Fixing Sex: Intersex, Medical Authority, and Lived Experience is a thoughtful study of the medical treatment of intersex, or what is sometimes called disorders of sex development (DSD). Intersex is an umbrella term that covers a variety of ways in which a child’s genitals to do not match typical male or female appearance. The author Katrina Karkazis, a Senior Research Scholar at the Center for Biomedical Ethics at Stanford, writes that “I hope to show how the lens of gender literally shapes the body, and what this means for individuals who undergo treatment procedures and interventions for intersexuality,” (14); and she does exactly that. The book approaches what has been a thoroughly medicalized condition—and thus somehow seen to transcend politics—from a feminist perspective, revealing, yet again, that gender is always political.
The book does several things: including describing the history of the treatment of intersexuality, exploring the perspectives of those affected (those born with the condition, their parents, and clinicians treating them), and chronicling the rise of activism around the issue of the last fifteen years or so. This important empirical work is done within an explicit context that insists on maintaining the complex relationship between nature and culture and sex and gender—refusing simple binaries those terms often imply. Neither term of these false dichotomies can be understood as simple opposites. As she writes, “The distinction between nature and culture relies on a model of nature that is eminently cultural—that is, on a specific concept of the natural that can stand for itself as a domain of immutable and fixed properties” (11). This interrogation of the oppositions that uphold our common sense notions of what it means to be a man or a woman is at the heart of the analysis that illuminates the cultural meanings expressed, exposed and made by the very question of ‘what we should do with’ intersexuality.
The complex relationship between sex and gender is basic to her study and Karkazis spends a good deal of time working through that knot. The feminist insight that separated sex from gender via the “sex/gender system,” coined by Gayle Rubin in 1975 has been refined within feminist studies to denaturalize both sex and gender so that “What was thought to be the base or root of gender is actually an effect of gender” (13). But, as she says, this idea has not really taken hold. As a society we are still attached to a binary gender system, and certainly to a naturalized idea of sex as the baseline for gender. One of the important assumptions of the book is that so much at issue surrounding ‘what we should do’ is centered around the privileging of the penis. Echoing insights of some classic second wave theorists like Anne Koedt in “The Myth of the Vaginal Orgasm,” one of the guiding underlying ideas here is the question of what qualifies as a penis and what qualifies as a proper receptacle for a penis, pointing yet again to the inextricable link between heteronormativity and male dominance.
The feminist insights here are not connected explicitly to transgender or queer identities or politics, but are certainly informed by those ideas, and in turn will offer important empirical support for the queer supposition that binary gender structured around heterosexual relating is not natural, and in fact, ‘nature’ produces all kinds of variety that we seem to need to reject.
Intersexuality, and more to the point, our reaction to it, is the canary in our gendered coal mine. Karzakis has written a definitive treatment on a topic for which there is no decisive answer. And she does not try to provide one. What she does is productively unsettle the assumptions that much of the medical approach works from by respectfully positing gender as a mystery not reducible to the simple construct we operate under currently.