For many people, the news of expecting a child elicits an unparalleled joy, followed by a nervous anticipation about the pregnancy and infant. Despite the numerous questions a parent may have, the most common question anyone else asks is, “Do you know what you are having?” In an era in which gender issues have emerged at the forefront of both pediatric medicine and the popular press, this question has become far more complex.
In some regions of the world, sex determination of the fetus has often led to sex-selective abortion; laws have thus been passed in these countries prohibiting ultrasonography for the purpose of sex determination.1 Although this has not been a problem in the United States, there are scenarios in which a sex assignment may later be questioned or reversed, leading to a significant amount of distress. Historically, expectant parents were able to learn about the infant’s genital...
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RE: The Gender Reveal: Implications of a Cultural Tradition for Pediatric Health
We applaud Dr. Leena Nahata for her thoughtful Perspective. Her commentary tackles much of what is troubling about the increasing focus on an infant’s sex (and presumed gender), taking time to include how intersex children in fact defy the scheme of easy categorization at the heart of the burgeoning “gender reveal” rituals.
The author also notes that, while decision-making responsibility about gender assignment, medical treatment, and consideration of any surgical procedures for intersex children should be shared by both doctors and parents, this does not necessarily preclude parents from worrying if they may have “chose[n] wrong” for their child. We call attention to the fact that, while incorrect gender assignment is certainly one risk, any discussion of this topic should acknowledge that surgeries altering the genitals or reproductive organs of intersex children without their consent can result in a litany of physical and psychological problems, from a lack of future sexual sensation to sterilization to PTSD. While these surgical interventions are often driven by a perceived need to “fit” the child into a category – either male or female – it is important to point out that surgical alteration of non-binary genitalia is necessary neither for gender assignment, nor to raise a healthy child. The same focus driving the “gender reveal” trend can lead to many different kinds of harm when “normalizing” surgery is chosen for intersex infants and children.
Dr. Nahata rightly observes that any child may grow up to have a gender that is different from what was predicted based on their appearance at birth. This is especially true for intersex children. We would urge all doctors who treat intersex children to take Dr. Nahata’s wise counsel to heart and, in addition, to remember that irreversible childhood surgery is risky, even if the gender assignment proves to be right.
Susan E. Stred, MD
Professor, Pediatric Endocrinology
SUNY Upstate Medical University
Syracuse, NY