A serious and scientific debate is needed regarding the problems arising from disorders of sexual development, not intersexuality.
Definition of Disorders of Sexual Development (intersexuality)
[dropcap]T[/dropcap]os Disorders of Sexual Development (DSD) They consist of the presentation of various anomalies in the anatomical development of the external and/or internal genitals, with the existence of structures, normally incomplete, of the male and/or female sex.
Both the name of intersexuality, As in pseudohermaphroditism y hermaphroditismThey have now practically disappeared from scientific literature because they lend themselves to confusion, stigmatization, and ideological manipulation by of the LGBT movement and the feminist current queer .
TDS Classification
The great advances in medical exploration techniques and molecular genetics have produced a radical change in the nomenclature of TDS over the past decade, with the Lawson Wilkins Pediatric Endocrinology y la European Society for Pediatric Endocrinology, those that proposed the change of nomenclature in 2006 (1) of hermaphroditism, pseudohermaphroditism e intersexuality By the Disorders of Sexual Development (TDS). His proposal has been widely accepted and is now the prevailing one in scientific and medical literature. This change explains this medical problem much more appropriately, facilitating the development of diagnostic and intervention protocols.
Table 1 shows the proposed changes with respect to the old nomenclature and Table 2 shows the application of the new nomenclature to the various clinical situations (2).
Table 1.
Table 2:
Of course, the etiology of TDS It is related to genetic, embryonic, and environmental causes (toxic, food-related, etc.).
Approaches from the gender ideology
For this ideological current, in its most radical expression, biological sex is irrelevant. What matters is gender, and this is a purely social construct. Thus, we no longer speak of male and female (binary) sexes, but rather of a vast array of variations depending on the option each individual freely chooses to identify with. We speak of homosexuality, lesbianism, transsexuality, bisexuality, pedophilia, zoophilia, asexuality, gender neutrality, queerness, etc. For this current, binary sex/gender is a purely cultural construct that stems primarily from the impositions of heteropatriarchy, religious beliefs, or other cultural, economic, and/or sociopolitical interests.
Gender dysphoria is not a medical condition, but rather a form of gender expression; it represents natural variations in the expression of sex and gender. Therefore, it is not an illness. This is why the LGBT movement has incorporated the "I" into its acronym. LGBTI movement.
I believe this approach is ideological, lacking any scientific basis. However, in my opinion, this trend has produced something positive: Today, more consideration is given to a group that, until just a few years ago, was limited to undergoing surgery to correct genital anomalies based almost exclusively on chromosomal sex.
Medical approach
Traditionally, when faced with a disorder, the first step was to look for the underlying cause. Today, the causes associated with a disorder have expanded considerably, especially due to the possibilities offered by molecular genetics.
From a traditional perspective, early surgical intervention was decided based on chromosomal or phenotypic sex. However, beyond the surgical outcomes, the evolution of the condition presents other problems related to sexual orientation and gender dysphoria that were not initially considered and that have been a source of great suffering for many patients.
It's important to keep in mind that genetic abnormalities, chromosomal sex, and problems related to fertilization and embryonic development are not necessarily linked to future sexual orientation and gender identity. For example, androgen insensitivity, o Morris syndromeIt produces a genital feminization that causes these individuals to grow up somatically and socially as women, even, in many cases, with their male chromosomal sex (XY) being discovered in routine examinations.
Therefore, before any surgical decisions are made, each case is evaluated by an interdisciplinary team, including developmental psychiatrists and bioethicists, to maximize therapeutic interventions. These surgical procedures are not always cosmetic, contrary to what many detractors, misleadingly and irresponsibly, claim.
Critical aspects of both approaches
The medical approach, Until just a few years ago, and even today, the focus has been on identifying the etiopathogenesis and determining surgical or hormonal intervention. However, in developmental disorders (DDs), as Kim Suk Kim et al. (2011)(2) write, "It is important to diagnose the cause correctly and as early as possible in order to advise parents appropriately. The evaluation and management of DDs is complex and should be carried out by a multidisciplinary team that includes a pediatric urologist, a developmental psychiatrist, and a pediatric endocrinologist."
Therefore, the criticism that can be made of the medical approach is the real fact that DSDs are still not being addressed appropriately, as required by clinical guidelines. As del Valle (4) states, given the numerous failures of surgery based on binary sex, in recent years there has been a genuine paradigm shift.
A gender ideologyThey are asked not to politicize a multidisciplinary issue. While some dilemmas related to the expression of sexuality, whether orientation or identity, may arise as the topic develops, they cannot ignore that sexual disorders are the result of a medical condition that requires further research by medicine and biology, in collaboration with other professionals, to implement the best possible treatments in the future.
Certainly, both from the perspective of human rights, as from the bioethical principles of patient autonomy and the right to bodily integrity, We must be immensely respectful, but LGBT movements can contribute little to the very diverse problem of "intersexuality." An example of this is theLaw to guarantee the rights of people who identify as LGBTI and to eradicate LGBTIphobia in Andalusia"which in its very extensive articles, only dedicates to "intersexuality" a meager Art. 13 designed more on how to penalize than on how to help newborns with this serious problem.
TDS and gender neutrality
I don't like the term "gender neutral" because it doesn't truly reflect the reality we face in gender dysphoria. We start from the biological fact that gender dysphoria is present at birth, where, in reality, nothing is known about gender. We can only say that, in many cases, the situation is difficult or impossible to classify according to the gender binary. It's true that we shouldn't make a hasty decision about a problem for which at least 40 different causes have been identified.
Therefore, I agree more with Germany's 2013 decision not to record sex/gender in cases of gender dysphoria until the sexual orientation of these patients is clearly known. This is especially true given that the "approximate" and altered chromosomal sex often does not coincide with the subsequent sexual orientation, whether due to chromosomal, genetic, or biochemical abnormalities.
Furthermore, it is a decision in accordance with respect for children's human rights.
In my opinion, and as recommended by American Academy of Child and Adolescent Psychiatry For other dilemmas related to sexual orientation and identity, what would be appropriate is support or affirmative therapyThat is, to affirm the gender expression that a person with a gender dysphoria spontaneously presents, regardless of chromosomal sex, or chromosomal, genetic, and/or biochemical alterations the patient may have. However, here it is necessary to introduce the nuance that education should be flexibly oriented towards phenotypic sex. The child needs a guiding framework From birth, their overall personality, not just their sexual orientation, will be built upon this foundation. We cannot leave to spontaneity what requires guidance, support, and the modulating attachment of adults, always with a flexible attitude.
The surgical interventions, If they are not necessary (correction of vital or functional deformities, prevention of cancers, etc.) they should be delayed as long as possible until a time when the individual can decide.
That is why I would change the word "gender neutral" to " "not defined".
In any case, it is a complex issue that should be free of ideological contamination out of respect for patients suffering from any disorder and always keeping in mind in the best interests of the child.
Bibliography
(1)Third Joint Meeting of the European Society for Pediatric Endocrinology (ESPE) and Lawson Wilkins Pediatric Endocrinology Society (LWPES), Jerusalem, October 29-November 3, 1989. DOI: doi: 10.1159 / 000181135
(2)Kun Suk Kim et al. Disorders of Sex Development. Korean J Urol, 2012; 53:1-8. DOI: 10.4111/kju.2012.53.1.1
(3) Miguel del Valle et al. Reflections of the Bioethics Committee of a pediatric hospital on the implications of the diagnosis and treatment of disorders of sexual development. Arch. Argent Pediatr. 2015; 113(3): 260-264. DOI: 10.5546/aap.2015.260
