This chapter focuses on the complex, and at times contradictory, rhetorics on what constitutes an in/significant organ as they emerge in medical and juridical documents and discourses surrounding intersex and trans people, in Sweden, from the late 1960s to the present. The chapter relies on extensive data from juridical and medical documents (such as preparatory reports, legislative texts, referrals and parliament discussions, research articles and reports). It details the medico-juridical discourses around how sex organs are deemed significant or insignificant for the determination of a person’s juridical gender assignment, and thus addresses not only the meaning-making around sex as a sociocultural category of classification but also the discursive negotiations between expert and lay knowledge, and those between the interest of the state or the public and that of the individual. My analysis reveals the complexities and contradictions involved in decision-making, concluding that while genital surgery in the case of trans is thought to be so controversial that the legislation needs to regulate access in rigid forms, early genital surgery on intersex children, performed without consent, is relegated to the realm of medical decision-making, leaving young children unprotected from potential bodily harm.