Shadow Report to the 5th and 6th National Report of the the Republic of
Costa Rica on the United Nations Convention on the Elimination of All Forms of
Discrimination Against Women (CEDAW), 27.06.2011
This Shadow Report was considered by the 49th Session of the Committee
on the Elimination of Discrimination against Women (CEDAW) in New York, July
The entry on Intersex Genital Mutilation on p. 8-11 of the shadow
Intersex People (9) and the Right to Health:
An intersex condition is much more common than most people are aware.
For instance, 1.7% of the world population is intersex; 1 of every 200 births
is of an intersex person; and there are as many intersex people in the world as
people with red hair. (10) The typical medical response to an intersex
condition is medical intervention. Yet, sex assignment surgeries performed in
intersex persons create feelings of betrayal, mistrust and depression.
In the past, the prevailing opinion in medical circles was that it was
best to assign a sex to an intersex child as soon as possible, often on the
basis of the child’s external genitalia and not even related to their
chromosomal make-up. Parents were instructed that there should be no ambiguity
in their minds about their child’s sex. Surgery was quickly scheduled to
extirpate the testicular or ovarian tissue of the “undesirable” sex with
irreparable consequences in relation to reproductive capacity.
The aim of surgery was allegedly to normalize the genitals and prevent
suffering later in life because of lack of conformity with binary sexual
As a general rule, female genitals were considered more easily
“rebuildable” than functional male ones, so whenever the “right” choice was not
evident, a child was assigned to the female sex.
Most intersex children in Cost Rica undergo surgical intervention before
reaching two years of age. The most common manifestation of intersexuality
treated at the Hospital Nacional de Niños (National Children’s Hospital) is
congenital adrenal hyperplasia, detected through tests performed four days
after a baby is born. 12 But in spite of the good intentions of the
interdisciplinary team of the National Children’s Hospital, intersex persons
suffer as a result of the scars and insensitivity produced by surgery (among
In 2006, the American National Academy of Paediatrics recommended that
sex assignment surgeries cease to be performed on intersex children.
Yet the Assistant Director of the National Children’s Hospital stated in an
interview with newspaper Al Día that the notion that intersex persons could
choose their gender and sex when reaching adolescence was inaccurate and solely
promoted by extremists. (13) Mulabi / Latin American Space for Sexualities and
Rights, the International Gay and Lesbian Human Rights Commission and others
are concerned that the hospital has disregarded the recommendation of the
national authority on pediatric care and is performing discredited surgeries.
Furthermore, these organizations argue for the right to self-determine one's
own body and for the need to stop the practice of surgeries that attempt to
“normalize” bodies, particularly on children who cannot consent, based on
Though experts the National Children’s Hospital report that five to ten
children per year are born with genital ambiguity, there are few documented
cases. However the Urology Journal of San Juan de Dios Hospital, reported the
account of 16 year old boy with congenital adrenal hyperplasia (one of many
manifestations of intersexuality). Doctors wanted to perform a bilateral
orchidectomy (the surgical removal of both testicles) on him and then insert a
prosthesis but the boy himself and his family did not allow the procedure.
This kind of interventions for the sole purpose of conforming the bodies
of intersex people to social standards of gender binary, and their implications
for the reproductive, psychological and physical integrity are a clear
violation of Article 12 of the convention.
(9) Intersex Persons: Some babies are born with genitalia and
reproductive organs that do not fit with the patterns culturally accepted as
defining “female” or “male” anatomy. The older term for this disease
–hermaphroditism‐ blends together the names of a Greek god and goddess, Hermes
and Aphrodite. Hermes was the god of male sexuality (among other things) and
Aphrodite the goddess of sexuality, love and female beauty.
(10) Fausto‐Sterling, Anne (2000) Sexing the body: gender politics and the
construction of sexuality. Basic Books. NewYork.
(11) Cabral, Mauro (2009) Interdicciones
(12) Congenital Adrenal Hyperplasia refers to a group of hereditary disorders
affecting the adrenal glands. Congenital suprarenal hyperplasia can affect both
boys and girls. People suffering this condition lack an enzyme required by the
suprarenal gland to produce the cortisol and aldosterone hormones. Without
these hormones, the body produces more androgens, a type of male sexual
hormone, causing the early (or inappropriate) onset of male characteristics.
About 1 of every 10,000‐18,000 children are born with congenital suprarenal
(13) Interviewed by journalist Franklin Arroyo, from newspaper Al Día.
(14) Urology Journal at BINASS (Biblioteca Nacional de Salud y Seguridad Social
de la Caja Costarricense de Seguro Social)
The recommendation Re: Intersex Genital Mutilation on p. 13 of the shadow
That corrective or sex assignment surgeries cease to be the preferred
option for treating intersex children at the National Children’s Hospital, and
that the parents of these children are supported by specific counselling and
orientation groups that will provide them with the necessary tools to deal with
this situation in the best way possible, always having the best interests of
the intersex person as a guiding principle. One way to achieve this is by
implementing a care policy for the intersex population that will allow them to
decide in the future the best way to be followed because it is their lives that
are being affected.
Note: Unfortunately, in its >>> Concluding
Observations (PDF, 68 kb) the Committee only mentioned intersex
once, and as a "tail light" to LBT, furthermore criticising "abuse and
mistreatment by health service providers" and calling for "appropriate
training" to "health service providers, in order to avoid abuse and
mistreatment of these women" (CEDAW/C/CRI/CO/5-6, see p. 9 para
In September 2012, the UN Office of the High Commissioner for Human
Rights (OHCHR) referenced para 40 in its publication
free and equal" (PDF 1.7 mb) with regards to the the following
Statement by OHCHR Re: Intersex Genital Mutilation in "Born Free and
Equal", p. 51:
"In addition, intersex children, who are born with atypical sex
characteristics, are often subjected to discrimination and medically
unnecessary surgery, performed without their informed consent, or that of their
parents, in an attempt to fix their sex."
"Born free and equal" (HR/PUB/12/06, PDF 1.7 mb)