Intersexuals and Intersexed People
INTERSEXUALS AND INTERSEXED PEOPLE
Intersexual people have sex chromosomes, external genitalia, or an internal reproductive system that are not considered "standard" for either the male or female sex according to the dominant point of view of modern Western culture. The definition of intersexuality is complex because there is profound disagreement, especially among physicians, intersexual people, and their parents. Physicians mostly identify intersexuality as an "abnormal" condition in which parts characteristic of both sexes are to some extent (really or apparently) combined. However, intersexual people have recently organized to oppose the medical definition, arguing that sex does not constitute a dichotomous phenomenon and that the human population cannot simply be divided into males and females. On the contrary, intersexual organizations believe that variety is predominant among human beings.
According to the prevailing medical view, genitals that cannot clearly be classified as male or female organs mark a disorder and there should be a treatment in order to correct the deficiency. The prevailing medical perspective also pathologizes those whose chromosomes do not fit clearly into the "standard" male (XY) or female (XX) pattern. This point of view encourages genital surgeries, hormonal treatment, and other forms of medical intervention in order to make genitals and/or the body fit into a regular male or female model. Intersexual people, as well as some scholars who specialize in the study of sexuality, have stated that the dominant medical approach is not interested in life-saving or improving the quality of life. On the contrary, intersexual activists think that many physicians want to construct what they identify as an "aesthetic" organ in order to avoid the threat that inter-sexual people pose to an oppressive culture organized around binary conceptions of sex, gender, and sexuality.
In classical Greece, intersexuals were identified as "hermaphrodites," a term with a mythical origin. According to the myth, Hermaphroditus was the son of Hermes and Aphrodite (or Mercury and Venus in the Roman tradition). The nymph Salmacis fell in love with Hermaphroditus, and as a result of her obsession to possess him, she embraced him tightly and did not let him go. Salmacis asked the gods to fuse their bodies into one. Another representation of sexually ambiguous bodies in classical Greece is Aristophanes's speech in Plato's Symposium. Aristophanes describes the original human beings as individuals with four legs, four arms, and two sets of sexual organs. According to this speech, Zeus, the father of all the Olympic gods, decided to cut human beings into halves because they were very arrogant and he wanted to punish them by making them incomplete. This forced men and women to long for their other part, a process that gave birth to love.
The term "hermaphroditism" continued to be used throughout the Middle Ages and is sometimes still used by physicians and others. Historians have studied some of the legal cases involving intersexual people, but very little is known about their lives before the nineteenth century. The term "intersexuality" has been in use since the beginning of the twentieth century, but only recently has its use become widespread.
The Emergence of a Scientific Interpretation
At the end of the eighteenth century, as biology became a modern scientific field of study, it acquired greater legitimacy to claim authority over ambiguous bodies. The French scientist Isidore Geoffroy Saint-Hilaire (1805–1861) founded a new biological subfield named "teratology" (from Greek teras, meaning "monster") in order to deal with all kinds of unusual birds. This area of knowledge would explore what he defined as the pathological side of embryology.
According to Saint-Hilaire, nature constituted a whole and every organism was part of a general plan. That plan had begun with no sexual differentiation and later it had evolved toward ambiguously sexual individuals that became genitally dichotomous at the end of the evolutionary scale. This interpretation conceived of a unilinear biological evolution where binary sex difference constituted the final aim of nature's plan. By placing intersexuality into evolution, Saint-Hilaire questioned the belief that identified it as an unnatural phenomenon and instead explained sexual ambiguity as the product of natural history. Under this paradigm, when scientists identified human genitals and/or bodies as having anatomical "pathologies," they would classify them as organisms arrested in their development. Scientists claimed that human intersexuality had to be interpreted through previous organic forms of what they considered older species.
Other nineteenth-century thinkers legitimated this interpretation concerning the relationship between inter-sexuality and evolution. Charles Darwin, Herbert Spencer, Ernst Haeckel, and other biologists also considered natural history as a process beginning with asexual cells and culminating in complete sexual differentiation between individuals of "opposite" sexes. Evolutionists understood the split between two sexes as a necessary feature of the higher stages of evolution. Using this approach, Haeckel believed that a "normal" embryological history had to "recapitulate" his vision of a natural history, culminating in a binary division between male and female. If recapitulation was not complete and the newborn had ambiguous genitals, then it meant that the body had suffered a halt in its embryological evolution, which was supposed to be "abnormal" for a higher species such as humans.
In her book Hermaphroditism and the Medical Invention of Sex (1998), Alice Domurat Dreger explains how, between the late nineteenth century and the beginning of the twentieth, physicians attempted to neutralize genital ambiguity by examining internal sexual organs—named "gonads." Because physicians considered those organs as the criteria necessary for establishing "true" sex, Dregger defines the period as "the age of gonads." Referring to a specific case, this scholar explains how a woman with female sexual organs was forcibly redefined as male because the physician found her gonads to be testes. Medical texts characterized "hermaphroditism" as an "error of sex," and because they thought that gonads could eliminate the ambiguity, they preferred to refer to this biological condition as "pseudo-hermaphroditism." This concept implied that only a clearly defined male or female was "real," while ambiguities of the external sexual organs were "false" manifestations of a "true" gonad to be found through ablation and microscopic analysis of tissue. Only in the second decade of the twentieth century did physicians recognize the existence of individuals with ambiguous gonads named "ovotestes." This contributed to the fall of the "age of gonads." Those intersexuals who had ovotestes, as opposed to the pseudo-hermaphrodites, became known as "true-hermaphrodites."
Twentieth-century Medical Approach
Although the medical approach of distinguishing the "true" sex through gonads was questioned earlier, only in the 1970s was it fully replaced by a new approach. In this decade, John Money argued that there was no "true" biological sex because sex was actually a cultural construction. In 1972, Money took the decision of reassigning the gender of an infant boy, whose penis had been ablated in a routine circumcision gone horribly wrong, through the surgical creation of female genitals. When this case was published, physicians thought it was an interesting experiment because the infant had an identical twin. This situation would allow an evaluation of the role of socialization and biology in the determination of sex. Money claimed that his surgery would provide an anatomical base for the subject's happiness in adulthood. However, Milton Diamond found out later that the child, "Joan," had rejected the assigned female identity. Diamond performed another surgery and provided hormone treatment to help "Joan" become "John."
Money's original reassignment was interpreted as evidence of the primacy of socialization, while the later failure became a point to support biological interpretations of the origin of sex. According to Suzanne Kessler, however, in Lessons from the Intersexed (1998), Money's failure does not prove that biology determines sex, because Joan/John was probably raised by parents who provided inconsistent gender messages. Kessler also argues that despite the fact that Money questioned the biological origin of sex, he took for granted the existence of two sexes. According to Money's view, an individual would not be able to lead a "normal" life if his/her genitals were not culturally perceived as either male or female, and thus it was necessary to eliminate ambiguity through surgery. The main difference between Money's view and the previous medical approach was that although Money recommended an early intervention on the infant's body, the criteria for the surgical construction of genitals was not the search for truth in the internal sexual organs. Under the new paradigm it became important to evaluate which sex would be more feasible under the given biological circumstances of a specific body.
In the last quarter of the twentieth century, through the work of John Money and the sanction of the American Academy of Pediatrics, physicians adopted specific treatment protocols. According to these rules, clinicians have to evaluate the genitals and decide which sex would be easier to construct in each specific case. This implies a set of assumptions, including the idea that a boy's gender identity is based on the possession of an adequate penis. In line with this approach, if the penis size does not fulfill physicians' definitions of normality, then it is easier to construct a vagina and to reduce the size of what has now become accepted as a big clitoris.
The Emergence of the Intersexual Movement
In 1993, an episode at the World University Games in Kobe, Japan, brought public attention to discussions about intersexuality. Maria Patiño, Spain's top woman hurdler, had forgotten to take a medical certificate stating that she was a woman, and before competing she had to go through an analysis of some cells obtained from the inside of her cheek. Because Patiño had been born with a condition known as androgen insensitivity, her body did not respond to the hormone that produces a penis and what is understood as male secondary sex characteristics. Even though she had a Y chromosome, she never developed a male body. After the sex test she realized that despite her body and genital appearance, both her chromosomes and her internal sexual organs were read by physicians as male. As a result of the medical exam, she was banned from the games and her entire career was ruined.
In 1993, an intersexual woman named Cheryl Chase founded the Intersex Society of North America (ISNA). Her aim was to make physicians reconsider their approach toward intersexuality in order to prevent unnecessary surgical interventions from happening. Meanwhile, the emergence and evolution of the Internet in the 1990s allowed a group of intersexuals and professionals to share their experiences. Since 1994 the members of ISNA have exposed their views in a newsletter called Hermaphrodites with Attitude, and they have contributed to the emergence of a public discussion on inter-sexuality. In 1996 the ISNA created its own Web page, providing information for the general public and for physicians. Many intersexual persons joined the organization and in 1997 ISNA decided that its main aim would now be to influence the medical profession.
Intersexual activists argue that physicians perform compulsive surgeries on intersexual people not because they want to solve a health problem, but rather because they think that a person without a definite sex would be incapable of dealing with daily life. The members of ISNA have stated that intersex surgeries are comparable to female genital mutilation, and that despite the attention that the latter has received, there is a lack of awareness about the personal and psychological damage that inter-sex surgery creates. Arguing that intersex surgeries are mutilations, activists claim that they as well as female circumcision should be banned.
The Internet and the writing of texts have not been the only political tools used by the ISNA; they have also resorted to picketing at hospitals that are reluctant to discuss their views and prefer to continue performing inter-sex surgeries. Chase and other activists have also organized pickets at medical congresses, especially ones whose topic is pediatrics. Through this pressure tactic, the intersexual movement has forced physicians to reconsider their voices. Whereas in the 1990s the criticisms of intersex patients have been mostly disregarded by physicians, in May 2000 the Lawson Wilkins Pediatric Endocrine Society, the largest organization including specialists in children's hormones, invited Chase to participate in its conference and offer her own understanding of how physicians should deal with intersexuality.
By participating in conferences and classes at several universities, intersexual people have counteracted the view that identifies physicians as the experts who have the right to make decisions about bodies with ambiguous genitals. The ISNA has stated, as part of its suggested guidelines for nonintersex individuals writing about intersexuality and intersex people, that it is important to "recognize that you are not the experts about intersex people, intersexuality, or what it means to be intersexed—intersexed people are." This claim becomes especially important in a context in which, as Kessler has pointed out, no real research about the life of surgically and hormonally treated intersexed patients has been conducted by physicians, who actually take for granted what should be questioned. Intersexual activists have tried to over-come their silence by claiming their right to decide about their own lives. They do not oppose surgeries in those cases where some health issue is at stake, but in the majority of the cases, where no real risk is involved, they claim the individual right to choose and then ask physicians to stop making decisions at an early stage of life by manipulating parental fears and misinformation.
The ISNA has promoted an alternative understanding of intersexuality where anatomy is interpreted as complex and variable and there is no distinction made between a normal and an abnormal genital or body. This patient-centered model wants to challenge the idea that difference equals disease. As a result of ISNA's influence, new intersex support groups are emerging in Canada, Europe, Asia, Japan, and New Zealand.
Chase compares the emergence of intersex claims in the 1990s with the lesbian and gay movement of the 1950s. She thinks that the idea of coming out is crucial to inspire legal reforms that limit physicians' power to make decisions about intersex bodies. In this context, ISNA focuses on local activism and has encouraged some activists to come out publicly as intersexuals, showing that they are not just people attached to a certain anatomical condition, but are regular people who hold all kinds of jobs and professions, as in the case of Marge Witty, a psychologist; Hale Hawbecker, an attorney; Martha Coventry, a journalist; and Michael Walker, who is undergoing training as a therapist.
In line with intersexual activists' claims regarding their primacy as experts on the management of their own bodies, some recent scholars who are not intersexual have learned lessons from intersexual people and are challenging the whole dominant sex and gender system while developing a whole new paradigm that defies the traditional medical model.
Domurat Dreger, Alice, Hermaphrodites and the Medical Invention of Sex. Cambridge, Mass.: Harvard University Press. 1998.
Fausto-Sterling, Anne, Sexing the Body: Gender Politics and the Construction of Sexuality. New York: Basic Books, 2000.
Kessler, Suzanne, Lessons from the Intersexed. New Brunswick, N.J.: Rutgers University Press, 1998.
see alsobenjamin, harry; gender and sex; hall, thomas/thomasine; money, john, and anke ehrhardt; transsexuals, transvestites, transgender people, and cross-dressers.