Sexual assignment operations can produce “a legal medical nightmare,” he warned.
Some children who underwent these procedures have grown up and formed organizations in opposition to them, calling attention to the transgender movement, said Dr. Zurawin.
“The paradox there is the best time to do the surgery is when [children] are 3 years old, before they are old enough to establish their sexual identity and before the surgery is traumatic,” he said. “But on the other hand, psychologically speaking, you have cases of kids coming back later and saying, 'Why did you do this to me? I wanted to be whatever I was.'”
If parents want to go ahead with the surgery, he recommended legal counseling for the parents and the physician, and suggested that they consult transgender societies for their advice as well. “Parents don't have carte blanche in determining the surgical outcomes of their children,” he said.
Child abuse cases are also risky for gynecologists who are not experienced in developmental anomalies, according to Dr. Zurawin.
“You have to be clinically precise,” he said. “It's especially important to be experienced and competent when being called to evaluate for sexual abuse. You can't just assume a hymen is a hymen.”