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What about the locker room?
Children with differences of sex development should be protected from schoolyard bullying.
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“My problem is the adolescent period … When she’s a teenager and she’s in a girls' locker room, it’s not going to be a cute situation … If we lived in a deserted island she’d never need this.”
The quote above, which originally appeared in the New York Times, is from the mother of a child with congenital adrenal hyperplasia, explaining why she chose clitoroplasty for her daughter. Her reasoning and reference to the locker room reflect a common theme in discussions about caring for children with differences of sex development. Even in medical literature, the locker room looms large. Generally, the phrase is used without further elaboration. There is no need to explain — everyone knows what will happen to a child with atypical sex development in the locker room.
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If there is one thing I’ve learned from my experiences with people with DSDs or intersex conditions, however, it’s this: What “everyone knows” isn’t always so. With that in mind, I want to re-open the question: What about the locker room? Is it inevitable that a child with a DSD will be forced into a public changing routine, and that schoolyard bullying will follow? If such a scenario does happen, are caregivers helpless to intervene?
Changing times
It’s understandable that anyone who cares about a child with a DSD would look forward with dread to the day that child heads off to gym class. However, this fear may be based in outdated memories of parents’ and doctors’ own school experiences.
These days, cuts in physical education funding and changes in school routines mean that group showers and locker-room nudity are much less common than they used to be. Few schools require showers, and those that do are more likely to offer single stalls. A New York Times article on the subject reported that the post-gym shower has become “virtually extinct.” It is entirely possible that a child with a DSD could go through his or her entire school career without ever being in a situation where public nudity is unavoidable.
We have also seen important changes in recent years in the way schools respond to bullying episodes.
School officials are more aware than they were in the past of the psychological harm caused by bullying. Tragic incidents like the shootings at Columbine have brought the message home that these problems can be serious. Successful antibullying programs have demonstrated that there is much adults can do to stop student-on-student harassment.
Additionally, state and federal laws addressing discrimination on the basis of sex, gender, perceived sexual orientation and disability all provide some measure of protection against in-school harassment to children with DSDs. It is likely that the 1990 Americans with Disabilities Act and other laws that apply to educational settings include children with DSDs. This means that schools must take reasonable steps to accommodate the child’s special needs. An example of reasonable accommodation for a child with a DSD would be allowing access to a private bathroom or permitting him or her to change clothes for gym class in a private area. Most schools are already familiar with the requirements of the Americans with Disabilities Act and understand their responsibility to make accommodations. Anti-sexual harassment laws are also likely to apply if a child is being teased cruelly about atypical sex anatomy.
Where school officials have retained outdated “kids-will-be-kids” attitudes toward bullying, lawsuits by children who suffered severe in-school harassment have been successful. Large judgments against apathetic schools and improved antidiscrimination laws have combined to make schools address bullying incidents in a more comprehensive way. Taken all together, these changes mean that children with DSDs are not doomed to torment in or out of the locker room. If they do face teasing or bullying in school, they and their families are not helpless to resist.
How can physicians help?
Physicians need to understand the modern reality behind the image of the locker room so they can counsel parents appropriately about their options. It is especially important to reflect on current realities if parents of young children are making decisions about medical intervention based partly on assumptions about the child’s future school experiences.
Of course, it would be ridiculous to completely discount the possibility that children with DSDs will face teasing or bullying. If a child is bullied at school, families may turn to their physician for help. Additionally, because children with DSDs may be at increased risk for psychological harm from teasing or bullying, primary care providers should consider screening for this as they would for other risk factors or psychosocial issues that affect health.
If a doctor discovers that a child is being bullied, he or she can help the family by informing them there may be laws requiring the school to address the situation and by offering referrals to social services, counseling and peer support groups. Physicians should also understand the basic requirements of the Americans with Disabilities Act and be able to direct parents to resources if they need help obtaining accommodation from the school. A physician’s letter explaining the medical need for such an accommodation can go far in getting schools to take action. If a child’s school is reluctant to effectively address a bullying situation, or refuses to offer reasonable accommodations to a child with a DSD, an attorney may be able to help them understand their responsibility to protect the child.
Anne Tamar-Mattis, JD, is an Executive Director of Advocates for Informed Choice, Cotati, Calif. She welcomes responses to this article at director@aiclegal.org.
For more information:
- Dotinga R. Where have all the showers gone? Christian Science Monitor. Feb. 3, 2004.
- Johnson D. Students still sweat, they just don’t shower. New York Times. Apr. 22, 1996.
- Kessler S.Lessons from the Intersexed. Rutgers University Press. 1998.
- National Center for Lesbian Rights website: http://www.nclrights.org.
- Olweus D.Bullying at school: What we know and what we can do. Malden, MA: Blackwell Publishers. 1993.