My problem is the adolescent period
When shes a
teenager and shes in a girls' locker room, its not going to be a
If we lived in a deserted island shed never need
The quote above, which originally appeared in the New York
Times, is from the mother of a child with congenital adrenal
hyperplasia, explaining why she chose clitoroplasty for her daughter. Her
reasoning and reference to the locker room reflect a common theme in
discussions about caring for children with differences of sex development. Even
in medical literature, the locker room looms large. Generally, the phrase is
used without further elaboration. There is no need to explain everyone
knows what will happen to a child with atypical sex development in the locker
If there is one thing Ive learned from my experiences with people
with DSDs or intersex conditions, however, its this: What everyone
knows isnt always so. With that in mind, I want to re-open the
question: What about the locker room? Is it inevitable that a child with a DSD
will be forced into a public changing routine, and that schoolyard bullying
will follow? If such a scenario does happen, are caregivers helpless to
Its understandable that anyone who cares about a child with a DSD
would look forward with dread to the day that child heads off to gym class.
However, this fear may be based in outdated memories of parents and
doctors own school experiences.
These days, cuts in physical education funding and changes in school
routines mean that group showers and locker-room nudity are much less common
than they used to be. Few schools require showers, and those that do are more
likely to offer single stalls. A New York Times article on the
subject reported that the post-gym shower has become virtually
extinct. It is entirely possible that a child with a DSD could go through
his or her entire school career without ever being in a situation where public
nudity is unavoidable.
We have also seen important changes in recent years in the way schools
respond to bullying episodes.
School officials are more aware than they were in the past of the
psychological harm caused by bullying. Tragic incidents like the shootings at
Columbine have brought the message home that these problems can be serious.
Successful antibullying programs have demonstrated that there is much adults
can do to stop student-on-student harassment.
Additionally, state and federal laws addressing discrimination on the
basis of sex, gender, perceived sexual orientation and disability all provide
some measure of protection against in-school harassment to children with DSDs.
It is likely that the 1990 Americans with Disabilities Act and other laws that
apply to educational settings include children with DSDs. This means that
schools must take reasonable steps to accommodate the childs special
needs. An example of reasonable accommodation for a child with a DSD would be
allowing access to a private bathroom or permitting him or her to change
clothes for gym class in a private area. Most schools are already familiar with
the requirements of the Americans with Disabilities Act and understand their
responsibility to make accommodations. Anti-sexual harassment laws are also
likely to apply if a child is being teased cruelly about atypical sex anatomy.
Where school officials have retained outdated
kids-will-be-kids attitudes toward bullying, lawsuits by children
who suffered severe in-school harassment have been successful. Large judgments
against apathetic schools and improved antidiscrimination laws have combined to
make schools address bullying incidents in a more comprehensive way. Taken all
together, these changes mean that children with DSDs are not doomed to torment
in or out of the locker room. If they do face teasing or bullying in school,
they and their families are not helpless to resist.
Physicians need to understand the modern reality behind the image of the
locker room so they can counsel parents appropriately about their options. It
is especially important to reflect on current realities if parents of young
children are making decisions about medical intervention based partly on
assumptions about the childs future school experiences.
Of course, it would be ridiculous to completely discount the possibility
that children with DSDs will face teasing or bullying. If a child is bullied at
school, families may turn to their physician for help. Additionally, because
children with DSDs may be at increased risk for psychological harm from teasing
or bullying, primary care providers should consider screening for this as they
would for other risk factors or psychosocial issues that affect health.
If a doctor discovers that a child is being bullied, he or she can help
the family by informing them there may be laws requiring the school to address
the situation and by offering referrals to social services, counseling and peer
support groups. Physicians should also understand the basic requirements of the
Americans with Disabilities Act and be able to direct parents to resources if
they need help obtaining accommodation from the school. A physicians
letter explaining the medical need for such an accommodation can go far in
getting schools to take action. If a childs school is reluctant to
effectively address a bullying situation, or refuses to offer reasonable
accommodations to a child with a DSD, an attorney may be able to help them
understand their responsibility to protect the child.
Anne Tamar-Mattis, JD, is an Executive Director of Advocates for
Informed Choice, Cotati, Calif. She welcomes responses to this article at
For more information:
- Dotinga R. Where have all the showers gone? Christian
Science Monitor. Feb. 3, 2004.
- Johnson D. Students still sweat, they just dont
shower. New York Times. Apr. 22, 1996.
- Kessler S.Lessons from the Intersexed. Rutgers University
- National Center for Lesbian Rights website:
- Olweus D.Bullying at school: What we know and what we can
do. Malden, MA: Blackwell Publishers. 1993.