Courtesy Of Fackeltraeger Verlag / Courtesy of Fackeltraeger Verlag
Christiane Voelling is a 52-year-old intersexual who lives in Dusseldorf, Germany and has fought for greater rights for people like herself whose sexual gender is indeterminate.
By Andy Eckardt , NBC News Producer
MAINZ, Germany – Pink? Or blue? For most parents this is the paramount question when it comes to organizing a baby shower or choosing a color for a newborn's room.
But, what happens if the exact gender of the child cannot be determined? It is estimated that in Germany alone approximately 80,000 people are intersexual, so-called hermaphrodites, who have physical features – such as chromosomes, hormones, gonads and outer sexual organs – which cannot be unambiguously attributed to just one gender.
Christiane Voelling, 52, is an intersexual.
She is a nurse living in Düsseldorf who was born without defining gender characteristics.
Because German law requires that a newborn's personal data – including gender specification – is registered within a week, Christiane was proclaimed a boy at birth and called Thomas after a midwife supposedly mistook her enlarged clitoris for a penis.
In Voelling's case, it was later diagnosed that her indeterminate external genitalia were the result of a rare genetic disorder of the adrenal gland, the so-called congenital adrenal hyperplasia, or CAH.
"My childhood and teenage development was often agonizing because I did not really know what was wrong with me and where I belonged," Voelling said in a recent interview with NBC News.
Following a push from various human rights groups, Germany‘s government commissioned its National Ethics Council in December 2010 to consider the issue and come up with recommendations on how to identify intersexuals so they could live with greater dignity. The council, which in February of this year released its recommendations, even grappled with the question of whether or not a “third sex” should be introduced.
Invasive surgery
For Voelling, her gender issues were rarely discussed in her family growing up in a small town in a rural area of western Germany since her parents were convinced that they were raising a male child. Yet, in school, she would often be reminded of her ambivalence, when she played soccer with the "other boys," but also felt very much integrated in the girls clique.
She was experiencing an inner conflict that is rather common among intersexuals, or so-called differences of sex development (DSD) affected individuals, experts say.
"By the mid 90s, the first intersexual patients started seeking psychological help at our offices and most of them were preoccupied with feelings of shame, humiliation and a burdening tabooization of their problems," said Dr. Sophinette Becker, a sexologist and psychologist from Frankfurt.
For Voelling, her emotional trauma grew significantly larger at age 18, when physical scars were added in an unnecessary operation.
After being admitted to a local hospital for an appendix surgery, doctors diagnosed that their patient had mixed male-female genitals and an atrophied reproductive system.
But, when the young adult landed on the operating table, the surgeon found a full set of female reproductive organs, including an intact womb and ovaries.
Without consent from the patient, the organs were removed.
"I never received a truthful explanation of my condition and after the operation I felt a lot of physical and emotional pain for many years," Voelling said.
"Some 95 percent of all intersexuals systematically undergo genital surgery and other interventions without medical informed consent and without clear scientific proof," said Lucie Veith, the head of "Intersexuelle Menschen eV" in Hamburg, a group that represents hermaphrodites in Germany.
Gratification after legal battle
Only a couple of years later, Voelling also started receiving the regular administration of testosterone, or steroid male hormones.
"For 27 years, I was more or less exposed to severe doping," Voelling said.
"At age 47, when I felt more like a woman than a man anyway, I said enough is enough," she added.
Today, intersexual activists are trying to educate the medical community, affected families and the public about the often harsh consequences of genital reconstruction surgery and other severe medical interventions.
"These massive medical interferences plunge the intersexed child into total imbalance and lead to irreversible damages," said Veith, whose organization has nearly 600 members in Germany.
In 2008, Voelling decided to take her case to court and sued the doctor that had removed her female reproduction organs over unlawful intervention.
In its verdict, the court ordered the surgeon to pay 100,000 euro, (approximately $133,000) in compensation for performing an operation converting a hermaphrodite into a man without consent.
"I felt very relieved and it was really more of a moral reparation than anything else, but it unfortunately did not have consequences for the legal rights of intersexuals," said Voelling. She officially changed her gender from male to female, as well as her name from Thomas to Christiane, in a long bureaucratic process that same year.
Preparing legal framework
While experts say that Voelling's case is legally unique and will not set a precedent, the topic nevertheless started to receive more public attention after she wrote a book called "I was man and woman – My Life as an Intersexual.“
Despite some disagreements with the recommendations of Germany’s National Ethics Council released last month, Voelling and other intersexuals hope that the council’s recommendations will help give their status a legal framework in the future.
"In our recommendation to the German government earlier this year, the main message was that intersexuals are different from other human beings, but they need to be respected and belong in the center of our society," said psychologist Dr. Michael Wunder, a member of the German National Ethics Council.
Because irreversible medical interventions of gender assignment in people with ambiguous genitalia are typically conducted during early childhood years, the German Ethics Council determined that these operations present an infringement of the right to physical integrity, thus a violation of basic human rights.
The Ethics Board also said that "a non-justifiable encroachment on the personal rights and the right to equal treatment is present when people who cannot be assigned as ‘female’ or ‘male’ because of their physical condition are legally compelled to assign themselves to either category in the civil registry."
Following Australia's example, the German Ethics Council recommended that in addition to the registration of "female" or "male," the German government should introduce the category "other" or should allow a “no entry,” until the affected person have made a personal decision themselves.
Last September, Australia introduced new guidelines, which allow its citizens to change the sex details on their passport to female (F), male (M) or indeterminate (X).
"This amendment makes life easier and significantly reduces the administrative burden for sex and gender diverse people who want a passport that reflects their gender and physical appearance," said Australian Foreign Minister Kevin Rudd.
In Germany, rights activists, representatives from the Ethics Council and intersexuals now hope that German lawmakers will soon implement regulations, which will help to protect the rights of hermaphrodites and remove discrimination on the grounds of gender identity and sexual orientation.
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