Her new job means a salary above the average monthly wage of an urban office worker in Vietnam, but since she started working there last November Huỳnh Chấn Nghiệp or Vịt has gone unpaid.
The rules at her new company in Ho Chi Minh City state that salaries that are higher than VND 10 million or US$440 cannot be paid in cash, so Vịt was asked to open an account at a designated bank where her monthly pay could be sent. But the bank has been refusing to deal with her because her female appearance does not match the personal details on her ID card that say that she is male. While the company accepts her as a woman, it has its hands tied over how it can convince the bank to recognize the 29-year-old as such.
Vịt came out as a transwoman in 2018. Yet, without gender-affirmation surgery, she will continue to be identified as male on official documents. In Vietnam — as in some other countries across the globe — one cannot officially change one’s gender without medical intervention.
Vịt’s story, however, is not simply about someone with a male body wishing to be a woman. She is part of a tiny and largely invisible population in Vietnam and elsewhere: intersex people, or those born with physical or biological sex characteristics that do not match the typical binary idea of male or female.
Intersexuality is a spectrum, with variations across sexual anatomy, reproductive organs, hormonal patterns, and/or chromosomal patterns. Some intersex traits are apparent at birth, while for some people, these emerge later in life. Vịt, for example, was brought up as male and even performed two years of military service. She says that she also thought of herself as male despite having a rather high-pitched voice and delicate features. She was also romantically attracted to females. At age 24, however, she began to menstruate.
Hiker Chiu, founder of Intersex Asia, says that there are no available statistics on just how many intersex people there are in Vietnam and other countries, but it is believed that they are few in number.
In the case of Vietnam, the term “intersex” in Vietnamese, “liên giới tính,” has not entered common parlance. Instead, “lưỡng tính,” which literally means “hermaphrodite,” is often used to refer to intersex people, mistakenly implying that they have both female and male genitals.
Indeed, many Vietnamese medical professionals are not even aware of the term “intersex” and still associate those with intersex characteristics with having “disabilities at birth.” “Intersex” is also often mistaken as being synonymous with “transgender,” which is more about gender identity. Transgenders are those who feel that their identity is different from the sex at birth or those who do not identify with gender-binary.
“Correcting” with scalpels
Vịt is both intersex and transgender. When she was born, her outside appearance was typical male. Or as she puts it, “I had the privilege of looking ‘normal’ when I was born. Otherwise, doctors would have ‘corrected’ me.”
“Most Vietnamese doctors are not aware of intersexuality and cannot think beyond binary terms,” says an intersex activist and representative of Intersex Asia in Vietnam based in Vũng Tàu City. “So newborn babies with ambiguous sex characteristics are subject to corrective surgeries to be ‘normalized’.”
According to the 2015 Shadow Report for the 61st Session of the Committee on the Elimination of Discrimination against Women, medical interventions are still performed on intersex infants and children without their informed consent in Vietnam.
“Those normalization surgeries have traumatized many members of the Vietnamese intersex community,” says the activist, who has chosen to call himself “Phong” and who also considers himself lucky for having a “normal” appearance at birth.
Says Phong, who was born looking female: “Those ‘normalization’ surgeries have traumatized many members of the Vietnamese intersex community.”
Phong notes as well that when intersex people are seen as those with sexual-development disorder or disabilities, it is very hard for them to purchase life insurance. Vit herself says that she has been denied health services after being seen as gender deviant or suffering from lệch giới tính.
Meanwhile, the Institute for Studies of Society, Economics, and Environment, a Hanoi-based NGO working toward the rights of minority groups in the society, says that references to the intersex group are full of derogatory connotations and misperceptions, such as “tragedy,” “irony,” “pain,” and “silence,” and consider a non-binary body as a disability that needs to be treated.
According to a pediatrician at a public hospital in Hà Nội, as long as a child does not fit the image of either a girl or a boy, doctors tend to suggest their families perform a surgery to “rectify the wrong.”
“We will do a chromosomal scan and ultrasound to find the testes and uterus, to determine the cause of the issue,” says the doctor who declines to be named. “Then we will advise parents if medication or a surgery is needed for scrotal resection or reconstruction.”
Laws and semantics
Clause 1, Article 36, of Vietnam’s 2015 Civil Code reads: “The re-determination of the gender identity of a person is implemented where the gender of such person is subject to a congenital defect or has not yet been accurately formed and requires medical intervention in order to identify clearly the gender.”
That the term “sex reassignment” or “xác định lại giới tính” in Vietnamese law is used to refer to surgeries aimed at “normalizing” babies with “gender defects” speaks volumes about a daunting challenge facing intersex people: Their body is seen as a mistake that needs to be corrected so as to conform to the binary norms.
By seeking to redefine intersex people, the state fails to acknowledge gender diversity. Furthermore, Article 36 of the Civil Code contravenes Principle 3 of the Yogyakarta Principles on the Application of International Human Rights Law in relation to Sexual Orientation and Gender Identity, which states, “No one shall be forced to undergo medical procedures, including sex reassignment surgery, sterilization or hormonal therapy, as a requirement for legal recognition of their gender identity.”
Phong also says that while a sex-reassignment surgery can be covered by medical insurance, a gender-affirmative operation is not. And while the former is encouraged, he says that the latter is not.
In the West, “sex reassignment” and “gender affirmation” are interchangeable and mean the same thing, although transgenders prefer the latter term. In Vietnam, however, these terms are distinct in both the Vietnamese language and in law.
Sex-reassignment surgery (phẫu thuật xác định lại giới tính) is done on “persons with congenital sex defects or of unidentifiable sex” according to Decree 88/2008/NĐ-CP on sex reassignment. Gender-affirmation surgery (phẫu thuật chuyển giới, which literally means “transgender surgery”) refers to one performed on adults clear and complete biological sex organs but who wish to make changes on their bodies to match their gender identity. The former is performed out of need — as perceived by the state — while the latter is done out of desire. Before Civil Code 2015 came into effect, having a sex-reassignment operation was seen as a right, but getting a gender-affirmation surgery was a legal offense.
While Vịt and Phong escaped “corrective” surgery when they were newborns, they are now preparing for gender-affirmation surgeries. According to Vịt, lawyers whom she asked for help regarding her bank situation told her they could not find anything in the law to defend her with. Article 37 of the Civil Code, which came into effect in 2017, does recognize the right to legal gender recognition of transgender people. But the Law on Transgender that is required to further regulate it remains pending as of this writing. Unless Vịt has the surgery, she will remain male in the eyes of the government — and the bank.
For Phong, only with a surgery and a changed ID card would make him eligible to marry a woman. Even though same-sex weddings are no longer fined by the government, homosexual couples are not officially recognized.
Surgeries as sole solutions
The United Nations has recommended that “the scope of the law [on transgender] be expanded to include also transgender persons who do not wish to undergo medical interventions or wish to only undergo partial medical interventions as well as intersex persons identifying as transgender, and it should be clarified that legal gender marker change is reversible.”
In the meantime, it can be argued that because Vịt and Phong are intersex people, their operations would be sex reassignments. But that would imply that there is something “wrong” with their bodies, which both Vịt and Phong adamantly deny. Both say that they want to undergo surgery primarily to formally change their gender on their ID cards and be officially recognized as the gender they have chosen. They will, however, have to pay for their surgeries with their own money. The operations will also have to be done overseas, because there are no surgeons who perform them in Vietnam.
In truth, an intersex person from Hồ Chí Minh City who wants to be identified as “An” recounts being frustrated with doctors whom she consulted after she began wondering why she still had no period at age 17.
Without her family’s knowledge, An decided to go for medical checkups alone. She underwent one examination after another, which left doctors puzzled at first. Eventually she was told that she has no female reproductive organs (no cervix, no uterus, no ovaries), but does have underdeveloped testes.
The final round of examination confirmed that she has male chromosomes. But experienced doctors at Ho Chi Minh’s Từ Dũ Hospital, a leading institution in sexual health in Vietnam, were still clueless as to what was going on.
“They told me that I lacked this and that,” says An. “They recommended nothing but surgeries.”
“They encouraged me to remove the two testes, though they did not explain whether they pose any danger to me,” she adds. “What is wrong with these?”
Deciding there was really no one in Vietnam to ask about her condition, An turned to the internet. Her online research in English language sites led her to discover intersexuality and international intersex communities.
She has refused to undergo any surgery. An says, “I am lucky to be educated enough to understand that there is nothing wrong with my body.” ●
Vũ Hồng Trang is a social entrepreneur from Vietnam and gender advisor at Equal Asia Foundation.