Sex educator and author Dr Caroline West explores Ireland's latest response to healthcare for intersex people, and how the history of so-called 'treatments' for sexuality shows how much more work we need to do in educating and supporting others today.
* This article contains upsetting accounts of surgery on young children.
The recent news that Ireland has now adopted guidelines for addressing surgery on people born with intersex traits has been lauded by campaigners who have drawn attention to the often lifelong negative impacts of surgery on children, both physically and emotionally.
This milestone marks a long journey from how we used to think about sex and sexuality, and what we deemed as wrong.
It is estimated that up to 1.7% of people across the world are born with an intersex variation, which can manifest as variations to a person's sex characteristics or as more subtle differences in the body that may not be identified until later in life. There are up to 40 known intersex variations.
Intersex campaigners have for years lobbied against the practice of carrying out non-emergency and invasive surgeries on intersex children that were designed to "normalise" them, but that can have life-long physical impacts, as well as emotional ones. In these instances, the children are too young to consent to surgery that will affect their lives.
Read more: Out & Proud: Why we need education for familes of intersex people
Children's Health Ireland, the body that oversees children's hospitals in Ireland, has stated that "the decision to proceed with any surgical intervention involves a detailed, robust multi-disciplinary discussion on an individual basis to fully inform and involve the patient or family in the decision-making process".
But surgeries on infants and children have had a long history in society, by those concerned about bodies and sexual desires that they deem 'wrong' - preconceptions that we are still unlearning as a society today.
We can trace it back to how we thought about sexuality. In the 18th and 19th centuries, it seems that sex and masturbation were considered a threat by polite society.
Moral panics about sex served to maintain the line between what was perceived to be the 'correct' form of sexuality and 'bad' sexuality that transgressed social norms.
This legacy shows us why sex education and an understanding of bodily autonomy are critical.
This dividing line, it was believed, was the barrier to various deviant sexual acts which were waiting to corrupt innocent people and turn them on to a life of depravity and chaos.
Masturbation was one such area that appeared to evoke horror in some. Throughout the 18th and 19th centuries, the idea of masturbation in children was the subject of widespread moral panic propped up by the medical system.
One of the main texts that influenced this discourse was the 1758 book Onanism: A Treatise on the Maladies Produced by Masturbation, written by Dr Samuel-Auguste Tissott.
Tissott firmly believed that masturbation in men equated to a loss of essence, with physical results such as drooling and eyes being too wide set, becoming idle, weak, effeminate, and losing their lust for life, arguing that masturbators would waste away to death.
This negative view of masturbation carried on throughout societal and medical discourse in the 19th century. Joseph William Howe wrote the book Excessive Venery, Masturbation and Continence in 1884.
He was adamantly opposed to masturbation, especially in girl children. He believed that masturbation in women led to deformation of the genitals, writing that "I have seen cases in the hospital where [the labia minora] resembled the ear of a small spaniel."
Howe was an advocate for the surgical removal of the clitoris, apparently more so for blonde women. The stereotype of blondes having more fun is apparently not a recent invention, if this quote by Howe is anything to go by:
"Nymphomania is apt to occur between the ages of 16 and 25. Blondes are more frequently subject to it than brunettes. It is characterised by an uncontrollable appetite for lascivious pleasures, exhibited (in its worst forms) in public and private, without regard to time, place, or surroundings….The only cure for the affection is marriage, or amputation of the clitoris."
Someone that you may be familiar with who was also extremely active in his efforts to stamp out masturbation was Dr John Harvey Kellogg.
Kellogg advocated for the consumption of bland food in order to dampen sexual desire, following his religious views on vegetarianism and the impact of diet on a person's overall health. This viewpoint led him and his family to develop food such as cornflakes as a bland food to restore health.
Kellogg was also a firm believer in female genital mutilation, in order to stop them from masturbating. For girls, he found the ''application of pure carbolic acid to the clitoris [to be] an excellent means of allaying the abnormal excitement."
He argued that leaving the child’s genitals covered in blisters would stop them, and he also used surgery to solve this problem:
"A Desperate Case.—A little girl about 10 years of age was brought to us by her father, who came with his daughter to have her broken of the vile habit of self-abuse into which she had fallen. Having read an early copy of this work, the father had speedily detected the habit, and had adopted every measure which he could devise to break his child of the destructive vice which she had acquired, but in vain… it finally became necessary to resort to a surgical operation, by which it is hoped that she was permanently cured, as we have heard nothing to the contrary since, and as the remedy seemed to be effectual."
In boys, he advocated for circumcision without any anesthetic, to make the child see that masturbation was wrong. He called for the use of chastity cages, or sowing silver wires through the foreskin to prevent erections.
He found that it ‘worked’, noting: ‘We have employed it with entire satisfaction’. One can imagine it was not to the child's satisfaction to undergo such a procedure.
Now we can see that a lot of the same symptoms attributed to masturbation in children were also signs of sexual abuse, such as damage to genitals, restlessness, lack of interest in usual activities, or sexual awareness at a young age. But the topic of child sexual abuse was not one that was acceptable at the time.
When psychoanalyst Sigmund Freud raised this as a possibility his career suffered, and he retracted his theories, arguing instead that children reporting abuse were merely fantasising or working out their Oedipal complex.
Thankfully, we now support children rather than deforming them, and recognise female genital mutilation as violence, and don't put boys in chastity cages. Many men are raising awareness about their experience of unconsensual circumcision.
But as the new guidelines for intersex children - which will also help protect children from genital surgery - show, there is still room for growth away from how society mistreated, rather than supported, vulnerable people in the name of 'right and wrong'.
All food for thought next time you have your bowl of cornflakes.
The views expressed here are those of the author and do not represent or reflect the views of RTÉ.
If you have been affected by issues raised in this story, please visit: www.rte.ie/helplines.
