Part I Experiences of being lesbian, gay, bisexual, transgender and intersex in the Asia Pacific 4.3.2. Psycho-social rationales Psycho-social rationales are frequently used to inappropriately justify surgeries and other medical interventions on intersex children. These rationales equate intersex traits and other people’s negative reactions to those traits as a psycho-social risk.272 Examples of these psycho-social risks include: • the risk of social or cultural disadvantage to the child; for example, reduced opportunities for marriage or intimate relationships or reduced opportunity for meaningful employment and capacity to earn an income • the risk of social isolation, restrictions or difficulties; for example, caused by embarrassment or social stigma associated with having genitalia that does not match the gender in which the person lives.273 Other clinicians have critiqued such an approach, noting that the central challenge is “finding a way to help families (and healthcare professionals) overcome the shame and anxious secrecy that may shape minds and force hands in ways that ultimately harm all involved”.274 Pressure to perform medical interventions based on a fear of social stigma, including rejection from parents, raises significant human rights concerns and is not in the best interests of the child. An intersex child may grow up and reject their assigned sex. The implications of such a decision are much greater if the child has undergone medically unnecessary surgeries or hormone treatment. Examples from intersex people in this region demonstrate the power of psycho-social rationales in justifying so-called ‘sex-normalising’ procedures. 275 My parent and doctors told me I am a boy, a boy [who] had an illness, a boy [who] will never marry and will never have children! I listened, I believed! It is very very important, I must [be] a boy in the Chinese family system. My parent make the decision [for] the benefit of the family ... The doctors gave me the surgeries since 8 years old … I have done over 15 … operations till 13 years old, but [all] failed … I rejected go[ing] to hospital when I was 14, because I couldn’t tolerate the painful experience [any]more. Small Luk, intersex activist, Hong Kong275 In Malaysia, research has shown that decisions about the sex assignments of infants with the same intersex variation differed depending on their parent’s culture and attitudes towards dowries.276 In countries where male children are more highly valued than female children, this can influence decisions about the sex assigned to an intersex infant or child. This has been reported to occur in countries in both East and West Asia.277 This can result in pressure for ‘sex-normalising’ surgeries or other medical treatments or, where families cannot afford treatments, there is an increased likelihood that intersex children may be killed or abandoned.278 272 L. Gillam, J. Hewitt and G. Warne, Ethical principles for the management of infants with disorders of sex development, 2012. 273 Ibid. 274 A. Dreger, D.E. Sandberg and E.K. Feder, ‘From Principles to Process in Disorders of Sex Development Care’ in Hormone Research in Paediatrics, 2010;74(6):419–20. 275 Small Luk, Intersex Report from Hong Kong, produced for the Being LGBT in Asia Regional Dialogue, February 2015. Small Luk was raised as a boy in Hong Kong and forced to have multiple surgeries as a child. As an adult, she chose to have reconstructive surgeries and now lives as a female. 276 U. Kuhnle and W. Krahl, ‘The Impact of Culture on Sex Assignment and Gender Development in Intersex Patients’ in Perspectives in Biology and Medicine, 45 No. 1 Winter, 2002, pp. 85-103. 277 P.A. Lee et al, ‘Advances in Diagnosis and Care of Persons with DSD over the Last Decade’ in International Journal of Pediatric Endocrinology, No. 1, 2014; at www.ijpeonline.com/content/2014/1/19. 278 Small Luk, Beyond Boundaries: intersex in Hong Kong and China, 20 October 2015; at http://intersexday.org/en/beyondboundaries-intersex-hk-china/. Chapter 4: Being intersex in Asia and the Pacific | 71