Editing Sex assignment (section)

==Assignment in cases of infants with intersex traits, or cases of trauma==
{{main|Intersex medical interventions|History of intersex surgery}}
{{Intersex sidebar|rights}}
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. In such cases, the infant may be assigned male or female, and may receive [[intersex surgery]] to confirm that assignment. These medical interventions have increasingly been seen as a [[Intersex human rights|human rights]] violation due to their unnecessary nature and the potential for lifelong complications.<ref name="un-fact">{{Cite conference |last1=United Nations |last2=Office of the High Commissioner for Human Rights |title=Free & Equal Campaign Fact Sheet: Intersex |date=2015 |url=https://unfe.org/system/unfe-65-Intersex_Factsheet_ENGLISH.pdf |url-status=live |archive-url=https://web.archive.org/web/20160304071043/https://unfe.org/system/unfe-65-Intersex_Factsheet_ENGLISH.pdf |archive-date=4 March 2016}}</ref><ref name="Cabral">{{cite web |editor1-last=Cabral |editor1-first=Mauro |editor2-last=Carpenter |editor2-first=Morgan |editor1-link=Mauro Cabral |editor2-link=Morgan Carpenter |title=Intersex Issues in the International Classification of Diseases: a revision |date=2014 |url=http://transactivists.org/?attachment_id=652 |url-status=live |archive-url=https://web.archive.org/web/20151029142803/http://transactivists.org/?attachment_id=652 |archive-date=29 October 2015}}</ref><ref name="un2016"/>

[[File:Phall-O-meter', Intersex Society of North Wellcome L0031936.jpg|thumb|The [[Phall-O-Meter]] satirizes clinical assessments of appropriate clitoris and penis length at birth, and the definition of ambiguous genitalia. It is based on research published by [[Suzanne Kessler]].]]
Cases of trauma include the famous [[John/Joan case]], where sexologist [[John Money]] claimed successful reassignment from male to female of a 17-month-old boy whose penis was destroyed during [[circumcision]]. However, this claim was later shown to be largely false. The subject, [[David Reimer]], later identified as a man.<ref name="Colapinto 2004">{{cite web |last=Colapinto |first=John |author-link=John Colapinto|title=Why did David Reimer commit suicide? |website=Slate Magazine |date=3 June 2004 |url=https://slate.com/technology/2004/06/why-did-david-reimer-commit-suicide.html |access-date=20 March 2022 |archive-date=20 March 2022 |archive-url=https://web.archive.org/web/20220320015008/https://slate.com/technology/2004/06/why-did-david-reimer-commit-suicide.html |url-status=live}}</ref>

The number of births with ambiguous genitals is in the range of 1 in 2,000 to 1 in 4,500 (0.05% to 0.02%).<ref name="witchel" /> Typical examples would be an unusually prominent [[clitoris]] in an otherwise apparently typical girl, or complete [[cryptorchidism]] in an otherwise apparently typical boy. In most of these cases, a sex is tentatively assigned and the parents told that tests will be performed to confirm the apparent sex. 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]]. In some of these cases a [[pediatric endocrinologist]] is consulted to confirm the tentative sex assignment. The expected assignment is usually confirmed within hours to a few days in these cases.

Some infants are born with enough ambiguity that assignment becomes a more drawn-out process of multiple tests and intensive education of the parents about [[sexual differentiation]]. 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. Intersex activists have criticised "normalising" procedures performed on infants and children, who are unable to provide informed consent.<ref name="Cabral" />

=== History ===
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. Under Roman law, a hermaphrodite had to be classed as either male or female.<ref>{{cite journal |doi=10.1111/1468-0424.00075 |title=The Ideology of the Eunuch Priest |journal=Gender & History |volume=9 |issue=3 |pages=542–559 |year=1997 |last1=Roller |first1=Lynn E.|s2cid=143133728 }}</ref><!--footnote on page 558: "Note also the Roman treatment of a hermaphrodite, who could not be legally recognized as a third gender, but had to be classified as either male or female; see Yan Thomas, "The Division of the Sexes in Roman Law", in ''A History of Women: From Ancient Goddesses to Christian Saints'', ed. Pauline Schmidt Pantel (Harvard University Press, Cambridge, MA and London, 1992), pp. 84–7"--> The 12th-century ''[[Decretum Gratiani]]'' states that "Whether a hermaphrodite may witness a testament, depends on which sex prevails".<ref>{{cite web |url=http://geschichte.digitale-sammlungen.de/decretum-gratiani/kapitel/dc_chapter_1_1585 |title=Decretum Gratiani (Kirchenrechtssammlung) |work=Bayerische StaatsBibliothek ([[Bavarian State Library]]) |date=5 February 2009 |url-status=live |archive-url=https://web.archive.org/web/20161220084841/http://geschichte.digitale-sammlungen.de/decretum-gratiani/kapitel/dc_chapter_1_1585 |archive-date=20 December 2016}}</ref><ref name="Raming">{{cite book |title=A History of Women and Ordination |last1=Raming |first1=Ida |last2=Macy |first2=Gary |last3=Bernard J |first3=Cook |publisher=[[Scarecrow Press]] |date=2004 |page=113}}</ref> 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."<ref>E Coke, The First Part of the Institutes of the Laws of England, Institutes 8.a. (1st Am. Ed. 1812) (16th European ed. 1812).</ref><ref>{{Cite journal |volume=41 |last=Greenberg |first=Julie |title=Defining Male and Female: Intersexuality and the Collision Between Law and Biology |journal=Arizona Law Review |date=1999 |ssrn=896307 |pages=277–278}}</ref> Legal cases where sex assignment was placed in doubt [[Intersex in history|have been described]] over the centuries.

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 [[intersex surgery|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.

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

In the 1950s, [[endocrinologist]]s developed a basic understanding of the major intersex conditions such as [[congenital adrenal hyperplasia]] (CAH), [[androgen insensitivity syndrome]], and [[mixed gonadal dysgenesis]]. The discovery of [[cortisone]] allowed survival of infants with severe CAH for the first time. New hormone tests and karyotypes allowed more confident diagnosis in infancy and prediction of future development.

Sex assignment became more than choosing a sex of rearing, but also began to include surgical treatment. Undescended testes could be retrieved. A greatly enlarged clitoris could be amputated to the usual size, but attempts to create a [[human penis|penis]] were unsuccessful. [[John Money]] and others [[John/Joan case|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. The resulting medical model was termed the "Optimal gender model".<ref>{{Cite book |publisher=Community Affairs References Committee |isbn=978-1-74229-917-4 |last1=Australian Senate |author-link=Australian Senate |last2=Community Affairs References Committee |title=Involuntary or coerced sterilisation of intersex people in Australia |location=Canberra |date=October 2013 |url=http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Involuntary_Sterilisation/Sec_Report/index |url-status=live |archive-url=https://web.archive.org/web/20150923181927/http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Involuntary_Sterilisation/Sec_Report/index |archive-date=23 September 2015}}</ref>