Aims To explore why and how genital-normalising surgery is considered as legitimate medical treatment. To explore the moral and legal issues that influence genital-normalising surgery in infancy to develop an alternative approach.

Methodology Doctrinal and socio-legal methodology, with analysis of bioethical argument.

Results A symbiotic relationship was established between medicine and law that has directly influenced the consideration of intersex as Disorders of Sex Development (DSD) that at its most controversial justifies genital-normalisation surgery. The central focus is biological diagnosis that requires intervention in order to conform to the binary sex and gender expectations in society. Decision-making for intersex children facing genital-normalising surgery was addressed, in recognition of the concepts of parental and the child’s future autonomy. I argue that the current approach to decision-making for genital-normalising surgery is flawed and should be regarded as unlawful when determining a child’s best interests. To address this I propose a shared decisionmaking approach that involves the child, parents and a multi-disciplinary healthcare team to promote a holistic approach. I finally argue that the human rights of intersex children are being breached in genital-normalising surgery.

Conclusions Genital-normalising surgery has the potential for catastrophic harm to the intersex child’s physical and psychological welfare. Fundamental to my concerns is detriment to the physical integrity of the intersex child, where that child is not able to consent to an irreversible intervention. The legal preference for certainty of binary biological sex is symbiotic to the view of medicine that intersex is an abnormality requiring correction. This symbiotic relationship promotes an approach to the child’s best interests that is based on parental welfare and fails to consider the child’s future autonomous interests. Furthermore, the breach of the child’s rights in infant genital-normalising surgery requires that the law has an implicit obligation to safeguard these rights. I propose that a shared decision-making approach be legally and professionallyrequired to allow the child to make the decision to undergo or refuse genital-normalising surgery, with support from parents and healthcare professionals through a process based on education, information and protection of the child’s physical integrity.