor protected as such in privacy regulations".[34] Australian government guidelines state that "departments and agencies that collect sex and/or gender information must not collect information unless it is necessary for, or directly related to, one or more of the agency's functions or activities"[36]

Sex registration was introduced in the Netherlands in 1811 due to gender-specific rights and responsibilities, such as military conscription.[34] Many gender-specific provisions in legislation no longer exist, but the provisions remain for rationales that include "speed of identification procedures".[34]

ReferencesEdit

  1. ^ Rathus SA, Nevid JS, Rathus LF (2010). Human Sexuality in a World of Diversity. Allyn & Bacon. p. 168. ISBN 978-0-205-78606-0. Archived from the original on 2021-06-06. Retrieved 2019-12-05.
  2. ^ Reiner WG (2002). "Gender identity and sex assignment: a reappraisal for the 21st century". Adv. Exp. Med. Biol. Advances in Experimental Medicine and Biology. 511: 175–89, discussion 189–97. doi:10.1007/978-1-4615-0621-8_11. ISBN 978-1-4613-5162-7. PMID 12575762.
  3. ^ a b c Witchel, Selma Feldman (2018). "Disorders of Sex Development". Best Practice & Research. Clinical Obstetrics & Gynaecology. 48: 90–102. doi:10.1016/j.bpobgyn.2017.11.005. ISSN 1521-6934. PMC 5866176. PMID 29503125.
  4. ^ Dhamankar Rupin (2020). "Fetal Sex Results of Noninvasive Prenatal Testing and Differences With Ultrasonography". Obstet Gynecol. 135 (5): 1198–1206. doi:10.1097/AOG.0000000000003791. PMC 7170435. PMID 32282607. S2CID 215758793.
  5. ^ a b Sax, Leonard (August 2002). "How common is intersex? a response to Anne Fausto-Sterling". Journal of Sex Research. 39 (3): 174–178. doi:10.1080/00224490209552139. ISSN 0022-4499. PMID 12476264. S2CID 33795209. Archived from the original on 2021-02-28. Retrieved 2020-06-27.
  6. ^ Blackless, Melanie; Charuvastra, Anthony; Derryck, Amanda; Fausto-Sterling, Anne; Lauzanne, Karl; Lee, Ellen (11 February 2000). "How Sexually Dimorphic Are We? Review and Synthesis" (PDF). American Journal of Human Biology. 12 (2): 151–166. doi:10.1002/(SICI)1520-6300(200003/04)12:2<151::AID-AJHB1>3.0.CO;2-F. PMID 11534012. S2CID 453278. Archived (PDF) from the original on 12 June 2021. Retrieved 11 June 2021.
  7. ^ "On the number of intersex people". Intersex Human Rights Australia. 28 September 2013. Archived from the original on 2018-07-17. Retrieved 2018-05-10.
  8. ^ a b Mieszczak, J; Houk, CP; Lee, PA (Aug 2009). "Assignment of the sex of rearing in the neonate with a disorder of sex development". Curr Opin Pediatr. 21 (4): 541–7. doi:10.1097/mop.0b013e32832c6d2c. PMC 4104182. PMID 19444113.
  9. ^ a b c United Nations; Office of the High Commissioner for Human Rights (2015). Free & Equal Campaign Fact Sheet: Intersex (PDF). Archived (PDF) from the original on 2016-03-04.
  10. ^ UN Committee against Torture; UN Committee on the Rights of the Child; UN Committee on the Rights of People with Disabilities; UN Subcommittee on Prevention of Torture and other Cruel Inhuman or Degrading Treatment or Punishment; Juan Méndez, Special Rapporteur on torture and other cruel inhuman or degrading treatment or punishment; Dainius Pῡras, Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health; Dubravka Šimonoviæ, Special Rapporteur on violence against women its causes and consequences; Marta Santos Pais, Special Representative of the UN Secretary-General on Violence against Children; African Commission on Human and Peoples' Rights; Council of Europe Commissioner for Human Rights; Inter-American Commission on Human Rights (October 24, 2016), "Intersex Awareness Day – Wednesday 26 October. End violence and harmful medical practices on intersex children and adults, UN and regional experts urge", Office of the High Commissioner for Human Rights, archived from the original on November 21, 2016
  11. ^ Swiss National Advisory Commission on Biomedical Ethics NEK-CNE (November 2012). On the management of differences of sex development. Ethical issues relating to "intersexuality".Opinion No. 20/2012 (PDF). 2012. Berne. Archived from the original (PDF) on 2015-04-23.
  12. ^ Involuntary or coerced sterilisation of intersex people in Australia Archived 2015-09-23 at the Wayback Machine, Australian Senate Community Affairs Committee, October 2013.
  13. ^ World Health Organization (2015). Sexual health, human rights and the law. Geneva: World Health Organization. ISBN 978-92-4-156498-4.
  14. ^ Cecilia Hardacker; Kelly Ducheny; Magda Houlberg (17 October 2018). Transgender and Gender Nonconforming Health and Aging. Springer. p. 3. ISBN 978-3-319-95031-0. Archived from the original on 21 October 2020. Retrieved 23 May 2020. The government, society, healthcare and school systems, and the child's parents have traditionally assumed that all children with a female sex assigned at birth will grow up to be women and all children with a male sex assigned at birth will grow up to be men. It has been assumed that people are cisgender, in other words, that people's sex assigned at birth was automatically identical to their gender identity - which is their personal felt experience of gender, of being male, female, a combination of male and female, or a unique blend of those genders. It was also assumed that gender was binary and that there are only two ways to experience gender either as a girl/woman or as a boy/man.
  15. ^ Flores, Andrew R.; Herman, Jody L.; Gates, Gary J.; Brown, Taylor N.T. (June 2016). "How Many Adults Identify as Transgender in the United States?" (PDF). Williams Institute. Archived from the original (PDF) on 2021-10-27. Retrieved 2021-11-16.
  16. ^ Shaw, Alison; Ardener, Shirley (2005). Changing sex and bending gender, p. 21. Berghahn Books, ISBN 978-1-84545-099-1
  17. ^ a b Terry Altilio; Shirley Otis-Green (2011). Oxford Textbook of Palliative Social Work. Oxford University Press. p. 380. ISBN 978-0-19-983827-1. Archived from the original on December 1, 2016. Retrieved April 12, 2016. Transgender is an umbrella term for people whose gender identity and/or gender expression differs from the sex they were assigned at birth (Gay and Lesbian Alliance Against Defamation [GLAAD], 2007).
  18. ^ a b Craig J. Forsyth; Heith Copes (2014). Encyclopedia of Social Deviance. Sage Publications. p. 740. ISBN 978-1-4833-6469-8. Archived from the original on December 1, 2016. Retrieved April 12, 2016. Transgender is an umbrella term for people whose gender identities, gender expressions, and/or behaviors are different from those culturally associated with the sex to which they were assigned at birth.
  19. ^ a b Marla Berg-Weger (2016). Social Work and Social Welfare: An Invitation. Routledge. p. 229. ISBN 978-1-317-59202-0. Archived from the original on December 1, 2016. Retrieved April 12, 2016. Transgender: An umbrella term that describes people whose gender identity or gender expression differs from expectations associated with the sex assigned to them at birth.
  20. ^ a b Council of Europe; Commissioner for Human Rights (April 2015), Human rights and intersex people, Issue Paper, archived from the original on 2016-01-06
  21. ^ "Terminology | Adolescent and School Health". Centers for Disease Control and Prevention (CDC). December 18, 2019. Archived from the original on May 7, 2020. Retrieved May 23, 2020.
  22. ^ Raveenthiran, V (2017). "Neonatal Sex Assignment in Disorders of Sex Development: A Philosophical Introspection". Journal of Neonatal Surgery. 6 (3): 58. doi:10.21699/jns.v6i3.604. ISSN 2226-0439. PMC 5593477. PMID 28920018.
  23. ^ a b Harrington, Lee (May 2016). Traversing Gender: Understanding Transgender Realities. Mystic Productions Press. pp. 50, 56. ISBN 978-1-942733-83-6. Archived from the original on 2016-12-21.
  24. ^ a b Serano, Julia (October 2013). Excluded: Making Feminist and Queer Movements More Inclusive. Seal Press. p. 301. ISBN 978-1-58005-504-8. Archived from the original on 2016-12-21.
  25. ^ a b Cabral, Mauro; Carpenter, Morgan, eds. (2014), Intersex Issues in the International Classification of Diseases: a revision, archived from the original on 2015-10-29
  26. ^ Colapinto, John (2004-06-03). "Why did David Reimer commit suicide?". Slate Magazine. Archived from the original on 2022-03-20. Retrieved 2022-03-20.
  27. ^ Roller, Lynn E. (1997). "The Ideology of the Eunuch Priest". Gender & History. 9 (3): 542–559. doi:10.1111/1468-0424.00075. S2CID 143133728.
  28. ^ Decretum Gratiani, C. 4, q. 2 et 3, c. 3
  29. ^ "Decretum Gratiani (Kirchenrechtssammlung)". Bayerische StaatsBibliothek (Bavarian State Library). February 5, 2009. Archived from the original on December 20, 2016.
  30. ^ Raming, Ida; Macy, Gary; Bernard J, Cook (2004). A History of Women and Ordination. Scarecrow Press. p. 113.
  31. ^ E Coke, The First Part of the Institutes of the Laws of England, Institutes 8.a. (1st Am. Ed. 1812) (16th European ed. 1812).
  32. ^ Greenberg, Julie (1999). "Defining Male and Female: Intersexuality and the Collision Between Law and Biology". Arizona Law Review. 41: 277–278. SSRN 896307.
  33. ^ Australian Senate; Community Affairs References Committee (October 2013). Involuntary or coerced sterilisation of intersex people in Australia. Canberra: Community Affairs References Committee. ISBN 978-1-74229-917-4. Archived from the original on 2015-09-23.
  34. ^ a b c d van den Brink, Marjolein; Tigchelaar, Jet (2014), M/F and beyond, Gender registration by the state and the legal position of transgender persons. English summary, Ministerie van Veiligheid & Justitie, archived from the original on 2016-03-04
  35. ^ Chan, Emily (26 May 2015). "Get gender off birth certificates, B.C. activists argue". CTV News. Archived from the original on 2015-11-18. Retrieved 2016-01-01.
  36. ^ Australia; Attorney General's Department (2013). Australian Government Guidelines on the Recognition of Sex and Gender. Archived from the original on 2015-07-01.