Intersex medical guidelines in the UK and Germany: a critical discourse analysis

The medical care of infants born with atypical sex characteristics sits at a peculiar ideological intersection. While many healthcare practitioners hold biologically essentialist views on sex development, the history of intersex medical management also illustrates the ways in which the sexed body is socially constructed. In practice, this meant that children born with an intersex trait or difference in sex development (DSD) were often subjected to non-consensual, invasive procedures in the name of sex assignment. The fields of paediatric endocrinology and surgery have since undergone reforms, centering open communication and family support while delaying surgical interventions. However, surgical corrective practices are still widespread, demonstrating that the underlying ideological conflict has not changed in a substantial way. The most recent DSD medical guidelines from the UK and Germany were released in 2021 and 2024, respectively. This article analyses and compares these texts by using a critical discourse analysis framework as a guide and placing them in dialogue with poststructuralist queer theory. This study is the first to systematically analyse the most recent paediatric endocrinological guidelines. Studying medical intersex discourse has implications beyond patient management. It can reveal both the power and possibility inherent in guidelines as performative speech acts, as well as the ways in which sex and gender are constructed and negotiated in medical discourse across different national contexts.