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Beginning in the late nineteenth century, medicine became the primary means for dealing with intersex. Before then, the vast majority of people with intersex conditions went unnoticed by legal, religious, or medical establishments and only a few cases per year came to the attention of authorities. When a newborn had a high degree of genital ambiguity, midwives, grandmothers, and other local elders appear to have assigned the sex.
Medical doctors created an arbitrary standard based on gonadal tissue , which persists in most medical texts today. So the theoretical approaches and surgical techniques evolved bit by bit, though motivation remained the same: It should be noted that, in the last half of the nineteenth century, a small percentage of patients with intersex had started to ask for, and some surgeons had started to offer surgical reconstruction of large clitorises, small vaginas, and hypospadic penises.
With the exception of the rare clitorectomy performed on a child because she had a large clitoris, most of the genital surgeries performed for cosmetic reasons in the nineteenth century were performed on adults at their request.
Both patients and surgeons generally avoided elective surgery for reasons of safety. There is also reason to believe that most people with intersex were socially healthy without surgery; they did not disproportionately live as hermits or attempt suicide. Psychologist John Money studied adults with intersex and found—before the era of standard cosmetic surgical intervention for intersex—that they enjoyed a lower rate of psychopathology than the general population.
Nevertheless, like many other realms of biology, sexuality, and psychology, intersex increasingly became the purview of medicine. For a small number of people with intersex—namely those at risk for gonadal cancers and salt-wasting—the medicalization of intersex probably improved their health, sometimes even saving their lives.