The Phall-O-meter is a satirical measure that critiques medical standards for normal male and female phalluses. The tool was developed by Kiira Triea based on a concept by Suzanne Kessler and is used to demonstrate concerns with the medical treatment of intersex bodies; the Phall-O-meter was developed by Kiira Triea based on a concept by professor of psychology Suzanne Kessler. Kessler summarized the range of medically acceptable infant penis and clitoris sizes in the book Lessons from the Intersexed. Kessler states that normative tables for clitoral length appeared in the late 1980s, while normative tables for penis length appeared more than forty years before that, she combined those standard tables to demonstrate an "intermediate area of phallic length that neither females nor males are permitted to have", that is, a clitoris larger than 9 mm or a penis shorter than 25 mm. The meter was printed by the now-defunct Intersex Society of North America as a means of demonstrating concerns with the medical treatment of intersex bodies.
Anne Fausto-Sterling described how members of the intersex rights movement had developed a phall-o-meter, in her book Sexing the Body in 2000. Fausto-Sterling noted that, despite the existence of normative tables, clinicians' practices are more subjective: "doctors may use only their personal impressions to decide" on an appropriate clitoris size. In a paper presented to the American Sociological Association in 2003, Sharon Preves cites Melissa Hendricks, writing in the Johns Hopkins Magazine, November 1993 on subjective clinical norms and their relationship to surgical management: In truth, the choice of gender still comes down to what the external genitals look like. Doctors who work with children with ambiguous genitalia sometimes put it this way, “You can make a hole but you can’t build a pole.” Surgeons can decrease the size of a phallus and create a vagina, but constructing a penis that will grow as the child grows is another matter Copies of the Phall-O-Meter are now held by the Wellcome Library in London, the Smithsonian Institution.
An image of the Phall-O-Meter has been used to illustrate a report on the numbers of surgeries on intersex children in Germany between 2005 and 2014. While the scale as used by the Intersex Society of North America was a satirical tool for activism, numerous clinical scales and measurement systems exist to define genitals as normal male or female, or "abnormal", including the orchidometer, Prader scale and Quigley scale. Intersex medical interventions Intersex human rights Intersex rights in the United States Sex assignment
The European Union is a political and economic union of 28 member states that are located in Europe. It has an area of an estimated population of about 513 million; the EU has developed an internal single market through a standardised system of laws that apply in all member states in those matters, only those matters, where members have agreed to act as one. EU policies aim to ensure the free movement of people, goods and capital within the internal market, enact legislation in justice and home affairs and maintain common policies on trade, agriculture and regional development. For travel within the Schengen Area, passport controls have been abolished. A monetary union was established in 1999 and came into full force in 2002 and is composed of 19 EU member states which use the euro currency; the EU and European citizenship were established when the Maastricht Treaty came into force in 1993. The EU traces its origins to the European Coal and Steel Community and the European Economic Community, established by the 1951 Treaty of Paris and 1957 Treaty of Rome.
The original members of what came to be known as the European Communities were the Inner Six: Belgium, Italy, the Netherlands, West Germany. The Communities and its successors have grown in size by the accession of new member states and in power by the addition of policy areas to its remit; the latest major amendment to the constitutional basis of the EU, the Treaty of Lisbon, came into force in 2009. While no member state has left the EU or its antecedent organisations, the United Kingdom signified the intention to leave after a membership referendum in June 2016 and is negotiating its withdrawal. Covering 7.3% of the world population, the EU in 2017 generated a nominal gross domestic product of 19.670 trillion US dollars, constituting 24.6% of global nominal GDP. Additionally, all 28 EU countries have a high Human Development Index, according to the United Nations Development Programme. In 2012, the EU was awarded the Nobel Peace Prize. Through the Common Foreign and Security Policy, the EU has developed a role in external relations and defence.
The union maintains permanent diplomatic missions throughout the world and represents itself at the United Nations, the World Trade Organization, the G7 and the G20. Because of its global influence, the European Union has been described as an emerging superpower. During the centuries following the fall of Rome in 476, several European States viewed themselves as translatio imperii of the defunct Roman Empire: the Frankish Empire and the Holy Roman Empire were thereby attempts to resurrect Rome in the West; this political philosophy of a supra-national rule over the continent, similar to the example of the ancient Roman Empire, resulted in the early Middle Ages in the concept of a renovatio imperii, either in the forms of the Reichsidee or the religiously inspired Imperium Christianum. Medieval Christendom and the political power of the Papacy are cited as conducive to European integration and unity. In the oriental parts of the continent, the Russian Tsardom, the Empire, declared Moscow to be Third Rome and inheritor of the Eastern tradition after the fall of Constantinople in 1453.
The gap between Greek East and Latin West had been widened by the political scission of the Roman Empire in the 4th century and the Great Schism of 1054. Pan-European political thought emerged during the 19th century, inspired by the liberal ideas of the French and American Revolutions after the demise of Napoléon's Empire. In the decades following the outcomes of the Congress of Vienna, ideals of European unity flourished across the continent in the writings of Wojciech Jastrzębowski, Giuseppe Mazzini or Theodore de Korwin Szymanowski; the term United States of Europe was used at that time by Victor Hugo during a speech at the International Peace Congress held in Paris in 1849: A day will come when all nations on our continent will form a European brotherhood... A day will come when we shall see... the United States of America and the United States of Europe face to face, reaching out for each other across the seas. During the interwar period, the consciousness that national markets in Europe were interdependent though confrontational, along with the observation of a larger and growing US market on the other side of the ocean, nourished the urge for the economic integration of the continent.
In 1920, advocating the creation of a European economic union, British economist John Maynard Keynes wrote that "a Free Trade Union should be established... to impose no protectionist tariffs whatever against the produce of other members of the Union." During the same decade, Richard von Coudenhove-Kalergi, one of the first to imagine of a modern political union of Europe, founded the Pan-Europa Movement. His ideas influenced his contemporaries, among which Prime Minister of France Aristide Briand. In 1929, the latter gave a speech in favour of a European Union before the assembly of the League of Nations, precursor of the United Nations. In a radio address in March 1943, with war still raging, Britain's leader Sir Winston Churchill spoke warmly of "restoring the true greatness of Europe" once victory had been achieved, mused on the post-war creation of a "Council of Europe" which would bring the European nations together to build peace. After World War II, European integration was seen as an antidote to the extreme nationalism which had devastated the continent.
In a speech delivered on 19
An orchidometer is a medical instrument used to measure the volume of the testicles. The orchidometer was introduced in 1966 by Swiss pediatric endocrinologist Prof. Andrea Prader of the University of Zurich, it consists of a string of twelve numbered wooden or plastic beads of increasing size from about 1 to 25 millilitres. Doctors sometimes informally refer to them as "Prader's balls", "the medical worry beads", or the "endocrine rosary." The beads are compared with the testicles of the patient, the volume is read off the bead which matches most in size. Prepubertal sizes are 1–3 ml, pubertal sizes are considered 4 ml and up and adult sizes are 12–25 ml; the orchidometer can be used to determine size of testes. Discrepancy of testicular size with other parameters of maturation can be an important clue to various diseases. Small testes can indicate either secondary hypogonadism. Testicular size can help distinguish between different types of precocious puberty. Since testicular growth is the first physical sign of true puberty, one of the most common uses is as confirmation that puberty is beginning in a boy with delay.
Large testes can be a clue to one of the most common causes of inherited generalised learning disability, fragile X syndrome. Professor Stephen Shalet, a leading endocrinologist who works for the Christie Hospital in Manchester, is reported to have told The Observer, "Every endocrinologist should have an orchidometer. It's his stethoscope."Orchidometers are commonly used to measure testicular volume in rams. Numerous clinical scales and measurement systems exist to define genitals as normal male or female, or "abnormal", including the prader scale, quigley scale and the satirical Phall-O-Meter. Prader, A. "Testicular size: Assessment and clinical importance", Triangle, 1966, vol. 7, pp. 240 – 243 Taranger, J. Engström, I. Lichtensten, H. Svenberg-Redegren, I. "Somatic Pubertal Development", Acta Pediatr. Scand. Suppl. 1976, vol. 258, pp. 121 – 135
Legal recognition of intersex people
Intersex people are born with sex characteristics, such as chromosomes, gonads, or genitals that, according to the United Nations Office of the High Commissioner for Human Rights, "do not fit typical binary notions of male or female bodies". According to the Asia Pacific Forum of National Human Rights Institutions, few countries have provided for the legal recognition of intersex people; the Asia Pacific Forum states that the legal recognition of intersex people is firstly about access to the same rights as other men and women, when assigned male or female. The Asia Pacific Forum, the Council of Europe, the Malta declaration of the Third International Intersex Forum have called for non-binary gender classifications to be available on a voluntary, opt-in basis; the Council of Europe has called for greater consideration of the implications of new sex classifications on intersex people, while the Third International Intersex Forum called for the long term removal of sex or gender from official identification documents.
In some countries, legal recognition may be limited, access to any form of birth certificate may be difficult, while some other countries recognise that intersex people may have non-binary gender identities. Sociological research in Australia, a country with a non-binary gender marker, has shown that 19% of people born with atypical sex characteristics may prefer that option. In European societies, Roman law, post-classical Canon law, Common law, referred to a person's sex as male, female or hermaphrodite, with legal rights as male or female depending on the characteristics that appeared most dominant. Under Roman law, a hermaphrodite had to be classed as either male or female; the 12th-century Decretum Gratiani states that "Whether an hermaphrodite may witness a testament, depends on which sex prevails". The foundation of common law, the 16th Century Institutes of the Lawes of England described how a hermaphrodite could inherit "either as male or female, according to that kind of sexe which doth prevaile."
Single cases have been described in other legal cases over the centuries. Intersex scholar Morgan Holmes states that much early anthropological material on non-European cultures described gender systems with more than two categories as "primitive", but that subsequent analysis of third sexes and genders is simplistic or romanticized: much of the existing work on cultural systems that incorporate a'third sex' portray simplistic visions in which societies with more than two sex/gender categories are cast as superior to those that divide the world into just two. I argue that to understand whether a system is more or less oppressive than another we have to understand how it treats its various members, not only its'thirds'... recognition of third sexes and third genders is not equal to valuing the presence of those who were neither male nor female, hinges on the explicit devaluation of women In recent years, civil society organization and human rights institutions have raised issues relating to legal recognition.
Research indicates a growing consensus that diverse intersex bodies are normal—if rare—forms of human biology, human rights institutions are placing increasing scrutiny on medical practices and issues of discrimination against intersex people. A 2013 first international pilot study. Human Rights between the Sexes, by Dan Christian Ghattas, found that intersex people are discriminated against worldwide: "Intersex individuals are considered individuals with a «disorder» in all areas in which Western medicine prevails, they are more or less treated as sick or «abnormal», depending on the respective society."In 2015, an Issue Paper on Human rights and intersex people by the Council of Europe highlighted several areas of concern, including legal recognition: unnecessary "normalising" treatment of intersex persons, unnecessary pathologisation of variations in sex characteristics. Unnecessary medicalisation is said to impact a right to life. Inclusion in equal treatment and hate crime law. Access to information, medical records and other counselling and support.
Legal recognition, including respect for self-determination in gender recognition, through expeditious access to official documents. According to the Asia Pacific Forum of National Human Rights Institutions, few countries have provided for the legal recognition of intersex people; the Asia Pacific Forum states that the legal recognition of intersex people is firstly about access to the same rights as other men and women, when assigned male or female. Like all individuals, some intersex individuals may be raised as a particular sex but identify with another in life, while most do not. A 2012 clinical review suggests that between 8.5-20% of persons with intersex conditions may experience gender dysphoria, distress or discomfort as a result of the sex and gender they were assigned at birth. Like non-intersex people, some intersex individuals may not identify themselves as either female or male. Sociological research in Australia, a country with a third'X' sex classification, shows that 19% of people born with atypical sex characteristics selected an
Intersex rights in Germany
Intersex people in Germany have no recognition of their rights to physical integrity and bodily autonomy, no specific protections from discrimination on the basis of sex characteristics. In response to an inquiry by the German Ethics Council in 2012, the government passed legislation in 2013 designed to classify some intersex infants to a de facto third category; the legislation has been criticized by civil society and human rights organizations as misguided. Research published in 2016 found no substantive reduction in numbers of intersex medical interventions on infants and children with intersex conditions in the period from 2005 to 2014; the United Nations and Amnesty International have joined local intersex civil society organizations in calling for protections. The 12th-century canon law collection known as the Decretum Gratiani states that "Whether an hermaphrodite may witness a testament, depends on which sex prevails" On ordainment, Raming and Cook found that the Decretum Gratiani states, "item Hermafroditus.
If therefore the person is drawn to the feminine more than the male, the person does not receive the order. If the reverse, the person is able to receive but ought not to be ordained on account of deformity and monstrosity." Historical accounts of intersex people are scarce, but 19th-century medical journals document Gottlieb Göttlich, a man who made a living from being studied by medical practitioners. In the 20th-century, the term intersex was coined by the German-born geneticist Richard Goldschmidt. In 1932 gynecologist and obstetrician Hans Naujoks performed what was described as the first complete and comprehensive intersex surgery and hormone treatment on a patient with both ovarian and testicular tissue, at the University of Marburg; the female patient was described as functional after surgery and, starting in 1934, spontaneously menstruated. During Nazi rule in Germany many intersex people were either hidden from the public. German athlete Dora Ratjen competed in the 1936 Olympic Games in Berlin, placing fourth in the women's high jump.
She competed and set a world record for the women's high jump at the 1938 European Championships. Raised as a girl, tests by the German police concluded. Ratjen took the name Heinrich Ratjen following an official registry change. Formal sex verification testing was controversially introduced in sport. Time magazine reported that Ratjen tearfully confessed that he had been forced by the Nazis to pose as a woman "for the sake of the honor and glory of Germany". In the 21st-century, legal cases by Christiane Völling and Michaela Raab, provide first and examples of successful legal action against coercive intersex medical interventions. In this century, Germany introduced what may be the first form of third gender recognition in Europe, albeit controversially as a requirement for some intersex infants and otherwise not available; this was introduced as a measure to prevent early intersex medical interventions, but intersex civil society organizations fear that it will encourage such interventions, there is no evidence of reductions in surgery numbers.
Civil society organizations, including Intersexuelle Menschen, OII Germany and Zwischengeschlecht, have submitted reports to Land and international human rights institutions. The organization Intersexuelle Menschen first submitted a Shadow Report to the United Nations Committee on the Elimination of All Forms of Discrimination Against Women in July 2008, detailing human rights violations in medical settings and failures to act in the best interests of the child. In 2010, the German Ethics Council was instructed to review the situation of intersex people in Germany following a demand by CEDAW to protect the human rights of intersex persons. A 2012 report by the German Ethics Council stated that, "Many people who were subjected to a'normalizing' operation in their childhood have felt it to have been a mutilation and would never have agreed to it as adults." Legislation was subsequently passed to assign infants who could not be determined as male or female to a de facto third classification. Research published by Ulrike Klöppel at the Humboldt University in December 2016 shows that, over the period 2005 to 2014, there were no significant trends in numbers of intersex medical interventions.
An average of 99 feminizing surgeries took place each year, with a change only to the types of medical classification adopted. Rising numbers of masculinizing surgeries took place. Between 10-16% of children diagnosed with hypospadias underwent a plastic reconstruction of the penis. In a hearing of the United Nations Committee on the Elimination of Discrimination against Women, German government stated that irreversible medical interventions were permissible where they are "a life-saving procedure, or the best interest of the child, for example if a child was suicidal."In 2017, Amnesty International published a report condemning "non-emergency and irreversible medical treatment with harmful effects" on children born with variations of sex characteristics in Germany and Denmark. It found that surgeries take place with limited psychosocial support, based on gender stereotypes, but without firm evidence. Amnesty International reported that "there are no binding guidelines for the treatment of intersex children".
Two legal cases seeking reparations for unwanted, harmful medical interventions have succeeded, those of Christiane Völling and Michaela Raab. Both were adults at the time of the medical interventions. There appear to be no statutory provisions offering reparations, however, at a hearing of the United Nations Committee on the Elimination of Discrimination against Women in Fe
Intersex medical interventions
Intersex medical interventions are surgical and other medical interventions performed to modify atypical or ambiguous genitalia and other sex characteristics for the purposes of making a person's appearance more typical and to reduce the likelihood of future problems. The history of intersex surgery has been characterized by controversy due to reports that surgery can compromise sexual function and sensation, create lifelong health issues. Timing, evidence and indications for surgeries in infancy, adolescence or adult age have been controversial, associated with issues of consent. Interventions on intersex infants and children are recognized as human rights issues. Intersex organizations, human rights institutions question the basis and necessity of such interventions. In 2011, Christiane Völling won the first successful case brought against a surgeon for non-consensual surgical intervention. In 2015, the Council of Europe recognized, for the first time, a right for intersex persons to not undergo sex assignment treatment and Malta became the first country to prohibit involuntary or coerced modifications to sex characteristics.
The goals of surgery vary with the type of intersex condition but include one or more of the following: Physical health rationales: to improve the potential for fertility to provide an outlet for menstruation to prevent or reduce urinary tract infections or obstruction to reduce risk of cancer in gonads with high risk levels to close open wounds or exposed internal organs to improve urinary or fecal continence. Psychosocial rationales: to alleviate parental distress over the atypical genital appearance. To make the appearance more normal for the person's sex of rearing to reduce effects of atypical genitalia on psychosexual development and gender identity to improve the potential for adult sexual relationshipsBoth sets of rationales may be the subject of debate as the consequences of surgical interventions are lifelong and irreversible. Questions regarding physical health include assessing risk levels and timing. Psychosocial rationales are susceptible to questions of necessity as they reflect parental and cultural concerns.
There remains no clinical consensus or clear evidence regarding surgical timing, type of surgical intervention, degree of difference warranting intervention and evaluation method. Such surgeries are the subject of significant contention, including community activism, multiple reports by international human rights and health institutions and national ethics bodies. Interventions include: surgical treatment hormone treatment genetic selection and terminations treatment for gender dysphoria psychosocial supportSurgical interventions can broadly be divided into masculinizing surgical procedures intended to make genitalia more like those of typical XY-males, feminizing surgical procedures intended to make genitalia more like those of typical XX-females. There are multiple approaches for each procedure; some of these are needed for variations in degrees of physical difference. Techniques and procedure have evolved over the last 60 years; some of the different techniques have been devised to reduce complications associated with earlier techniques.
There remains a lack of consensus on surgeries, some clinicians still regard them as experimental. Some children receive a combination of procedures. For example, a child regarded as a undervirilized boy with a pseudovaginal perineoscrotal hypospadias may have midline urogenital closure, third degree hypospadias repair, chordee release and phalloplasty, orchiopexy performed. A child regarded as a virilized girl with congenital adrenal hyperplasia may undergo both a partial clitoral recession and a vaginoplasty. Orchiopexy and hypospadias repair are the most common types of genital corrective surgery performed in infant boys. In a few parts of the world 5-alpha-reductase deficiency or defects of testosterone synthesis, or rarer forms of intersex account for a significant portion of cases but these are rare in North America and Europe. Masculinizing surgery for virilized individuals with XX sex chromosomes and CAH is rarer. Orchiopexy for repair of undescended testes is the second most common surgery performed on infant male genitalia.
The surgeon moves one or both testes, with blood vessels, from an abdominal or inguinal position to the scrotum. If the inguinal canal is open it must be closed to prevent hernia. Potential surgical problems include maintaining the blood supply. If vessels cannot be stretched into the scrotum, or are separated and cannot be reconnected, a testis will die and atrophy. Hypospadias repair may be a single-stage procedure if the hypospadias is first or second degree and the penis is otherwise normal. Surgery for third degree hypospadias is more challenging, may be done in stages, has a significant rate of complications and unsatisfactory outcomes. Potential surgical problems: For severe hypospadias constructing a urethral tube the length of the phallus is not always successful, leaving an opening proximal to the intended urethral opening. Sometimes a second operation is successful, but some boys and men have been left with chronic problems with fistulas and contractures that make urination or erections uncomfortable, loss of sensation.
It is recognized that long-term outcomes are poor. Epispadias repair may involve comprehensive surgical repair of the genito-urinary area during the first 7 years of life, including reconstruction of the urethra, closure
Europe is a continent located in the Northern Hemisphere and in the Eastern Hemisphere. It is bordered by the Arctic Ocean to the north, the Atlantic Ocean to the west and the Mediterranean Sea to the south, it comprises the westernmost part of Eurasia. Since around 1850, Europe is most considered to be separated from Asia by the watershed divides of the Ural and Caucasus Mountains, the Ural River, the Caspian and Black Seas and the waterways of the Turkish Straits. Although the term "continent" implies physical geography, the land border is somewhat arbitrary and has been redefined several times since its first conception in classical antiquity; the division of Eurasia into two continents reflects East-West cultural and ethnic differences which vary on a spectrum rather than with a sharp dividing line. The geographic border does not follow political boundaries, with Turkey and Kazakhstan being transcontinental countries. A strict application of the Caucasus Mountains boundary places two comparatively small countries and Georgia, in both continents.
Europe covers 2 % of the Earth's surface. Politically, Europe is divided into about fifty sovereign states of which the Russian Federation is the largest and most populous, spanning 39% of the continent and comprising 15% of its population. Europe had a total population of about 741 million as of 2016; the European climate is affected by warm Atlantic currents that temper winters and summers on much of the continent at latitudes along which the climate in Asia and North America is severe. Further from the sea, seasonal differences are more noticeable than close to the coast. Europe, in particular ancient Greece, was the birthplace of Western civilization; the fall of the Western Roman Empire in 476 AD and the subsequent Migration Period marked the end of ancient history and the beginning of the Middle Ages. Renaissance humanism, exploration and science led to the modern era. Since the Age of Discovery started by Portugal and Spain, Europe played a predominant role in global affairs. Between the 16th and 20th centuries, European powers controlled at various times the Americas all of Africa and Oceania and the majority of Asia.
The Age of Enlightenment, the subsequent French Revolution and the Napoleonic Wars shaped the continent culturally and economically from the end of the 17th century until the first half of the 19th century. The Industrial Revolution, which began in Great Britain at the end of the 18th century, gave rise to radical economic and social change in Western Europe and the wider world. Both world wars took place for the most part in Europe, contributing to a decline in Western European dominance in world affairs by the mid-20th century as the Soviet Union and the United States took prominence. During the Cold War, Europe was divided along the Iron Curtain between NATO in the West and the Warsaw Pact in the East, until the revolutions of 1989 and fall of the Berlin Wall. In 1949 the Council of Europe was founded, following a speech by Sir Winston Churchill, with the idea of unifying Europe to achieve common goals, it includes all European states except for Belarus and Vatican City. Further European integration by some states led to the formation of the European Union, a separate political entity that lies between a confederation and a federation.
The EU originated in Western Europe but has been expanding eastward since the fall of the Soviet Union in 1991. The currency of most countries of the European Union, the euro, is the most used among Europeans. In classical Greek mythology, Europa was a Phoenician princess; the word Europe is derived from her name. The name contains the elements εὐρύς, "wide, broad" and ὤψ "eye, countenance", hence their composite Eurṓpē would mean "wide-gazing" or "broad of aspect". Broad has been an epithet of Earth herself in the reconstructed Proto-Indo-European religion and the poetry devoted to it. There have been attempts to connect Eurṓpē to a Semitic term for "west", this being either Akkadian erebu meaning "to go down, set" or Phoenician'ereb "evening, west", at the origin of Arabic Maghreb and Hebrew ma'arav. Michael A. Barry, professor in Princeton University's Near Eastern Studies Department, finds the mention of the word Ereb on an Assyrian stele with the meaning of "night, sunset", in opposition to Asu " sunrise", i.e. Asia.
The same naming motive according to "cartographic convention" appears in Greek Ἀνατολή. Martin Litchfield West stated that "phonologically, the match between Europa's name and any form of the Semitic word is poor." Next to these hypotheses there is a Proto-Indo-European root *h1regʷos, meaning "darkness", which produced Greek Erebus. Most major world languages use words derived from Europa to refer to the continent. Chinese, for example, uses the word Ōuzhōu. In some Turkic languages the Persian name Frangistan is used casually in referring to much of Europe, besides official names such as Avrupa or Evropa; the prevalent definition of Europe as a geographical term has been in use since the mid-19th century. Europe is taken to be bounded by large bodies of water