性别指派

医学名词
(重定向自出生性别指定

性别指派(英语:sex assignment),是根据出生时检查性别特征以确定婴儿性别[1]在大多数分娩中,亲属、助产士护士或医生在婴儿分娩时和进行性别指派时都会检查生殖器,且排除模棱两可的指派。[2]性别也可以在分娩前透过产前性别鉴别完成。

出生时的指派性别通常与孩子的解剖上的性别与性表型相符。据报导婴儿当中的双性人,也就是并非未真正符合女性男性严格定义的出生人数可能低至0.018%,最高可达约1.7%,这取决于哪些条件可以被当作双性人[3][4][5]生殖器模棱两可的的出生人数在0.02%至0.05%的范围内。[6]这些情况可能会使性别指派复杂化。[7]其他原因包括非典型染色体性腺激素[3][8]人们通常认为通过性别指派手术荷尔蒙治疗的干预来强化性别指派会侵犯个人人权[9][10][11][12]

性别指派行为带有对未来性别认同的隐含期望,即未来的性别认同将伴随者指派相关的生理性别与抚养方式一同发展。[13]在大约99%的情况下,孩子的性别认同与他们的指派性别相符。[14]如果指派性别和性别认同不一致,则该人可能是跨性别非常规性别[15][16][17][18]双性人的指派性别也可能与他们未来的性别认同矛盾。[19]

术语

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性别指派是对婴儿出生时性别的确定。[20][21]可能与性别指派有关的术语是:

  • 出生时被指派男性(Assigned male at birth, AMAB):任何年龄的人,不论当前社会性别,出生时的指派性别为“男性”。例如,当主治医生或助产士宣布“这是一个男孩”。[22][23]

  • 出生时被指派女性(Assigned female at birth, AFAB):任何年龄的人,不论当前社会性别,出生时的指派性别为“女性”。例如,当主治医生或助产士宣布“这是一个女孩”。[22][23]

根据联合国人权事务高级专员办事处的报告,在人类和其他动物中,双性人的性别特征包括染色体、性腺、性激素或生殖器的变异导致“不符合男性或女性身体的典型二元概念”。[8]这可能会使婴儿出生时的性别指派复杂化,并可能导致根据性表型的指派性别与其正常基因型不一致。[7][19]

跨性别的性别认同或性别表现方式不同于他们的指派性别。[16][17][18]如果跨性别人士希望医疗协助从一种性别转换到另一种性别,则有时将其称为变性人

性别重置疗法:由心理医学外科方法相结合的治疗程序,旨在从物理上改变一个人的性别特征

历史

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至今为止,对于辨别婴儿的性别几乎被普遍认为是对婴儿固有的性别特征的观察或辨识。[来源请求] 性别指派和性别登记的理由似乎很少受到质疑。荷兰的一份关于性别登记的报告指出,由于像是军事方面在内对特定性别的权利和责任,性别登记在1811年被引入为人口登记的内在组成部分。[24]立法中的许多歧视性规定已不复存在,但这些规定仍然适用于包括“识别性别程序的速度”在内的理由。[24]

对于具有双性人特征和生殖器外伤的性别指派

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在双性人婴儿和儿童中,以及在早期生殖器创伤的情况下,观察或识别婴儿的性别可能会变得复杂。在这种情况下,性别指派通常被视为需要接受医学治疗以确认该指派,但造成争议原因是由于这种医疗行为对人权的影响。[8][25]

双性人广泛地表示存在非典型性特征,也就是生殖器、体内器官、第二性征、性腺组织或染色体的至少某些方面是另一种典型的性别。当外生殖器介于两者之间时,它们被描述为模棱两可的情况。[26]

生殖器外伤案例包括著名的大卫·利马,在利马17个月时由于包皮环切术时被意外摧毁,其中性学约翰·曼尼的建议下,被重新指派成女性。但是,此主张后来被证明是错误的。之后,利马后来重新认定自己是一名男子。

在大约每两千名婴儿中,就有一名外生殖器的外观变化足以使医师对于性别的适当指派感到犹豫不决。[27]典型的例子是在一个原本看起来很典型的女孩却出现异常突出的阴蒂,或者在另一个原本看起来典型的男孩却完全隐睾。在大多数情况下,会暂定性别,父母被告知将进行测试以确认较显著性别。在这种情况下,典型的检查可能包括盆腔超声检查,以确定子宫的存在,还有睾酮17α-羟孕酮水平或核型。在某些情况下,请教儿科内分泌科医生以确认暂定的性别,性别指派的确认通常预计在数小时至数天内完成。

在更少的案例中,指派过程更为复杂,既涉及确定的性别特征的生物学因素,也涉及为了抚养孩子以确定最佳的性别。大约每两万名婴儿中,就有一名出生时模棱两可,以至于婴儿的性别指派流程变得更加困难,以及对父母进行有关性别分化的强化教育。在其中一些案例中,很显然,孩子长大后会面临身体上的困难或社会的污名,而决定性别的工作涉及权衡指派任一性别的优缺点。双性人维权人士批评这是未经婴儿知情同意而对婴儿和儿童实施的“正常化”过程。[25]

争议

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关于双性人的性别指派手术方面的争议,往往集中在有关手术适应症和最佳时机上。然而,双性人组织及人权机构批评这种医学模式,因为它们不是基于个体的意愿进行这种不可逆转的手术治疗的,并且结果可能不合适或不佳。[28][29]例如,安妮·塔玛尔-马蒂斯说,“真正的选择不在早期和晚期手术之间,而是早期手术与患者自主权之间的选择。”[29]人权机构现在将这种做法称为“有害做法”。[9]

然而,尽管外科手术干预仍处于实验阶段,并且尚未确立对构建“正常”生殖器解剖结构的临床信心,但除外科手术外,尚无医学上可靠的途径。[30]在当前的千年中,对临床建议的更改尚未解决人权问题,包括同意权、儿童的身份权、隐私权、免遭酷刑和不人道待遇以及身体完整性的权利问题。[19][10][11]

2011年,ChristianeVölling赢得了首例针对外科医生进行非自愿手术干预的成功判例。德国科隆地方法院判给她10万欧元。[31]

2015年,欧洲委员会确认了双性人不接受性别指派治疗的权利,并认定双性人的病理化本质上是荒谬的。[19]2015年4月,马耳他成为第一个承认身体完整性和身体自主权的国家,并禁止对性别特征进行未经同意的修改。该法受到民间社会组织的广泛赞誉。[32][33][34][35][36]

性别重新指派

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性别重新指派是指在婴儿期原先的性别登记之后性别角色或性别认同发生变化。这可能发生在几种类型的情况下。

  • 初期的重新登记可能纠正一些明显的指派错误。最常见的例子是一个新生儿被认定是一个男孩,尽管无睾丸畸形也被指派为男孩。如果在1-4周龄时因为新生儿筛查,发现大脑耗盐症候群,或隐睾症的检查,发现他患有CAH和发现拥有卵巢子宫,XX染色体。这个孩子很可能被重新登记为女性。当明显出现男性第二性征时,重新登记可能会被拒绝或拖延。
  • 由于生殖器无法弥补的先天缺陷或由于外伤或其他事故导致的阴茎丢失,男婴已在几天、几周或几个月内重新登记成女婴。因为围绕着1990年时被公开实验失败造成事后再次重新登记的案例:大卫·利马,该领域的大多数专家不再建议这样做。
  • 有双性人状况的孩子拒绝原本的指派性别,主张相反的性别身份,并要求重新指派。例如,青少年患有几种形式的CAH5α还原酶缺乏症英语5α-Reductase deficiency
  • 最常见的性别重新指派发生在没有检测到任何双性人特征的儿童或成人,可是具有不同的性别认同时,并要求或主张承认其新主张的性别时发生的。一般被描述为跨性别人士。一般来说,性别重置疗法可以在成年进行。自从2000年代以来,性别重置疗法逐渐地扩及青少年。寻求这些医疗资源的人们通常会在跨性别社群中形成一个子集认同,变性人,但并非所有这样的跨性别都这么认同。

性别指派要求面临的挑战

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近年来,人们认为合法地指派性别的必要性越来越受到挑战。[24][37]荷兰安全与司法部的一份报告指出:“越来越多的人将性别视为一种‘敏感的’身份特征,但到目前为止,隐私法规中并未对此加以考虑和保护。”[24]澳大利亚政府指导方针规定:“部门和机构不得收集性别资讯,除非是与该机构的一项或多项职能或活动所必需或直接相关。”[38]

相关条目

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参考文献

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