Embracing Difference in Intersex Variations.

US medical providers have historically tried to prevent the harms of stigma by “normalizing” the sex of children with intersex variations/differences of sex development (I/DSD), also called variations of sex characteristics (VSC). Meanwhile, adults with I/DSD have reported suffering resulting from even well-meaning pediatric protocols. Revised care models, intended to be informed by bioethics, were designed with the intention to avoid this suffering. However, if clinical ethics cannot imagine a future in which sex diversity is accepted and affirmed, clinical care risks enacting the future it aims to avert: an adult struggling with trauma, shame, and internalized stigma. US intersex adults have reported poor general and mental health and sexual well-being. In a community survey of US adults with I/DSD, 61.7% screened positive for depressive symptoms, and 31.8% reported a lifetime suicide attempt, markedly higher than the US lifetime prevalence of 4.6%. In service of the Pediatric Endocrine Society’s goal to “support efforts to raise resilient individuals who have genital differences,” a paradigm that radically destigmatizes I/DSD is overdue.