Sex assignment

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This article is about sex assignment in humans. Sex assignment_sentence_0

For sex assignment in other animals, see sexing. Sex assignment_sentence_1

Sex assignment (sometimes known as gender assignment) is the discernment of an infant's sex at birth. Sex assignment_sentence_2

Assignment may be done prior to birth through prenatal sex discernment. Sex assignment_sentence_3

In the majority of births, a relative, midwife, nurse or physician inspects the genitalia when the baby is delivered, and sex is assigned, without the expectation of ambiguity. Sex assignment_sentence_4

Sex assignment at birth usually aligns with a child's anatomical sex and phenotype. Sex assignment_sentence_5

The number of births where the baby is intersex - where they do not fit into typical definitions of male and female - has been reported to be as low as 0.018% up to roughly 1.7%, depending on which conditions are counted as intersex. Sex assignment_sentence_6

The number of births with ambiguous genitals is in the range of 0.02% to 0.05%. Sex assignment_sentence_7

These conditions may complicate sex assignment. Sex assignment_sentence_8

Other intersex conditions involve atypical chromosomes, gonads or hormones. Sex assignment_sentence_9

Reinforcing sex assignments through surgical or hormonal interventions is often considered to violate the individual's human rights. Sex assignment_sentence_10

The act of assignment carries the implicit expectation that future gender identity will develop in alignment with the physical anatomy, assignment, and rearing. Sex assignment_sentence_11

In about 99% of cases, the child's gender identity matches their sex assignment. Sex assignment_sentence_12

If sex assignment and gender identity do not align, the person may be transgender or gender non-conforming (GNC). Sex assignment_sentence_13

The sex assignment of an intersex individual may also contradict their future gender identity. Sex assignment_sentence_14

Terminology Sex assignment_section_0

Sex assignment is the discernment of an infant's sex at birth. Sex assignment_sentence_15

Terms that may be related to sex assignment are: Sex assignment_sentence_16

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". Sex assignment_sentence_17

For example, when an attending midwife or physician announces, "It's a boy!" Sex assignment_sentence_18

Synonyms: male assigned at birth (MAAB) and designated male at birth (DMAB). Sex assignment_sentence_19

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". Sex assignment_sentence_20

For example, when an attending midwife or physician announces, "It's a girl!" Sex assignment_sentence_21

Synonyms: female assigned at birth (FAAB) and designated female at birth (DFAB). Sex assignment_sentence_22

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". Sex assignment_sentence_23

These may complicate the sex assignment of a newborn and can result a phenotypical sex assignment that is inconsistent with normal genotype. Sex assignment_sentence_24

Transgender people have a gender identity, or gender expression, that differs from their assigned sex. Sex assignment_sentence_25

Transgender people are sometimes called transsexual if they desire medical assistance to transition from one sex to another. Sex assignment_sentence_26

Sex reassignment : a treatment program consisting of a combination of psychological, medical, and surgical methods intended to physically change a person's sexual characteristics. Sex assignment_sentence_27

History Sex assignment_section_1

The discernment of an infant's sex was, until recently, almost universally considered an observation or recognition of an inherent aspect of a baby. Sex assignment_sentence_28

The rationales for sex assignment and consequential registration appear to have been little questioned. Sex assignment_sentence_29

A Dutch report on gender registration states that sex registration was introduced in 1811 as an intrinsic component in population registration, due to gender-specific rights and responsibilities, such as military conscription. Sex assignment_sentence_30

Many discriminatory provisions in legislation no longer exist, but the provisions remain for rationales that include "speed of identification procedures". Sex assignment_sentence_31

Assignment in cases of infants with intersex traits, or cases of trauma Sex assignment_section_2

Main articles: Intersex medical interventions and History of intersex surgery Sex assignment_sentence_32

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. Sex assignment_sentence_33

In such cases, sex assignment is generally taken to require medical treatment to confirm that assignment, but this is disputed in part due to the human rights implications of such treatment. Sex assignment_sentence_34

Intersex broadly denotes the presence of atypical sex characteristics: at least some aspect of the genitalia, internal organs, secondary sex characteristics, gonadal tissue, or chromosomes is more typical of the other sex. Sex assignment_sentence_35

When the external genitalia appear to be in between, they are described as ambiguous. Sex assignment_sentence_36

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. Sex assignment_sentence_37

However, this claim was later shown to be largely false. Sex assignment_sentence_38

The subject, David Reimer, later identified as a man. Sex assignment_sentence_39

The number of births with ambiguous genitals is in the range of 1 in 2,000 to 1 in 4,500 (0.02% to 0.05%). Sex assignment_sentence_40

Typical examples would be an unusually prominent clitoris in an otherwise apparently typical girl, or complete cryptorchidism in an otherwise apparently typical boy. Sex assignment_sentence_41

In most of these cases, a sex is tentatively assigned and the parents told that tests will be performed to confirm the apparent sex. Sex assignment_sentence_42

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. Sex assignment_sentence_43

In some of these cases a pediatric endocrinologist is consulted to confirm the tentative sex assignment. Sex assignment_sentence_44

The expected assignment is usually confirmed within hours to a few days in these cases. Sex assignment_sentence_45

In a much smaller proportion of cases, the process of assignment is more complex, and involves both discerning what the biological elements of characteristic sex may be and choosing the best sex assignment for the purposes of rearing the child. Sex assignment_sentence_46

Approximately 1 in 20,000 infants is born with enough ambiguity that assignment becomes a more drawn-out process of multiple tests and intensive education of the parents about sexual differentiation. Sex assignment_sentence_47

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. Sex assignment_sentence_48

Intersex activists have criticised "normalising" procedures performed on infants and children, who are unable to provide informed consent. Sex assignment_sentence_49

History Sex assignment_section_3

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. Sex assignment_sentence_50

Under Roman law, a hermaphrodite had to be classed as either male or female. Sex assignment_sentence_51

The 12th-century Decretum Gratiani states that "Whether an hermaphrodite may witness a testament, depends on which sex prevails". Sex assignment_sentence_52

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." Sex assignment_sentence_53

Legal cases where sex assignment was placed in doubt have been described over the centuries. Sex assignment_sentence_54

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. Sex assignment_sentence_55

Before the 1950s, assignment was based almost entirely on the appearance of the external genitalia. Sex assignment_sentence_56

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. Sex assignment_sentence_57

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. Sex assignment_sentence_58

The discovery of cortisone allowed survival of infants with severe CAH for the first time. Sex assignment_sentence_59

New hormone tests and karyotypes allowed more confident diagnosis in infancy and prediction of future development. Sex assignment_sentence_60

Sex assignment became more than choosing a sex of rearing, but also began to include surgical treatment. Sex assignment_sentence_61

Undescended testes could be retrieved. Sex assignment_sentence_62

A greatly enlarged clitoris could be amputated to the usual size, but attempts to create a penis were unsuccessful. Sex assignment_sentence_63

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. Sex assignment_sentence_64

The resulting medical model was termed the "Optimal gender model." Sex assignment_sentence_65

The view of gender as a purely social construction, and gender identity as a result of nurture rather than nature reached widespread acceptance, at least in liberal, progressive, and academic portions of Western society. Sex assignment_sentence_66

The primary goal of assignment was to choose the sex that would lead to the least inconsistency between external anatomy and assigned psyche (gender identity). Sex assignment_sentence_67

This led to the recommendation that any child without a penis or with a penis too small to penetrate a vagina could be raised as a girl, taught to be a girl, and would develop a female gender identity, and that this would be the best way to minimize future discrepancy between psyche and external anatomy in those infants determined to be genetically male (i.e. XY genotype) but without a penis that meets medical norms (e.g., cloacal exstrophy), and also in those like in the John/Joan case who lost it to accidental trauma in early infancy. Sex assignment_sentence_68

From the 1960s, pediatric surgeons attempted and claimed success with reconstruction of infant genitalia, especially enlargement or construction of vaginas. Sex assignment_sentence_69

The recommended rules of assignment and surgery from the late 1960s until the 1990s were roughly: Sex assignment_sentence_70

Sex assignment_unordered_list_0

  • Any XX infant, no matter how virilized, should be raised as a girl to preserve the chance of future fertility. A large, protruding clitoris should be reduced in size with a nerve-sparing recession or reduction rather than simple amputation.Sex assignment_item_0_0
  • Any undervirilized XY infant should be raised as a boy if the penis could be expected to be large enough to stand to urinate and to insert into a vagina for coitus. If it was too small or atypically formed (e.g., cloacal exstrophy) for these functions, it was recommended that the baby be assigned as female, any gonads removed, a vaginal opening surgically constructed, and estrogen provided at puberty.Sex assignment_item_0_1
  • An infant with mixed chromosomes (e.g., mixed gonadal dysgenesis or true hermaphroditism) could be raised either way depending on appearance of genitalia and size of phallus.Sex assignment_item_0_2
  • Gender identity is set by 2 years of age and reassignment after that age should not be attempted unless requested by the patient.Sex assignment_item_0_3
  • Non-disclosure of the intersex condition to the individual on whom sex assignment treatment was conducted.Sex assignment_item_0_4

Since the 1990s, a number of factors have led to changes in the recommended criteria for assignment and surgery. Sex assignment_sentence_71

These factors have included: Sex assignment_sentence_72

Sex assignment_unordered_list_1

  • Public disclosure by intersex individuals and organizations about unsatisfactory sexual function or incongruent gender identity, and criticism of infant surgery for "psychosocial rationales".Sex assignment_item_1_5
  • In 1997, the rest of David Reimer's story, referred to above as John Money's John/Joan case, was made public. He was the boy who had lost his penis to a botched circumcision at 8 months in 1966, was reassigned from boy to girl at 18 months with further surgery to remove testes and estrogen treatment beginning at age 12. Although John Money had described the reassignment as a success in the 1970s, Reimer went public with his account of continuing to have a male gender identity despite the reassignment to a female sex of rearing. At age 15, Reimer reverted to living as a male. At age 38, he committed suicide.Sex assignment_item_1_6
  • A large proportion of XY infants born with cloacal exstrophy and raised as female from early infancy have requested reassignment to male gender in late childhood and adolescence.Sex assignment_item_1_7

Clinical recommendations in the 2000s for assignment changed as a result: Sex assignment_sentence_73

Sex assignment_unordered_list_2

  • Raise nearly all XX infants with functional ovaries as female. The only rare exception would be completely and unambiguously virilized XX infants with CAH, who might be raised as male with genital surgery deferred.Sex assignment_item_2_8
  • Raise most ambiguous XY infants with testes as male unless the external genitalia are more female than male, marked androgen insensitivity is present, and testes are absent or non-functional. Raise as male any XY infant with unambiguous micropenis. Raise as male any XY infant with functional testes and normal androgen sensitivity but atypically formed or absent penis.Sex assignment_item_2_9
  • Raise infants with mixed gonadal tissue, true hermaphroditism, or other chromosome anomalies as the sex most consistent with external genitalia, since gonads are usually nonfunctional.Sex assignment_item_2_10
  • Gender identity is set by 1–2 years of age and reassignment after that age should not be attempted unless requested by the patient.Sex assignment_item_2_11

These recommendations do not explicitly necessitate surgical or hormonal interventions to reinforce sex assignments, but such medical management persists worldwide, utilizing rationales such as the mitigation of parental distress and trauma, reducing the likelihood of stigma, making a child feel more "normal", and improving marriage prospects. Sex assignment_sentence_74

Controversy Sex assignment_section_4

Further information: Intersex human rights Sex assignment_sentence_75

Controversies over surgical aspects of intersex management, have often focused on controversies regarding indications for surgery and optimal timing. Sex assignment_sentence_76

However, intersex and human rights organizations have criticized medical models as they are not based on the consent of the individuals on whom such irreversible medical treatments are conducted, and outcomes may be inappropriate or poor. Sex assignment_sentence_77

Anne Tamar-Mattis, for example, states that, "The true choice is not between early and late [surgery], but early surgery versus patient autonomy. Sex assignment_sentence_78

Human rights institutions now refer to such practices as "harmful practices". Sex assignment_sentence_79

However, while surgical interventions remain experimental, and clinical confidence in constructing "normal" genital anatomies has not been borne out, medically credible pathways other than surgery do not yet exist. Sex assignment_sentence_80

Changes to clinical recommendations in the current millennium do not yet address human rights concerns about consent, and the child's right to identity, privacy, freedom from torture and inhuman treatment, and physical integrity. Sex assignment_sentence_81

In 2011, Christiane Völling won the first successful case brought against a surgeon for non-consensual surgical intervention. Sex assignment_sentence_82

The Regional Court of Cologne, Germany, awarded her €100,000. Sex assignment_sentence_83

In 2015, the Council of Europe recognized the right for intersex persons to not undergo sex assignment treatment, identifying issues with the pathologization of intersex bodies as inherently disordered. Sex assignment_sentence_84

In April 2015, Malta became the first country to recognize a right to bodily integrity and physical autonomy, and outlaw non-consensual modifications to sex characteristics. Sex assignment_sentence_85

The Act was widely welcomed by civil society organizations. Sex assignment_sentence_86

Reassignment of sex or gender Sex assignment_section_5

Main articles: Sex reassignment therapy and Sex reassignment surgery Sex assignment_sentence_87

Challenges to requirements for sex assignment Sex assignment_section_6

In recent years, the perceived need to legally assign sex is increasingly being challenged. Sex assignment_sentence_88

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". Sex assignment_sentence_89

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" Sex assignment_sentence_90

See also Sex assignment_section_7

Sex assignment_unordered_list_3

Credits to the contents of this page go to the authors of the corresponding Wikipedia page: assignment.