United States partial military ban on intersex people

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(DoDI) 6130.03, 2018, section 5, 13f and 14m
United States Department of Defense
  • Department of Defence Instruction 6130.03: Section 5; subheader 13 Female Genitalia System paragraph f and subheader 14 Male Genitalia System paragraph m
Citation DOD INSTRUCTION 6130.03 MEDICAL STANDARDS FOR APPOINTMENT, ENLISTMENT, OR INDUCTION INTO THE MILITARY SERVICES
Enacted by United States Department of Defense
Summary
Barring of people with ovotesticular disorder of sex development, "pseudohermaphroditism" and pure gonadal dysgenesis from serving in the United States military
Keywords
Intersex, military service, Armed Forces of the United States, Urological disorders
Status: Current legislation

The (DoDI) 6130.03, 2018, section 5, 13f and 14m is the writing which bars persons with "true hermaphroditism" (ovotesticular disorder of sex development), "pseudohermaphroditism" and "pure gonadal dysgenesis" from serving in the United States Armed Forces. The three are all intersex conditions and are as of now considered to be medically incompatible with military service in the United States. "DoDI" stands for "Department of Defense Instruction," the 6130.03 instruction concerns "Medical Standards for Appointment, Enlistment, or Induction in the Military Services" in the Armed Forces of the United States. Section 5 focuses on disqualifying conditions of the male and female reproductive system, on the female page the subheader 13 and paragraph f name true hermaphroditism, pseudohermaphroditism and pure gonadal dysgenesis specifically, and on the male page the subheader 14 and paragraph m also name exactly true hermaphroditism, pseudohermaphroditism and pure gonadal dysgenesis, respectively. There is no differentiation made between males and females with these conditions. [1] Many doctors, medical professionals and intersex advocates find the terms hermaphroditism to be outdated and stigmatized, [2] therefore it and its derivative words are seldom used in the 2000s, [3] with the word hermaphrodite itself being considered a slur when used against a human. [4] [5]

Contents

Statement

13.
—Female Genitalia System:
f.
History of major abnormalities or defects of the genitalia, such as hermaphroditism, pseudohermaphroditism, or pure gonadal dysgenesis. [1]
Page 24
14.
—Male Genitalia System:
m.
History of major abnormalities or defects of the genitalia such as hermaphroditism, pseudohermaphroditism, or pure gonadal dysgenesis. [1]
Page 26

Context

"True hermaphroditism," which is clinically known as ovotesticular disorder of sex development, [6] is a medical term for an intersex state in which a human is born with both testicular and ovarian tissue. Often one or both gonads is an ovotestis which contains both types of tissue. It is similar in some ways to mixed gonadal dysgenesis but the conditions can be distinguished histologically. [7] The condition has several effects on the body, one of which is imbalanced hormonal output, which is why it is currently considered a disqualifying condition for military service in the United States.

"Pseudohermaphroditism" on the other hand is an old clinical term for a person that is born with primary sex characteristics of one sex but develops the secondary sex characteristics [8] [9] that are different from what would be expected on the basis of the gonadal tissue (ovary or testis). Use of the term "pseudohermaphroditism" can be problematic, and is now widely considered redundant. [10] Because of this, the language still used by the armed forces has fallen out of favor in the 21st century due to misconceptions and pejorative connotations associated with the term hermaphrodite . [11]

Several militaries, whether they accept intersex people (such as Israel) or not, use different wording. [12] The website Military.com clumps all three conditions together as "hermaphroditism" on their list of conditions which disqualify one from service. [13]

History

Background

Barring of intersex persons with ovotesticular disorder of sex development and "pseudohermaphroditism" like states dates back to at least as far back as 1956. Despite this, John F. Patton of the Office of the Surgeon General and Center of Military History of the U.S. Army, wrote in 1988 that "Lesser degrees of these abnormalities, however, were obviously overlooked or regarded as compatible with military service." [14] Mentions of gonadal agenesis as an obstacle in military servie has been recorded since the early 1970s if not before. [15]

Developments

The guideline with the current wording was first conceived in 2010 and implemented in 2011. [16] [17] At first it was not addressed if persons who have had surgeries to address their genital abnormalities were acceptable or not but later updates added in notes about people also being barred if they had medical interventions done. In 2013 guidelines stated that "a history of, or current manifestations of, personality disorders, disorders of impulse control not elsewhere classified, transvestism, voyeurism, other paraphilias, or factitious disorders, psychosexual conditions, transsexual, gender identity disorder to include major abnormalities or defects of the genitalia such as change of sex or a current attempt to change sex, hermaphroditism, pseudohermaphroditism, or pure gonadal dysgenesis or dysfunctional residuals from surgical correction of these conditions render an individual administratively unfit," which while specifying that only unsuccessful corrective surgeries for the conditions rendered someone unfit for service also lumped together disorders of sex development (DOSD) with gender identity, fetishes, mental illness, neuroatypicality, personality disorders and paraphilias in the same level of disqualification, which is not consistent or optimal for rules of enlistment. [18] [19] [20] The 2016 amendments to the 6130.03 guidelines to allow transgender people to serve did not touch on intersex people whatsoever and their situation remained unchanged. [21] At the time the location of the writing was at "Enclosure 4, 14f. and 15r," here it was listed as "major abnormalit[y] or defect of genitalia." [22] The amendments made for transgender people were motivated by changes in the medical and psychological community, and while the use of the word hermaphroditism was criticized as archaic and medically outdated there was no major push by the larger LGBT community to have it corrected nor was any effort made on the part of the military to consider having it reworded. [23] [24] [25]

Effectiveness

The Consensus Study Report from the Board on Children, Youth, and Families (part of the DOD's Military Family Readiness System) in 2019 notes that despite the restriction it is very possible for someone whose genitalia have been surgically modified to comply with social norms due to these conditions to enter the military completely undetected. [26]

See also

Related Research Articles

<span class="mw-page-title-main">Intersex Society of North America</span> Advocacy group for intersex people in the U.S. and Canada

The Intersex Society of North America (ISNA) was a non-profit advocacy group founded in 1993 by Cheryl Chase to end shame, secrecy, and unnecessary genital surgeries on intersex people. Other notable members included Morgan Holmes, Max Beck, Howard (Tiger) Devore, Esther Morris Leidolf and Alice Dreger. The organization closed in June 2008, and has been succeeded by a number of health, civil and human rights organizations including interACT.

<span class="mw-page-title-main">XY gonadal dysgenesis</span> Medical condition

XY complete gonadal dysgenesis, also known as Swyer syndrome, is a type of defect hypogonadism in a person whose karyotype is 46,XY. Though they typically have normal vulvas, the person has underdeveloped gonads, fibrous tissue termed "streak gonads", and if left untreated, will not experience puberty. The cause is a lack or inactivation of an SRY gene which is responsible for sexual differentiation. Pregnancy is sometimes possible in Swyer syndrome with assisted reproductive technology. The phenotype is usually similar to Turner syndrome (45,X0) due to a lack of X inactivation. The typical medical treatment is hormone replacement therapy. The syndrome was named after Gerald Swyer, an endocrinologist based in London.

Sex assignment 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. 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.

<span class="mw-page-title-main">Intersex medical interventions</span> Performed to modify atypical or ambiguous genitalia

Intersex medical interventions (IMI), sometimes known as intersex genital mutilations (IGM), are surgical, hormonal and other medical interventions performed to modify atypical or ambiguous genitalia and other sex characteristics, primarily for the purposes of making a person's appearance more typical and to reduce the likelihood of future problems. The history of intersex surgery has been characterized by controversy due to reports that surgery can compromise sexual function and sensation, and create lifelong health issues. The medical interventions can be for a variety of reasons, due to the enormous variety of the disorders of sex development. Some disorders, such as salt-wasting disorder, can be life-threatening if left untreated.

<span class="mw-page-title-main">History of intersex surgery</span>

The history of intersex surgery is intertwined with the development of the specialities of pediatric surgery, pediatric urology, and pediatric endocrinology, with our increasingly refined understanding of sexual differentiation, with the development of political advocacy groups united by a human qualified analysis, and in the last decade by doubts as to efficacy, and controversy over when and even whether some procedures should be performed.

Ovotesticular syndrome is a rare congenital condition where an individual is born with both ovarian and testicular tissue. It is one of the rarest DSDs, with only 500 reported cases. Commonly, one or both gonads is an ovotestis containing both types of tissue. Although it is similar in some ways to mixed gonadal dysgenesis, the conditions can be distinguished histologically.

Gonadal dysgenesis is classified as any congenital developmental disorder of the reproductive system characterized by a progressive loss of primordial germ cells on the developing gonads of an embryo. One type of gonadal dysgenesis is the development of functionless, fibrous tissue, termed streak gonads, instead of reproductive tissue. Streak gonads are a form of aplasia, resulting in hormonal failure that manifests as sexual infantism and infertility, with no initiation of puberty and secondary sex characteristics.

Denys–Drash syndrome (DDS) or Drash syndrome is a rare disorder or syndrome characterized by gonadal dysgenesis, nephropathy, and Wilms' tumor.

Pseudohermaphroditism is an outdated term for when an individual's gonads were mismatched with their internal reproductive system and/or external genitalia. The term was contrasted with "true hermaphroditism", a condition describing an individual with both female and male reproductive gonadal tissues. Associated conditions includes Persistent Müllerian duct syndrome and forms of androgen insensitivity syndrome.

<span class="mw-page-title-main">Disorders of sex development</span> Medical conditions involving the development of the reproductive system

Disorders of sex development (DSDs), also known as differences in sex development or variations in sex characteristics (VSC), are congenital conditions affecting the reproductive system, in which development of chromosomal, gonadal, or anatomical sex is atypical.

<span class="mw-page-title-main">Hermaphrodite</span> Sexually reproducing organism that produces both male and female gametes

A hermaphrodite is a sexually reproducing organism that produces both male and female gametes. Animal species in which individuals are either male or female are gonochoric, which is the opposite of hermaphroditic.

<span class="mw-page-title-main">Intersex</span> Atypical congenital variations of sex characteristics

Intersex people are individuals born with any of several sex characteristics, including chromosome patterns, gonads, or genitals that, according to the Office of the United Nations High Commissioner for Human Rights, "do not fit typical binary notions of male or female bodies".

Hermaphrodites with Attitude was a newsletter edited by Cheryl Chase and published by the Intersex Society of North America (ISNA) between 1994 and 2005. The full archives are available online. In 2008, ISNA transferred its remaining funds, assets, and copyrights to Accord Alliance and then closed.

45,X/46,XY mosaicism, also known as X0/XY mosaicism and mixed gonadal dysgenesis, is a mutation of sex development in humans associated with sex chromosome aneuploidy and mosaicism of the Y chromosome. It is a fairly rare chromosomal disorder at birth, with an estimated incidence rate of about 1 in 15,000 live births. Mosaic loss of the Y chromosome in previously non-mosaic men grows increasingly common with age.

<span class="mw-page-title-main">Intersex people in history</span>

Intersex, in humans and other animals, describes variations in sex characteristics including chromosomes, gonads, sex hormones, or genitals that, according to the UN Office of the High Commissioner for Human Rights, "do not fit typical binary notions of male or female bodies". Intersex people were historically termed hermaphrodites, "congenital eunuchs", or even congenitally "frigid". Such terms have fallen out of favor, now considered to be misleading and stigmatizing.

<span class="mw-page-title-main">Intersex rights in the United States</span> Overview of intersex peoples rights in the United States of America

Intersex people in the United States have some of the same rights as other people, but with significant gaps, particularly in protection from non-consensual cosmetic medical interventions and violence, and protection from discrimination. Actions by intersex civil society organizations aim to eliminate harmful practices, promote social acceptance, and equality. In recent years, intersex activists have also secured some forms of legal recognition. Since April 11, 2022 US Passports give the sex/gender options of male, female and X by self determination.

<span class="mw-page-title-main">Intersex people and military service</span> Minority in military service

Military service of intersex people varies greatly by country. Some armed forces such as the Australian Defence Force fully embrace intersex people in the modern era, while others such as the United States Armed Forces have vague rules or policies or treat the subject on a case by case basis.

<span class="mw-page-title-main">Intersex people in the United States military</span>

The regulations regarding the service of intersex people in the United States Armed Forces are vague and inconsistent due to the wide range of human intersex conditions. The United States Armed Forces as a whole does not officially ban intersex people from service but does exclude many based on the form of their status. Policies regarding all intersex people are not addressed formally although depending on the type of sex variation some intersex people are allowed to serve. The United States military and their requirements for service makes it so they are frequently in a unique predicament when it comes to intersex bodies. With their position of needing to discern between male and female bodies, they are exposed to a broad variety of people, such as those who are intersex whose bodies may not match either classification and are more difficult to make decisions on. This ambiguity leads to confusion regarding military medical, behavioral, and legal laws.

<span class="mw-page-title-main">Eric Vilain</span> French-American physician-scientist

Eric Vilain is a physician-scientist and professor in the fields of differences of sex development (DSDs) and precision medicine. He is the Associate Vice Chancellor for Scientific Affairs at the University of California, Irvine Health Affairs and also the director of the UCI Institute for Clinical and Translational Science. He previously was the director of the Center for Genetic Medicine Research at Children's National Medical Center and the chair of the Department of Genomics and Precision Medicine at the George Washington University School of Medicine & Health Sciences in Washington, D.C. Vilain is a fellow of the American College of Medical Genetics, serves on the International Olympic Committee's Medical Commission, and sits on the Board of Scientific Counselors for the National Institute of Child Health and Human Development (NICHD).

Sexual anomalies, also known as sexual abnormalities, are a set of clinical conditions due to chromosomal, gonadal and/or genitalia variation. Individuals with congenital (inborn) discrepancy between sex chromosome, gonadal, and their internal and external genitalia are categorised as individuals with a disorder of sex development (DSD). Afterwards, if the family or individual wishes, they can partake in different management and treatment options for their conditions.

References

  1. 1 2 3 "DoD Instruction 6130.03 Medical Standards For Appointment, Enlistment, Or Induction Into The Military Services" (PDF). September 27, 2018. Archived from the original (PDF) on September 27, 2018 – via Wayback Machine.
  2. ↑ "Frequently Asked Questions" (printable). Intersex Society of North America. Archived from the original on January 30, 2019. Retrieved January 30, 2019. The words "hermaphrodite" and "pseudo-hermaphrodite" are stigmatizing and misleading words. Unfortunately, some medical personnel still use them to refer to people with certain intersex conditions, because they still subscribe to an outdated nomenclature that uses gonadal anatomy as the basis of sex classification.
  3. ↑ "Frequently Asked Questions". Intersex Society of North America. Archived from the original (printable) on January 30, 2019. Retrieved January 30, 2019. In a paper titled "Changing the Nomenclature/Taxonomy for Intersex: A Scientific and Clinical Rationale":/node/979, five ISNA-associated experts recommend that all terms based on the root "hermaphrodite" be abandoned because they are scientifically specious and clinically problematic. The terms fail to reflect modern scientific understandings of intersex conditions, confuse clinicians, harm patients, and panic parents. We think it is much better for everyone involved when specific condition names are used in medical research and practice.
  4. ↑ Wallace Swan; The Routledge Handbook of LGBTQIA Administration and Policy
  5. ↑ "Slurs". Genderkit.org.uk. Gender Construction Kit. Retrieved January 24, 2019.
  6. ↑ Lee P. A.; Houk C. P.; Ahmed S. F.; Hughes I. A. (2006). "Consensus statement on management of intersex disorders". Pediatrics. 118 (2): e488–500. doi:10.1542/peds.2006-0738. PMC   2082839 . PMID   16882788.
  7. ↑ Kim, Kyu-Rae; Kwon, Youngmee; Joung, Jae Young; Kim, Kun Suk; Ayala, Alberto G.; ťRo, Jae Y. (2002). "True Hermaphroditism and Mixed Gonadal Dysgenesis in Young Children: A Clinicopathologic Study of 10 Cases". Modern Pathology. 15 (10): 1013–9. doi: 10.1097/01.MP.0000027623.23885.0D . PMID   12379746.
  8. ↑ "Dorlands Medical Dictionary". Archived from the original on December 28, 2007. Retrieved December 7, 2007.
  9. ↑ "MESH" . Retrieved December 7, 2007.
  10. ↑ Lee PA, Houk CP, Ahmed SF, Hughes IA (August 2006). "Consensus statement on management of intersex disorders. International Consensus Conference on Intersex". Pediatrics. 118 (2): e488–500. doi:10.1542/peds.2006-0738. PMC   2082839 . PMID   16882788.
  11. ↑ Dreger, Alice D.; Chase, Cheryl; Sousa, Aron; Gruppuso, Phillip A.; Frader, Joel (August 18, 2005). ""Changing the Nomenclature/Taxonomy for Intersex: A Scientific and Clinical Rationale."" (PDF). Journal of Pediatric Endocrinology and Metabolism. 18 (8): 729–733. doi:10.1515/JPEM.2005.18.8.729. PMID   16200837. S2CID   39459050. Archived from the original (PDF) on December 20, 2016. Retrieved July 27, 2016.
  12. ↑ Speckhard, Anna and Paz, Reuven; " Transgender Service in the Israel Defense Forces: A Polar Opposite Stance to the U.S. Military Policy of Barring Transgender Soldiers from Service" (2014); Academia.edu
  13. ↑ "Medical Conditions That Can Keep You From Joining the Military". Military.com . Archived from the original on January 30, 2019. Retrieved January 30, 2019.
  14. ↑ John F. Patton; Urology – Page 148
  15. ↑ Military Medicine ; Association of Military Surgeons, United States, 1970 – Page 788-790
  16. ↑ Assessing the Implications of Allowing Transgender Personnel to Serve Openly – Page 65
  17. ↑ Sexual Assault in the U.S. Military: The Battle Within America's Armed – Page 87
  18. ↑ Staff (2013). "Chelsea Manning illuminates the struggle of transgender individuals in the U.S." The Louisville Cardinal . Retrieved January 24, 2019.
  19. ↑ Diane H. Mazur (October 2014). "Arbitrary And Capricious: Six Inconsistencies Distinguishing Military Medical Policies For Transgender And Non-transgender Personnel" (PDF). PALM Center; Blueprints for Sound Public Policy. Retrieved January 24, 2019.
  20. ↑ "AR 40-501 STANDARDS OF MEDICAL FITNESS". Milreg.com. Archived from the original on August 19, 2018. Retrieved January 24, 2019.
  21. ↑ Inclusion in the American Military: A Force for Diversity – Page 163
  22. ↑ Inclusion in the American Military: A Force for Diversity – Page 154
  23. ↑ Brynn Tannehill; Allyson Dylan Robinson; Sue Fulton (February 2015). "Transgender Military Service: A Guide to Implementation" (PDF). SPλRT*A: Service Members Partners Allies For Respect And Tolerance For All. Retrieved January 24, 2019.
  24. ↑ "UNITED STATES COURT OF APPEALS FOR THE DISTRICT OF COLUMBIA CIRCUIT * JANE DOE et al. v. DONALD J. TRUMP et al" (PDF). Jane Doe v. Trump . GLAAD . Retrieved January 24, 2019.
  25. ↑ "IN THE UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT * RYAN KARNOSKI, et al., Plaintiffs-Appellees, STATE OF WASHINGTON, Attorney General's Office Civil Rights Unit, Intervenor-Plaintiff-Appellee, v. DONALD J. TRUMP, in his official capacity as President of the United States, et al. Defendants-Appellants. ON APPEAL FROM THE UNITED STATES DISTRICT CO" (PDF). Cdn.ca9.uscourts.gov. Retrieved January 24, 2019.
  26. ↑ Kenneth W. Kizer; David Albright; Stephen J. Cozza; Ellen DeVoe; et al. (July 19, 2019). Kizer, Kenneth W; Menestrel, Suzanne Le (eds.). Chapter: 3 Demographic and Military Service Characteristics of Military Families. The National Academic Press. p. 76. doi:10.17226/25380. ISBN   978-0-309-48953-9. PMID   31600043. S2CID   199850390 . Retrieved September 22, 2019– via nap.edu.{{cite book}}: |work= ignored (help)

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