Between the Lines

Centre for Gender Advocacy Hosts Intersex Support Group, Challenges Gender Markers and Intersex Treatment

Special IssueMichelle Pucci — Published March 21, 2016

On Feb. 21, four people met for the first time to discuss what it’s like being intersex.

It’s a conversation that doesn’t happen often, especially in Quebec.

“The problem is that, some intersex people think they’re alone in life, that there aren’t any other people who are intersex,” said Hélène Beaupré, an intern with the Centre for Gender Advocacy. “It was the opportunity to realize, ‘wow, I’m not alone.’”

The Concordia-based organization campaigning for gender and sexual rights hosted the first meeting for an intersex support group, which is expected to become a monthly gathering.

“A lot of intersex people don’t even know they’re intersex,” said Gabrielle Bouchard, peer support and trans advocacy coordinator at the centre. “It’s hidden, there’s lies, it’s often presented as something nature did wrong.”

Janik Bastien-Charlebois was born intersex, but didn’t understand this until after they agreed to surgeries at 17 that would make their genitals look “more female.”

Bastien-Charlebois, who uses the gender-neutral pronoun, grew up with clitoris hypertrophy—the clinical word for an enlarged clitoris or a small penis, they described in a personal essay published in the Montreal Gazette. Though their mother rejected the doctor’s suggestion for surgery for infant Bastien-Charlebois, they still visited doctors every year or two to see how their genitals had “developed.”

But mostly, no one talks about growing up intersex.

Depending on your definition of the word, one child out of 1,000 or 2,000 is intersex. Some differences appear only in puberty. Others appear in one out of 200 people.

Now a professor in sociology at UQAM, and a frequent resident of Germany, Bastien-Charlebois describes how violating those visits were, and continue to be for other intersex children. Doctors prod a child’s clitoris or penis to test for “sensation,” something Bastien-Charlebois calls sexual violence.

“We don’t have control over decisions that have to do with our bodies.”

Without knowing the number of children who do undergo surgery, Bastien-Charlebois was able to delay theirs, until they felt pressured at 17 to accept the operation that would no longer be free when they became an adult.

“It’s hard to put exact numbers on how many people escape non-consensual surgery soon after birth,” Bastien-Charlebois said. The majority of births are carried out in hospitals. This gives doctors easy access to intersex bodies, they added.

Children who undergo surgery, or are diagnosed with a disorder of sexual development are often discouraged from speaking about their different bodies. These diagnoses include different sexual anatomy, variations in size or shape of penises, clitorises, scrotums, labia, gonads or internal reproductive organs. Some people also have atypical hormone production or chromosomes that combine, deviate or defy the XX-female or XY-male dichotomy. Some young intersex people are treated with hormones, as parents may not understand the consequences of operations that could lead to sterilization and a lifetime of surgeries.

“The medical system wants to ‘invisibilize’ these people and standardize them,” Beaupré said.

Genital surgeries can lead to scarring, loss of sensitivity and function, pain and sometimes require several follow-up surgeries for children who are only toddlers. On top of mental and physical health difficulties, treatment can create challenges to relationship building.

“They’re going to say the techniques improved, but we’re the only ones who can make the final conclusions regarding that,” Bastien-Charlebois said. “What they refuse to hear from us is that the principle of consent is crucial.

Submitting us to non-consensual interventions is a violation of our integrity.”

There is no service that offers adequate adapted psychosocial support to intersex people, according to Bastien-Charlebois. The physical effects and trauma that follow surgeries make it hard to organize.

“It’s really hard, especially for the kind of position intersex people are in, the very sort of treatment how medicine has managed us means it’s very hard to be political,” Bastien-Charlebois said. Intersex organization and activism has happened on a national and international level, but is largely absent from the local communities.

The past decade has seen the release of key statements by human rights groups about the importance of self-determination and intersex rights.

In 2013, the UN Special Rapporteur on Torture condemned non-consensual surgeries, which often sterilize, stigmatize and reduce the quality of life of intersex people. In his report, Special Rapporteur Juan E. Méndez called countries to end and repeal laws allowing “forced genital-normalizing surgery, involuntary sterilization, unethical experimentation, medical display, ‘reparative therapies’ or ‘conversion therapies,’” without consent.

In Canada, a law exists under the criminal code allowing for genital mutilation under section 268 covering aggravated assault. The exception gives medical professionals the right to “excise, infibulate or mutilate” with the purpose of giving someone “normal reproductive functions or normal sexual appearance or function.”

The only country in the western world to ban non-consensual surgeries is Malta, which passed a law in April of last year forbidding unnecessary medical treatment of intersex infants.

Australia adopted the Sex Discrimination Amendment (Sexual Orientation, Gender Identity and Intersex Status) Act in 2013, which included intersex as a status prohibited from discrimination.

Based at Concordia, the Centre for Gender Advocacy—which advocates for issues related to gender identity—alongside two trans parents, are bringing these issues forward publicly. In a lawsuit denouncing the requirements of gender markers on provincial documents, the plaintiffs argue that lifting requirements will benefit trans youth, non-citizens, trans parents, and intersex youth.

“We’re asking for people to have a choice,” said lawyer Audrey Boctor, who is a partner with Irving Mitchell Kalichman and is representing the Centre for Gender Advocacy and the parents. “We’re asking for people to have an option.”
Understanding this court case requires the acknowledgment of a decision made at the National Assembly in the summer of 2015.

Stéphanie Vallée, Quebec’s Justice Minister, with a committee of National Assembly members, modified the rules governing gender markers, making it possible for trans or people identifying as a gender not assigned to them at birth to modify certain provincial documents.

The regulations themselves were the last step to implementing a bill passed in 2013 allowing trans people to change their gender without undergoing reassignment surgery, which are often difficult to get in Quebec and can be costly and dangerous if done in other countries.

Since the regulations came into effect in the fall, there have been 250 requests for change of sex designation, according to Boctor.

“I think this shows the extent to which this is important,” she said. “We need to act, we need to move forward, we can’t just wait for something to happen. Experience has demonstrated that it takes an awfully long time, and in the meantime this is having a serious impact on people’s health.”

The ongoing lawsuit seeks the extension of these regulations to minors and non-citizens, which are currently excluded from changing their gender markers. Parents who transitioned after the birth of their child are also unable to change the identifier on birth certificates, which lists them as “father” or “mother” based on the gender marker at the time of their child’s birth.

Right now, the plaintiffs are waiting on the Attorney General of Quebec to file its expert reports, before the case can go to trial, according to Boctor. In early March, the Attorney General filed a motion requesting more time to deliver its reports. The file was expected April 4, but may be delayed until July.

“We’ll be contesting the motion,” Boctor said. “For our clients it’s not like a regular civil case where the delays are a matter of cost or something like that. This is crucial, there are people waiting for these rule to change.”

If the lawsuit is successful at eliminating proscribed gender markers, advocates like Bouchard believe the number of surgeries for intersex people will decrease, because doctors won’t have to make choices about a child’s gender or function when their body is outside of the norm. There are no operation or genital requirements to choosing a gender marker, Beaupré said

“Obviously this is not the solution, but we think it’s part of the solution,” Bouchard said. “There won’t be that pressure that we have to decide whether it’s a boy or a girl.”

But Bastien-Charlebois said that while winning the lawsuit will be a victory for people who are trans, it won’t help children who are intersex.

“There are aspects that sort of overlap between our experiences, but they’re not the same,” they said. “The discrimination that we’re facing does not have to do with our gender, it has to do with our body.”

The next support group meeting will take place on April 17 at the Centre for Gender Advocacy.