The Kerala High Court has rejected a couple's plea to allow sex-affirmative surgery for their seven-year-old child with ambiguous genitalia. Citing the absence of regulations governing such surgeries on minors, the court directed the state government to form a medical board for recommendations. It also ordered the government to establish guidelines for sex-selective surgeries on infants within three months.The child, whose parents had filed the petition, had been diagnosed with congenital adrenal hyperplasia. While surgery was recommended for the child by doctors, surgeons were not willing to proceed without legal authorisation. Adrenal hyperplasia is a disorder causing the adrenal glands to overproduce hormones, leading to diverse health complications. In girls, symptoms of adrenal hyperplasia can include early development of pubic hair, rapid growth, ambiguous genitalia and irregular menstrual periods, while in boys, it may lead to early enlargement of the testicles and penis, and rapid growth as well.Justice V G Arun emphasized that non-consensual sex-affirmative surgery on a minor violates their dignity and privacy. Until state-level norms are established, sex-selective surgery is permitted only if deemed necessary to save the child's life by a multidisciplinary committee.The court underscored the significance of recognizing an individual's right to choose their gender identity, as enshrined in Articles 14, 19, and 21 of the Indian Constitution. It cautioned that permitting such surgery could lead to emotional and psychological challenges if the child develops a different gender orientation later.Genital reconstructive surgeries, also known as gender reassignment surgeries, help individuals with gender dysphoria transition to their preferred gender. While surgery is the final step in the process, its significance requires thoughtful consideration.Image used for representational purposes only.