the 2006 Consensus Statement, termed a Global Disorders of Sex Development Update stated, A 2016 paper on "Surgery in disorders of sex development (DSD) with a gender issue" repeated many of the same claims, but without reference to human rights norms. A commentary to that article by Alice Dreger and Ellen Feder criticized that omission, stating that issues have barely changed in two decades, with "lack of novel developments", while "lack of evidence appears not to have had much impact on physicians' confidence in a standard of care that has remained largely unchanged." Another 2016 commentary stated that the purpose of the 2006 Consensus Statement was to validate existing practices, "The authoritativeness and "consensus" in the Chicago statement lies not in comprehensive clinician input or meaningful community input, but in its utility to justify any and all forms of clinical intervention." Controversies and unsettled questions Management practices for intersex conditions have evolved over the last 60 years. In recent decades surgical practices have become the subject of public and professional controversy, and evidence remains lacking. Comparing early against late surgeries Argued or putative advantages of infant surgery: Tissue is more elastic and heals better according to many surgeons. Genital surgery performed before the age of memory is less emotionally traumatic. Surgery in infancy avoids asking adolescent to make a decision that is stressful and difficult even for adults. Assuming infant surgery is successful, there is no barrier to engaging in normal sexual activities, and less distortion of psychosexual identity. Argued or putative advantages of surgery in adolescence or later: If outcome is less than satisfactory, early surgery leaves a person wondering if she would have been better off without it. Any surgery not absolutely necessary for physical health should be postponed until the person is old enough to give informed consent. Genital surgery should be handled differently than other birth defect surgery; this is a type of surgery that parents should not be empowered to make decisions about because they will be under social pressure to make "bad" decisions. By mid-adolescence or later, persons may decide that their atypical genitalia do not need to be changed. Infant vaginoplasties should not be done because most people who have had them performed report some degree of difficulty with sexual function; even though we have no evidence that adult sexual function will be better if surgery is deferred, the outcomes couldn't be worse