Promoting and Protecting Human Rights in relation to Sexual Orientation, Gender Identity and Sex Characteristics A Manual for National Human Rights Institutions 4.3. THE RIGHT TO PHYSICAL INTEGRITY In all parts of the world, it is common to perform surgeries and other medical treatments on intersex children that aim to make their appearance conform to narrow binary sex stereotypes of male or female bodies.249 UN experts have criticised cosmetic and other medically unnecessary surgeries on children’s genitals and other reproductive organs that occur without the child’s views being considered.250 A 2014 statement from seven UN agencies, including OHCHR and the World Health Organization, highlighted that these so-called ‘sex-normalising’ procedures have irreversible, lifelong physical and mental health consequences.251 They can cause ‘permanent infertility, pain, incontinence, loss of sexual sensation and ongoing mental suffering, including depression’.252 In many instances, surgeries and other medical interventions are performed while an intersex person is too young to be part of the decision-making process. They may be proposed on the basis of weak evidence and parents themselves may have insufficient information or access to alternative options.253 For example, it is very uncommon for parents to have contact with intersex adults and their families or to have access to positive portrayals of bodily diversity. In a 2009 report on informed consent, the Special Rapporteur on the right to health called on health care providers to “strive to postpone non-emergency invasive and irreversible interventions until the child is sufficiently mature to provide informed consent”.254 The Special Rapporteur noted that “[surgery on children] is particularly problematic in the case of intersex genital surgery, which is a painful and highrisk procedure with no proven medical benefits”, citing decisions from the Colombian Constitutional Court.255 In 2013 the Special Rapporteur on torture examined forms of abuse in health care settings that may cross a threshold of mistreatment that “is tantamount to torture or cruel, inhumane or degrading treatment or punishment”.256 He identified intersex people as a marginalised group and criticised non-consensual, medically unnecessary and irreversible surgeries performed on intersex infants and children. The Special Rapporteur called on all States to “repeal any law allowing intrusive and irreversible treatments, including forced genital-normalizing surgery… when enforced or administered without the free and informed consent of the person concerned [and] to outlaw forced or coerced sterilization in all circumstances and provide special protection to individuals belonging to marginalized groups”.257 68 249 The routine practice of performing these surgeries or medical interventions on an intersex person’s body contrasts with the resistance from some clinicians to enabling any form of medical transition for transgender people. In part this demonstrates the mistaken, contrasting beliefs that intersex bodies are unhealthy or abnormal and should be ‘fixed’ but that transgender people who transition are ‘mutilating’ a healthy body. Both views have been criticised severely by ethicists, health professionals and human rights bodies. 250 OHCHR, Discriminatory laws and practices and acts of violence against individuals based on their sexual orientation and gender identity, 2011, A/HRC/19/41, para. 57; OHCHR, UN Women, UNAIDS, UNDP, UNFPA, UNICEF and World Health Organization, Eliminating Forced, Coercive and Otherwise Involuntary Sterilization, An Interagency Statement, 2014; Committee on the Rights of the Child, Concluding Observations: Switzerland, 2015, CRC/C/CHE/CO/2-4; Committee against Torture, Concluding Observations: Germany, CAT/C/DEU/CO/5; Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, 2013, A/HRC/22/53; Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, 2009, A/64/272. 251 OHCHR, UN Women, UNAIDS, UNDP, UNFPA, UNICEF and World Health Organization, Eliminating Forced, Coercive and Otherwise Involuntary Sterilization, An Interagency Statement, 2014. See also World Health Organization, Sexual health, human rights and the law, 2015. 252 OHCHR, Fact Sheet: Intersex, 2015. 253 OHCHR, UN Women, UNAIDS, UNDP, UNFPA, UNICEF and World Health Organization, Eliminating Forced, Coercive and Otherwise Involuntary Sterilization, An Interagency Statement, 2014; M. Cabral and M. Carpenter, Intersex Issues in the International Classification of Diseases: A Revision, introductory response to the interagency statement prepared by participants at the September 2014 GATE International Initiative on the ICD Reform Process; at http://transactivists.org/?attachment_id=652. 254 Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, 2009, A/64/272. 255 Colombian Constitutional Court, Sentencia SU-337/99 and Sentencia T-551/99. 256 Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, 2013, A/HRC/22/53. 257 Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, 2013, A/HRC/22/53, para. 88.