Editing Sex assignment

{{Short description|Process of discerning sex at birth}}
{{pp-semi-indef|date=August 2024}}
{{About|sex assignment in humans|sex assignment in other animals|sexing}}{{Redirect|AGAB|the enzyme|AgaB}}
{{See also|Determination of sex}}
{{Use dmy dates|date=August 2022}}
{{Medical references|date=June 2023}}

'''Sex assignment''' (also known as '''gender assignment'''<ref>{{cite web |title=gender assignment |url=https://dictionary.apa.org/gender-assignment |access-date=2023-06-06 |website=APA Dictionary of Psychology |publisher=[[American Psychological Association]] |language=en |archive-date=6 June 2023 |archive-url=https://web.archive.org/web/20230606121209/https://dictionary.apa.org/gender-assignment |url-status=live }}</ref><ref name=":0">{{cite book |title=[[Diagnostic and Statistical Manual of Mental Disorders]] |date=2022 |publisher=American Psychiatric Association |isbn=978-0-89042-575-6 |editor-last=American Psychiatric Association |editor-link=American Psychiatric Association |edition=Fifth edition, text revision |location=Washington, DC |pages=511}}</ref>)<!-- NOTE: "Gender assignment" is here, per WP:Alternative title; read that Wikipedia policy. "Gender assignment" is the alternative name for this article and redirects here. Also, see what the rest of this article states.--> is the discernment of an infant's [[sex]], typically made at birth based on an examination of the baby's external [[genitalia]] by a healthcare provider such as a [[midwife]], [[nurse]], or [[physician]].<ref name="Rathus">{{cite book |vauthors=Rathus SA, Nevid JS, Rathus LF |title=Human Sexuality in a World of Diversity |isbn=978-0-205-78606-0 |publisher=[[Allyn & Bacon]] |year=2010 |page=168 |url=https://books.google.com/books?id=ZotYAAAAYAAJ |access-date=5 December 2019 |archive-date=6 June 2021 |archive-url=https://web.archive.org/web/20210606214653/https://books.google.com/books?id=ZotYAAAAYAAJ |url-status=live}}</ref> In the vast majority of cases (99.95%), sex is assigned unambiguously at birth. However, in about 1 in 2000 births, the baby's genitalia may not clearly indicate [[male]] or [[female]], necessitating additional diagnostic steps, and deferring sex assignment.<ref name="witchel">{{cite journal |author=Selma Feldman Witchel |date=2018 |title=Disorders of Sex Development |journal=Best Practice & Research. Clinical Obstetrics & Gynaecology |volume=48 |pages=90–102 |doi=10.1016/j.bpobgyn.2017.11.005 |pmc=5866176 |pmid=29503125 |issn=1521-6934}}</ref><ref>{{cite journal |author=Dhamankar Rupin |date=9 April 2020 |title=Fetal Sex Results of Noninvasive Prenatal Testing and Differences With Ultrasonography |journal=Obstet. Gynecol. |language=English |publication-date=9 April 2020 |volume=135 |issue=5 |pages=1198–1206 |doi=10.1097/AOG.0000000000003791 |pmc=7170435 |pmid=32282607 |s2cid=215758793}}</ref> 

In most countries the healthcare provider's determination, along with other details of the birth, is by law recorded on an official document and submitted to the government for later issuance of a [[birth certificate]] and for other legal purposes.<ref name="UNCRVS">{{cite web |title=Birth and Death Registration Completeness |url=https://unstats.un.org/unsd/demographic-social/crvs/ |website=Demographic and Social Statistics |publisher=United Nations |access-date=19 August 2024}}</ref>

The prevalence of [[intersex|intersex conditions]], where a baby's sex characteristics do not conform strictly to typical definitions of male or female, ranges between 0.018% and 1.7%.<ref>{{cite web |date=16 September 2019 |orig-date=28 September 2013 |title=Intersex population figures |url=https://ihra.org.au/16601/intersex-numbers/ |access-date=3 July 2023 |website=Intersex Human Rights Australia |archive-date=17 July 2018 |archive-url=https://web.archive.org/web/20180717183724/https://ihra.org.au/16601/intersex-numbers/ |url-status=live }}</ref><ref name="sax">{{cite journal |last1=Sax |first1=Leonard |date=2002 |title=How common is intersex? a response to Anne Fausto-Sterling |url=https://www.leonardsax.com/how-common-is-intersex-a-response-to-anne-fausto-sterling/ |journal=Journal of Sex Research |language=English |publisher=Scholarly Publications |volume=39 |issue=3 |pages=174–178 |doi=10.1080/00224490209552139 |pmid=12476264 |s2cid=33795209 |access-date=27 June 2020 |archive-date=28 February 2021 |archive-url=https://web.archive.org/web/20210228000512/https://www.leonardsax.com/how-common-is-intersex-a-response-to-anne-fausto-sterling/ |url-status=live |url-access=subscription }}</ref><ref>{{cite journal |last1=Blackless |first1=Melanie |last2=Charuvastra |first2=Anthony |last3=Derryck |first3=Amanda |last4=Fausto-Sterling |first4=Anne |author-link4=Anne Fausto-Sterling |last5=Lauzanne |first5=Karl |last6=Lee |first6=Ellen |date=2000 |title=How Sexually Dimorphic Are We? Review and Synthesis |department=Department of Molecular and Cell Biology and Biochemistry |journal=[[American Journal of Human Biology]] |language=English |volume=12 |issue=2 |pages=151–166 |doi=10.1002/(SICI)1520-6300(200003/04)12:2<151::AID-AJHB1>3.0.CO;2-F |pmid=11534012 |s2cid=453278}}</ref> While some intersex conditions result in [[Ambiguous genitalia|genital ambiguity]] (approximately 0.02% to 0.05% of births<ref name="witchel" />), others present genitalia that are distinctly male or female, which may delay the recognition of an intersex condition until later in life.<ref name="Mieszczak2009">{{cite journal |last1=Mieszczak |first1=J |last2=Houk |first2=CP |last3=Lee |first3=PA |title=Assignment of the sex of rearing in the neonate with a disorder of sex development |journal=Curr Opin Pediatr |date=Aug 2009 |volume=21 |issue=4 |pages=541–7 |pmid=19444113 |doi=10.1097/mop.0b013e32832c6d2c |pmc=4104182}}</ref><ref>{{Cite web |date=2006 |title=Answers to Your Questions About Individuals With Intersex Conditions |url=https://www.apa.org/topics/lgbtq/intersex.pdf |access-date=2023-06-07 |website=www.apa.org |publisher=[[American Psychological Association]] |archive-date=24 May 2023 |archive-url=https://web.archive.org/web/20230524103131/https://www.apa.org/topics/lgbtq/intersex.pdf |url-status=live }}</ref> 

Societally and medically, it is generally assumed that a person's gender identity will align with the sex assigned at birth, making them [[cisgender]]. However, for a minority, assigned sex and gender identity do not coincide, leading to [[transgender]] identity experiences. When assigning sex to intersex individuals, some healthcare providers may consider the gender identity that most people with a similar intersex condition develop, although such assignments may be revised as the individual matures.<ref name=":0" /><ref name="HardackerDucheny20182">{{cite book |url=https://books.google.com/books?id=SfhyDwAAQBAJ&pg=PA3 |title=Transgender and Gender Nonconforming Health and Aging |publisher=Springer |year=2019 |isbn=978-3-319-95031-0 |editor-last=Hardacker |editor-first=Cecilia |location=Cham |page=3 |language=en |doi=10.1007/978-3-319-95031-0 |s2cid=52986156 |editor-last2=Ducheny |editor-first2=Kelly |editor-last3=Houlberg |editor-first3=Magda |access-date=23 May 2020 |archive-date=3 August 2024 |archive-url=https://web.archive.org/web/20240803145441/https://books.google.com/books?id=SfhyDwAAQBAJ&pg=PA3#v=onepage&q&f=false |url-status=live }}</ref>

The use of surgical or hormonal interventions to reinforce sex assignments in intersex individuals without informed consent is considered a violation of human rights, according to the Office of the [[United Nations High Commissioner for Human Rights]].<ref name="witchel2">{{cite journal |last1=Witchel |first1=Selma Feldman |date=2018 |title=Disorders of Sex Development |journal=Best Practice & Research. Clinical Obstetrics & Gynaecology |volume=48 |pages=90–102 |doi=10.1016/j.bpobgyn.2017.11.005 |issn=1521-6934 |pmc=5866176 |pmid=29503125}}</ref><ref name=":0" /><ref name="un2016">{{cite press release |last1=UN Committee against Torture |title=Intersex Awareness Day – Wednesday 26 October. End violence and harmful medical practices on intersex children and adults, UN and regional experts urge |date=24 October 2016 |url=http://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=20739&LangID=E |work=[[Office of the High Commissioner for Human Rights]] |archive-url=https://web.archive.org/web/20161121185256/http://ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=20739&LangID=E |url-status=live |archive-date=21 November 2016 |last2=UN Committee on the Rights of the Child |last3=UN Committee on the Rights of People with Disabilities |last4=UN Subcommittee on Prevention of Torture and other Cruel Inhuman or Degrading Treatment or Punishment |last5=Juan Méndez, Special Rapporteur on torture and other cruel inhuman or degrading treatment or punishment |last6=Dainius Pῡras, Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health |last7=Dubravka Šimonoviæ, Special Rapporteur on violence against women its causes and consequences |last8=Marta Santos Pais, Special Representative of the UN Secretary-General on Violence against Children |last9=African Commission on Human and Peoples' Rights |author1-link=United Nations Convention against Torture#Committee against Torture |author2-link=Committee on the Rights of the Child |author3-link=Committee on the Rights of Persons with Disabilities |author5-link=Juan E. Méndez |author9-link=African Commission on Human and Peoples' Rights |last10=Council of Europe Commissioner for Human Rights |author10-link=Commissioner for Human Rights |last11=Inter-American Commission on Human Rights |author11-link=Inter-American Commission on Human Rights}}</ref><ref name="who2015">{{Cite book |last=World Health Organization |title=Sexual health, human rights and the law |date=2015 |publisher=World Health Organization |isbn=978-92-4-156498-4 |location=Geneva |author-link=World Health Organization}}</ref>

==Terminology==
Sex assignment refers to the identification of an infant's sex at birth, typically based on observable physical characteristics. This is also known as gender assignment.<ref name=":0" /><ref name="Raveenthiran2017">{{cite journal |last1=Raveenthiran |first1=V |year=2017 |title=Neonatal Sex Assignment in Disorders of Sex Development: A Philosophical Introspection |journal=Journal of Neonatal Surgery |volume=6 |issue=3 |pages=58 |doi=10.21699/jns.v6i3.604 |doi-broken-date=24 December 2024 |issn=2226-0439 |pmc=5593477 |pmid=28920018 |doi-access=free}}</ref>

In clinical and medical contexts, terms such as "birth-assigned sex" or "birth-assigned gender" are used to describe the sex identified at birth, while "assigned sex" and "assigned gender" may also refer to any subsequent reassignments, especially common among intersex individuals.

The terminology has evolved across various editions of the [[Diagnostic and Statistical Manual of Mental Disorders]] (DSM) maintained by the [[American Psychiatric Association]]. Initially, the third edition of the DSM referred to "anatomic sex".<ref>{{Cite book |title=Diagnostic and Statistical Manual of Mental Disorders (DSM III) |series=DSM Library |url=https://dsm.psychiatryonline.org/doi/abs/10.1176/appi.books.9780521315289.dsm-iii |edition=3rd |date=1980 |publisher=American Psychiatric Association |via=DSM Library |language=en |doi=10.1176/appi.books.9780521315289.dsm-iii |doi-broken-date=1 November 2024 |isbn=978-0-521-31528-9 |id=[https://aditpsiquiatriaypsicologia.es/images/CLASIFICACION%20DE%20ENFERMEDADES/DSM-III.pdf PDF Download] |access-date=16 December 2023 |archive-date=16 December 2023 |archive-url=https://web.archive.org/web/20231216150930/https://dsm.psychiatryonline.org/doi/abs/10.1176/appi.books.9780521315289.dsm-iii |url-status=live }}</ref> By the fourth edition in 1994, the term "assigned sex" was introduced, with subsequent editions also using "biological sex" and "natal gender". The latest revision in 2022 streamlined the language to consistently use "sex assignment".<ref>{{Cite book |title=Diagnostic and Statistical Manual of Mental Disorders (DSM IV)  |series=DSM Library |edition=4th |url=https://dsm.psychiatryonline.org/doi/abs/10.1176/appi.books.9780890420614.dsm-iv |via=DSM Library |date=1994 |publisher=American Psychiatric Association |language=en |doi=10.1176/appi.books.9780890420614.dsm-iv|isbn=0-89042-061-0 }}</ref><ref name=":0" /><ref>{{Cite journal |last1=First |first1=Michael B. |last2=Yousif |first2=Lamyaa H. |last3=Clarke |first3=Diana E. |last4=Wang |first4=Philip S. |last5=Gogtay |first5=Nitin |last6=Appelbaum |first6=Paul S. |date=2022 |title=DSM-5-TR: overview of what's new and what's changed |journal=World Psychiatry |language=en |volume=21 |issue=2 |pages=218–219 |doi=10.1002/wps.20989 |pmc=9077590 |pmid=35524596 |doi-access=free}}</ref>

A 2006 consensus statement on intersex conditions also adopted the terms "assigned sex" and "assigned gender". Sex is assigned as either male or female, leading to specific terms:<ref name="HardackerDucheny20182" /><ref name=":0" /><ref name=":2">{{Cite journal |last1=Hughes |first1=I A |last2=Houk |first2=C |last3=Ahmed |first3=S F |last4=Lee |first4=P A |date=July 2006 |title=Consensus statement on management of intersex disorders |journal=Archives of Disease in Childhood |volume=91 |issue=7 |pages=554–563 |doi=10.1136/adc.2006.098319 |issn=0003-9888 |pmc=2082839 |pmid=16624884}}</ref>

{{glossary start}}
{{anchor|}}
{{term|Assigned male at birth|{{vanchor|Assigned male at birth|AMAB|MAAB|Male assigned at birth|DMAB|Designated male at birth|Male designated at birth}}}}{{defn|A person of any age and irrespective of current gender whose sex was assigned as male at birth. Often shortened to ''AMAB''. Synonyms include ''male assigned at birth'' (MAAB) and ''designated male at birth'' (DMAB).<ref name="Harrington2016">{{cite book |last=Harrington |first=Lee |author-link=Lee Harrington |title=Traversing Gender: Understanding Transgender Realities |url=https://books.google.com/books?id=PBMHDAAAQBAJ&pg=PT56 |date=May 2016 |publisher=Mystic Productions Press |isbn=978-1-942733-83-6 |pages=50, 56 |url-status=live |archive-url=https://web.archive.org/web/20161221075208/https://books.google.com/books?id=PBMHDAAAQBAJ&pg=PT56 |archive-date=21 December 2016}}</ref><ref name="Serano2013">{{cite book |last=Serano |first=Julia |author-link=Julia Serano |title=Excluded: Making Feminist and Queer Movements More Inclusive |url=https://books.google.com/books?id=IfcuCwAAQBAJ&pg=PA301 |date=October 2013 |publisher=Seal Press |isbn=978-1-58005-504-8 |page=301 |url-status=live |archive-url=https://web.archive.org/web/20161221053236/https://books.google.com/books?id=IfcuCwAAQBAJ&pg=PA301 |archive-date=21 December 2016}}</ref>}}
{{term|Assigned female at birth|{{vanchor|Assigned female at birth|AFAB|FAAB|Female assigned at birth|DFAB|Designated female at birth|Female designated at birth}}}}
{{defn|A person of any age and irrespective of current gender whose sex was assigned as female at birth. Often shortened to ''AFAB''. Synonyms include ''female assigned at birth'' (FAAB) and ''designated female at birth'' (DFAB).<ref name="Harrington2016" /><ref name="Serano2013" />}}
{{term|AGAB}}
{{defn|Acronym for ''assigned gender at birth''.<ref>{{Cite web |title=Definition of 'AGAB' |url=https://www.collinsdictionary.com/dictionary/english/agab |website=Collins Dictionary |access-date=14 June 2023 |archive-date=3 August 2024 |archive-url=https://web.archive.org/web/20240803145443/https://www.collinsdictionary.com/dictionary/english/agab |url-status=live }}</ref>}}
{{glossary end}}

More visible adoption of the terminology of sex assignment has led to public debate and criticism.<ref>{{Cite web |title=The Debate About Sex Assigned at Birth {{!}} Psychology Today United Kingdom |url=https://www.psychologytoday.com/gb/blog/denying-to-the-grave/202406/the-debate-about-sex-assigned-at-birth |access-date=2024-08-30 |website=www.psychologytoday.com |language=en-GB}}</ref>

There is a consensus in the use of the term "sex assignment" for newborns with intersex conditions;<ref name=":2" /> observed chromosomal sex and assigned sex may intentionally differ for medical reasons (based upon predictions of psychosocial and psychosexual health in later life).<ref>{{Cite journal |last1=Markosyan |first1=Renata |last2=Ahmed |first2=S. Faisal |date=2017-12-30 |title=Sex Assignment in Conditions Affecting Sex Development |journal=Journal of Clinical Research in Pediatric Endocrinology |volume=9 |issue=Suppl 2 |pages=106–112 |doi=10.4274/jcrpe.2017.S009 |issn=1308-5727 |pmc=5790324 |pmid=29280745}}</ref>

==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>

==Challenges to requirements for sex assignment==

Australian government guidelines published in 2013 stated that "individuals should be given the option to select M (male), F (female) or X (Indeterminate/Intersex/Unspecified)" and that government "[d]epartments and agencies will continue to collect sex and/or gender information to inform service delivery, perform their specific function or to contribute to broader government statistical or administrative purposes."<ref>{{Cite book |last1=Australia |url=http://www.ag.gov.au/Publications/Pages/AustralianGovernmentGuidelinesontheRecognitionofSexandGender.aspx |title=Australian Government Guidelines on the Recognition of Sex and Gender |last2=Attorney General's Department |date=2013 |archive-url=https://web.archive.org/web/20150701084543/http://www.ag.gov.au/Publications/Pages/AustralianGovernmentGuidelinesontheRecognitionofSexandGender.aspx |archive-date=1 July 2015 |url-status=live}}</ref>

A 2014 report for the Dutch [[Ministry of Justice and Security]] allowed that while many gender-specific provisions in legislation no longer existed, sex registration, which had been introduced in 1811, was still required for a number of important state functions: family law, pregnancy protections, gender-segregated facilities, affirmative-action policies, and "a limited number of laws and regulations that are specifically aimed at men or women, such as military service." It also found that a majority of civil servants foresaw problems if official gender identifications were removed expanded beyond male and female. It noted that gender "seems to be increasingly experienced as 'sensitive' personal data, but is not yet protected as such by privacy regulations," and advocated for more flexibility and less official requests for gender identification.<ref name="brink">{{cite web |last1=van den Brink |first1=Marjolein |title=M/F and beyond, Gender registration by the state and the legal position of transgender persons. English summary |date=2014 |url=https://www.wodc.nl/onderzoeksdatabase/2393-de-mogelijheid-en-consequenties-van-het-onbepaald-laten-van-het-geslacht.aspx?cp=44&cs=6796#publicatiegegevens |archive-url=https://web.archive.org/web/20160304045500/https://www.wodc.nl/onderzoeksdatabase/2393-de-mogelijheid-en-consequenties-van-het-onbepaald-laten-van-het-geslacht.aspx?cp=44&cs=6796#publicatiegegevens |publisher=Ministerie van Veiligheid & Justitie |archive-date=4 March 2016 |last2=Tigchelaar |first2=Jet |url-status=live}}</ref>

In 2015, Canadian activists petitioned the [[British Columbia Human Rights Tribunal]] to force the government to stop recording the sex of newborns on birth certificates in order to avoid what complainants called "misgendered birth certificates" which they asserted were harmful to transgender people.<ref>{{Cite web |last=Chan |first=Emily |date=26 May 2015 |title=Get gender off birth certificates, B.C. activists argue |url=http://www.ctvnews.ca/canada/get-gender-off-birth-certificates-b-c-activists-argue-1.2391604 |url-status=live |archive-url=https://web.archive.org/web/20151118053446/http://www.ctvnews.ca/canada/get-gender-off-birth-certificates-b-c-activists-argue-1.2391604 |archive-date=18 November 2015 |access-date=1 January 2016 |work=[[CTV News]]}}</ref> In 2021, Canada changed the "sex" designation on birth certificates to "sex at birth" in order to reflect that a small number of Canadians subsequently change their gender.<ref>{{Cite web |last=Government of Canada |first=Statistics Canada |date=2023-12-12 |title=Sex at Birth of Person Reference Guide |url=https://www.statcan.gc.ca/en/concepts/dds/sbp |access-date=2025-04-17 |website=www.statcan.gc.ca}}</ref>

==References==
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{{Intersex}}
{{Sexual identities}}
{{Medical ethics}}
{{LGBTQ|identities}}

{{DEFAULTSORT:Sex Assignment}}
[[Category:Genital modification and mutilation]]
[[Category:Human sexuality]]
[[Category:Intersex healthcare]]
[[Category:Sex-determination systems]]
[[Category:Transgender health care]]