Decision-making dynamics in Italian paediatric care for Intersex and Variations of Sex Characteristics (VSC) involve a complex interplay between medical practices, parental perspectives, and socio-cultural factors. This article explores how medical professionals and parents make decisions amid cultural debates on gender, the body, and autonomy. It addresses aspects of why surgical intervention, with limited child involvement, is often seen as the ‘only option’ in the ‘conservative’ culture of Italy. The article continues to highlight the rise of parent-led human rights-based activism in Italy, challenging prevailing narratives in intersex/VSC paediatric care. Using qualitative data from two studies, including interviews with 15 Italian stakeholders and 38 Italian parents, as well as participant action research, the article provides insights into Italian medical and parental perspectives. The findings emphasize the need for nuanced support, education, and resources to empower parents in order to uphold the rights and well-being of intersex individuals.