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Violence against LGBTI Persons in the Americas

Inter-American Commission on Human Rights | Organization of American States

In 2015, the Inter-American Commission on Human Rights paid much attention to intersex rights in the report Violence against LGBTI Persons in the Americas. Chapter 4, section E, is entirely devoted to human rights violations that intersex people experience. In that section it quickly becomes clear which recommendations the commission will make in the seventh chapter.

Chapter 4 | Forms and Contexts of Violence against LGBTI Persons

(Section E starts on page 114)

E. Medical violence against Intersex Persons

  1. As indicated in chapter two of this Report, the IACHR has received reports of generalized human rights violations carried out against intersex persons because their bodies do not physically conform to socially accepted standards for “female” and “male” bodies. 554 Intersex advocacy groups and organizations have indicated that human rights violations suffered by intersex persons are different from the human rights violations which lesbians, gays, bisexuals and trans persons typically suffer.555 The IACHR has been informed that specific human rights violations commonly suffered by intersex persons include: irreversible sex assignment and genital “normalizing” surgeries; involuntary sterilization; being subjected to excessive genital exams, photography and display; human experimentation; lack of access to information and medical records or history; delayed birth registration, and denial of health care services or health insurance, among others.556
  2. In March 2013, an intersex trans man testified before the IACHR: “[t]he 41- year-old man sitting before you right now was once, a long time ago, a 14- year-old girl who, upon being told that she was born without a vagina or a uterus, was also told that it was necessary to cut part of her intestine in order to surgically ‘create a vagina’. The purpose of that surgery was to ensure that I would grow up to become a woman who could be penetrated by a man. The failure of this procedure is obvious and after two surgeries and six years of vaginal dilations with a piece of metal called a “bougie,” what I can attest to as a consequence of that intervention is the transformation of the healthy teenager that I used to be into the man that I am—someone who survives every day the experience of having been raped repeatedly, while asleep on an operating table.”557
  3. The IACHR has been increasingly receiving reports of sex assignment and genital surgeries practiced without informed consent on intersex children and adults, most of which are reported to be irreversible in nature and aimed at attempting to “normalize” the appearance of the person’s genitals.558 The IACHR has been informed of cases documented in Argentina,559 Brazil,560 Canada,561 Colombia,562 Costa Rica,563 Chile,564 El Salvador,565 Mexico,566 United States,567 and Uruguay,568 among others. Nevertheless, the IACHR has been informed that these interventions are standard practice in countries across the Americas.569 The Commission notes that documentation and data around this problem is scarce,570 which is addressed in more depth in Chapter 6 of this Report under the obligation of States to collect data.
  4. Studies brought to the attention of the IACHR show that “genital-normalizing” surgeries –i.e., interventions with cosmetic purposes- have no medical benefits, because intersex presentations of the body, in the majority of cases, pose no danger to life or health.571 Intersex organizations and activists refer to these surgeries as “cosmetic” because their only purpose is making bodies look like the dominant standard of what constitutes a “male” or “female” body. The “medical urgency” behind these surgeries during infancy stems from the alleged impossibility of parents, the medical community, the civil registry and society in general to accept sexual “uncertainty” because the infant cannot be easily and promptly classified as a girl or boy.572 These interventions are carried out because variations in sex characteristics are generally considered obstacles to leading a “normal” life, not because they themselves pose a risk to the lives of intersex persons.573 Indeed, organizations have reported that these surgeries are part of an attempt to prevent suffering later in life that is caused by “lack of conformity with binary sexual standards.”574 Given these implications, some intersex organizations and human rights defenders characterize these surgeries as culturally accepted forms of infant genital mutilation.575
  5. These non-medically necessary surgeries and procedures have been reported to cause intersex children and adults great harm, including —but not limited to— chronic pain, life-long trauma, genital insensitivity, sterilization and diminished or lost capacity for sexual pleasure.576 Reports indicate that most procedures do not consist of a single intervention, but instead involve multiple invasive surgeries (which repeatedly expose children to the inherent risks of anesthesia and surgery in infancy), recurrent use of dilation contraptions, or administration of hormones. During these processes, intersex children are usually exposed to abusive display and repeatedly examined for training or scientific purposes, which in turn humiliates them and may cause deep psychological harm.577 For example, the Commission has been informed that regular vaginal dilation is often imposed on a child following vaginoplasty. This is achieved through the repeated forcing of an object into the vagina of a child, a practice which has been described as “extremely painful, highly traumatic, and comparable to sexual abuse in terms of the patient’s experience.”578 The UN Special Rapporteur on the right to health has described it as “a painful and high-risk procedure with no proven medical benefits.”579
  6. An intersex person testified before the IACHR: “twenty six years ago a team of medical professionals discovered that I had “XY” chromosomes and internal testes, more commonly referred to today as “partial androgen insensitivity syndrome.” Immediately after that, a surgery was scheduled to remove those internal testes, I was one then. When I was three, another surgery was performed. This time, it was to reduce the size of my clitoris, which was judged to be “half a centimeter too long.” Then, when I was eleven and entering puberty, I underwent a third surgery. This time was to construct a “more acceptable” vagina via the method called “vaginoplasty.” I was lied to and told that I had cancerous ovaries and that the doctors were saviors, and had saved me.”580
  7. Further, the IACHR was informed that these interventions are regularly carried out without the informed consent of intersex persons or that of their parents or legal guardians. In fact, the UN Committee against Torture and the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment have expressed concern over the lack of informed consent for these surgeries.581 The UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health has noted the importance of informed consent for intersex persons. Further, he recommended that health-care providers strive to postpone non-emergency invasive and irreversible interventions until the patient is sufficiently mature to provide informed consent.582
  8. The IACHR has been informed that medical protocols in force in several OAS Member States are still based on concepts that pathologize all intersex persons and all variations in sex characteristics and usually prescribe surgeries for “normalization” of the genitals. In some cases the consent of the patient may not even be legally required.583 For example, it is reported that legal provisions in force in some OAS Member States, which allow doctors to make urgent decisions justifying interventions in cases of medical emergency, and which override parental consent have been applied in cases of surgeries that aim at “standardizing” the genitals of intersex children.584 In other cases, doctors may consult parents but provide scarce or no information on the implications of procedures. A study conducted in the United States by the Human Rights Commission of San Francisco found that many parents choose “normalizing” medical interventions for their intersex children based on misinformation and/or coercion from doctors recommending such procedures.585 Testimony at IACHR hearings has included that of intersex persons whose parents had asked doctors to do “whatever it takes” to make the intersex persons “normal.”586
  9. Moreover, a report issued by the United Nations Development Programme (UNDP) and the Office of the Ombudsman (Procuraduría para la Defensa de los Derechos Humanos) in El Salvador noted that legal provisions in the Health Code of El Salvador do not prohibit “sex assignment surgeries” on intersex children and do not require free and informed patient consent, even in cases where the children are old enough to have the capacity to accept or reject such alterations to their bodies. 587 Chilean organizations have reported that in 2003, a 20-year-old man discovered through a series of medical tests that just after his birth, the doctor who had been authorized by his parents to treat an inguinal hernia had in fact removed the child’s testicles and operated on his genitals. According to the report, the parents had neither given consent to gender reassignment nor were they informed after the surgery. Activists alleged that this is not an isolated case in the Chilean public healthcare system.588 According to a researcher of intersex issues in Brazil, it is extremely rare that doctors decide not to conduct surgeries on intersex children at birth.589
  10. In an inter-agency statement, several international UN human rights bodies and agencies have noted that these surgeries and procedures may result in the termination of all or some of the reproductive capacity of intersex persons.590 Sexassignment treatments often involve the removal of viable gonads or other internal and external reproductive organs, leaving intersex persons with permanent, irreversible infertility.591
  11. . The IACHR emphasizes that forced and involuntary sterilization of intersex persons represents a serious human rights violation. Involuntary sterilization has serious implications for the physical and psychological integrity, right to reproductive autonomy, and right to self-determination of intersex persons. The Commission recommends that medical classifications that pathologize all intersex persons or all variations in sex characteristics should be reviewed and modified accordingly in order to ensure that intersex persons can effectively enjoy the highest attainable standard of health and other human rights. 592
  12. The UN Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment has recognized that “medical treatments of an intrusive and irreversible nature, when lacking a therapeutic purpose, may constitute torture or ill-treatment when enforced or administered without the free and informed consent of the person concerned.”593
  13. The IACHR notes that the principle of free, prior and informed consent is of utmost importance and must be the guiding principle in every decision made in relation to surgeries, procedures, hormone treatments, or any other medical treatment of intersex persons. The Inter-American Commission on Human Rights recommends that OAS Member States make necessary amendments to policy and law to prohibit medically unnecessary procedures on intersex persons, when it is administered without the free informed consent of the intersex person. Amendments must be made to medical protocols to ensure the right to autonomy of intersex persons: intersex persons must decide for themselves whether they want to undergo surgeries, treatment or procedures.594 Considering that the majority of these medical interventions are not medically necessary and given that, in general, there is a high risk that they will cause irreversible damage to the physical and mental health of intersex persons, those interventions can only be undertaken when the intersex child can provide his or her prior, free and informed consent. Surgeries and other medical interventions that are not medically necessary must be postponed until intersex persons can decide for themselves.
  14. Finally, according to information provided by human rights defenders, activists and intersex persons during the March 2013 public hearing, the Inter-American Commission on Human Rights recommends OAS Members States to (i) conduct trainings of medical personnel and medical community in order to provide adequate treatment and support to intersex persons and their families; (ii) create multidisciplinary groups to provide support and counseling to parents and relatives of intersex children and infants and to provide care and support to intersex persons from childhood into adolescence and adulthood; (iii) conduct awareness-raising and sensitization campaigns at the national level on the shortterm and long-term effects of “normalizing” interventions on intersex children; and (iv) carry out educational campaigns in conjunction with the ministries of education in order to bring down stereotypes, stigma and invisibility surrounding intersex persons.

7 | Conclusions and Recommendations

Based on the findings in the report the Inter-American Commission on Human Rights issues the following recommendations to OAS Member States in order to protect and guarantee the rights of intersex persons, or those perceived as such, to a life free from violence in the countries of the Americas.

(The section General recommendations starts at page 266)

General recommendations

  1. Undertake efforts and allocate sufficient resources to systematically collect and analyze data on the prevalence and nature of violence and discrimination based on prejudice against LGBTI persons, or those perceived as such. Access to disaggregated data and statistics is an important tool for evaluating the effectiveness of measures to prevent, punish, and eradicate violence against LGBTI persons, and for formulating any needed policy changes. In collecting this data, States must take into account the following:
    1. Data collection efforts must be carried out in coordination with all branches of government, and, where applicable, with Offices of the Ombudsperson, Offices of Public Prosecution, and Public Defender’s Offices. Data collection systems must be capable of gathering information from a wide variety of sources including, but not limited to, police, forensic agencies, tribunals and courts, prosecution and public defender offices, all other relevant agencies of the justice system, ombudspersons’ offices, agencies providing assistance to victims, hospitals, schools, shelters, prison administration agencies, and other relevant governmental agencies and public institutions which may provide useful data on violence against lesbian, gay, bisexual, trans and intersex persons.
    2. […]
    3. States must collect data on human rights violations against intersex persons, including the prevalence of medical treatment of and surgeries performed on intersex persons, particularly surgical interventions aimed at altering the appearance of the genitals to make them more “female” or “male”. Data in this regard must include the review of medical protocols and practices in public and private hospitals.
    4. […]
    5. […] The characterization of the perpetrators must include, among other information, their relationship with the victim, if any. Other elements –such as the place where the violence took place- are also important to understanding violence based on prejudice.

[…]

  1. Design and implement policies and programs to eliminate stigmatization, stereotyping and discrimination against LGBTI persons, or those perceived as such. Adopt comprehensive measures to encourage respect for the rights of LGBTI persons and social acceptance of diversity in sexual orientations, gender identities and persons who view themselves outside of the man/woman binary or whose bodies do not coincide with the socially accepted standard for male and female bodies.
  2. Adopt measures to eradicate social stigma regarding intersex persons, which includes urgent measures to raise awareness, through policies and programs that sensitize the general public and the medical community, of human rights violations faced by intersex persons.
  3. National Human Rights Institutions (NHRIs) are urged to strengthen their work on the promotion and protection of the human rights of LGBTI persons, including specific measures to counteract prejudices and to eradicate practices that are based on stereotypes of LGBTI persons and which may legitimize or exacerbate violence against them. NHRIs are also urged to conduct outreach to intersex children and their families, to provide victim support services, facilitating contact with other intersex persons and with peer support groups.

[…]

  1. Make necessary amendments to law and public policy to prohibit medically unnecessary procedures on intersex persons, when such procedures are administered without the free informed consent of the person concerned.
  2. Undertake all necessary measures to ensure compliance with the obligation to adequately redress human rights violations and provide reparations to LGBTI persons and their relatives who are victims of human rights violations.

[…]

  1. Design and conduct educational campaigns, in coordination with ministries of education, in order to eliminate stereotypes, stigma, and invisibility surrounding intersex persons in school curricula. Ensure that education policies are specifically designed to modify harmful social and cultural patterns of conduct. The principles of equality and nondiscrimination, with a special focus on sexual, gender, and bodily diversity, should be key elements of such policies.
  2. Conduct awareness-raising and sensitization campaigns at the national level concerning the short-term and long-term effects of socalled “normalizing” interventions on intersex children

[…]

  1. Enact anti-discrimination legislation or amend existing legislation in order to prohibit all forms of discrimination, that include sexual orientation, gender identity and gender expression, sex characteristics or intersex status.

[…]

  1. Adopt laws and national regulations expressly prohibiting non-medically necessary surgery and related medical intervention for intersex children and intersex persons, when administered without their full and informed consent.

Health

  1. Regarding intersex persons,
    1. Prohibit non-medically necessary interventions on intersex children without their full and informed consent. Non-medically necessary surgeries on intersex infants should be postponed until the concerned person is able to provide full, prior, and informed consent. A decision not to undergo medical procedures should be respected. Nonintervention should not hinder or delay registration of birth by relevant State authorities.
    2. Incorporate specific safeguards for intersex children into legal instruments and medical protocols to protect and ensure their right to informed consent, particularly in the context of non-necessary medical interventions and surgery.
    3. Adopt measures to ensure that professionals properly inform patients and their parents of the consequences of surgical and other medical interventions.
    4. Undertake training of medical personnel and members of the medical community in order to provide adequate treatment and support to intersex persons and their families. Support intersex persons and their families via interdisciplinary teams during all stages of development, from infancy through childhood and adolescence to adulthood.
    5. Ensure intersex persons have access to their medical records.
    6. Adopt measures to prevent medical photography and unnecessary genital exams for non-consensual research concerning intersex persons and infants.
    7. Ensure effective consultation with intersex activists, organizations, peer-support groups, and other intersex advocates, in the design and implementation of all state measures to prevent violence against intersex persons.

Specific recommendations: particular groups of LGBTI persons

Children and youth

  1. Prohibit non-medically necessary interventions on intersex children without their full and informehttps://intersexrights.org/wp-admin/post.php?post=7681&action=edit#d consent. Non-medically necessary surgeries on intersex infants should be postponed until the concerned person is able to provide full, prior, and informed consent. A decision not to undergo medical procedures should be respected. Non-intervention should not hinder or delay registration of birth by relevant State authorities.
  2. Create multidisciplinary groups to provide support and counseling to parents and relatives of intersex children and infants and to provide care and support to intersex persons from childhood into adolescence and adulthood. Ensure that intersex persons and activists are consulted.
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OAS Cataloging-in-Publication Data

Inter-American Commission on Human Rights.
Violence against lesbian, gay, bisexual, trans and intersex persons in the Americas.
v. ; cm. (OAS. Official records ; OEA/Ser.L)

OEA/Ser.L/V/II. Doc.36/15 Rev.2

ISBN 978-0-8270-6580-2

Footnotes

  1. Cabral, Mauro IACHR, Hearing on Situation of Human Rights of Intersex Persons in the Americas, 147th Period of Sessions, March 15, 2013.
  2. Zwischengeschlecht.org, Intersex Genital Mutilations: Human Rights Violations of Children with Variations of Sex Anatomy, March 2014, p. 12.
  3. IACHR, Hearing on Situation of Human Rights of Intersex Persons in the Americas, 147 th Period of Sessions, March 15, 2013. See also, Advocates for Informed Choice (Tamar-Mattis, Anne), Report to the InterAmerican Commission on Human Rights, 2013, p. 2-7. See also, Council of Europe, Commissioner for Human Rights. Issue paper: Human Rights and Intersex People. Silvan Agius. May 12, 2015. See also, Montreal Gazette, My Coming Out: The Lingering Intersex Taboo, August 9, 2015.
  4. Testimony given by Mauro Cabral (Argentina) at IACHR, Hearing on Situation of Human Rights of Intersex Persons in the Americas, 147th Period of Sessions, March 15, 2013.
  5. IACHR, Public Hearing: Human Rights Situation of Intersex Persons in the Americas, 147th Period of Sessions, March 15, 2013. IACHR, Public Hearing on Discrimination against Trans Persons in the Americas, 153rd Period of Sessions, October 30, 2014.
  6. IACHR, Hearing on Situation of Human Rights of Intersex Persons in the Americas, 147th Period of Sessions, March 15, 2013.
  7. IACHR, Hearing on Situation of Human Rights of Intersex Persons in the Americas, 147th Period of Sessions, March 15, 2013.
  8. See articles by Janik Bastien-Charlebois (Université du Québec à Montréal).
  9. See below, reference to a decision by the Colombian Constitutional Court.
  10. IACHR, Hearing on Situation of Human Rights of Intersex Persons in the Americas, 147th Period of Sessions, March 15, 2013.
  11. IACHR, Press Release No. 131A/14, Report on the 153rd Session of the IACHR, December 29, 2014.
  12. United Nations Development Program (UNDP) & “Procuraduría para la Defensa de los Derechos Humanos” (El Salvador), Informe sobre la situación de los Derechos Humanos de las Mujeres Trans en El Salvador, 2013, p. 23.
  13. See Eva Alcántara Zavala, “Pobreza y condición intersexual en México: reflexiones y preguntas en torno al dispositivo médico,” in “Interdicciones: Escrituras de la Intersexualidad en Castellano” (Mauro Cabral, editor), Córdoba, February 2009.
  14. IACHR, Hearing on Situation of Human Rights of Intersex Persons in the Americas, 147th Period of Sessions, March 15, 2013.
  15. Heinrich Böll Foundation (Ghattas, Dan Christian), Human Rights between the Sexes: A preliminary study on the life situations of inter* individuals, Vol. 34 Publication Series on Democracy, 2013, p. 46.
  16. IACHR, Public Hearing on Situation of Human Rights of Intersex Persons in the Americas, 147th Period of Sessions, March 15, 2013.
  17. This has been acknowledged by States. See, e.g. Response to the IACHR Questionnaire on Violence against LGBTI Persons in the Americas submitted by the State of Ecuador, Note 4-2-380/2013 received by IACHR Executive Secretariat on December 2, 2013, p. 2.
  18. Tamar-Mattis, Anne Exceptions to the Rule: Curing the Law’s Failure to Protect Intersex Infants” in Berkeley Journal of Gender, Law & Justice, Volume 21, Issue 1, September 2013, p. 99, citing: Ford, Kishka-Kamari, “First, Do No Harm, The Fiction of Legal Parental Consent to Genital-Normalizing Surgery on Intersexed Infants” in Yale Law & Policy Review, No. 19, 2001, p. 476; Beh, Hazel Glenn & Diamond, Milton, An Emerging Ethical and Medical Dilemma: Should Physicians Perform Sex Assignment Surgery on Infants with Ambiguous Genitalia? in Michigan Journal of Gender and Law, No. 7, 2000, p. 7.
  19. Luciana Lavigne, “La regulación biomédica de la intersexualidad. Un abordaje de las representaciones socioculturales dominantes” in “Interdicciones: Escrituras de la Intersexualidad en Castellano” (Mauro Cabral, editor), Córdoba, February 2009, at p. 55.
  20. Luciana Lavigne, “La regulación biomédica de la intersexualidad. Un abordaje de las representaciones socioculturales dominantes” in “Interdicciones: Escrituras de la Intersexualidad en Castellano” (Mauro Cabral, editor), Córdoba, February 2009.
  21. Mulabi & International Gay and Lesbian Human Rights Commission (IGLHRC), Situation of lesbian, bisexual, transsexual, transgender and intersex women in Costa Rica in regards to discrimination: Shadow Report, July 2011, p. 9.
  22. IACHR, Public Hearing on Situation of Human Rights of Intersex Persons in the Americas, 147th Period of Sessions, March 15, 2013;
  23. IACHR, Public Hearing on Situation of Human Rights of Intersex Persons in the Americas, 147th Period of Sessions, March 15, 2013; IACHR, Annex to the Press Release Issued at the close of the 147th Period of Sessions, April 5, 2013.
  24. Human Rights Commission of The City & County of San Francisco, A Human Rights Investigation into the Medical “Normalization” of Intersex People, April 28, 2005, pp. 31, 43; Advocates for Informed Choice (Tamar-Mattis, Anne), Report to the Inter-American Commission on Human Rights: Medical Treatment of People with Intersex Conditions as a Human Rights Violations, 2013, p. 5.
  25. Advocates for Informed Choice (Tamar-Mattis, Anne), Report to the Inter-American Commission on Human Rights: Medical Treatment of People with Intersex Conditions as a Human Rights Violations, 2013, p. 3.
  26. UN, Human Rights Council, Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, A/64/272, August 10, 2009, para. 49.
  27. Testimony by Jen Pigeon Pagonis, IACHR, Public Hearing on Human Rights Situation of Intersex Persons, 147th Period of Sessions, March 15, 2013.
  28. Committee against Torture (CAT), Concluding observations: Germany, CAT/C/DEU/CO/5, December 12, 2011, para. 20; UN, Human Rights Council, Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, A/HRC/22/53, February 1, 2013, para. 77; OHCHR, Discriminatory laws and practices and acts of violence against individuals based on their sexual orientation and gender identity, A/HRC/19/41, November 17, 2011, para. 57
  29. UN, Human Rights Council, Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, A/64/272, August 10, 2009, para. 46.
  30. IACHR, Public Hearing on Discrimination against Trans Persons in the Americas, 153rd Period of Sessions, October 30, 2014; IACHR, Public Hearing on Human Rights Situation of Intersex Persons, 147th Period of Sessions, March 15, 2013.
  31. IACHR, Public Hearing on Discrimination against Trans Persons in the Americas, 153rd Period of Sessions, October 30, 2014. Activists referred to the case of Article 46 of the Costa Rican Code of Children and Adolescents (Law No. 7.739): “Article 46: Denial of consent. If parents, legal representatives or guardians refused to consent, for any given reason, the urgent hospitalization, treatment or surgery of any of their children, the medical professional will be entitled to take the necessary steps to protect their life or their physical or emotional integrity, in accordance with Article 144 of the Family Code.”
  32. Human Rights Commission of The City & County of San Francisco, A Human Rights Investigation into the Medical “Normalization” of Intersex People, April 28, 2005, p. 19.
  33. Human Rights Commission of The City & County of San Francisco, A Human Rights Investigation into the Medical “Normalization” of Intersex People, April 28, 2005, p. 42.
  34. United Nations Development Program (UNDP) & Procuraduría para la Defensa de los Derechos Humanos (El Salvador), Informe sobre la situación de los Derechos Humanos de las Mujeres Trans en El Salvador, 2013, p. 23.
  35. Global Rights, IGLHRC, MOVILH, Organización de Transexuales Masculino, Violations of the Rights of Lesbian, Gay, Bisexual, Transgender and Intersex Persons in Chile: A Shadow Report, 2008, p. 12.
  36. Information provided by Paula Sandrine Machado, Public Hearing on Human Rights Situation of Intersex Persons, 147th Period of Sessions, March 15, 2013.
  37. Office of the High Commissioner for Human Rights, UN Women, UNAIDS, UNDP, UNFPA, UNICEF and the World Health Organization, Eliminating forced, coercive and otherwise involuntary sterilization: An interagency statement, 2014, p. 7.
  38. Advocates for Informed Choice (Tamar-Mattis, Anne), Report to the Inter-American Commission on Human Rights: Medical Treatment of People with Intersex Conditions as a Human Rights Violations, 2013, p. 4.
  39. Council of Europe, Commissioner for Human Rights. Issue paper: Human Rights and Intersex People. Silvan Agius. May 12, 2015, p. 9. Regarding the issue of “pathologization” of intersex persons, the IACHR takes note of a document prepared by intersex activists and human rights defenders from around the world in the context of the process of review and reform of the International Classification of Diseases (ICD) produced by the World Health Organization. See document entitled Intersex issues in the ICD: a revision, drafted following a consultation held in Geneva onSeptember 8-9, 2014.
  40. Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, A/HRC/22/53, February 1, 2013, para. 32; Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, A/63/175, July 28, 2008, para. 47.
  41. IACHR, Public Hearing on Human Rights Situation of Intersex Persons, 147th Period of Sessions, March 15, 2013