intersex: neither wholly male nor female -- 5/18/15

Today's selection -- from Galileo's Middle Finger by Alice Dreger. Thousands of babies are born each year with dual or anomalous sexual characteristics. The standard practice for attending physicians has been to try to "fix" the problem. Alice Dreger argues that this generally does more harm than good and often results in permanent damage or diminished function:

"Human sex comes in two big themes -- male and female -- but nature seems to enjoy composing variations on those themes. Some sex variations occur at the level of sex chromosomes, some at the level of hormones, some at the level of hard-to-detect internal structures, and some at the level of anatomical parts you can see with the naked eye (assuming your eye isn't the only thing that's naked). If you call all of these variations intersex, you can then ask how common intersex is. That's a question people love to ask. The problem is that to answer that question, one has to first decide how subtle a variation to count. How small should a penis be to count as intersex rather than male? How big a clitoris should count? How subtle a difference in hormone receptors? The truth is that human sex isn't simple. Human sex is practically fractal.

"Nevertheless, wherever nature draws unclear boundaries, humans are happy to curate. And the specialist curators of sex tell us this: In America today, about one in two thousand babies is born with genitals so notably intersex that a specialist team is immediately called in. About one in three hundred babies has genitals unusual enough that the average pediatrician will give the parents a referral to a specialist. If you add up all of the dozens of kinds of sex anomalies -- including incredibly subtle things you might never know you had without the benefit of a lot of fancy medical scans your insurance company probably doesn't want to cover -- the frequency of intersex in the human population comes to about one in a hundred. ...

"[Starting] in the 1910s -- biopsies [became] possible, and ... suddenly doctors could conclusively diagnose working ovaries in men, working testes in women, and ovotestes in both -- not a happy thing unless you're a gender radical. So again doctors did what they had to do to preserve the two-sex social order. Although they still categorized a patient's 'true sex' according to gonadal tissue, in practice they classified patients according to which gender was most believable. If an attractive housewife happened to have testicles, no one besides her doctor needed to know her diagnosis of male pseudohermaphroditsm. If a man really was menstruating, you just quietly took his ovaries out and hoped no one found out about his insides. Doctors continued to clean up nature's little indiscretions and thus take care not only of individual bodies, but also the social body.

"Given the way intersex could always threaten a sexist two-gender society, this approach of 'cleaning up' nature's sexual 'mistakes' persisted in American medicine. ... Modern medicine now sought to reinforce the 'optimum gender of rearing' by early management of children born with sex anomalies by means of 'sex-normalizing' surgeries, hormone treatments, delicate euphemisms, and sometimes lies. ...

"This was ... the system that led to a lot of really angry intersex adults who discovered that they had been harmed by the medical care meant to 'save' them and who knew the same basic system was still being used on children who would likely grow up as hurt and angry as they were. In the early 1990s, a core group of these people formed [an] intersex rights movement. ... Some of these intersex adults had been physically harmed -- left with damaged sexual sensation, incontinence, or repetitive infections. Many had been psychologically harmed -- left with a sense of having been too monstrous for their parents to accept as they came, of being sexually freakish, of being fountains of familial shame. All were left with a burning desire to try to save others from going through what they had. ...

"[In 1995, I reviewed] the standard of care for genital anomalies. [What medical students] were being taught, in the latest medical books, was this: If a baby is born with a large clitoris, she might turn out to be a lesbian, so you have to cut down her clitoris. If a boy is born with hypospadias -- wherein the opening of his urethra is not at the tip of the penis but on the underside or down near the scrotum -- he will not be able to write his name in the snow next to other little boys, and then he might turn out gay. Therefore you have to do a 'corrective' surgery to make sure he can pee standing up. Mind you, this surgery failed so often that doctors had a special term for the men in whom it failed. They were called hypospadias cripples, because life is tough with a surgically scarred, infection-prone penis, but, the urologists insisted, you had to try to get that boy to pee standing up. Or else."


Alice Dreger


Galileo's Middle Finger: Heretics, Activists, and the Search for Justice in Science


Penguin Press


Copyright 2015 by Alice Dreger


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