For many intersex people, these surgeries happened as infants, with parents and doctors making the decisions. As the advocacy group Human Rights Watch noted in its 2017 report on the phenomenon in the United States, these early surgeries were the default in the medical world until the last two decades of activism brought attention to their potential harm. Now, HRW reports, a “growing number of doctors are opposed to doing unnecessary early surgery”—but even still, the medical world has “uneven” and “piecemeal standards of care” for intersex newborns.

Some surgeons, HRW notes, “continue to perform medically unnecessary, cosmetic surgeries on children, often before they are one year of age.” HRW reached out to several specialists working in the area and although they anecdotally reported “a general decrease in surgeries on intersex infants,” none could say that their clinics had banned early, medically-unnecessary interventions altogether.

Even at age 13, Saenz doesn’t feel like they were given enough time or information to consent to surgery. In fact, it didn’t seem like there was another way.