Muschialli Luke, Allen Connor Luke, Boy-Mena Evelyn, Malik Aiysha, Pallitto Christina, Nihlén Åsa, Gonsalves Lianne
Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
PLOS Glob Public Health. 2024 Aug 28;4(8):e0003568. doi: 10.1371/journal.pgph.0003568. eCollection 2024.
Children with intersex variations continue to be subject to elective, irreversible, "sex-normalising" surgical interventions, despite multiple human rights and legislative bodies calling for their prohibition. Our systematic review aims to understand how medical literature reports rationales for "sex-normalising" surgical interventions conducted in childhood, and how they are contextualised within the medical and social controversy surrounding such interventions. PubMed, EMBASE and CINAHL were searched for English language, peer-reviewed articles reporting primary data on elective, genital, "sex-normalising" surgical interventions conducted on individuals <10 years, published 01/07/2006-30/06/2023 (PROSPERO ID: CRD42023460871). Data on outcomes reported, rationale for the conduct and timing of interventions and acknowledgement of controversy were extracted. Narrative synthesis described rationales and controversy. Risk of bias was assessed using Johanna Briggs Institute Tools. 11,042 records were retrieved, with 71 articles included for analysis. One of the most common outcomes collected in included literature were cosmetic outcomes, primarily reported by surgeons or parents. 62.0% of studies reported no rationale for intervention timing, 39.4% reported no rationale for conduct and 52.1% acknowledged no controversy in intervention conduct. Rationales included parental desire for intervention, anatomical/functional/cosmetic reasons, and a perceived goal of aligning with sex assigned by surgical teams or parents. Controversies addressed included concerns about the quality of interventions, the ethics of intervention conduct and gendered and social considerations. "Sex-normalising" interventions are conducted based largely on rationales that were not adequately supported by evidence, a desire from parents and surgeons to match genital cosmesis typically ascribed to male and female bodies, and a parental desire for intervention conduct. Legislating and medical regulatory bodies should advocate for ending the conduct of irreversible, elective, "sex-normalising" interventions conducted without the full, free and informed consent of the person concerned, to promote and protect the highest attainable standard of health for people with intersex variations.
患有性发育异常的儿童仍然会接受选择性的、不可逆转的“性别正常化”手术干预，尽管多个人权和立法机构呼吁禁止此类手术。我们的系统评价旨在了解医学文献如何报道儿童期进行“性别正常化”手术干预的理由，以及这些理由如何在围绕此类干预的医学和社会争议背景中得到阐释。我们在PubMed、EMBASE和CINAHL数据库中检索了2006年7月1日至2023年6月30日期间发表的、以英文撰写且经过同行评审的文章，这些文章报告了针对10岁以下个体进行的选择性生殖器“性别正常化”手术干预的原始数据（PROSPERO注册号：CRD42023460871）。提取了关于所报告结果、干预实施及时间安排的理由以及对争议的承认等数据。采用叙述性综合分析来描述理由和争议。使用乔安娜·布里格斯研究所工具评估偏倚风险。共检索到11,042条记录，纳入71篇文章进行分析。纳入文献中收集到的最常见结果之一是美容效果，主要由外科医生或家长报告。62.0%的研究未报告干预时间安排的理由，39.4%未报告实施干预的理由，52.1%未承认干预实施过程中存在争议。理由包括家长对干预的期望、解剖学/功能/美容方面的原因，以及与手术团队或家长指定的性别保持一致这一可感知的目标。涉及的争议包括对干预质量的担忧、干预实施的伦理问题以及性别和社会方面的考量。“性别正常化”干预很大程度上基于缺乏充分证据支持的理由、家长和外科医生使生殖器外观符合通常归因于男性和女性身体的美容标准的愿望，以及家长对进行干预的期望。立法和医疗监管机构应倡导停止在未经相关人员充分、自由和知情同意的情况下进行不可逆转的选择性“性别正常化”干预，以促进和保护患有性发育异常者的最高可及健康标准。
