Srl pointed me to this NYT magazine article about “corrective” surgery performed on intersex children. srl introduced it as “not directly relevant” to the question of fear and hatred of, as az put it, “people whose physical bodies trouble their socially visible gender, or sex.” I’m not so sure.* I think there are some common forces behind, say, the unwillingness to acknowledge people like Robert Eads and the need to alter people like Chase before they can be accepted. Both groups represent “trouble,” and that trouble must be resolved for the sake of group integrity and comfort.
When Brian Sullivan — the baby who would before age 2 become Bonnie Sullivan and 36 years later become Cheryl Chase — was born in New Jersey on Aug. 14, 1956, doctors kept his mother, a Catholic housewife, sedated for three days until they could decide what to tell her. Sullivan was born with ambiguous genitals, or as Chase now describes them, with genitals that looked “like a little parkerhouse roll with a cleft in the middle and a little nubbin forward.” Sullivan lived as a boy for 18 months, until doctors at Columbia-Presbyterian Medical Center in Manhattan performed exploratory surgery, found a uterus and ovotestes (gonads containing both ovarian and testicular tissue) and told the Sullivans they’d made a mistake: Brian, a true hermaphrodite in the medical terminology of the day, was actually a girl. Brian was renamed Bonnie, her “nubbin” (which was either a small penis or a large clitoris) was entirely removed and doctors counseled the family to throw away all pictures of Brian, move to a new town and get on with their lives. The Sullivans did that as best they could. They eventually relocated, had three more children and didn’t speak of the circumstances around their eldest child’s birth for many years. As Chase told me recently, “The doctors promised my parents if they did that” — shielded her from her medical history — “that I’d grow up normal, happy, heterosexual and give them grandchildren.”
The story comes back again and again to this prospect of normalcy: if you remove this difference, your child will be exactly like everyone else. If you don’t, your child will remain a freak forever. The parents are described as terrified of abnormality, and of the potential for abnormality to damage their child’s life. So pernicious is this difference that the child must be protected even from the knowledge of it ever having existed. That’s one of the justifications for performing the surgery in infancy: this way, the child is too young to know what’s going on, to form any troubling affiliations with the wrong gender:
The old protocol for dealing with an intersex birth, the protocol Chase was subjected to as a child, was based on the belief that children should be saved from the anguish of looking weird, or of even knowing they were born looking weird. This would come to be known as the “optimal gender of rearing” protocol and was put forth by John Money, a psychologist who in 1965 founded the Johns Hopkins Gender Identity Clinic, which specializes in transgender surgery. Money’s protocol guided doctors to perform genital surgery on intersex babies and then discourage families from discussing the child’s ambiguity, for fear that the child would grow up questioning his or her sexual identity.
(Incidentally, this was an early component of transition via the gender clinics: transsexuals were supposed to stop ever having been any gender but the one they transitioned into.)
Even though the surgery is traumatic, the restorative benefits outweigh any question of harm:
According to Chase’s notes from that conversation (both of her parents have since died), her mother maintained that the clitoridectomy had not impacted her daughter’s life. “When you came home,” Cathleen Sullivan told Chase about her return from the hospital after surgery, “there seemed to be no effect at all. Oh, yes, wait a minute. Yes, there was one thing. You stopped speaking. I guess you didn’t speak for about six months. Then one day you started talking again. You had known quite a lot of words at 17 months, but you forgot them all.”
The most disturbing thing about this article, for me, anyway, was the weight given to the parents’ feelings about how their childrens’ bodies should look. Their fear, shame, and disgust were not received as a set of emotional reactions to a fraught situation. The standard protocol does not shunt them into therapy so that they may be taught how to discard their prejudices and learn to love and accept their child without qualification. They are not exposed to subjective experiences of people who are different, or intersex childen who did not undergo surgery. No, a parent’s horror at a child’s intersex body is seen as a good reason to perform corrective surgery on that child before the child is old enough to know what’s happening, let alone consent to it:
Within the medical community, Chase has been successful in tempering the explicitness with which people publicly make this argument. As Chase has explained innumerable times, intersex babies are not having difficulty with sexual identity or self-image. The parents are, and parental anxiety about the appearance of a child’s genitals should be treated with counseling, not with surgery to the child. When I met Melvin Grumbach, one of the doctors who cared for Chase as an infant and who went on to become one of the most respected pediatric endocrinologists in the country, he’d clearly heard Chase’s line of reasoning many times. He participated in forming the consensus, and he also signed it. He knew what he was supposed to say. “We say, ‘Don’t do surgery unless it’s necessary, unless it’s important,’ ” he told me in early summer in his office at the University of California in San Francisco, where he’s now an emeritus professor. “But I think if the external genitals are really masculinized, you work it out with the family. I mean, good grief. What about the parents? The parents are raising the child. Don’t they have some say?”
And:
The consensus is a major victory for Chase. Yet making progress from here may prove extremely difficult. Chase now must take her arguments not just to medical professionals but also to parents of intersex children, almost all of whom will be feeling intensely stressed and almost none of whom will have considered the complexity of raising an intersex child. One doctor, who didn’t want to be named, put her chances of persuading parents not to choose surgery for their intersex children at “honestly, zero.” From the parents’ perspective, the argument for surgery is almost impervious to reason. As one mother of an intersex girl wrote on a message board: “How can anyone possibly think that a child can grow up and feel confident of her sexuality looking down at her genitals that look like a penis? Come on.”
And later:
“But is there ever a good reason for reducing the size of a clitoris?” Chase pressed Sandberg.
“If the parent cannot tolerate it,” Sandberg replied.
It was also interesting–and depressing as hell–to see the many ways in which sexism informed the treatment of intersex infants. A clitoris was dispensable until very recently. Shaving it down is still not viewed as a horrible idea:
Still, Baskin acknowledges that intersex is different: genital surgery has the potential to diminish sexual function, and how do parents weigh that risk? Doubtless, surgical techniques have improved since Chase’s clitoridectomy — Baskin describes the old operations as being “like bloodletting,” when doctors were only able to excise the clitoris, not try and reduce it. Now, he says, “We have a pretty good handle on where all the nerves are.”
In Chase’s case, sexism in her mother’s life informed her mother’s decision about her child:
Chase says that her own mother’s discomfort with and ignorance about sexuality contributed to the decision to have Chase’s clitoris amputated. When Chase flew from Japan to Florida to discuss her childhood with her mother, she also quizzed her mother about sex. “No, I don’t know what human genitals look like, exactly,” Chase’s mother told her. “I have never looked at myself, and I never looked closely at my children. The doctor said your clitoris had to go. Mine never meant anything to me, so I didn’t think it was wrong to remove yours.”
Female genitalia are normatively defined as absence. This means that any intersex child with less cannot possibly be a healthy adult man, and also that cutting down to absence is a great way to create normal female genitalia:
To do this, Chase has been honing her arguments about who has the right to do what to other people’s bodies. Those arguments first took shape in 1998, when Chase wrote an amicus brief to the constitutional court of the country of Colombia. At the time, Colombia was considering the ethical and human rights implications of genital surgery, as it pertained to a case of a 6-year-old boy with a micropenis and the question of whether his penis should be reduced to the size of a clitoris, his testes removed and a vagina constructed out of a piece of his ileum. Medical convention has traditionally held that the phallic structure must be at least 2.5 centimeters long on baby boys and shorter than 1 centimeter for girls. And since it’s easier to surgically construct a vagina than to make a penis, children with anatomies that fell in the middle were almost always raised as girls.
Parents were also horrified by their child’s interaction with intersex genitalia, both in ways informed by sexism and in ways uncomfortably reminiscent of sexist veiling of female bodies and sexual response:
The vast majority of adults — parents and doctors included — find intersex bodies, especially sexualized intersex bodies, unsettling. Karkazis, the medical anthropologist, heard from clinicians she interviewed of numerous cases of parents who initially decided against surgery but changed their minds when their children started to explore their own sex organs, often around the age of 2. “Masturbation in little girls with clitoromegaly” — abnormal enlargement of the clitoris — “is a situation I’ve encountered quite a few times, and that’s actually pushed many parents toward surgical intervention,” one doctor told Karkazis. “The little girl was masturbating, and the parents just fell apart and were back in the office the next week for surgery.”
A common thread in the article was the conflation of conformity to social expectation and objective happiness. The idea that it might be a shell game was a minority position:
Chase’s position — that cosmetic genital operations on intersex children should be stopped and that children should be made to feel loved and accepted in their unusual bodies — is still considered radical. Most people believe, reflexively, that irregular-looking genitals would be extremely difficult to live with — for a child on a sports team, for an adult seeking love and sex — so why not try to make them look more normal? Katrina Karkazis, a medical anthropologist at the Center for Biomedical Ethics at Stanford, interviewed 19 clinicians and researchers of various specialties who treat intersex individuals, 15 intersex adults and 15 parents of intersex children, and she found that a majority of the doctors and parents felt surgery was a good idea. “We chose surgery for my daughter mainly because we did not want her to grow up questioning her sexual identity,” one mother explained about her baby, who was born with congenital adrenal hyperplasia, a genetic defect of the adrenal glands that causes girls’ genitals to appear masculinized at birth. “We felt that she should look like a female, so we chose the clitoroplasty and the vaginoplasty. We felt that she would have a better self-image if she did not have a ‘phallic structure’ and ‘scrotum.’ ”
Nowhere did I see parents interrogating their own ability to make a child feel loved, accepted, and happy with him- her or hir-self, even alongside passages like this:
Both say that medical professionals, right from the start, should behave as they would with any healthy baby and encourage parents to do the same — name the child, fall in love and bond.
As opposed to drugging the mother into unconsciousness for three days while they figure out how to tell her her child’s a monster, I suppose.
And in few if any cases was there any attempt to figure out exactly how people with “irregular-looking genitals” live their lives as adults. The assumption was that a child who did not undergo surgery would grow up feeling like Chase does as a survivor of surgery. All in all, the article presented a really troubling degree of cognitive dissonance.
*It’s important to draw some distinctionsl; there are some very important differences, and intersex experience has some history of appropriation by some transsexual/transgender activists. Some of this is the big-tent principle, wherein we are all transgendered, even if we might not want to be. Some of it is an extension of the idea–which has some truth behind it–that medicalization is one way to garner a kind of acceptance from the mainstream. Since intersex people have something that our society has traditionally recognized as a medical condition, whereas transpeople may not be allowed into that category, trans activists should latch onto the intersex community like remorae and ride that cure-model train all the way to insured SRS. They have a genetic defect, we have a genetic defect. You wouldn’t suffer poor Cheryl Chase to go through life with her genitalia intact, would you?
There are obvious problems with this, the biggest one being that intersex people disagree with the idea that they have a deformity that must be corrected in infancy lest they grow up unhappy and confused. A dysphoric person does not follow from an intersex body, and “corrective” surgery is not analagous to SRS. It has more to do with relieving discomfort on the part of society than on the part of the patient. As the article makes clear, “corrective” surgery does not know its own goal; there is no reliable way to predict the identity of an intersex child. While there are perhaps some analogies to be made between the way intersex infants are forced into one box and the way we all are, it seems both self-serving and insulting to ignore the specific trauma intersex children endure. Medicalizing intersex bodies has resulted in horrendous abuse of those bodies. When transpeople support that paradigm for their own reasons, they become apologists for that abuse. Moreover, any comparisons between the “therapies” described in the article and traditional treatment of transsexuals as either corrective or coercive must be heavily qualified: I am not a child.
There’s also the big-tent problem with some of the connotations of “transgendered,” i.e. “transgressively gendered” or “genderqueer.” Intersex people do not necessarily identify as anything other than men or women, and may very much resent any implication to the contrary. There’s some overlap between the two communities–Raven Kaldera, for example, is intersex and transgendered–and some intersex people might well find some value in ideas set down by transpeople. There’s no natural affinity, though, and it would be shallow to pretend otherwise.
Would it really be so impossible to let the children BE, and if they want corrective surgery, to let them decide at puberty, or even legal adulthood? It seems unconscionable to me to alter a person’s body without their consent.
What if you are in every way masculinely identified and charged with male hormones, but you have a “micropenis”? You are still a male! It seems horrible to me that a male’s penis seems to be considered more important than the male person! As a man, this child can at least grow up to father children, and possibly have a family. Remove his balls and micropenis, and give him a fake vagina (with no womb, and I imagine no sensation), and the poor thing will not only be sterile, but also non-orgasmic and totally confused! Granted, it would not be great to have an almost invisible penis, but I myself would rather have a teeny one WITH sensation, than nothing at all.
As far as being born female, with a clitoris so large that it looks like a penis, well I don’t really see a huge problem there. Again, let the person decide for themselves if they want to alter their bodies.
FWIW, I don’t think I ever saw other kid’s genitals growing up. I am a girl, so maybe it is different for boys, but genitals are pretty private even with kids. No one wants their child to be taunted and considered a freak, but that is not reason enough to sterilize and castrate them!
AFter re-reading the post, I now see that the fake vagina is made out of INTESTINES !! YEAH, that’s gonna WORK! These doctors sound like Dr. Frankensteins, cobbling together a golem out of bits. Because life without a big schlong just ain’t worth living.
And God Forbid a little girl should MASTURBATE! She touched her genitals for pleasure…..schedule the surgery. Females aren’t supposed to ever feel pleasure.
Is it just me, or does it sound like people are mutilating their children out of pure homophobia? Because far worse than being sterilized and mutilated: They might feel ambiguous about their sexuality!
Yes. Yes, exactly. Where I utterly lost it in the article was towards the end, when, at a friend’s urging, Chase was attempting to understand a parent’s reasons for choosing surgery. I just thought, “You want this woman, mutilated herself without any say in the matter, against her will, to empathize with parents who might choose to do likewise to their children?” That’s insane. It’s simply insane.
So much, so much . . . Good God, I CANNOT imagine paying someone to mutilate my child’s genital’s without their consent. Or being so hung up on gender to force a child into a role before they even get a chance to figure out what it means. Or compromising their ability to reproduce or experience sexual pleasures because of my discomfort with a non-conforming body. It just seems to terrifyingly selfish to me, acting as if the child’s body is property to alter at the whim of the parents. And so . . . stupid. One mother said that she had surgery performed on her daughter because she never wanted her to question her sexual identity. I’m guessing that an awful lot of people with “normal” (sorry, can’t think of a better word mid-rant) genitalia question their sexual orientation and gender identity. And mutilating little girls because they masterbate – what CENTURY are we living in?! Augh. More later.
And God Forbid a little girl should MASTURBATE!
Well early masturbation is the main way you can tell if a girl is possessed by the cock demons – and you can’t be too careful with cock demons, who will take a crap in your shoes and take over the world with communism if left unchecked.
And that’s still slightly less nonsensical than the actual reasons for this crap.
This is such a difficult ethical problem.
I think that a small child’s genitals should be left alone (except by the child himself or herself, of course).
On the other hand, I can sort of empathize with parents and the healthcare providers. In our society, it’s not an option for little kids to straddle two genders. I know we live in a bigoted society, but you can’t avoid assigning a gender to your kid at birth. People will demand to know which pronoun to use when referring to your child in the third person.
So, inevitably, parents have to guess which gender to attribute to their child. With any luck, nobody outside the immediate family and healthcare providers will see the kid’s genitals for many years.
Unfortunately, there’s the risk that the kid won’t feel that their socially assigned gender matches their self-identified gender. If there’s a mismatch there’s going to be incredible psychological trauma for the kid. If you left the kid’s genitals alone, there would still be incredible trauma when they got to the age where they had to choose a gender, or choose to continue life as an intersexual.
I can sort of see why parents and doctors prefer to make a permanent decision before the kid is old enough to remember and take it from there. Worst-case scenario, you make the wrong decision and the kid ends up being trans and has the option of further corrective procedures.
The only way I can wrap my mind around this decision is to think what I would want I had been an intersexual child. Frankly, I would have wanted to raised as a girl (sans “corrective” surgery) and supported in my adult decision to revise that gender assignment, or to undergo further surgery to look “normal” for my chosen gender.
By “the age where they had to choose a gender” is assuming that the pubescent hormone rush might reinforce the person’s assigned gender, or make them feel alienated from their assignment. Obviously, this doesn’t happen for everyone.
And even if it did, it wouldn’t imply that a gender choice is morally or socially necessary.
My first son had an outie navel. The doctor immediately suggested surgery. I said forget it, if he is bothered by it later in life and wants the surgery done, we will do it then. When my second son was born he had big ears that stuck straight out. We had another doctor at this time, and what did he suggest? Surgery. I said forget it, if he is bothered by it later in life and wants the surgery done, we will do it then. What is it with these doctors who are so quick to cut up babies when they aren’t “normal”.
I’m wondering what is wrong with getting the best idea of the sex of the child, maybe an ultrasound to detect a uterus and ovaries, or testicles, raising the child as that sex, but not mutilating him or her? Letting the child decide if he or she wants surgery at all? I am completely horrified with the idea of removing a penis or clitoris and never giving that child the chance to have sensation during sex. What would give the parents the idea that they have the right to do that to their child, to make that kind of decision? What gives doctors that right? Why don’t they think doing something like this is unethical?
NB: I’m almost absolutely sure it’s “intersex,” not “intersexual.”
Those corrective procedures are major procedures, and an initial surgery can severely limit your options.
I don’t think this is right; it implies that this is a question of attempting to find the right box and occasionally choosing the wrong one. I’m not sure an ambiguous body should be treated as necessarily alienating, so much so that surgery to alter it becomes a solution to alienation.
The worst-case scenario is that the child becomes alienated from the post-op body for reasons that have nothing to do with being transsexual. (I’m not sure that is the proper term for, “an intersex child medically assigned a sex at birth which does not correspond to their gender identity,” although Raven Kaldera feels differently.) Cheryl Chase is not transgendered, did not transition to male, and does not feel conflicted about being a woman such that she does not want to be one. She did, however, have to deal with years and years of baggage around her body and its history. I’m not sure how much the nature of her surgery and the way she was treated contribute to that; I’m sure they’re significant factors. I think, though, that her complaint is that intersex people are not allowed to be intersex men and women. The ambiguous body is supposedly irreconciliable with a straightforward identity, and surgery is a question of when rather than whether.
This is a good point. While it’s true that puberty is the time when we start sorting ourselves even harder, it’s not true that social assignment and reinforcement of gender starts there, or that a child will necessarily know their own preference. Adolescence could even be especially fraught.
Good points, piny.
I think on the whole, the best course would be to swear off genital surgery, but to err on the side of assigning gender by karyotype.
I’m just saying that it’s probably not viable to avoid assigning a gender to the kid. The only question is which gender assignment would do the least harm.
IMO, it’s probably safer to give the large clit people female names and female pronouns. Our society has less to say about what a “normal” clit looks like than a “normal” cock. Sure, there’s porno in personal prejudice to consider. But there’s massive stigma to having a tiny and less-than-functional cock. Better to have an overachieving clit, IMO.
I feel like that would be a good band name — “The Overachieving Clits.”
One point I found interesting in the article is the measuring technique they use to determine whether they should classify something as a penis or a clitoris. This struck me as entirely ridiculous — if a child has female chromosomes and female internal sexual organs, it makes very little sense to classify that child as “male” because their ambiguous genitals measure a certain length.
I know we live in a bigoted society, but you can’t avoid assigning a gender to your kid at birth. People will demand to know which pronoun to use when referring to your child in the third person.
This rubs me so wrong, I just really hate the idea that the sane reaction to a bigoted society is to capitulate to it and try to work within the bigotry with the minimum of fuss – yes it’d be hard, yes assholes will “demand” that they be assigned a gender pronoun by uppity asshole grammar nazis, and their life will be a struggle, but if no one makes that struggle nothing will change.
And the unassigned child would only be unassigned until it could assign a gender to itself – that’s the trouble here, the parent doesn’t know what, if any, gender the child identifies with at birth, but the child will be able to it figure out eventually, and they’re the only person with the moral right AND the ability to make that choice for them.
Us irreligious need to figure some sort of secular naming/coming of age ritual that takes into account trans and intersex issues, something like the way southern chinese give their male children female names and treat them as girls so as to stop evil demons getting them before they grow up enough to be given their real name – but without the misogyny, obviously.
I didn’t even have my son circumsized because I thought it would be unfair to make permanent modifications to his genitals. I understand that some people are so fucked up that they think it is okay to modify babies’ genitals permanently at the cost of reduced function just to fit cosmetic norms. I understand it, but I still have nothing but contempt for those people.
It is just so incredible (in a negative way) how easily people are willing to surgically alter a newborns genitals. The same busybodies that were lobbying for me to circumcise my boys as infants were horrified that I might allow them the choice as teenagers.
Discomfort of an adult should never result in invasive cosmetic procedures in children. Just sayin’
-n3rdchik
This just further proves to me that this society is way too obssessed with everybody else’s genitals.
Some people think they have the right to do any damn thing they want to with their kids, just because the kid’s body came out of theirs, like the waste that comes from their bowels. Then they have the colossal nerve to say they love the kid(s). It isn’t always the idea of some doctor, sometimes it starts at home.
I think R. Mildred above got it best. You keep giving in, things won’t change fast enough, or at all.
The barbarity of this would seemingly be obvious if only the adults involved would place themselves in the child’s place. I get freaked out at the very idea of someone cutting on me before I’d be too old to remember it and having a numb crotch the rest of my life. However, the comment by Chase’s mother belies this idea. Someone who’s never looked at their own crotch? Does she close her eyes in the shower and forbid full length mirrors from the house? Apparently.
Look, I have normal genitals for my assigned sex and I still spend my life feeling like something is wrong with me. Having the “correct” genitals doesn’t guarantee non-freakdom any more than having intersex genitals guarantees freakdom.
Or the poor kid’s life will be an extended episode of “It’s Pat.”
I don’t see what’s so difficult about assigning a sex to a kid and raising hir gender-neutral. It doesn’t have to be It’s Pat. It can Johnny isn’t taught that boys don’t cry, or Suzy is encouraged to take toasters apart, and at some point their irregular genitals are brought up in an age-appropriate fashion so the child can begin to think about if they okay being Johnny/Suzy, if they’d feel better if they looked like other Johnnys/Suzys, or if they’d rather be Suzy/Johnny instead. Putting a letter on a birth certificate doesn’t mandate the gender role. For a kid raised without restrictive stereotypes, all it signifies for years is what bathroom they use.
Society has a very hard time dealing with ambiguity. People like absolutes (which is why conservative politics and religion tend to go hand in hand).
Physiological gender ambiguity is identifiable at birth, psychological gender ambiguity isn’t. It has always seemed to me that the treatment of intersex children is based on much the same reasoning that John Money’s more flawed experiments were – namely the loose notion that somehow gender identity is a matter of socialization. {I’m not going to get into a debate over the merits of Money’s work – this is just an observation}
While I accept Piny’s apparent thesis (and please correct me if I’ve abused your intention, Piny) that transsexuality and intersex are distinct conditions that only share superficial similarities {and therefore only limited “political commonality”}, I do believe that in both cases, the ultimate decisions are up to the affected individual. If an intersex person, as an adult – or at least teenager – requests surgery to make their genitalia more congruous with one particular gender, it should be made available to them. Similarly, should a transsexual request treatment and (eventually) surgery as part of a gender transition, it should be made available.
In neither case should arbitrary sanctions be imposed on the person as a result of their request or lack of it.
I rather read it as “Never broke out a mirror and a flashlight and went spelunking,” since taking a gander at my own naked body in the shower and walking past a full-length mirror nude doesn’t necessarily guarantee that I’ll come away with a picture-perfect idea of what my bits n’ bobbles look like.
True, Sara. I was exaggerating a bit. Even so, as a young adult I knew something was down there that felt different and good. Perhaps the woman is inorgasmic or has just never connected that funny crotch feeling with her clit, but she seems to display an astounding ignorance and callousness about the whole thing, as though clits were just a throwaway part.
I’d guess inorgasmic, but agreed about the ignorance and callousness. Though — if she’s inorgasmic or otherwise ignorant of her own body and its functions, it’s understandable that she wouldn’t place a whole lotta emphasis on her own clitoris.
(And sorry if I overreacted — it’s just that I get a whole lot of that from guys I know in terms of “What do you mean you don’t know what it looks like?” and then I have to give the whole “Well it’s not like they’re in plain sight or anything” speech, so it’s rather become a default response.)
All I had to read in that article was the name “Dr. Money” and knew what to expect in the rest.
That man, deeply disturbed, has done so much harm and kept everyone from approaching intersex…and gender itself … in any kind of rational manner.
I first read about him here.
Don’t forget that Chase was born in the 1950′s and even up through …oh 80′s? Doctors were considered godlike. If Doctor said “X”, one had better accept it or be blamed for the “dire consequences.” And Money did every thing possible to make sure his theory that gender is “fluid” and “no set” until age 2 or 3 was accepted as fact and acted on accordingly.
The past tense is a bit optimistic, I think – the vast majority of doctors still consider themselves gods. And with a situation as confusing and unfamiliar to most patients as gender, well, I would imagine that only makes things worse.
Chase herself argues for the “opt for a gender, but avoid the knife” course of action. Sounds sensible to me. I can’t help wonder about the trauma and scarring caused by surgeries to “correct” these apparent ambiguities. Also, how did anyone come up with a set of measurements for a “normative” penis? (Or any other genital part, for that matter…)
I’m wondering, if this child had a uterus, but no vagina, would the child’s uterus attempt to menstruate at puberty, but not have an “exit” available?
That would necessitate some sort of surgery, and corrective surgery early, rather than waiting until it becomes a medical crisis, would probably be appropriate.
Still no need for to remove the clitoris, of course. But that concern may have been behind at least part of the doctor’s reasoning, rather than pure fear of ambiguous gender.
As I discovered from a new friend in the last few months, it isn’t only parents who feel that they have the right to make surgical decisions for individuals on the intersex continuum. He went in for an urethral operation a few years ago, and while he was under anaesthetic, the surgeon decided to “correct” his genitals without asking.
I don’t know the anatomical details of this particular set of (apparently only just on the continuum of) intersex genitals, nor exactly what the surgeon did, because I haven’t asked for prurient details. I do know my friend is still adjusting to his different genitalia that he never wanted changed in the first place. His parents raised him as a boy without surgery and he’s always felt masculine without having had any surgery, but one arrogant surgeon felt that he knew better.
His is apparently far from an isolated case amongst adult intersex patients.
That sounds right. It’s complicated a bit, though, by the fact that parents aren’t the only ones modeling gender for their kids.
My three-year-old’s sense of gender roles is pretty fluid. But she was the only girl at a costume party over the summer who didn’t go as a princess or a fairy or a butterfly. More recently, her twin six-year-old cousins had seperate birthday parties for the first time — his was sports-themed, and hers was princess-themed, and for a few days after, my kid was saying she wanted a princess party for her next birthday.
And then a few days ago, she and I went into McDonalds for the first time (we were hungry in a place where there were no other food options), and ordered a Happy Meal after noticing a sign for Pirates of the Carribean HMs. (In my daughter’s opinion, “Johnny Depp is the nicest pirate in the world.”) But when we ordered, they told us that the PotC promotion was over, and asked if I wanted the “boy or girl” HM. The boys’ toy was a robot monster with guns in each hand, and the girls’ toy was a Little Mermaid purse.
For most Americans — myself included — getting out from under that kind of bombardment entirely would be virtually impossible. You can minimize it, and I try to, but it’s incredibly pervasive.
any developmental biologists out there? I’m not sure if this is possible. I don’t have my reference text with me, and I am not googling “developing vagina” at work.
There is such a thing as an imperforate hymen which is a hymen with no opening. Girls with late menarche will be checked for this. Presumably the menstrual blood goes somewhere, so the body has some way of dealing with it.
I gotta say I agree with R Mildred above; society is stupid about ambiguity and gender, so reinforcement of the acknowledged problem is the only solution? To me, it’s like saying, “Sure, it’s sexist for people to assume women in short skirts are looking for sex, but it’s safer to not wear short skirts ever for fear of giving the wrong impression.” I don’t understand why a frigthening number of commentors are pushing for binary-only gender assignment, while at the same time acknowledging (or at least appearing to, if implicitly) that binary-only is problematic.
Frumious,
It’s called “imperforate vagina”. The poor woman who wound up as “the Black Dahlia” had it, among others. And yes, it causes menstrual pain.
As a parent, I’m just not sure how I would handle anything else — and it’s a question I’ve thought a lot about.
My wife is pregnant right now, as it happens, with our second child. Let’s say the kid is intersex, and we decide not to assign it a gender. What next?
Well, we’d have to convince both our extended families, and all of our friends, that our child had no gender identity. We’d spend a huge amount of time answering questions about what the kid “really was.” Probably we wouldn’t be able to convince everyone, and we’d have to decide what to do if one of the kid’s grandparents (say) insisted on using gendered pronouns to refer to the kid.
We’d have to figure out what to say to the kid’s cousins — three of them aged six — and the kid’s sister — aged almost-four. We’d have to figure out what to tell those kids to say when somoene asked whether their new cousin/sibling was a boy or a girl. I’m pretty confident my kid could deal, actually, but I don’t know how she’d respond when someone asked, and she said “it’s not a boy or a girl” (or “we don’t know yet,” or whatever). Most folks wouldn’t respond well to that answer, and if no clued-in adult was around to deal with the situation, she could wind up in a lot of weird conversations.
We’d have to decide what to tell the kid, and how to respond when the kid made declarations about his or her gender. I think that would probably be manageable, actually, but I don’t know.
We’d have to figure out what to tell strangers. People constantly ask you what your baby “is,” and I’m not sure I’d be up for holding an intersex-awareness seminar for random people in the park and on the subway seventeen times a day.
All in all, I think it would be a huge amount easier to give the kid a “place holder” gender assignment, with no surgery, and to make it clear to the kid — and to friends and family — that the kid was free to change his or her mind whenever he or she wanted.
This is, in fact, what I’ve done (in mostly subtle ways, and without much of the “friends and family” part) with my three-year-old (cisgendered and not-intersex as far as I can tell) daughter. We’ve always treated gender identity as fluid — we never corrected her, for instance, when she said she was going to grow up to be a daddy. We never stressed, early on, that boys and men belong to one category, and girls and women to another. (I’ve talked a bit about this in a bit more detail here.)
That feels to me like the right approach. If a kid publicly identifies as genderless, that kid’s gender identity is going to be subject to a huge amount of scrutiny and pressure. Better, I think, to give the world an answer to its inevitable questions, while helping the kid create the space to chart his or her own path going forward.
That’s battery.
He went in for an urethral operation a few years ago, and while he was under anaesthetic, the surgeon decided to “correct” his genitals without asking.
Sue the bastard for malpractice and emotional trauma.
I mean, I can understand that your friend probably isn’t really looking for publicity, but those doctors have to be stopped. Hell, if I ever have kids, I’m thinking of drawing up a ten-page legal document to prevent the doctors from dicking around with my or my kid’s genitalia during or after childbirth. (And it really sucks that I’d even think about that.)
Aw, hell. Let’s pass a law saying that doctors can’t fuck with a child’s phallus (penis/clitoris) until the age of fourteen. The only exceptions will be male circumcision and anything having to do with physical, NOT “psychological/mental/gender identity” health.
Seriously, have there ever been any women with large clitorises who’d wished they’d had a reduction when they were babies? Just curious.
I thought that “uterus but no vagina” was what the original article was describing, along with the oversized clitoris.
If I had an intersex child, I’d pick a name for the kid that could change genders easily. For example, if the kid was XX, but had a large clit that the doctors thought was a problem, name zir something like Alexandra, call zir Alex, and if zie ever decides to have surgery to make zirself physically male, zie can change zir name to Alexander, and retain the nickname Alex. In normal conversation, call her “her” unless/until she requests otherwise. Provide information as appropriate.
I’d really like to raise any kids I have as free of gender roles as possible anyway, and the thought of surgery to “correct” something that I don’t see as a problem weirds me out. I mean, we all have to match some picture of an ideal woman/man now? Even in the privacy of our own heads? Even naked, with people we love/ who love us?
Hmm. I’m getting into a similar* discussion over on Alas, so maybe I’ll try to spell out my thoughts here.
I think I’d say “broad” or “initial” similarities, which isn’t quite the same thing as superficial. There are problems and needs common to both groups–and, like you say, objectives such as self-determination. For example, the idea that an ambivalent identity and ambiguous place must follow from an incongruous body is something transsexuals are very familiar with; some of us struggle daily with the official disjunct between “trans” and “man” and “woman.”
However, it’s possible to overfocus on those similarities and forget differences to the detriment of both groups. One of the biggest, most immediate pitfalls is appropriation. Transpeople fit “corrective” surgery into the SRS narrative and end up denying the trauma and coercion that intersex people feel as a result of “corrective” surgery. Conversely–and I’ve seen this, albeit not as frequently–intersex people can fold SRS back into their revised model of “corrective” surgery and end up concluding that SRS is coercive and damaging. These coalitions are valuable, but it’s important not to turn your allies into mirror-images.
*But not exactly the same.
Assigning gender based on karyotype, by the way, isn’t necessarily the best option: one particular intersex disorder, AIS (androgen insensitivity syndrome) produces hypertrophy of secondary female sex characteristics and (relatively) normal genitals, but has an XY phenotype.
– ACS
Sounds good to me. But I wonder why male circumcision is exempt, even though in most cases has nothing to do with physical health.
Because otherwise it wouldn’t pass, as the practice is rather closely tied to some religions. (I’m a pragmatist.)
You always hear “hurf a durf, it’ll confuse the children” arguments against accepting gay people, transpeople, intersex people, whatever else people as, y’know, people. Bullshit. Kids have a wonderful ability to accept what’s in front of them as normal. Kids aren’t hung up on gender stuff like adults are.
But then, I suspect “it’ll confuse the children” really means “it will teach the children tolerance”, which scare the shit out of that crowd.
There may or may not be health benefits to circumcizing baby boys, but when I hear someone say he just wants the doctor to make his son look just like him, I just want to puke.
It isn’t just the privates. A while back there was an episode of For Better or Worse, about a baby girl who had 12 fingers not 10, and after the mother quit freaking about what she must have “done” to have a baby that wasn’t “perfect”, the nurse had no other answer than to just whop off the 2 extra fingers, and nothing more was said even though so far as I could tell they were not deformed. It bugged me and I still wish I’d written the author about it.
Then there was the idiot in Florida back in ’92 who wrote into a newspaper column about how to get her 10-year-old son to agree to having his ears cut back just because she thought they stuck out too much. Fortunately some readers lambasted her good on this one, but I never found out what happened. If she was concerned about his social acceptance, why couldn’t she teach him self-defense instead? Seems to me a lot of things done to kids are not so much for any functional/health value as just to standardize them.
As for what happened to me, I can’t even stand to talk about it.
Sorry to get off topic; carry on.
And that’s a good excuse to perform surgery on someone against their will? “My God said I should cut off your dick?”
Ambiguous genitalia, sticking-out ears, extra fingers, outy belly buttons – you know where this ends up? It ends up with two one-year-old babies in an operating room, with an incredibly high probability that at least one will die, because it is better to kill both of them, than to force them to grow up sharing a few internal organs.
It doesn’t end there, either. Because they could put tubes in the ears, take out the adnoids, remove the tonsils, and hell, while we’re at it, why not a nose job to remove that little bump there, or some jaw surgery to correct that overbite. There are a lot of surgeons who no doubt mean well, but there is only
one tool they have for fixing everything. So you end up with adults undergoing continual operations to make them look a little more perfect every time.
There are parents who would have their infant son circumcised because up until, what, 10 years ago, all baby boys routinely were. People who didn’t get the memo that it is now cosmetic surgery. They wouldn’t necessarily agree to other more invasive surgeries.
We need to dispel the myth of “informed consent”. When the doctor tells you that there is something wrong, that it will cause problems later on, that it is fixable now, with minimal pain and a short recovery time, and you’re a brand new parent who hasn’t even recovered from childbirth yet, then even though the odds of something very bad are spelled out, you’re still going to say “yes”.
There has to be a better way. Maybe a reflection period before a decision can be made for anything other than immediately life-saving techniques. Surgeons need to learn that it is not ethical to push parents into surgeries, and they could sure use a lot of education about acceptance. Parents and patients need to be supported and reinforced and reminded of their rights and maybe there are cases that require someone outside the family to speak for the child that is too young.
I think it’s great that people are talking about it.
One thing I note here is that there’s absolutely no roadmap for parents of an intersex child to use. When there are no roadmaps, examples, rules, etc, I note that it’s extremely difficult to effect change.
I applaud Chase’s efforts here, I’m just saying that this is an enormous obstacle, even if you find parents willing to give it a shot.
The one thing that does gobsmack me completely is using anything other than chromosomal results (yes, I’m aware of XXY, XYY, etc permutations) to determine m/f… Might as well use height and weight for the definition…!