The Intersex Roadshow

On Sex/Gender Checkboxes

2012-02-05T14:58:00.005-06:00

Day in and day out, sex and gender minorities are boxed in by being confronted with sex/gender checkboxes. This starts the moment we are born, when a binary sex must be checked on our birth certificates: “male” or “female.” For individuals who are born with visibly intersex bodies, this requirement causes a crisis. Families and doctors make hasty decisions about which box they'll force us into, and we have to live with the consequences all of our lives. Having checked off a binary “M” or “F,” those with authority over our infant bodies often feel that trying to reshape our bodies conform to the box they've picked is unavoidable. Thus, genital surgeries are routinely performed, despite the deep unhappiness so many intersex people voice about the results as adults. Great pain might be avoided if parents were allowed to acknowledge our physical truth on birth certificates which included an intersex checkbox, or if the gender marker requirement were simply removed.

For people who are trans gender, gender transitioning is made traumatic in large part due to the checkboxes we must face daily. Binary gender markers are everywhere: on our drivers' licenses and passports, on loan applications and job applications, and on websites everywhere (from Facebook to shopping sites to online radio stations). Once you've checked off one box, changing it is bureaucratically and legally difficult—and sometimes there's no way to change it at all. This leads to all sorts of hassles and embarrassment, as we're “outed” in odd contexts. Worse still, if the gender we're living in doesn't match the marker on our ID, we're subject to being banned from flying, arrested by bigoted police officers, and denied employment.

For folks who don't identify with a binary gender, the world of checkboxes constantly denies our very existence. We go institutionally unrecognized, with no way to even try to say “I am here!”

Sex and gender minorities have some protection in institutional settings that bar discrimination on the basis not only of sex, but of gender identity or expression. But often, such policies are adopted with no follow-through on what it really means for a university or company or city to protect gender identity and expression. Unaware of our needs, administrators think only of ensuring that trans people aren't being kicked out just for gender transitioning. While this is certainly important, there are many more needs that must be addressed. And central among these are that sex/gender checkboxes protect the rights of sex and gender minorities.

I have written a Best Practices guide that is under discussion at my university. It lays out a plan for rewriting sex/gender checkboxes that is meant to address the needs of intersex, trans gender, and gender variant people, in this case, in a university setting. There are some inevitable compromises in it between institutional desires for simplicity and brevity, and our desires as individuals to have our identities recognized in all of their fullness and uniqueness. But I wanted to share it here so that other people who are looking for a guideline to use in seeking to better the way institutions around them limit sex/gender choices would have something to start with. It doesn't address the problem of birth certificates, for example, since universities don't issue them. It does, however, address the question of how sex and gender and sexuality should be measured in research in some detail.

Please feel free to share, critique, edit, and employ at will.

Best Practices for Identification of Sex/Gender

Compiled by Dr. Cary Gabriel Costello

I. Foundational Principles

Institutions which commit themselves to protecting against discrimination on the basis of sex and of gender identity or expression (GIE) must give individuals the right to self-identify their sex/gender.

Whenever data are gathered about sex/gender, the rights of GIE minorities (intersex individuals, trans men, trans women, and individuals with alternative gender identities) must be protected.

II. Definitions

“GIE minorities” include intersex individuals, trans gender individuals (trans men, trans women, and individuals with alternative gender identities), and people with variant gender expression.

Intersex Persons

While it is common to believe that sex is binary—that is, that all people are born either male or female—in fact, sexual characteristics exist as a spectrum. There is a great deal of variation in chromosomes (XX, XY, XXY, XYY, etc.), hormones (relative levels of estrogen, progesterone and testosterone), secondary sexual characteristics (breasts, hair distribution, etc.) genital configurations, and gonads (ovaries, ovotestes, testes). Intersex people are individuals whose sexual characteristics fall toward the middle of the spectrum. Approximately 1 in 200 people are intersexed according to medical diagnostic criteria. Most are very private about this status, though some are public about it.

Trans Gender Individuals

Individuals whose gender identity does not match the sex they were assigned at birth are deemed trans gender. A trans man was assigned female at birth but identifies as male; a trans woman was assigned male at birth but identifies as female; a genderqueer individual may identify as neither male nor female. Trans gender individuals often transition to their sex of identification, though they may do so in different ways. Some transition socially by changing name, pronoun, and dress. Others also take hormones (testosterone or estrogen/progesterone) to alter their bodies. In addition, some get surgery to change their chests or genitalia. Because surgery is quite expensive, may not be covered by insurance, and because it carries serious risks, many trans gender individuals in the U.S. do not seek or are unable to access surgical transition services.

Variant Gender Expression

People of any sex or gender may have an atypical gender presentation—male femininity, female masculinity, or androgyny.

III. Best Practices in Collecting Data about Sex/Gender

The best practices for collecting data about sex/gender depend on context. If collecting data about sex/gender serves no purpose for the individuals from whom it is collected, then eliminating the question is the best practice. If data are being gathered to protect the rights and well-being of individuals, then individuals should be given self-identification options that allow GIE minorities to self-identify. These options include a shorter form for ordinary uses, and longer forms to be employed in research contexts.

Eliminating Unnecessary Requirements for Individual Sex/Gender Identification

There are many institutional contexts in which people are routinely asked to identify their sex/gender based on common marketing practices or institutional tradition rather than an intent to protect the individuals from discrimination on the basis of their sex/gender. (For example, this is a common requirement in registering to use website services.) In this situation, the best practice is simply to eliminate the unnecessary requirement of declaring sex/gender.

Standard Best Practices Short Form for Sex/Gender Identifications

In contexts in which data is collected order to ensure equal treatment and respect for all, information about sex/gender should be collected in a manner that protects GIE minorities. The goal in implementing sex/gender categories for general data collection is to protect the rights of all people, whatever their physical sex status or gender identity, including intersex individuals, trans men and trans women, and individuals with alternative gender identities. Thus, the inappropriate single question (“Sex: Male__, Female__”) should be replaced with a three-stage approach.

Gender identity: Male __, Female __, Alternate Self-identification (please write in) ______________.
Do you have an intersex condition? Yes__, No__.
Are you trans gender? Yes__, No__.

In order also to ensure nondiscrimination on the basis of sexual orientation, best practices add a fourth question unrelated to GIE:

Sexual orientation: Heterosexual __, LGBQ __.

AVOID poor practices which undermine individuals' identities instead of protecting them. A common poor practice is to use a single additional checkbox: “Male__, Female__, Transgender___.” This is inappropriate for several reasons. First, it does not allow intersex individuals a way to identify themselves. Secondly, it discriminates against trans men and trans women by framing trans gender identification as incompatible with “real” male or female status. And thirdly, it does not allow for recognition of the distinct needs and identities of individuals who identify as neither male nor female.

Best Practices Long Forms for Research Contexts

Data about sex and gender are often collected in the course of research. If data are to be analyzed along the dimensions of sex and/or gender, two sets of needs must be met. The first relate to the rights of research subjects, who must be protected from harm, including the harm of discrimination on the bases of sex, gender identity or gender expression. In conducting research with human subjects, researchers will inevitably recruit research subjects who are intersex, trans gender, or variant in their gender expression, and are ethically obliged to treat them with respect. The second issue relates to the need of the researcher to have research questions carefully worded in a manner that subjects will understand and respond to in a reliable and valid manner.

Many scientific studies today continue to use “sex” as an independent variable, and measure this in a binary fashion. This is a methodological flaw, as well as discriminating against GIE minorities. It does not allow the researcher to measure what actually accounts for observed variance in the dependent variable: is it physical sex status, internal gender identity, gender-conformity or nonconformity? Just as a study that uses religion as an independent variable is improved when it not only identifies subjects as “Christian,” but allows the subjects to identify a more specific denomination, asks them how religiously observant they consider themselves, and inquires as to how often they attend church, increasing the sophistication of sex/gender questions improves study results. The following measures are suggested:

What gender do you identify with? Male__, Female__, Other (please write in the identity)________________.
What category were assigned at birth? Male__, Female__.
As far as you know, were you born with an intersex or sex variant body? Yes__, No__.
Please indicate how masculine or feminine you are in your dress and manner on the following scale: (1) very masculine, (2) moderately masculine, (3) a bit masculine, (4) androgynous, (5) a bit feminine, (6) moderately feminine, (7) very feminine.

In order also to ensure the study is not discriminating on the basis of sexual orientation, and to gather better data, best practices suggest that subjects also be surveyed on their sexual identity. Problems are often raised by the traditional method of asking subjects if they are “heterosexual, homosexual, or bisexual.” For example, people who are gender transitioning or who identify as neither male nor female are often unable to use these sexual orientation categories to classify themselves. Furthermore, it is well established that there is a difference between how many people identify their sexual orientation and the sexual activities in which they actually engage. This may be addressed through questions such as the following:

To whom are you attracted, sexually and romantically? (1) only men, (2) mostly men, (3) a bit more toward men than toward women, (4) equally toward men and women, (5) a bit toward women than men, (6) mostly women, (7) only women.
With whom have you been sexually involved? (1) only men, (2) mostly men, (3) a bit more men than women, (4) equally men and women, (5) a bit women than men, (6) mostly women, (7) only women.
Are the people to whom you are attracted (1) very masculine, (2) moderately masculine, (3) a bit masculine, (4) androgynous, (5) a bit feminine, (6) moderately feminine, (7) very feminine.
Consider the idea of a partner who identifies as neither male nor female, but as some other gender such as “genderqueer.” Do you find that (1) very appealing, (2) moderately appealing, (3) a bit appealing, (4) I feel neutral about it, (5) a bit unappealing, (6) moderately unappealing, (7) very unappealing.

Researchers who choose specifically to study GIE minorities should consider them a vulnerable subject pool for IRB human subject protection purposes. In cases of studies recruiting intersex, trans gender, or gender-variant subjects, procedures should be set in place to protect these vulnerable subjects, and the questions asked about sex and gender carefully designed to accord all subjects with full respect for persons. Confidentiality should be strictly protected, data collected in a location where subjects will not be at risk of having others see or overhear their responses, and information sheets listing appropriate support groups and links to mental health resources distributed to those recruited to participate.

Intersex Fertility

2011-09-07T22:12:00.009-05:00

My daughter was not of woman born. That is a concept that has fascinated people through the ages.

My daughter's gestation was perfectly “natural,” I should point out--but I carried her, and I was never of the female sex; I am a so-called “true hermaphrodite.” I was assigned female at birth, and was living as such when I gave birth to her, but I never identified as a woman, and am now legally male.

A lot of myths circulate around the topic of intersex fertility, many of them perpetuated by doctors. They all relate to the current Western insistence on the ideology of sex dyadism. That ideology holds that there are two and only two sexes, and that this is required by “nature” in order to perpetuate the human species. In fact, sex is a spectrum (see here and here for more information). About one in 200 people has some intersex characteristic. However, in contemporary Western society we are hidden away, medically “corrected,” erased. And often this erasure is bound up in rhetoric about fertility.

One way in which medical textbooks frame intersex people as “tragic” is by presenting us as usually infertile. I'm not going to spend time critiquing the idea that a person must procreate to be a fully mature and valid adult, though I certainly don't believe that to be true. What I want to address from an intersex perspective is the fact that many of us are capable of reproducing. In fact, doctors often take surgical steps to “normalize” our bodies that render us infertile. For example, children born with external testes but absent or very small phalli are often surgically assigned female. The removal of their testes of course renders them infertile. Doctors frame these children as being born “incapable of reproduction” because of their small or absent penises, but this is laughable. Deep penetration is not necessary for pregnancy to occur via intercourse. Size really is irrelevant to the delivery of sperm. In fact, the availability of in vitro fertilization means that intercourse itself is unnecessary. What doctors are doing is conflating having a large phallus with fertility and with male identity. It's magical thinking—but it is used by supposedly rational scientists to justify surgical castration of children with variant genitalia.

In framing intersex individuals as usually infertile, doctors present procreation by intersex people as a medical curiosity, justifying the publication of medical journal articles about a “case.” And they frame facilitating such a procreative act as a sort of “medical miracle,” in which the doctor treating the patient is the hero. Wishing to be seen in such a light, doctors wind up putting a lot of pressure on those of us whom they know to be intersex and potentially fertile to reproduce. This sort of external pressure is uncomfortable and almost coercive, as I myself experienced. I was told by doctors that my fertility would probably decline over time, that my atypical uterus would probably eventually “have to come out,” and I was regularly urged not to postpone trying to have a baby. Though I love my kid immensely, I see the pressure that was put on me to conceive as unethical. My road to parenthood was painful, involving a series of miscarriages, a difficult pregnancy, and a labor, with my atypical uterus, that lasted 53 hours and left me with injuries that took several years to fully heal.

In facilitating an intersex conception or gestation, doctors frame themselves as heroic in two ways. First, they are heros for making this new life possible (as if they were the ones doing the procreating). Doctors present themselves in this way in all sorts of infertility treatments, not just in the case of intersex patients. But the second heroic framing is unique: the prior doctors who chose a dyadic sex for the intersex person are presented as having done a brilliant thing. Doctors treat a successful fertilization as validating the intersex person's sex assignment. If an intersex person assigned female becomes pregnant (or an intersex person assigned male successfully inseminates), then doctors presume they made the “right choice” in the sex assignment. Thus, if an intersex patient expresses unhappiness with their sex of assignment, doctors may put even more pressure on them to procreate. Unhappiness with one's assigned sex implies a critique of the medical professionals who made it, which makes many doctors uncomfortable. Rather than questioning the practice of surgical sex assignment in infancy, doctors want the critique to go away.

This pressure placed on unhappy intersex individuals to procreate in order to validate the medical sex assignment that is causing the person unhappiness is unfair—and also bizarre. It follows the pattern of medically assessing a “correct assignment” through sexual activity. If a person is assigned female, then all is well if they are able to “accept a penis” in vaginal intercourse—and if they can actually become pregnant through this, hark—the herald angels sing the savior doctors' praises. As someone who was assigned female and did eventually have a successful pregnancy, I can tell you that this assumption did not work for me. For me, as for many, what mattered most in my sex assignment is gender identity. I did not identify as female, and thus I was uncomfortable in my assigned sex. Experiencing a pregnancy did not relieve my discomfort. Carrying a child did not “cure” my gender dysphoria with my assigned sex. It didn't make me “feel like a real woman.” It just made me feel pregnant.

I'm glad that I was able to become a parent, but believing that this should have “cured” me of my distress with my assignment is magical thinking along the lines of believing that procreating will “cure” a lesbian or gay man and make them heterosexual. Gender identity, sexual orientation, and procreative status are independent characteristics. Lesbians and trans men and intersex individuals aren't mystically “converted” by pregnancies. Gay men and trans women and intersex individuals who inseminate someone aren't thereby made straight or cis or dyadically-male-sexed.

Sometimes intersex people assigned to the female sex inseminate a partner, or male-assigned intersex people become pregnant. In the first half of the 20^th century, when intersex children were rarely if ever surgically sex assigned, and doctors wrote about “cases of hermaphroditism” they encountered as adults, this was a popular topic in medical journal articles, but such is not the case today. Since there is no reason why intersex people should be born with less capacity for fertility that in the past, there are two possible explanations. Either medical interventions are rendering more intersex individuals infertile, or doctors have no incentive to publish about what they would deem “sex assignment failure.” A person a doctor has assigned female is not “supposed” to impregnate anyone, thereby supposedly providing embarrassing proof they should have been assigned male. The idea that someone might actually be happy with a female sex assignment and also pleased to be able to contribute to the conception of a child by providing sperm in the way their body permits does not enter the picture at all. The dyadic gender ideology doctors impose awkwardly onto intersex people is again revealed.

I believe that the framing of sex as dyadic also contributes to the everpresent popular question about fertility and “hermaphrodites”: can we impregnate ourselves? The answer is that it is extraordinarily unlikely, but I believe the reason this tired old query nevertheless comes up again and again is due to how people, having no idea at all of what intersex bodies are actually like, have to use their imaginations. Given the dyadic sex ideology, they figure that if a “hermphrodite” is both male and female, they must have both sets of “organs,” meaning a penis and vagina and testes and uterus and ovaries. Truly, if you ever want to despair of the level of ignorance about intersex bodies, just do an internet search for “hermaphrodite impregnate”. . . I find it hard to decide whether to laugh or cry reading people's musings on this topic.

But I can't really blame people on the street for the depth of their ignorance. People don't know about intersex bodies and experiences because we are hidden from them. Our sex status is erased by the legal requirement that we be declared male or female at birth. Our bodies are redacted by doctors trying to remove the evidence of our physical “deviance.” Information about intersex statuses is not taught in high school biology classes. The fact that sex variation is so common is a fact kept, for some reason, secret. And the large majority of intersex people are well-schooled to keep our “disorders” in the closet.

So I'm less bothered by the tediously-repeated “if you're a hermaphrodite, could you get yourself pregnant” question than I am by magical thinking on the part of medical practitioners. Intersex people are not tragic figures due to infertility. Some of us don't want children, and some of us adopt. Some of us do indeed produce children ourselves. We've done this throughout all of human history, not just recently due to medical miracles. Most of us who do reap the rewards of fertility do this in private, with no medical journal articles trumpeting a star in the east. In fact, some medical “corrections” of our physical differences render us infertile, and I don't see why that's treated as unimportant when doctors are so very willing to write articles about their “cases” who do prove fertile. And the magical thinking behind the idea that doctors can validate a sex assignment through the intersex person contributing the “correct” component, egg or sperm, to a conception just boggles my mind.

It's time for some more sophisticated thinking about intersex fertility.

A Companion Blog: TransFusion

2011-07-13T16:58:00.002-05:00

As an intersex person who gender transitioned to male, I think about both intersex and trans issues a lot. The Intersex Roadshow is a blog focused on issues central to the live of people with sex variant bodies, and I only post information and thoughts on trans issues here that center on intersex experience. Recently, however, I started up another sibling blog to focus on trans issues. It's called TransFusion, and you can find it here: http://trans-fusion.blogspot.com/.

I have written two prior posts on The Intersex Roadshow that discuss intersections between intersex and trans gender experience. You can find them here and here if you are interested.

2011-04-29T15:48:00.075-05:00

Intersex Genitalia Illustrated and Explained

There is a lot of variation in how the genitalia develop from person to person in all of us. Nature provides us with a wide spectrum of forms, onto which our society imposes two absolute categories of male and female. In my last pos t, I described how all people start out with the same genitals in the womb, and how the phalloclitoris differentiates during development. In this post I will discuss the range of natural genital forms, explaining how they develop from the shared embryonic phalloclitoral structures.

I will illustrate this post with simple diagrams. I know that there is a lot of interest in what intersex genitals actually look like—most of the people who find this blog do so by searching for these words. I've discussed elsewhere why I will not post medical photographs of intersex people's genitalia—these often picture children photographed without their consent, and I will not participate in their exploitation. But I do support people's impulse to know more about the range of human forms. I want to help lift the veil of medically-enforced secrecy that makes our bodies invisible, so that interesex bodies can be demystified and accepted. So: diagrams it is.

I will start by reviewing the structures of our shared original genital form, and showing how they develop in what are deemed “normal” males and females.

The Embryo

We all begin life with genitals that have four basic external elements. At the top is the part numbered 1 and colored pink on this illustration: the sensitive end of the phalloclitoris, which can differentiate into the head of the penis or clitoris. Below it is structure 2, drawn in orange, which is capable of differentiation into either a phallic shaft, or clitoral body and labia minora. In the center is structure 3, drawn in green: an inset membrane that can widen or can seal as the fetus develops. It will form the urethra, and the vagina, if any. And at the outside is the fourth part, colored blue: the labioscrotal swellings, which can develop into labia majora or a scrotum.

“Normal Differentiation”

You can see how the four sectors of the embryonic genitalia differentiate in the diagrams of “typical” male and female genitals pictured here (illustrated without the foreskin or "hood"). Click on any illustration to see it larger. Notice that the pink phalloclitoral head points downward in typical female development and upright in typical male development. The orange body of the phalloclitoris separates and is buried beneath the labia in females, while it closes around the urethra and forms the penile shaft in males.

Sex variance occurs in many forms, but they are not random. Intersex conditions are produced by regular patterns of variation in development of one or more of the four parts of the embryonic genitalia. Let us consider a series of intersex conditions to see how these variations arise, and how they are framed by doctors.

“Aphallia”

Aphallia the term given by doctors to a form of sex variance produced when the first two sections of the embryonic genitala do not develop. While this is equally likely to occur in individuals with ovaries as those with testes, it is only generally commented upon medically when the individual has testicles and XY chromosomes. This illustrates how Western medicine is permeated by a strong gender bias. Having a large, erectile penis is considered a necessity for males, and its absence a tragedy of the highest order, to be addressed by somber medical articles. Having a clitoris capable of sensation and erection, however, is given little attention—so little that its congenital absence is treated as worthy of nothing more than a footnote.

The gendered beliefs that permeate Western medicine are further illustrated by the treatment plan for infants with testes who have aphallia. American doctors typically give these children sex reassignment surgery to remove the testes and create a vagina, it being apparently impossible to tolerate the idea of children being raised as boys without a penis. Without this surgical castration, the children could grow up to be fertile, but their fertility is medically sacrificed without their consent. What is particularly noteworthy is that doctors speak of the sex-reassigned patient with aphallia as growing up to have “normal female sexual function.” “Normal,” for a female, is thus medically defined as being capable of receiving a penis in a vagina, not having sexual pleasure.

“Microphallus”

Some people have large feet and some people have small ones; some have large noses and while others' are petite. When the phalloclitoris is quite small in a person with external testes and a male genital configuration, doctors say the individual has “microphallus.” If the testes are deemed "inadequate," doctors often advise sex assignment to female in infancy as they do in the case of aphallia, because life as a man with tiny sex organs is deemed tragic. Again, the individual's fertility is sacrificed without consent. If the testes are considered normal the child may be treated instead with injections of testosterone, in effect triggering puberty in toddlerhood and leading to moderate enlargement of the clitorophallus (along with other premature pubertal effects such as the development of adult patterns of body hair).

Rarely considered as options by doctors are simply allowing the child to live life as a male with a small penis, or to decide for zirself what course of action to take. Whether the sacrifice of some or all sexual sensation to have genitals that appear female is better than living life as a person with testes and a very small phallus is not a question that science can give a single “correct answer.” It is a subjective and highly personal decision, and will be driven most strongly by the gender identity the child grows to develop. I and other intersex advocates believe that only the intersex person can make such a lifechanging decision, and that for doctors to force their choice upon an unconsenting child is both arrogant and cruel.

“Clitoromegaly”

When a child with typically-male-configured genitals has a large phalloclitoris, the doctors make admiring jokes with the parents. But when the child is female, having a large phalloclitoris is deemed a “birth defect.” Despite the lack of any functional harm from having a large clitoris, doctors perform surgery to “reduce” it to the “acceptable” female range. This often seriously impairs sexual sensation. Although today doctors like to brag that they preserve sexual sensation because they have abandoned the older surgical treatment of “clitoral amputation,” usually some sensation is lost in “clitoral reduction,” and sometimes the phalloclitoris loses all sensation, even though some of the tissue is permitted to remain. It is especially ironic that the removal of part of the clitoris in traditional female circumcision practices is renounced as “female genital mutilation” by Western doctors, yet they perform a similar procedure in cases of “clitoromegaly” without compunction.

“Chordee”

The head of the phalloclitoris bends down in typical “female” configuration. When it does so in a person assigned male, it is termed “simple chordee.” In some individuals, the only atypical characteristic is the folded-down head of the phallus, which is of typical penile size. Doctors present this status as a “malformation of unknown cause,” rather than as a typically-female shape of the phalloclitoris in a male, because they are averse to terming any condition in a child assigned male “intersex.” But chordee is not a random alternative shaping of the penis, as if the penile head might have been equally likely to spontaneously bend in an S-shape. Chordee arises when Sector 1 of the embryonic tissue develops in the “female” configuration, while the rest of the genital development is typically male. Doctors usually suggest surgical “correction” of the phalloclitoral bend, citing locker-room teasing and a purported challenge to fertility. Such surgery presents a serious risk to sexual sensation in the penile head. Furthermore, fertility is not impaired by having a bent or curved penis—the production of sperm is unaltered. Penetrating some partners may be more difficult, but there are many ways to engage in both sexual interaction and fertilization other than via penetrative sex, and only the possessor of the bent penis can decide whether it makes sense to risk the sacrifice of sensation in the phalloclitoral head to make it easier to engage in penetrative sex with partners who prefer a narrow penis. (Some partners may find the phallus with chordee to be more sexually stimulating than a typical penis.)

In other individuals with chordee, the phalloclitoris is of intermediate size. It appears as an intermediary form evenly balanced between the male and female manifestations of the phalloclitoris. Often the individual also has a shallow vagina (discussed below under “hypospadias”).

Whether individuals assigned female at birth may have phalloclitoral heads that do not bend down like a typical clitoris but conform instead to the linear shape typical of males is not discussed in Western medical literature, with its obsession with penises and general disinterest in clitori. I consider it extremely likely that this unnamed counterpart to chordee does occur.

“Diphallia”

Section 2 of the embryonic genitalia is generally expected to fuse into a single penile shaft in male development, or to spread apart to form the two clitoral crura around the labia majora in female development. If the genitals devleop along male lines but the two sides do not fuse, the individual is born with two separate phalloclitori, side by side, each associated with one testis and having only one corpus cavernosum. Doctors remove one of the phalli (the one deemed smaller, no surprise there), though as in clitoromegaly there seems to be no functional danger involved in having two clitorophalli. This gential configuration can be associated with actual functional problems like an imperforate anus, obviously a true surgical emergency, but constructing an anus has nothing to do with removing half of the phalloclitoris. Doctors do not deem diphallia an intersex condition—the off-the-cuff reading is that the child is “doubly male”--but in fact the clitorophallus has developed in a manner intermediate between male and female norms.

A rarer bodily form than diphallia is phalloclitoral duplication, in which the embryo begins to twin in the genital region but ceases there—similar to what happens in the case of conjoined twins or people born with three legs. The individual is born with two penises or clitori, which may be located side-by-side or one above the other.

“Hypospadias”

Physical statuses in which a child develops external testes while Sections 2 and 3 of the phalloclitoris develop atypically are grouped together under the medical term “hypospadias.” Segment 3 of the embryonic genitalia forms the urethra and vagina, if any. In the normative male configuration, there is a urethral opening at the tip of phalloclitoris, and no vaginal opening. In individuals with hypospadias, the urethral opening is closer to the typically female location, and there may be some vaginal tissue. Individuals born with hypospadias in the U.S. today are almost always assigned male, and doctors rarely call them intersex. This is an ideological choice rather than one driven by anatomical logic. The medical belief seems to be that if a child has external testes and the clitorophallus can be surgically reconstructed along penile lines, then the child should be assigned male and no question ever raised in the parents' minds about the child having an intersex status. Doctors believe being seen as less than “fully male” is untenable for a man.

The degree of difference between typical male morphology and the genital arrangement of individuals with hypospadias varies widely. In many, it is simply a displacement of the urinary meatus from the very tip of the penis, as shown in the first illustration above, so that the urinary orifice is located lower on the phallic head, which is of ordinary penile size. Doctors “correct” this in childhood, claiming that having a “displaced” urinary meatus is unacceptable, as it will lead to teasing, and ostensibly problems with urinating in a standing position and fertility. Loss of sensation in the head of the penis, fistulas, and problems with recurrent bladder infections are deemed a better outcome by doctors than perhaps needing to sit down to pee—though in adulthood, many who have had this surgery complain that the side effects outweigh any benefits in their lives. The idea that fertility is impaired by having semen emitted from a position slightly lower down on the penis is laughable.

Hypospadias is measured by doctors in degrees. The greater the degree, the more the phalloclitoris assumes a vaginal configuration. The urinary outlet takes the shape of a small vaginal slit if located further from the head of the phalloclitoris, becoming larger if located further down the shaft, as in the second illustration above. If the urethral opening is located at the base of the phalloclitoris, the condition is termed “perineal hypospadias.” In people born with this configuration, the genitalia appear intermediate between the female norm and the male, with a vagina located in front of or between the labioscrota. Testes are located in the labioscrotum, with surface skin that can appear more close to typical labia majora or to scrotal skin. The clitorophallus is often intermediate in size and the head may bend down in the typical clitoral configuration called chordee. While children with “perineal hypospadias with chordee” have genitalia that look closer to the female norm than the male, they still may not be classified as “officially” intersex by American doctors, and surgery that closes their vaginas, dissects the clitorophallus from the perineum, and repositions the urethra to the head of the clitorophallus is termed a “repair” rather than sex assignment surgery. Such extensive surgery is painful, life-altering, and usually leads to loss of sensation. Furthermore, a substantial number of people born with this intermediate configuration grow up to identify as female, despite their infant surgical sex assignment to male, and bitterly resent having been given surgery that removed their vaginal tissue while forming their phalloclitori into the sensation-impaired semblance of a penis.

Rarely mentioned by doctors in articles discussing hypospadias is that it can be accompanied by intermediate internal sex structures, particularly a large “prostatic utricle”. (The embryonic structure that typically develops into a uterus in more female bodies forms a small “utricle” in the center of the prostate in bodies that are typically male.) In intersex bodies, this may exist as a small or average sized uterine structure within or aside a prostate—the greater the degree of the hypospadias, the more likely there is a utricle, and the larger it is likely to be. It fascinates me that the fact that people with hypospadias often have a uterine structure, evident in any literature search on the prostatic utricle, is rarely mentioned in medical descriptions of hypospadias, while much rarer associations between intersex conditions and cancer are often mentioned in articles on other intersex conditions. I believe it is not mentioned because discussing a uterine structure would undermine the medical framing of children with hypospadias as “boys with a penile malformation” rather than as intersex children.

"Vaginal Agenesis"

In some individuals, external genitalia are formed which appear close to the female side of the spectrum, but Section 3 only creates a shallow vagina or smooth patch of lubricating skin. Internally, such children may have no gonads, or may have ovaries but no uterus, or may have ovaries and an atypical uterus. Individuals with vaginal agenesis are always called female rather than intersex by doctors, even when they have no gonads and will develop no secondary sexual characteristics (such as breasts or facial hair absence/presence) without taking hormone medications. Again, Western medical ideology seeks to define away intersexuality as much as possible.

There is a lot of attention given by doctors to the creation of a vagina for children with genitals that otherwise appear female to them. This is framed as necessary for “sexual functioning,” presuming that forms of sexual activity other than penetration of a vagina by a penis are “not really sex.” As is the case with many intersex bodies, surgeries are often performed which sacrifice the capacity for sexual sensation out of an ideology that this is necessary for “normal sex.”

“Female Pseudohermaphroditism”/ Congenital Adrenal Hyperplasia

In some intersex conditions, the four zones of the external genitalia develop so that they look typically male (with urethral opening at the tip of the penis, scrotum, and no vaginal opening) but the individual possesses a uterus and ovaries, and the scrotum is empty. The most common diagnosis in people with such a bodily form is congenital adrenal hyperplasia or CAH in XX individuals. While most any person on the street would say that having both a penis and a uterus is an intersex bodily form, doctors hem and haw, and say instead that the child, while intersex, is a “pseudohermaphrodite,” somehow really female. This is based on the move by doctors almost a century ago to define intersexuality out of existence by saying that only individuals with the very rare condition of having one ovary and one testis, or having intermediate ovotestes, are “true hermpahrodites.” An intersex person with testes was deemed “really male” and anyone with ovaries “really female” by the creation of the term “pseudohermaphrodite.”

At the time doctors came up with the idea of the “pseudohermaphrodite,” sex assignment surgery had not yet been developed. Today, however, doctors insist that babies with CAH should be surgically assigned female in infancy. The language of “female pseudohermphroditism” is used to sooth parents who are shocked at the idea of a doctor cutting off their baby's penis. Doctors tell them that it is not “really” a penis, but is “really a clitoris” that is malformed. The fact, of course, is that all babies have phalloclitori—and that their baby's is exactly like any other typical boy's penis. If doctors were consistent, they'd have to call all men's phalli “malformed clitori.”

In any case, doctors in the U.S. routinely perform what they term “clitoral reduction” on children with CAH—that is, removal of almost all of the phallus--and cut apart the scrotum to give it the form of labia majora. In pressing this surgical sex assignment plan, doctors present parents with an odd assessment of the risks and benefits of such a course of intervention. They gloss over the fact that cutting off most of the phallus seriously impacts adult sexual sensation. They tell parents that this must be done to avoid the catastrophe of adult menstruation through the phallus. (Note that they do not inform parents of children with perineal hypospadias that menstruation is a “danger,” or suggest that children with hypospadias be assigned female to avoid penile menstruation.) Doctors do not inform parents that an alternative would be hormone treatment to suppress menstruation, or that their children could grow up to identify as men and function sexually as males, albeit without semen production. (Some ejaculation could be possible, but it would not contain sperm.) Rather than warn parents that many children with CAH grow up not to identify as female and to despair over having been effectively castrated, they warn that the children “have a heightened risk of lesbianism,” which is an eye-goggling assertion that is both homophobic and ignores the issue of gender identity.

“Male Pseudohermaphroditism”/ Androgen Insensitivity Syndrome

Children with complete androgen insensitivity syndrome or CAIS are the counterparts to XX CAH children. Their external genitalia take the typical female form, but internally they lack a uterus, and in the place where one would ordinarily find ovaries, they have internal testes. Because their bodies do not respond to testosterone, they grow up to develop very feminine secondary sexual characteristics at puberty, though they will never have menstrual periods. Despite their typically-female appearance, doctors call these individuals “male pseudohermaphrodites” because they have testes. However, in contrast to the treatment of children with CAH, doctors do not go on to say that they CAIS children have “malformed penises” that must be surgically altered to fit their “true sex.” Instead of urging genital reconstruction, they tell parents to raise their CAIS children as girls, warn parents that their internal testes could possibly present a risk of cancer, and tell them to have the testes removed.

Unlike children with CAH, who often regret their sex assignment surgeries, individuals with CAIS seem to usually accept having been assigned female at birth. This is probably because of the contrast in the intersex individuals' experiences. Children with CAH are assigned female at birth via traumatic, scarring surgeries that impair sexual sensation, and then must take testosterone-suppressing drugs for life, while those with CAIS may not find out about their condition until puberty, retain uninjured and unaltered genitalia, and take no hormone-suppressant drugs. Nevertheless, despite typically identifying as female, these individuals are termed “male pseudohermaphrodites” on all of their medical records, and must live with the consequences of being deemed medically male throughout their romantic and sexual lives.

Some children have Partial Androgen Insensitivity Syndrome or PAIS. They are born with a wide range of phalloclitoral forms, from looking quite close to the male iconic form, to forms like that illustrated under “perineal hypospadias with chordee,” to looking typically female. Most have an intermediate form and are given childhood sex assignment surgery to one dyadic norm or the other. As usual, such surgery is traumatic, scarring, does not result in genitalia of fully “normal” appearance, and puts sexual sensation at serious risk. This probably explains why a third to half of individuals with PAIS grow up not to live as the sex they were assigned, while 80% of individuals with CAIS identify as “fully female.”

Those Not Pictured

Many bodies vary from sex-dyadic assumptions in ways that are not visible externally, so that they are rarely diagnosed at birth, such as variations in the sex chromosomes. We are told that “men are XY and women are XX,” but there are XX men and XY women who are not visibly distinct in their bodily forms from those with typical chromosomes. There are many individuals with XXY chromosomes, termed Kleinfelter's syndrome, with a typical male genital configuration but small testes—about 1 in 500 of people raised male turn out to have this intersex karyotype. People often only discover they are XXY when undergoing tests due to infertility, or sometimes in cases where they develop substantial breasts (“gynecomastia”). Another fairly common genetic variation is to just have a single X chromosome with no second sex chromosome at all, which doctors term Turner Syndrome. Having only 45 chromosomes instead of the usual 46 is associated with a host of physical problems, and the fact that the individual's gonads never develop is treated as secondary to the many physical and mental challenges the individual faces.

Other intersex conditions exist on a more macro level than tiny chromosomes, but are internal and so may go undiagnosed for years or for an individual's entire life. Included among these, ironically, are the only conditions deemed to constitute “true hermaphroditism” under medical taxonomies: the presence of an intermediate ovotestis, or even more rarely, of an ovary and a testis in the same person. I'll write more about “true hermaphroditism” in a later post.

Also not pictured are the bodies of people with an atypical sex steroid balance between the feminizing hormones (estrogens, progesterone, etc.) and masculinizing hormones (testosterone and its byproducts). Everyone produces all of these hormones, and requires both types for fertility and physical health, but those with bodies on the female size of the spectrum typically produce more feminizing hormones, and those with bodies on the male side typically produce more masculinizing hormones. Variations in this balance lead people with typically-female genitals to have higher levels of body and facial hair, muscle mass, likelihood of balding, and libido, and people with typically-male genitals to develop breast tissue, more curvaceous hips, etc. These variations are not termed intersex by doctors, but there is no logical reason why they should not be. Their intersex character is denied because most adults with such conditions have normative gender identities that match their genitals but are challenged by their contrasting secondary sexual characteristics. They and doctors together strongly assert that their variations do not make them any less male or female. While I agree that no one's gender identity should be deemed undermined by their physical appearance, I believe it would help all sex and gender variant individuals if society and medicine would acknowledge the prevalence of physical sex variance while supporting individuals in their gender identity assertions. Some intersex activists disagree, wishing to limit the conditions that will make a person “count” as intersex, and patrolling the boundaries of the community to exclude others as “wannabes.” Personally, I find this cruel and counterproductive. A woman with a beard lives a life in which her sexvariance is very visible, and saying she can't be included in a community of those with sexvariant bodies because she has typically-female genitalia does not make sense to me.

Another category of hormone-related variance includes individuals who produce low levels of sex steroids and whose bodies do not change much at the usual age of puberty. Such individuals are almost always treated with sex steroid therapy, without presenting them with the option of living in their androgynous bodies medically unaltered.

Finally, let me note that this catalog of intermediate bodily forms is not exhaustive. In my understanding, anyone whose body varies from the iconic male or female dyadic norms is sex variant, cannot be wished out of the intersex rubric by tricks of medical terminology, and should not be excluded from intersex community by gatekeepers.

We need society, the medical field, and intersex communities themselves to acknowledge that nature provides humanity with a wide range of forms, so that all of our bodies can be recognized as valid. Unless there is an actual rare functional problem, our bodies should not be altered in infancy, and only those functional problems should be addressed. Our genitals should be altered only if we ourselves request it, to make ourselves comfortable in our own skin, not to make society comfortable by our medical erasure. Society must come again to embrace the diversity that is nature's gift to us.

The Phalloclitoris: Anatomy and Ideology

2011-01-31T18:28:00.073-06:00

This is a diagram of our shared heritage--yours and mine. It is a drawing of the genitalia we all start out with in the womb.

The Western medical establishment is deeply invested in the ideology of sexual dyadism: the idea that there are two very different sexes with two very different sets of genitalia. When children are born with genitals that are intermediate between the two, it is called a "malformation" and treated as bizarre and in need of immediate "correction." My earlier posts explain how this causes great suffering for intersex people. What I want to write about today is how the language we use and the diagrams doctors draw to illustrate genitalia hide the similarities between everyone's genitals. I believe that if we use more accurate language and diagrams, not only will we all understand eachother's bodies better, but the treatment of intersex individuals will improve.

Everyday Understandings of Genitalia

In the U.S., we live in a society that believes in two "opposite" sexes, men and women. Tell average Americans that sex is actually a spectrum of differences, and that there are societies which divide this spectrum into three or more sexes, and they'll just look at you funny. This is not because Americans are ignoramuses--it's just what we learned at home and were taught at school. Men have penises and testicles, children are told. Women have . . . well, women are presented as more complicated. Often children are told, "men have penises, women have vaginas." But then they learn at school (or in schoolyard talk) that the vagina is "the hole where a penis can go," but there are more parts to the female anatomy, and the most sensitive bit is the clitoris. By high school biology class most of us have dutifully learned that the technical term for the female genitalia is the vulva, made up of not only clitoris and vagina but labia minora and majora, the inner and outer lips, and that inside women have ovaries and uteri. What we are taught about male anatomy remains simple: men have a penis and testes. From this anatomical distinction we are taught to understand people as falling into two camps: straightforward, goal-oriented, insensitive men and complicated, vulnerable, sensitive women. That's gender dyadism, American style--the fodder for endless TV sitcoms.

What we are not usually taught is that that all humans start out in the womb with the same initial genital structure. This is certainly studied by embryologists, if not familiar to the general public, and I will give a basic tour in this post. I'm not going to use the language embryologists do, though, because I find it very odd. They refer to the initial human form as the "indifferent stage," often say that the genitals "appear female," yet term the sensitive end of the genital structure the "phallus." The truth is that we all start out appearing neither female nor male, and we certainly don't start out with penises. We all start out intersex. Our initial form (which some of us retain) is pictured at the top of this post. Let's examine it.

Human Genital Development

We all begin life with genitals that have four basic external elements. At the top is the part numbered 1 on my drawing: the sensitive end of the phalloclitoris, which can differentiate into the head of the penis or clitoris. In the center is structure 2: an inset membrane that can widen or can seal as the fetus develops. It will form the urethra, and the vagina, if any. Around it is structure 3, which is capable of differentiation into either a phallic shaft, or clitoral body and labia minora. And at the outside is the fourth part, the labioscrotal swellings, which can develop into labia majora or a scrotum.

There is a lot of variation in how each of the four basic parts of the genitalia develop from person to person in all of us. For example, we acknowledge with a lot of rib-elbowing the variation in penile size. Variation in the size and shape of genitalia, and in other parts of the body, is part of human diversity. Surgeons are well aware that livers and lungs and blood vessels vary a lot between individuals, and may look quite different from an iconic anatomical diagram. But we rarely care about having an unusually shaped liver. The shape of genitals, however, is given huge cultural weight, because we pin our commitment to dyadic gender roles on them. We look at the shape of a newborn's genitalia and project a future of dresses and diets and talking about emotions, or sports and strength and getting under the hood of a car. We do know that people are complicated. Most of us want to be more than walking gender stereotypes. Still, we understand people through the lens of dyadic gender difference, and intersex people call that into question. When we see a baby born with intermediate genitalia, and can't project a future for them based on our well-known gender narratives, people in our society--including doctors--freak out.

Part of the reason our culture reacts so poorly to intersex people is that doctors have spent the past 75 years or so erasing the bodies of people like me. I'm referring not only to the fact that doctors surgically alter our genitals, nor only to the fact that we're given an "M" or an "F" on our birth certificates, but to the fact that anatomical illustrations don't illustrate our anatomies. Medical drawings and medical language obscure our existence. And since I want doctors and parents and society at large to stop freaking out and erasing us, I want that to change.

Anatomical Illustrations of Adult Genitalia

Variation in the shape of genitalia is a fact of nature. Some genital variations are labeled intersex conditions by doctors, and considered unacceptable malformations that must be "corrected." Other variations doctors insist with equal vehemence not to "really" be intersex. There is little logic to this if you look at it from the perspective of physical health or function. Instead what seems to matter are ideologies: first, an insistence that all people must be "really" male or female; and second, an anxious commitment to associating men with big penises. And this is visible when you examine anatomical drawings.

Let's look at how doctors portray adult genitalia. Anatomy drawings in Western medicine present two and only two types of "normal" genitals. I don't have permission to post copyrighted medical illustrations, but a sample female genital diagram can be see here, and an example of a male genital diagram here. These drawings of dyadic sexual anatomy could be critiqued in many ways, but for now let's consider just one thing: the way the phalloclitoris is portrayed. In the female drawing, it's presented as a tiny clitoral dot, with the label pointing at a spot the size of a small pea. In the male drawing, it's presented as a huge penis, shown in the illustration I've linked as extending beyond the testes, apparently 8 inches or more in length even in its flaccid state. To put it plainly, the "normal penis" in this medical drawing is porn-star sized rather than average, and massive in comparison to the petite "normal clitoris."

Not only do these medical illustrations exaggerate sexual differentiation, they obscure rather than illuminate shared anatomy. Note that only the tip of phalloclitoral structure protruding from the foreskin or "hood" is labeled "clitoris." In fact, the phalloclitoris is similar in size between people at all points on the sex spectrum. In people with genitals that conform closely to the male end of the sex spectrum, the structure I've labeled #3 above merges into one erectile column. "Men" get a "penile shaft." In people with genitals that conform closely to the female norm, the two sides of the structure spread apart and surround the labia majora. "Women" get . . . well, what do you call that? Anatomists call these two feminized sides of the phalloclitoris the "clitoral crura," a term that most laypeople have never learned at school. Just like the penile shaft they are made of several inches of spongy tissue that fills with blood and erects during sexual excitement. You can see an anatomical illustration here (look at the part labeled "crus clitoris," the singular of "crura" in Latin). As you can see, the phalloclitoris is actually quite similar in men and women. The tip bends down in women and the two sides are joined together in men, but the basic structure is the same.

You would imagine that anatomical drawings would illustrate all of our genital structures to increase understanding. But do a Google image search for "female genital anatomy" and you'll see hundreds of images that look like this--and just one image in the first 10 pages that shows the crura. The anatomical illustrations that are used on educational and medical websites conceal rather than illuminate the similarities in everyone's phalloclitoral anatomy.

Do a Google search for just "genital anatomy" and you see dyadic illustrations of two very different types of genitalia. You don't see the shared embryonic anatomy from which we all develop, you don't see how all people have similar phalloclitoral structures as adults, and you don't see the wide spectrum of adult genital forms that exist. You see the ideology of sex dyadism, rather than the fact of the sex spectrum.

The Moral of the Anatomical Fable

In my next post I will discuss the common variations on the human genital theme, and why some and not others are called intersex conditions by doctors. What I want to conclude with today is the fact that language and the images scientists and doctors use exaggerate the differences between "normal" male and female genitalia. In a culture where people believe genitals determine gender, this makes men and women seem in general more different, more alien from one another, harming us all. And for intersex people, anatomical drawings and language present us as bizarre, inexplicable freaks who require medical "correction."

We need to change the language we use. Yes, sexual differentiation of bodies happens. The average person who was assigned male at birth has smaller nipples than the average person who was assigned female at birth. But we call the erectile tip of the areola a "nipple" whatever the sex of the person it adorns. A phalloclitoris is a phalloclitoris, erectile and sensitive--no matter if the person possessing it is deemed male, female, or intersex. In simple terms, some of us are more "outies" and some are more "innies" and some right in between--but we all share the same genital structures. You have a phalloclitoris, and so do I. We are all variations on the same bodily theme, and there is no need to react to intersex bodies with pity or horror.

Do I Have the Right to Marry Anyone?

2010-12-03T13:23:00.078-06:00

On Sexual Identity and Intersex Experience

I'm married. I wonder if I'll be sent to jail.

DOMA, the Defense of Marriage Act, states that the U.S. federal government defines marriage as a legal union between "one man and one woman." My home state of Wisconsin goes further, providing that residents other than "one man and one woman" who go out of state to marry can be fined up to $10,000 and/or imprisoned for up to 9 months.

My spouse and I got married out-of-state.

The law scares me--because I'm intersex by birth.

My spouse, for whom I thank my lucky stars, is also intersex. We have very different bodies, different "conditions," but we share key experiences that bind us closely. And one of those shared experiences is a constant feeling of unease with regulations and categorizations--marriage laws, for example. If you were born neither male nor female, and you were looking at laws banning marriage unless it joined "one man and one woman," how would you feel? Unacknowledged, uncomfortable, socially unmoored? The people who wrote these discriminatory marriage laws had other aims--the existence of intersex people probably did not cross their minds when they were putting the bills together. But that's how a million regulatory regimes impact us. You are required to declare a dyadic sex, supposedly to protect your identity or serve your needs. That's why you have to check off an "M" or an "F" box to get a driver's license, or open a credit card account, or fill in a Facebook survey. True, these checkboxes conflate together physical sex and gender identity. I'm intersex, but my gender identity is masculine, so I can just check the "M" box on the Facebook survey about blue jeans.

But marriage is different. There's an inquiry into your "true sex"--supposedly to protect society at large.

The furor focuses on "same-sex marriage."

Conservative opposition to "homosexual activism" is what has driven the enactment of DOMA and the 29 separate state laws limiting marriage to "one man and one woman." I'm sure you're familiar with the rhetoric, which tends toward Biblical one-liners: "Male and female created He them;" "God created Adam and Eve, not Adam and Steve." There's the constant quotation from Leviticus, "You shall not lie with a male as with a woman. It is an abomination" (with the constant nonquotation of other passages from Leviticus, like the prohibition against wearing fabric mixing linen with wool, or eating pork, or trimming one's beard).

According to this simplistic interpretation of the Bible, God made men and women to be opposite and distinct, intended for procreative marriage, with a husband leading the household and a wife practicing submission to him. Heterosexual marriage based on these principles is said to be the foundation of society. Straying from it, we are warned most stridently, will undermine both morality and social order.

Advocates of same-sex marriage have written many eloquent defenses of allowing gay- and lesbian-identified couples to wed. I certainly agree with them that male couples and female couples should be able to marry.

But where do I fit in this picture, as an intersex individual?

Last year I had a conversation with the leader of a proselytizing Christian group that had taken over the central plaza on my college campus. They were holding up signs saying that any sex outside the context of a marriage between one man and one woman damned a person to hell. I'll give them this: they were coherent in their sexual beliefs. They were also holding up signs about masturbation earning one eternal damnation (an assertion that did not win them a lot of converts in the college audience).

I stepped aside with the leader, and asked him respectfully what his religious precepts would advise for me. I explained that while I lived as a man, and he saw me as one, I was born with an intersex condition and was assigned female at birth. Since I was neither male nor female, how was I to follow a command that marriage only be contracted between a man and a woman?

The religious leader stared at me for a bit, then rallied. He said that he wanted to tell me that he had great pity for me, and that God did not intend that I be born intersexed. "Birth defects," he explained, "exist because of Adam's fall. Original sin warped God's creation, and that's why tragedies such as the birth of a baby with crippled legs or like you occur." He explained that when Jesus came again, all of this disorder would be purged, and there would be no more people like me. I mustn't be angry at God but at sin for putting me in my position.

I told him that I believed that I was born exactly as the universe intended, and was not angry at God. What upset me was how I was treated by my fellow human beings. In any case, given that I did exist as an intersex person, whom did he believe I was permitted to marry?

He asked me what the doctor had put on my birth certificate, and I said "female." He gave me a grave face, and told me, "I'm sorry, but then that is what you are. You may look like a man but you are not, and you can't marry a woman. It's like the case of a transsexual, even though it is not your choice." So, according to this religious leader, sex assigned at birth governs marriage law, and there can be no sex transitions, for intersex people or for those born with normative genitalia. (Nonintersex trans people get the extra distasteful twist of the lip for a "choice," but the end result is the same.)

I then asked the religious speaker if he thought I should marry a man. He looked very uncomfortable and just shook his head. I said, "So you don't think I can marry anyone?" He suggested that I dedicate myself to God's will and eliminating sin rather than dwelling on my personal situation.

I guess that's what monks and nuns do: dedicate themselves to God, and live a life of celibacy. And since he didn't think I could marry anyone, and sex is only allowed in marriage between a woman and a man trying to procreate, celibacy is what he felt God required of me.

In the parlance of my Jewish ancestors, Feh.

I did ask him one more thing: why did he think that the doctors had picked the "right" dyadic sex for me? Couldn't I be trusted to look into my heart and know myself better than they? He just said that doctors are the ones who know, because they have the technology and the tests.

I don't know when or how doctors became the oracles of divine will for good Christians. In fact, I'm sure that when doctors declared that masturbation was healthy, the members of the group I encountered rejected that promasturbation prescription vehemently. . .

The majority of Americans would see the group I encountered as rather extreme. Yet the majority of Americans have enacted marriage laws that reach the same conclusion for intersex people: marriage is only acceptable between a "man" and a "woman." The fact that I'm neither by birth is some sort of unfortunate, bizarre accident. Doctors can be relied upon to pick the right sex for intersex babies, and that should clear the whole problem up.

But even doctors aren't so sanguine.

Doctors warn of a "risk of homosexuality" for babies born intersex.

Yes, you heard that right. Just read about some "DSD" or other and you'll see it there. Take congenital adrenal hyperplasia, or CAH, which is often manifested in the birth of a child with a penis outside and uterus and ovaries inside. Medical texts regularly state that "even with surgical and pharmacological treatment, CAH girls are at risk of homosexuality." In fact, there is now a highly controversial prenatal treatment program led by endocrinologist Dr. Maria New, intended to influence genital growth in CAH XX infants, so that they're born looking more like a typical female--and it is being reported not as an attempt to prevent intersex births, but as an attempt to "prevent homosexuality." You can check that out here. What a confusion of intersexuality and homosexuality! (And how eugenic. . .)

I have to ask you, from the perspective of birth sex, how can an intersex person be homosexual--unless they only have sexual relationships with other intersex people? Of course, birth sex does not dictate how sexual orientation is experienced . . . but doctors misapprehend how this works.

What the doctors really mean is this: they take babies born with average-looking penises but internal "female" organs and they cut their penises off. (The call this "clitoral reduction" nowadays.) They prescribe the children testosterone-suppressant drugs. They tell their parents, "See, you have a girl!" But the parents know the children are intersex--they saw them born with phalli. The children know they're intersexed--they bear the scars, they take the daily meds, and are forced to show their genitalia to doctor after doctor. Of course these children often grow up with gender identities and behavior that differ from "normal girls."

Apparently we intersex people often freak doctors out once we're not cute little tots over whose bodies they have vast power. They take an intersex baby with CAH, give hir sex assignment surgery, and want to believe that having sculpted a vulva-shape in hir flesh they'll have guaranteed hir a future of "normal womanhood," stereotypically defined as involving no great interest in sports, but lots of interest in fashion and boys. Sometimes their patients grow up into the pink feminine heterosexual icons of the doctors' imagination, expressing nothing but gratitude for the removal of those embarrassing "pseudophalli."

And sometimes CAH intersex patients show up in the doctors' office as depressed or angry teens in short hair and jeans. Maybe they identify as male, or as genderqueer, or as tomboys--doctors don't seem to ask about gender identities or if anyone wanted to keep that penis they had been born with. What they do ask about is sexual activity, and if the patients are involved with boys or girls or both.

The data they collect is pointless.

Without knowing gender identity, you can't tell someone's sexual orientation. Take two people with the same CAH bodily configuration, and one can grow up to identify as female and the other as male. If a person identifies as male and only wants female partners, his sexual orientation is heterosexual. But the doctors will label this person "homosexual," because they assigned him to be female, and they don't ask if that's the gender identity he actually grew up to have.

Doctors are acting just like the Christian sectleader I spoke with at my university. Intersexuality is a mistake, they say, unintended by nature. Doctors have the godlike power to divine the "right" dyadic sex for intersex babies, and correct their faulty bodies. And the "normal" thing for these intersex children to grow up and do is to marry a person of the sex other than the one the doctors picked for the child.

What does this all mean for me?

My spouse and I were both born intersex. I was assigned female at birth, and she was assigned male (I escaped surgical intervention but she was surgically misassigned, to her lifelong regret.) According to the sexes doctors put on our birth certificates, we are a "heterosexual" couple, though we share a physical status. Had we both grown up to identify with the sexes we were assigned, our intersexuality would be invisible to society--as both doctors and Christian antigay activists would wish it to be. We could have married and disappeared into the suburbs. Biologically speaking, we would not qualify as "one man and one woman" for marriage, but nobody would ever have raised a stink, so long as we accepted our lot and kept quiet about our birth status.

But we did not identify with our sexes of assignment. Eventually, we both found the strength and resources to enter the gender transition process. This has come as a great relief to us both, though it hasn't made our lives easy (read my last post to hear more about that). If transphobia were not the huge barrier that it is, and gender transition services could be easily accessed, and insurance covered the medical expenses, and the legal hurdles weren't so high, my spouse and I could have done a simple if ironic do-si-do and would now be married as a man and a woman.

Gender transition being the long, drawn-out, expensive, frustrating process that it is, however, according to our current legal documentation, we're both "male." No matter that my spouse was never biologically male. No matter that she has breasts and gets a menstrual period. No matter that she has identified as female since the age of 3 or 4. We're working on it, but you try supporting two gender transitions and a kid with a disability under trying economic conditions. . .

So: one thing we're dealing with now, despite the fact that we live as a married man and woman, is we are currently, according to our social security cards, in a same-sex marriage. At the time we got married, my legal documentation still listed me as female, so getting hitched was unproblematic--but at the moment we look different on paper. And since we went to San Francisco to get married, someone could now threaten us with that $10,000 fine and/or 9 months in jail Wisconsin law allows. We share this unhappy situation with other LGBT couples in Wisconsin who found routes to marriage, and I have great sympathy for them all.

Even if we are able to get my spouse's legal documents all in a row, and we're no longer a same-sex couple on paper, we won't be safe. Because we're open about having been born intersex. Because we gender transitioned, and people know that. Because we're visible, we'll always be vulnerable to harassment by some bigot who wants to argue we're not "one man and one woman" and try to invalidate our marriage.

Intersex people having to deal with marriage restrictions is not some abstraction or game.

It's nervewracking stuff, and it's my lived experience. Sometimes well-intentioned people who want to construct arguments against "same-sex marriage bans" bring up the idea of intersex people like some sort of abstract theory. Take, as just one example, this pos t entitled "Common Arguments Against Gay Marriage." A section titled "Hermaphrodites" poses intermediately-sexed bodies as a hypothetical and asks how "feminized" a "hermaphrodite" must be to be permitted to marry a man. The blogger gets excited about this just-so story, and states, "This is a type of sorites paradox. Traditional sorites paradoxes involve asking how many grains of sand you have to remove from a pile before it stops being a “pile,” or how many pounds a fat person has to lose before they are no longer “fat.” These are paradoxes because they involve characteristics which are vague — it’s not clear where a pile or fatness begins and ends."

Yes, this hypothetical of the Incompletely Feminized Hermphrodite follows the slippery slope, sorites paradox argument format. But we are not mythic creatures in some ancient Greek story Zeno might tell of arrows that get halfway to their targets. We are not some illustrative fable. In writing about intersex experience and one-man-one-woman marriage limits, I have to raise this issue, because I know there are other intersex people who are livid at how people who are supposedly our allies treat us--so angry that they think the intersex community should refuse to enter public discussions about how marriage restrictions affect us. I agree that we have been treated rudely, our bodies seized upon as fodder for arguments by people ignorant of our painful real life experiences. It's depressing.

But the fact that our lives have been appropriated by others should not silence us. And so I am speaking out, and asking for something simple.

I am a human being, and I ask for respect.

All bodies deserve respect. Intersex variations are not lusus naturae, medical defects, the wages of sin, or mistakes unintended by God. Sex is a spectrum by nature, and everyone's body is a gift.

All loving relationships deserve social support. To believe that it is ungodly of me as an intersex person to get married to a man or to a woman because the sex I was assigned at birth did not match the gender identity I developed--that is a failure to understand and embrace a God of Love. To grant or deny people the right to marry based on their sex or their gender is simply wronghearted. All people--straight and queer, trans gender and cis gender, intersex and dyadically sex-normative--should be treated with dignity when they commit to love.

For a person to be threatened with imprisonment for daring to marry . . . now that is moral evil.

Does It Get Better?

2010-10-20T11:40:00.016-05:00

This post is intersex-related, but is more broadly addressing LGBTI issues that arose in conjunction with Wear Purple Day events in the U.S.

On October 20th, thousands of Americans wore purple as part of the campaign to show support for young people who are being bullied because they are perceived to be lesbian, gay, bisexual, transgender or intersex. I am grateful to all of those who put on purple as a show of solidarity. Thank you for caring and for making this gesture of support. In the homophobic and transphobic cauldron of many American schools, large numbers of LGBTI teens are driven to despair, and some to its ultimate expression in suicide.

The Wear Purple Day campaign is affiliated with the “It Gets Better” project, in which adults record video messages to LGBTI teens to tell them that while they may despair now, they should keep hope alive, because life will get better when they get older. This too is a project that is well-intended, and I appreciate all the people who have made and contributed videos intending to support our youth.

But there is a problem with the framing of the “It Gets Better” project. Living with homophobia and transphobia does not magically disappear when one is handed a high school diploma. The title of the project implies that dealing with harassment and disrespect and violence is a phenomenon of childhood, as if “kids will be kids” and act immaturely, so we just need to wait it out and things will be fine. It focuses attention on the victim’s “not giving in” to mistreatment—which frames despair and depression as a sort of failure of the victim’s spirit, as weakness. (Notice that it is not a video campaign entitled, “Don’t Be a Jerk” aimed at homophobic, transphobic bullies.) It tells us to “be strong,” and we’ll be granted the prize of acceptance and respect when we grow up.

And that, I’m sorry to say, ain’t necessarily so.

There have been some dramatic incidents of anti-LGBTI violence against adults in the press of late. I think especially of the brutal homophobic beating and gang rape with baseball bats of three gay men in New York this month. These incidents are horrible and we must decry them. The possibility of being subject to such hideous attacks keeps many LGBTI people living in fear. But to focus our attention on hyperviolent acts like this directs the public eye away from the more quotidian experience of disrespect and veiled threat that many of us live with every day. While the number of us who will be gang-sodomized, let us pray, is few, thousands upon thousands of us continue to face, as adults, the sort of sneering and bullying that are common in high schools. And we too suffer low self-esteem, depression, despair. It is this that I want to address.

For some of us, being LGBTI in America today is not that bad. Those who are white, and middle-class, and gender conforming, and live in major urban areas may feel pretty comfortable. Even those in this privileged group still have to deal with people nudging one another and tittering at times, with marriage prohibitions denying them benefits, and with the insecurity of never knowing when they’ll be treated with disrespect—at a parent-teacher conference, or at a tax-return preparation service, or at a gas station. Even the conventionally attractive, young, white, churchgoing, well-educated suburban homeowners among us, apparently iconic ideal Americans, are usually aware of being second-class citizens. To say that this group’s lives got better after high school may be true, but it’s sad for the definition of “the good life” to be, “Well, I haven’t been subject to constant fear of violence since high school.”

And that’s the privileged group.

Let us be honest. The LGBTI youth who are subject to the most bullying are the ones who are less privileged. A middle-class gay white male high school jock is likely to face less maltreatment than an androgynous, poor kid of color. If you are a feminine boy (no matter what your sexual orientation), you are at high risk of bullying. If you are out as trans gender, you are at high risk. If you are marginalized already because you have a visible disability, or you wear out-of-style secondhand clothing because you are poor, or you are one of the only kids of your race/ethnicity at your school, your risk of maltreatment is much higher. And sadly, this does not magically melt away when you graduate from high school.

I’ve been thinking about this a lot today because yesterday was not a good one for my family in terms of LGBTI mistreatment. So I’m going to share this story with you. My family is suburban and middle class and middle American. My spouse and I are white (though our kid isn’t), I’m employed as a professor, we own a house and we keep the lawn mowed. My spouse and I are both trans gender, but as a trans man married to a trans woman, we have privileges many trans folk dream of. Our lives are supposed to be in the “it got better” category. But we still live with daily trouble with antiLGBTI bias.

It was my spouse who suffered directly yesterday. She’s intersex by birth, was surgically assigned male as an infant, but knew by the time she was four that she did not identify with her sex assignment. Rather than reassigning her female, however, she was treated with years of "gender therapy" intended to change her gender identity to fit her sex of assignment. This involved requiring her to do a lot of pushups, play football, and be physically punished for crying and other "girly" behavior. The “treatment” did not change her gender identity, but it did make her childhood miserable. She was not able to begin to gender transition until she was a legal adult, and by that time, without medication to postpone pubertal changes from testosterone, her body had masculinized. Starting hormone therapy did not reverse changes such as her having grown to be 6’3” and broadshouldered. (Because she has uterine tissue, however, it did start her menstrual cycle, made awkward by the masculinizing genital surgery she had as a child.) As a result of her history, my spouse must live her life in a body that will forever be androgynous, and here where we live, in the supposedly polite Midwest, this means constant street harassment.

For those of us who are gender-transgressive in appearance, whether we have chosen to be seen as genderqueer or would like nothing better than to be able to be gendernormative, but must live with physical androgyny, harassment does not end in high school. Especially when we are read as androgynously male, we are the butt of endless jokes and the subject of constant hostile stares. All my spouse and I have to do is go to our local Midwestern Walmart, and it’s like the circus came to town. People stop, and stare, and shake their friends’ elbows, and point. Sometimes there’s a supportive smile, and sometimes people pay us no mind at all, but we can never go without some people snickering and staring. Walking around in our suburb, my spouse has had to deal with parents yanking their children away from her as if she were about to abduct them on her afternoon constitutional. If she goes out walking at night to avoid these encounters, the police often curb crawl in a car behind her until she gives up and comes home. Going out to a restaurant we have to listen to people at the next table have an open conversation speculating on our genders and asking one another what’s wrong with people today. Every trip to a public bathroom exposes my spouse to danger of outrage or violence or police intervention, so she rarely ever uses one.

Gender transitioning has in some ways made our lives infinitely better than it was in high school. Living in a gender one does not identify with, with a body that gives one gender dysphoria, is terribly painful. But we are not now free from maltreatment and harassment, and my spouse suffers daily indignities. I’m androgynous too, but since I grew a beard I have more “passing privilege” and am usually read dyadically male, at least from the front. Also, I’m only 5’2”, and my spouse at 6’3” seems to trigger in young men out to prove their masculinity a lot more competitive transphobia.

But it’s not just individual harassment we have to deal with—it’s institutionalized transphobia. Yesterday, my spouse went to see her doctor to get her prescriptions refilled. It was not a good office visit. First, the receptionist loudly called her “Ma’am? Sir? Ma’am? Sir?” in front of the crowd of waiting patients. Of course, she was then subject to a sea of stares while she waited. And then the doctor refused to refill her prescription for estrogen, because her cholesterol was at 201, a point above the “normal” range. So my spouse has suddenly had the rug pulled out from under her medical therapy—medical therapy that is vital to her wellbeing.

I respect our doctor a lot, but she has never had a trans gender patient before (that she is aware of). Her reference point for estrogen therapy is menopausal women getting HRT. With them, denying a refill as a goad to lower cholesterol might be a nuisance, but that’s not the appropriate analogy. This is more like taking a person who was suicidal and is now doing better on antidepressants, and saying “I refuse to prescribe you any more antidepressants until you quit smoking.” But our doctor has had no training in dealing with caring for trans people, a failure of our medical schooling, and doesn’t understand how vital hormonal therapy is for a trans person. In a way, the doctor acknowledged that the issue was her lack of training. She said that she could not in good conscience continue to prescribe estrogen for my spouse, but that she’d give her a referral to see an endocrinologist with more expertise in hormone therapy.

The thing is, there is no endocrinologist our doctor knows of with training in dealing with trans people. There is no such endocrinologist in our health plan. Our health plan, in fact, refuses to pay for any trans gender care, and even though my spouse is intersex, and gets a menstrual period, they say she is “male” because that was what was put on her birth certificate—yet another example of the way we as LGBTI people are failed by institutions. There is no LGBTI health clinic in Wisconsin that can take over care. So, suddenly, we are caught without appropriate health care and a ten-day supply of estrogen left in which to fight to get access to someone who will treat my spouse with knowledge and respect. I’m staring at the number of the endocrinology office the nurse gave us. I asked the nurse if she could inquire if anyone there had ever treated a trans person, and she just sputtered uncomfortably and told me I could do that if I wanted to.

Would you want to be referred to a doctor who had never treated anyone like you, not knowing if that doctor in fact thought that people like you are “sick” and treating your condition a mistake? Not knowing if you would be sent home having been humiliated, with no treatment, and a large doctor’s bill your insurance plan refuses to cover? If as long as you didn’t get beaten up on the way home, would you say life is now good?

So, I wore purple on the 20th, and I extend appreciation to all the others around America who did so as well. But I have this to say: if you really want to help out, don’t just send smiling messages that life for LGBTI folks is fine after high school. Teach your children to respect all gender expressions and sexual orientations. Speak out against the way we are maltreated by institutions. Confront people on the street when you see them harassing us. Challenge school officials and parents and police officers who do nothing to stop the harassment. Be our good neighbors. Demonstrate your respect for all of us—not just to middle class married gay white suburban couples with 2.3 dogs. When you see someone who is visibly LGBTI on the street, smile at us. Advocate for same-sex marriage, yes, but remember the “T” and the “I” and also advocate for an end to sex assignment surgery on intersex infants, and for the respectful provision of medical care to trans folk. If you employer gives you health insurance, ask your HR department to negotiate for coverage of gender transition services. Take a step to ensure that life really does get better for your LGBTI fellow travelers. Please. . . wear purple, but do more than make a fashion statement.

Interphobia--Not Cured by Hiding Us Away

2010-09-12T19:04:00.019-05:00

This terribly disrespectful cartoon depresses me.

It's from a blog entry entitled "10 reason why Caster Semenya is a man. . . she set to run in June anyway," posted this April by a guy named Anthony. Here's a link, if you really want to see.

When Caster Semenya's name first became an international headline, I wrote a blog post about her situation, and I'm not going to revisit the specifics of her case now. Read the older post here if you wish. What I want to address now is the problem of bias against intersex people, which, following the conventions of the terms homophobia and transphobia, I'm terming interphobia. The cartoon of Caster Semenya standing to urinate from a presumed male phallus is an example of interphobic humor.

Caster Semenya's case has served as a lightening rod for interphobia.

If you wander the world of internet humor, you'll find plenty of other examples like the post by Anthony I discuss here. Internet mockery of Caster Semenya draws its vitriol from a variety of sources--you'll find it laced with sexist insecurities about women with athletic prowess, transphobia from authors who presume that Semenya is an MTF trans person, racism in the form of assertions that if she were a "real woman" she'd have straightened her hair--there's a whole banquet of bias being served up. But there are specific elements of interphobia that lie front and center. There's a lot of prurient har-har speculation about her intersex genitalia, framing Semenya as someone whose genitals are on freakshow display. And there's castigation of Semenya for identifying with her sex of rearing.

What the cartoon I've shared from Anthony's blog post illustrates is rage at Semenya for identifying as female, iconically represented by which bathroom she uses. Thus Caster Semenya is shown both in a vulnerable position, at the toilet, and as smirking at the viewers as if daring them to do anything about the fact that she knows she is not a "real woman," illustrated by her standing to urinate. The text of Anthony's blog post is a list of body parts that he claims prove Semenya is "really a man," including even the shape of nostrils (!), but focusing most obsessively on the flatness of her breasts. "NO breast...naada, not even 1% breast, not even fat man breast...," he declares, and, making fun of a photo of Semenya in a dress, he says "they dress up the person into a woman....but they failed to give it a cleavage or breast."

It.

What Anthony concludes is that Caster Semenya is a man and should be running in men's races. He declares her a cheat by virtue of her intersex status, the sex she was assigned at birth wrong, and her gender identity as a woman unacceptable. Basically, Anthony wants to force Semenya to undergo gender transition against her will.

And Caster Semenya followed the rules.

There are rules we live under in our contemporary Western societies that I and many, many other intersex advocates have criticized. The rule that the spectrum of physical sex characteristics we are born with must be forced into dyadic sex assignments, often accompanied by unconsented-to infant genital surgery. The rule that we are supposed to grow up to identify with our sex of assignment. These rules, we are told, are for our own safety.

Doctors tell the families of genitally variant babies that without surgical sex assignment we will be treated as freaks, but surgery will protect us from pariah status. Some of us face traumatic "gender therapy" as children in an attempt to cause us to identify with the sex we were assigned, and again, our families are told this is for the best because it will protect us from ostracism. Our families are told to keep our status a secret. We're told to keep silent, fit in. Our intersex status will thus be erased, and we'll be safe.

Well, Caster Semenya was assigned female at birth, raised as a girl, and identifies as a woman. Her intersex status wasn't known to anyone at all--it wasn't even diagnosed until she was forced to undergo "gender verification testing" when some sore-losing competitors demanded it.

What this proves is that having one's intersex status secret is no protection at all.

We may pass as our assigned sexes--but at any time we may run into a circumstance under which our intersex status is revealed. We get in a car accident. We find ourselves with an ex with a grudge. We're thrust into the limelight, perhaps by winning a race. And we're outed--and thrust into the path of vicious interphobia. We face ER staff who take cell phone photos of our genitalia to send to their friends while we're unconscious, exes telling all of our Facebook circle that we're freaks, and random bloggers mocking us and declaring that we should be forced to gender transition.

The "solution" that doctors pose to the fact that intersex happens--to hide us all in the closet--does nothing to stop interphobia. In fact, it encourages it by making us vulnerable, isolating us from support, keeping us ashamed. The real solution is to fight interphobia directly. We need to come out, accept ourselves, and demand that others do the same.

Deaf Children, Intersex Children, and DSDs

2010-09-01T11:38:00.041-05:00

I want to explain a division in our community, between intersex advocates and partisans of the terminology of "DSDs."

Every day, intersex children are born to parents who are shocked, lost at sea. "How can this be happening," they cry, "I've never even heard of such a thing." And this, this is the crux of the problem. It's this problem of being born as strange little changelings to our parents that perpetuates infant sex assignment surgery, despite the ever-mounting evidence that the results are frequently unsatisfactory. And it is the issue of how to approach infant sex assignment that lies behind our division into two warring camps: those who say the term "intersex" is overpolitical and imprecise and that the "proper" term is "Disorders of Sex Development," and those of us who say we are not disordered, and take pride in calling ourselves intersex people.

The intersex and DSD camps are constantly battling now, at least in the U.S. The thing is, this is not unique to our community. It is something we share with others. Similar controversies erupt around Deaf children born to hearing parents, for example, or, in some cases, children of color adopted by white parents. This commonality is very instructive--controversy arises when children of marginalized status are born or reared by parents who are privileged along that axis of identity.

Consider the organized Deaf community, which centers around institutions and locales where signing, ASL, is the norm. This Deaf community experiences itself as a linguistic minority, rather than "disabled." Members of such Deaf communities are not impaired in their daily lives. Able to communicate in their rich language with those around them, they are enabled to study and grow, and develop a strong culture, literature, and traditions.

The problem is that children who cannot hear are born to hearing parents all the time. And those parents are shocked, at sea. Some hearing parents don't want to give up on the future they had imagined for their children, and say, "I just want my child to be normal!" And "normal" for them means having their child live and go to school in a "mainstream" hearing context, and focus on learning to speak. It means getting cochlear implants and focusing everything on trying to make sense of a bit of sound. It means that these deaf children spend their days isolated, surrounded by people who can't understand them, and spending countless hours both in school and out trying to learn how to speak words they cannot hear, instead of quickly and easily learning a visual language they have the sensorium to perceive, and spending their hours at school learning math and history.

The signing Deaf community aches for these isolated children. They see the children as disabled by their parents, failed by the professionals who surround them, misunderstood by doctors. And the Deaf community pleads: please, parents, accept that your child cannot hear. Make them part of the Deaf community by allowing them to learn Sign from infancy; become part of the community yourself by learning Sign. Some parents take the message to heart and find their lives much enriched; others resist--but at least the message is out there, and Deaf children become aware of it soon enough. You can see a person born without hearing as defective, disabled, in need of medical alteration. Or you can see them as simply different, Deaf, members of a rich minority culture.

The split between the medicalized and cultural approaches to Deafness are parallel to the split between the advocates of DSD terminology and intersex activists, but the context is different, because there are no organized intersex institutions, no consolidated intersex neighborhoods. We have no Gallaudet (the excellent Deaf university in D.C.). The situation for intersex children is more like. . . well, imagine if all Deaf children were given forced cochlear implants and their families told to hide the equipment, never to let anyone know their children couldn't hear, and to avoid even acknowledging to the children themselves the issue of their not hearing. The parallel's not exact--it's harder to conceal an inability to hear or speak well--but it does give a sense of where we stand.

Most intersex/DSD advocates of any stripe share something in common: we want infant sex assignment surgery to be curtailed. We want intersex children to be allowed to retain their sexual sensation, any chance at fertility, and the right to have the gender identity that they develop be respected and recognized. Let the babies grow up, we plead, and decide what surgery, if any, they want. But the intersex advocacy community is small and diffuse, as compared to the Deaf community, and so far, we haven't gained much traction. Parents of intersex babies have never heard of us, and doctors dismiss us as a few disgruntled nutcases. So five times a day in the U.S., a baby receives sex assignment surgery. Most of us continue to be raised in shame and utter secrecy, our genitals never looking "normal" after surgery anyway, but insensate, in pain, and often being reared as a sex we don't feel is ours.

The situation is bad, and something needs to be done about it. And this is where the small pool of intersex advocates splits. Who should we turn to for help? How can we improve the lives of intersex people? Will professionals save us? Or do we save ourselves, through community building and selfadvocacy?

Those of us who identify as intersex activists, in those terms, follow the route familiar to all civil rights' movements (and a fair number of us have been involved in LGBT politics). The basic model for improving marginalized lives, in the civil rights vein, is to take pride in one's identity, however stigmatized by the majority, and then to take action to get the majority to treat one's community better. The route to social change is rooted in embracing selfhood, and then moves on to a familiar array of tactics: be visible; protest; write letters to the editor, one's senator, one's pastor or rabbi; seek protective legislation, etc. etc..

So we act up. And one of the things we do is let people know we are very dissatisfied with how we have been treated by doctors. Unsurpisingly, many doctors have not appreciated this. It's damaging to one's selfimage, to listen seriously to a person who says, "You were not my savior or my hero--you hurt me, you did me wrong." Far easier for a doctor to dismiss our small if vocal group as a radical fringe, or perhaps to see us pityingly as the victims of older forms of surgery, very unlike the babies they now save from freakish lives with their newer, shinier surgeries.

And here's where advocates of DSD terminology chime in. They say, "We simply cannot afford to alienate the doctors, because it's the doctors' actions that make or break us. We need them to stop performing unnecessary surgery on babies' genitalia. And the only way to do that is to convince doctors that we are sane and not crazy. We need to be respectful to them, so that they will listen to us, and we can appeal to their desire to improve treatment." And so the advocates of "people with DSDs" are the political advocates of depoliticization. They argue, "Intersex activists are too far out there. Doctors see red when they hear the term 'intersex' now. Parents, too. Parents don't want to hear that their kid is some other sex, like permanently. In fact, lots of people in our own community are uncomfortable with the term. They don't want to be part of some group lumped together with queer activists, they just want to be seen as people."

I don't want to be seen as oversimplifying the DSD advocacy position--there are more nuances to it. You can read an eloquent defense of the terminology that is respectful to intersex-identified people here. But basically, the position is one of not rocking the boat. We should look to professionals, to doctors, to save us. If we're rational and polite and deferential and apolitical in our presenting of our case to doctors, then in time they will change the treatment regimens, and parents will listen to the medical professionals.

The thing is, similar lines of argument have been raised in the past. I recall in the 1980s, when many quiet, marginalized gay-identified people, living without protection from any nondiscrimination policies, looked to professionals to save them. Political activism, they argued, just alienated the populace. They looked to scientists to save them by finding the "gay gene." But it has been the brave actions of masses of LGBT people coming out at home and work and being politically active that have led to the gains in protection for LGBT people and same-sex couples, not some scientific discovery.

Or consider Dr. Martin Luther King, Jr.'s famous 1963 "Letter From a Birmingham Jail," an impassioned defense of nonviolently confrontational civil rights activism. The letter was addressed to a collection of moderate clergymen who had appealed to King to stop pushing sit-ins and to wait patiently for the legislature to produce civil rights protections. In due time, these clergy argued, if you are polite and trusting, these professionals will act. Just stop agitating, stop alienating them, be patient. But King was right--it was continuing civil rights activism that led to the enactment of the Civil Rights Act of 1964. I believe the lessons of our history are clear: if you want your people to be treated better, then take pride in who you are and demand your rights. And that is what I intend to do.

It's for this reason that I do not identify with the term "DSD." I am not disordered. I was born as nature intended me, and I feel no shame in that. I am an intersex person, and I personally have no interest in having my genitalia surgically altered. I shall not sit meekly by and wait for professionals to quietly change their minds about how to treat the young members of my community. I am going to be noisy and public in my demands, and I am going to work with our nascent social movement. My goal is to make the public aware that we are here, and that infant sex assignment surgery is making things worse rather than better for so many of us. It's public pressure and a shift in public opinion that will finally end the era of attempting to erase us medically. We will be recognized, respected, and no changes to our genitalia will be made unless and until we reach an age where we can request them, uncoerced.

In the future, I hope, when intersex babies are born, their parents, though probably still feeling shocked intially, will know that we are out here, leading happy lives. They can embrace their children--see them as members of a minority, yes, but also as lovely, not defective. They can learn from their children, about privilege and marginalization, to be sure, but also about the vibrance of human diversity. And these children will be able to connect with our community, help build our culture as a people, and contribute to the enrichment of our nation's web of identities, as today's Deaf community does.

Five Myths that Hurt Intersex People

2010-04-29T08:50:00.022-05:00

I've had conversations with some intersex acquaintances recently about painful situations in which (nonintersex) people have accused my friends of not "really" being intersex. Besides revealing how rude people in our society can be about policing sex and gender, what these conversations have illustrated are some central myths about intersex status that come up over and over again. It's these that I will address in this blog post.

Myth 1: Intersex people all have intermediate genitalia

Imagine this: you're an intersex person, nervous about dating and finding a partner. You work up your courage to disclose your status to people you're interested in, and after a series of them seeming polite but disinterested in dating, you finally meet a guy who expresses interest. You date for a while, and get to the point where the clothes come off. Your boyfriend gets a good look at you naked, accuses you of "making up that story of being intersex" because your body looks female to him, and breaks off the relationship, leaving you feeling misunderstood and ill-used.

Many people are intersexed in ways that are not visible to their partners. For example, an individual with AIS (androgen insensitivity syndrome) is born with internal testes but genitalia that look typically female. Intersex people born with visibly intermediate genitals are often subject to infant sex assignment surgery, another reason why our bodies may not appear visibly intersex to others.

What disturbs me about incidents in which a partner seems interested in dating an intersex person until the clothes come off is that it generally reveals that the partner was fetishizing the intersex person--only interested in them for their "exotic" body. In the situation described here, the boyfriend wanted to have sex with someone who looked genitally intermediate generally. I've also heard stories from intersex people whose genitals are visibly atypical about how a partner lost interest in them when the clothes came off because they didn't see the kind of "hermaphrodite" genitals they'd dreamt of, with a big penis and a vagina (a configuration almost unheard of in real life, but popular in pornographic fantasy). It's depressing to find out your date wasn't really interested in you, but in playing with some fantasy set of genitalia.

Myth 2: Intersex conditions are always diagnosed in infancy

Here's another unfortunate scenario: a person is having infertility problems, so they visit some doctors. They receive a diagnosis and turn in shock to an online gender forum to post "I was just diagnosed as intersex." Somebody responds, "Stop trolling this blog. You're not really intersex--intersex people all know what they are from childhood. You probably have sick fantasies or think saying you're intersex will give you an excuse to gender transition without controversy." The non-intersex person is accusing the intersex individual of being a non-intersex person exploiting intersex individuals, which is pretty ironic.

As noted above, many intersex conditions aren't obviously visible in external genitalia. That means that people may not find out about their intersex status until quite late in life. While the experiences of late-recognized intersex people are different from those of intersex folks diagnosed in infancy, they are not "less" intersex, and have to deal with physical and psychological ramifications for which they need support.

Myth 3: All infant sex-assignment surgery is aimed at creating "female" genitalia

Imagine this situation: you were born with intermediate genitalia but surgically assigned male at birth. However, you grew up hating your male sex assignment, and so you transitioned to female. Your experience has given you a lot of empathy for people viewed as gendertransgressive, so when you notice that a friend of a Facebook friend identifies as genderqueer, you write her a nice message and offer her friendship. She refuses your offer and writes you a nasty note back about how she knows you are lying about being intersex, since "all intersex children are made into girls." She accuses you of being a stalking, posing, creepy man-in-a-dress. Ironic and sad, isn't it--that a woman who identifies as breaking down the boundaries of sex and gender is policing those boundaries so rabidly and wrongheadedly?

It is true that intersex infants are disproportionately surgically assigned female, based on the appalling medical aphorism, "it's easier to make a hole than a pole." But some intersex infants are surgically assigned male--usually when they have at least one external testis, but sometimes under other conditions. The myth that this "never happens" leaves intersex people assigned male at birth open to constant suspicion and exclusion, increasing the difficulties they have to face.

Myth 4: Intersex people should be genderqueer

This myth comes up again and again in academic, activist and feminist circles: that intersex people, being neither male nor female in physical sex, must be genderqueer and androgynous. We're supposed to be standard-bearers for the fight to subvert artificial dyadic gender categories. Encountering an intersex person with an ordinary and "boring" masculine or feminine gender identity who doesn't look at all androgynous, these activists express puzzlement and disappointment--and in private, speculate that the person must have some minor, mild intersex condition, so they are not "intersex enough" to be insightful.

Intersex people face pressure from doctors and families and society at large to genderconform. Facing the opposite pressure to gendertransgress--subversivism-- is just as unfair. Yes, most intersex people open enough to disclose our sex status agree that it is damaging for our society to insist that everyone must identify as male or female. But we live in a society that understands gender dyadically, and like non-intersex people, we commonly identify as masculine or feminine.

Myth 5: "Real" intersex people are not genderqueer

Frustrated and upset by pressure from gender activists to gendertransgress, as descibed in Myth 4, some intersex people have created a reactionary opposite myth: that "real" intersex people have no interest in subverting dyadic gender understandings of male and female. These genderconservative individuals often don't actually identify as "intersex" but as "people with DSDs (Disorders of Sex Development)." And they go around arguing to institutions that "real" intersex people don't identify as genderqueer--that people who say they are intersex and argue for third gender categories and the like are posers, probably crazed feminist zealots or deceptive trans people.

What makes the myth that intersex people are never genderqueer particularly painful to me is that it is spread by members of our community. To undermine your own intersex siblings and deny their identities is counterproductive, pathetic, and cruel. Many intersex people identify as typically masculine or feminine people, but there are plenty who do not do so, and like all genderqueer people, they face a lot of social bias. We have no duty as intersex people to be genderqueer, but I see a strong moral imperative for us to support people who do have genderqueer identities and manners of selfexpression. There are enough hurtful myths circulating about intersex people already. We don't need to add one of our own to the mix.

Caster Semenya - An Intersex Perspective

2009-08-22T09:59:00.015-05:00

Controversy and a lot of prurient interest exploded into the news this week when South African Caster Semenya outran her competition in the 800m world championships by a more than two second lead, only to be accused of cheating by being intersex. As an intersex person following this story, I've felt . . . well, largely appalled by what spews from the mouths of competitors, sport officials, news commentators, bloggers, and eyebrow waggling, head-shaking people on the street. It's hard not to feel depressed encountering innumerable snarky statements such as this one: "South African runner Caster Semenya (hehehe...she has semen in her name...hehehe) won the gold in the women's 800-meter at the World Championships in Berlin last night, but officials may snatch (peen, I mean, pun intended) away her victory if it turns out she's really a dude." (That one can be found here, if you're really inclined to read it.) So I wanted to share my perspective on this story. I do apologize to Caster for joining the pile of people giving her no privacy, but as the media are overflowing with details of her life already, I at least wanted to step in to defend her.

The basic outline of Caster's situation, as best as I can understand it through news reporting which is mediocre at its best, is that she was born intersex, assigned female sans surgery based on her predominant genital appearance, and raised as a girl. However, like lots of us whose genitals are visibly intermediate, she grew up knowing she was not a typical female, which liberated her from gender conventions. She was a classic tomboy, refusing to wear dresses and competing with boys in sports. From what I can gather from the news, Caster did not, however, question her female sex assignment, only gender role limitations. An excellent athlete, chances are that she was defined by her physical abilities, as are many tomboy athlete girls with typical female anatomy. When she began to compete in major sporting events, her status as a woman was questioned, and Athletics South Africa "cleared her," declaring her female. Now that she has proven her remarkable running ability on an international stage, her international competitors want her disqualified for "cheating" by not "really" being a woman. The International Association of Athletics Federations has stepped in and is investigating her status, in what most news sources are oddly calling "gender testing." Generally, the news media assume that they will be able to issue a definitive answer on what her "true" (dyadic) sex is.

The main thing that saddens me about this story is the emotional tone of the commentaries. Other athletes, people on the street, and low media blogs are full of sneers and winks and nosewrinkled disgust. The major media bring in scientists and voice patronizing sympathy for how humiliating this must be for Caster, meanwhile capitalizing on the prurient interest in the story to gather viewer attention. Underneath it all is a widespread impulse to yank down Caster's pants and let everyone have a good look. It's a freakshow, with an intersex person the object of millions of prying eyes.

Some basic themes that will be familiar to anyone intersex arise over and over in the news coverage. There's ignorance of the very existence of intersex people, evinced in frequent speculation by laypeople that Caster must have had a sex change or engaged in doping. There's confusion of physical sex with gender identity, with detractors, including some of Caster's competitors, referring to her with male pronouns and speaking disparagingly of her butch appearance. There's racist scientific hubris, with Western sports scientists asserting that they can determine Caster's "true" dyadic sex after doing an exhaustive investigation of her chromosomes, hormone levels, anatomy, gonadal tissue, and psychology, while speaking derisively of the ASA's investigation as being unsophisticated. And most of all, there's the overwhelming belief in the myth of dyadic sex. Caster must be female or male; intersex cannot exist as a sex category.

One depressing sideline of this insistence that Caster must have a definitive dyadic sex is the regularity with which the term "pseudohermaphrodite" is raised by detractors. I've posted on how this term emerged in Western medical science to try to define away the existence of intersexuality ( see here.) Basically, in trying to erase the challenge intersex people place to the medical ideology of sex dyadism, doctors in the 20th century decided to call all intersex individuals who did not have ovotestes as their gonads "pseudohermaphrodites," no matter what their anatomy or experience. Somebody can be raised female, with average-looking genitalia and secondary sexual characteristics such as breasts, living a typical valorized heterosexual life, femme as can be (housewife, reader of romance novels, cookie-baker), yet all unaware, have internal testes and androgen insensitivity syndrome. If she goes to a doctor for treatment of infertility, suddenly she'll find herself labeled a "male pseudohermaphrodite." The medical term defines her as "really a man," not even intersex, let alone a woman. Anyone with testes is "really a man" according to this scheme of classification--which reveals the sex politics and semantics in supposedly "objective" science.

Those same politics emerge from the mouths of Caster's detractors. She is a "pseudohermaphrodite," they claim--not a woman, not even intersex, but a man trying to cheat honest female competitors.

Here's an irony for you. According to Western medical practice, the majority of infants discovered to be intersex are assigned female. This is done for surgical convenience (it being considered easier to remove an "inappropriate" penis than create an "appropriate" one), and due to a covert assumption about gender psychology, that women can deal better with gender ambiguity than can men. So we're assigned female, told we are "really women," subjected to mutilating infant surgery, expected to identify as female, not intersex, told to keep our medical history, if we know it, a secret, and sent out to live dyadic female lives. Many of us carefully live by the rules. But it turns out that if we do as we are told, we are still subject to being outed, discredited, mocked, and returned unceremoniously to the status of intersex oddity, as Caster's life illustrates--accused of breaking the rules.

What Caster's situation illustrates, from an intersex perspective, is that we exist. Dyadic sex is a myth--sex is a spectrum. Hormones, chromosomes, genitals, gonads--they are all arranged in many complex ways, and imposing a binary onto them is arbitrary. It's as arbitrary as saying all fruit is either sweet or sour. Sure, ripe cherries are sweet and ripe limes are sour, but most fruit gets its savor from both tastes, and some fruits balance at the tangy sweet-and-sour midpoint. You can measure all the fructose and ascorbic acid you want, scientifically. You can create a rule that divides all fruit into sweet and sour categories using precise measurements of sugars and acids. But that will not eliminate the fact that the experience of tasting fruit is complex, and that this complexity is what makes eating fruit delicious.

Given that sex is a spectrum, and that some of us live near its center, being obviously intersex, society needs to deal with us in better ways than by denying our existence, hiding us medically, and then reasserting our existence to disqualify us from participating in sports. And let us acknowledge that this disqualification is based on the insulting assumption that "real women" are categorically inferior to "real men."

Really, what Caster's case makes us consider is the strange fact that athletics are divided along dyadic sex lines. Sensibly, if one is looking at any particular sport, advantages exist according to physical distinctions--tall, long-legged people do better as hurdlers, for example. But millions of female-assigned people are taller and have longer legs than a typical male-assigned person, so why is gender and not leg-length used to create categories of competitors? There are significant differences in average height by race/ethnicity--would you therefore suggest that we divide people by race for sports competition? That would be no less arbitrary than dividing competitors by gender, though today it would be much more controversial. A much more sensible approach would be to create competitor classes by relevant physical category--as weightlifters are divided into weight classes. Then the question of "true" dyadic sex would be as irrelevant as the question of "true race" for athletic competitors.

My heart goes out to Caster Semenya, an intersex sibling caught in an impossible position--required to live in a dyadic gender, and then accused of wrongdoing because the assignment suits poorly.

We've Always Been Here

2009-06-16T13:29:00.019-05:00

I exist.

When is the last time somebody told you that there is not such thing. . . as you?

OK, perhaps that's not an experience you've had, but I encounter it periodically. This morning I had a frustrating experience with a person who insisted that intersexuality is a myth. He was certain that sex dyadism was an unassailable natural fact--that people and animals come in two flavors, male and female. In his mind, hermaphrodites and centaurs and dragons were equally mythic creatures, and equally likely to be waiting in line at the store with him.

Really, what this guy objected to was my appearance, which is androgynously masculine. He wanted me to "make up my mind." Basically, he objected to genderqueering on the grounds that gender identities must be dyadic because bodies are sexually dyadic. When I pointed out that I am actually intersex, he dismissed me as making a deluded, faddish assertion. He compared me to a furry, and dissed me and furries together as crazy folk possessed by a trendy madness. He told me to "grow up."

How would you respond to that? Am I expected to walk around with an MRI in my pocket? I've already posted how people don't get to do a pants check on me.

I choose to respond less personally, with empirical data, scientific and historical. Though in truth, when people are religiously attached to a belief in sex dyadism, all the empirical evidence in the world may fail to convince them to let go of their dogma. That was the case in my conversation this morning. Still, others may listen, so I share some data you can use should you find yourself in a position like the one I was in today.

The Divine Androgyne

Many--perhaps most--world religions incorporate divine androgyny. This reflects the presence of intersexuality in the collective unconsciousness. Angels in Judeo-Christian tradition are neither male nor female. In Greek mythology, the child of Hermes (the jock god) and Aphrodite (prom queen goddess of love) was Hermaphrodite, as seen in the image attached to this post. The ancient Egyptian god/dess of the Nile was Hapi, whose breasts and phallus were depicted as constantly flowing with fertility, like the Nile itself.

Some intersex advocates are uncomfortable discussing intersex deities in the world pantheon, because they feel it links us with fantasy. But mythos is based in fact--sometimes psychological, and sometimes material. It can be very useful. Psychologically, it can give us validation, and materially, it gives us clues to the historical past. After all, Homer's city of Troy was considered mythic until archeologist Heinrich Schliemann took the Illiad seriously and located and excavated Troy's ruins.

What the myths of the world show us is that intersexuality did not signify barren disorder, as it does to Western doctors today. It signified perfection (for the Judeo-Christian), beauty (for the Greeks), creation (for the Egyptians).

Cultural Traditions

More important from the empirical position of "proof" of our eternal presence are the cultural traditions that societies have all over the world for giving social roles to the intersex. For example, I'm Jewish. Jewish religious practice is traditionally highly sexed and gendered--males are circumcised on the 8th day of life, females must immerse in a mikvah after completing a menstrual cycle. What then of intersex children? The gemara instructs that intersex children (and animals) are given two additional gender titles, androgyne and tumtum. A Jewish child whose genitalia include both a clitorophallus and an invagination is an androgyne, and must follow all of the rules applying to males and females. A child without significant external genitalia is tumtum and is exempted from all gendered rules.

Intersex people have been born into all cultures throughout history, so there are many traditions for giving them a place in society. As intersexuality has been erased by modern medicine, the meaning of these traditions has often shifted or been forgotten. For example, Native American traditions for giving a socially valuable place to the two-spirited are now typically understood as relating to lesbian, gay, or transgendered individuals, while the home they gave to intersex children is largely forgotton. The Hawai'ian role of mahu is another example. Today, the word "mahu" is often assumed to mean crossdresser, and has taken on a derogatory edge, like "fag." But in Hawai'ian tradition, intersex children were deemed mahu, and it was an important social role. Individuals who were mahu memorized oral traditions, were instructors of the revered hula, and were consulted when infants were named.

Scientific Evidence

It seems ridiculous to present scientific evidence that intersex conditions exist--rather like gathering scientific evidence that some people are born with red hair, or that animals of all sorts have albino offspring at times. But for convincing those who demand such evidence, some facts.

Intersexuality is common in pigs. The people of Vanuatu revered intersex pigs, and carved their likeness, genitalia and all, onto statuary and bowls. British farming tradition was less appreciative. Intersex livestock were called freemartins, and in some localities killed at birth. In the U.S., where the most revered animals are our domestic pets, intersex is studied by veterinarians in cats and dogs. Intersex conditions have been studied by scientsts in goats, in primates, in mice, in horses, in smallmouth bass . . . in fact, just about any animal you can name.

The Moral of the Story

Intersex happens. It always has happened; it's hardly some new discovery or "fad." In fact, the fad in the historical story is the recent medical erasure of intersex people, our surgical alteration, and the attachment of shame to our bodies. We've been made so invisible that most people in Western nations aren't even aware we exist, and can voice the myth that we are mythic right to our faces. Let's hope that this fad passes soon.

Viewing Intersex Genitalia (Note: Explicit Artwork Included)

2009-05-25T15:25:00.022-05:00

Disclaimer

This is a drawing I did of the genitals of an intersexed person. If you don't wish to see explicit material, please skip this post. If you are an intersexed person or an ally of ours who is concerned that posting images of intersex people's genitalia is abusive, please read my previous post. I discuss at length the many ways that photographs of us are exploited by medical practitioners and others, and why I believe humane images are necessary. Thanks.

Does a Picture Paint a Thousand Words?

When you look at the drawing above, what do you see? I see a set of external genitalia, an intersexed set that falls pretty near the center of the spectrum of male-to-female genital arrangements. Most people in our particular culture and historical moment apparently see something else. They see. . . something wrong. They want to know what it means. They want to be told whether these bits belong to someone who is "really a man" or "really a woman." And the authority they turn to to answer this (impossible) question is not the person possessing the genitals, nor regious authority, nor social scientists, but the medical profession.

Doctors get a lot of prestige from being the people who get to interpret life's mysteries for the masses. And they have an answer. I'll tell you what that answer is in a little while, but first, before what you see gets filtered through the medical lens, let me describe the structures you see depicted.

Anatomy of an Intersex Person

There are a great number of intersex bodily configurations, both internal and external. Our genitals come in many shapes and sizes--as in fact do those of people who are not categorized as intersex. What you see in this set of intermediate genitalia includes a phalloclitoris of intermediate size. Apparently many people experience something similar to a foreground-background illusion looking at the phalloclitoris (you know, like the illusion that looks either like two faces or a vase, which you can see here). They see a little penis, then a big clitoris, then a little penis. This flickering view has nothing to do with the genitals themselves, but with the lens of dyadic sex we've been trained to expect. This illustrates how we don't just see the world-in-itself out there, but a filtered view that imposes cultural understandings onto what we see.

The shaft and glans of this individual's phalloclitoris are mostly covered by a sheath of sensitive skin that we learn to call a clitoral hood or penile foreskin--again, dyadic terminology. The sheath of skin is bound down on either side, and the underside of the phalloclitoris is attached to the individual's body. Thus, when this person's phalloclitoris erects, it does not stand out from hir body but stays tucked close, pointing rearwards, as is typical for a clitoris.

At the center of this person's genitalia you see an invagination. It is fairly shallow, unlike the deeper vagina of someone with a classic female genital configuration. It is lined with delicate, lubricating skin. The urethral meatus ("pee hole") is in the central slit of the invagination.

Around the shallow invagination you see structures which are intermediate between labia majora (in female anatomic terms) or scrotum (in male terms). In this individual, there are testes that have descended and are held within the labioscrotum.

What Doctors See

As I've explained in an earlier post (here), doctors are the enforcers of sexual dyadism, and see all people as having a "true" or "best" sex, either male or female. Most often they like to assign intersex people to be female, and they remove or "reduce" our phalloclitori. They believe, though they tend not to say this, that it's better to be a female-assigned person with a surgically-constructed clitoris that feels nothing than to be a male-assigned person with a small penis. What they say, I kid you not, is that "it's easier to make a hole than a pole."

Doctors still take the "hard route" and attempt to construct a penis at times, and it's in individuals like the one whose genitals I've drawn here that they are most likely to do it: those with external testes. Internal ones they generally remove, claiming they pose a risk for cancer, but external ones they tend to leave in place. Finding external testes, doctors proclaim an intersex person to be "really male." Therefore, doctors looking at these genitals don't see a person of intermediate sex, they see a male with a "disorder of sex development" that they would term "perineal hypospadias with chordee."

On Hypospadias

As I've said, genitals exist on a spectrum. People with hypospadias run along the spectrum from maleformed genitals to the smack-dab center illustrated in this post. In people with what doctors call "first degree hypospadias," the genitals include typical testicles and a penile form that varies from the average male's only by having the urethra open, not at the center of the head of the penis, but on the underside of the head. Generally, the further down the shaft or perineum that the urethra opens, the more intermediate the genital form (doctors would say "the more severe the malformation").

Doctors almost always propose surgery for infants with hypospadias, even when there is only a small shift of the urethral opening. This causes scarring and loss of sensation, perhaps very mild, or perhaps leading to full numbness of the penile head and underside of the shaft. Constricted areas, holes that leak urine ("fistulas"), and recurrent bladder infections are common side effects, but are all deemed by doctors to be outweighed by the benefit of surgery. That benefit is basically avoiding the social mockery doctors presume is unavoidable for people with atypical genitals--the "locker room factor." Many male-identified people who had childhood surgery for minor hypospadias are very critical of the decision that was made for them, and, like intersex advocates, argue that no genital surgery should be performed unless and until a person grows up and chooses it. They'd rather have a penis with an off-center urethral opening that is fully sensate than a numbed phallus with an on-center urethra.

For people with perineal hypospadias, the consequences of surgery are more severe. Instead of having the functional genitals with which they were born--atypical but sensate intersex genitals that lubricate, erect, and experience pleasure--they wind up with small surgically-constructed penises that may be severely scarred and mostly numb. Instead of simply sitting down to pee, they may deal with multiple fistulas, a stuttering urine stream, and frequent bladder infections. In individuals with chordee, as in the drawing, since the clitorophallus is joined with the body, part of the glans and/or shaft will be cut off, left buried in the perineum or excised completely. Often there are multiple repair surgeries over the course of childhood--which is a source of stigma, not a shield from it. And significant numbers of these individuals grow up not identifying with the male assignment they were given, and in deep distress over the loss of genital forms they wish they had been permitted to retain.

The Moral of The Post

If people could look at intersex genitals and actually see them for what they are, a great deal of pain and suffering would be avoided. What you see in the image is an intermediate genital form, not warped female genitals or disordered male ones. When a child with intermediate genitals grows up, zie may identify as female, or male, or intersex, and should be allowed to decide what surgery if any is appropriate--but few get that chance. Wrong decisions are made for us all the time, and this happens in large part because our families have never seen genitals like ours before. They don't know how to interpret what they see because they have no context. So they turn to the doctors, who get a lot of prestige (and money) out of diagnosing us, selecting a dyadic sex for us, and surgically altering us without our consent. And not knowing anything about intersexuality, families go along. It's for this reason that I think it's so important that people see images of the full genital spectrum.

Artwork by Luminis, marker on paper, digitally manipulated. Copyright retained.

The Intersex Peep Show

2009-05-20T14:44:00.034-05:00

No, You Can't Look in My Pants

Since I started coming out publicly as intersex, I've been asked by some people I've barely or never met to show them a photo of exactly what I keep between my legs. This is a very odd question--consider how you'd react if you received this request from some stranger. It can be disconcerting and creepy to realize that someone you don't know is thinking about your genitalia, requesting a photograph.

So no, I don't spread my legs for strangers. And motivation doesn't matter much to me in answering requests. Some people ask because they're kinksters. Don't get me wrong--I support everyone's right to their consensual kink--but I have not consented, and they don't get to play. Other people ask because of simple intellectual curiosity, and I support intellectual curiosity too. But I am not a specimen any more than I am a porno spread. I'm a person, entitled to my dignity.

Recently somebody contacted me wanting me to describe my genitals and my surgical history so zie could feel confident I was really intersex and not some poser. And while I empathize with intersex people feeling used or misrepresented, the answer remains no, you don't get to look in my pants to perform your gatekeeping.

But How Can We Not Discuss Intersex People's Genitalia?

This is an entirely different question than asking to see my. . . jonk. You're right, it seems odd to discuss intersex status without discussing genitals. I do want to point out that we discuss male experience, female experience, and the experiences of androgynes and genderqueer folk all the time without discussing their genitals. We don't ask to verify what they've got down there before discussing their gendered lives. And what defines intersex experience isn't genitalia but the social reaction to our bits--the way our very existence seems to create a crisis for medical professionals, families, and ordinary folk. There's no need to discuss our genitalia to address that social reaction.

But. I do think we should, as a society, discuss genitalia. How they come in a wide variety of configurations, a spectrum not a binary. We need to be aware of variation, not just in the genitalia of those of us labelled intersex, but those considered unproblematically male or female. Lots of nonintersex people feel anxiety about whether their genitals are "normal," or too small, or too loose, or too asymmetrical. We should know what genitals really look like. And a picture does paint a thousand words.

What's Wrong with Pictures of Genitals

The photos and illustrations of genitals most people see are highly problematic. They do injury both to the viewer and the person being viewed. Mostly, we're exposed to two sorts of pictures: either pornographic images, or medical ones.

I'm strongly opposed to censorship, and I stand up for the right of people to produce and view porn, but most of it is terrible. I'll mention two of the reasons why: first, most porn does harm to the viewer by showing a single "idealized" vision of the human body, and secondly, it harms the models (especially the female-assigned ones) because they are viewed by our sexnegative society as whores and perverts. From an intersex position, the representations of "us" as "hermaphrodites" in most porn are actually usually photos of nonintersex male-to-female trans people financing their transitions by filling the demand for images of "chicks with dicks." In a world where sex transitions are both costly and not covered by medical insurance, and where trans people suffer profoundly from employment discrimination, I empathize with the "herm" porn models. But the fetish market that they feed gives people a very skewed perspective on the lives of intersex and trans folks, and this peep show teaches people very little about what intersex people's parts look like.

Then there are clinical medical images, of two varieties. One are the sort of illustrations we see in educational contexts. For example, buy a package of tampons or condoms, and you'll find instructional illustrations included. Intersex genitals are never pictured, but really, few people's genitals look like the images you see. The illustrations in the tampon packages are almost always hairless with tiny symmetrical labia minora--they look prepubescent, and prepubescent people don't get menstrual periods. The penises in the condom illustrations are all circumcized, erect at a high angle, and look more like a hot dog than a human. Clinical educational illustrations seem designed to make ordinary people feel anxious about their genitals, their small penises and large clitori, their veins and moles and asymmetries and hair.

Still, at least nonintersex people see illustrations that somewhat approximate their bits.

If you want to see what intersex people's genitals look like, you have to turn to another sort of medical image: the clinical photograph. And the photographs range from depressing to truly appalling. Generally they're photos of children, taken without their consent. Sometimes you can see that the child is being held down. Orifices are stretched open by adult hands, foreskins are pulled up in the jaws of forceps, and ruler scales cut into delicate skin. The photographs are utterly dehumanizing--people reduced to "disordered" genitals and treated as specimens, with as much consideration as a doctor would show a biopsied sample of a tumor. It's as much horror show as peep show. Intersex children are treated as freaks, forced to spread their legs, and hurt without their consent--and because it's done in the name of Science, it's supposed to be OK.

It's not OK.

My Complicity, My Shame

The lack of education about intersex genitals is harmful in multiple ways, and one of them is that it makes us into peepers, and collaborators in the abusive treatment of intersex children.

I grew up knowing I was genitally different, but unsure of what it might mean. By my early teens I was looking through medical journals for pictures that might tell me more. I'll post sometime on my academic research on teratology, the branch of medicine that deals with "birth defects"--suffice it to say for now that I've looked at a lot of medical images of intersex people. And I can try to justify it in terms of personal need and academic critique, but in the end, I'm complicit. Not that I've ever sent a stranger an email saying "Can you send me a photo of your privates?" But I've contributed to maintaining the market for exploitative and abusive medical photography of intersex people.

What Can Be Done?

It seems to me that there is a real need for a collection of cruelty-free, nondistorted images of intersex people's bodies, including our genitals, for people to view. I imagine that illustrations would be best. There may be people out there with various intersex conditions or "DSDs" who would be willing to be photographed by a respectful ally for a public image gallery, but I suspect most people, like myself, would be very wary of the idea. Drawings would avoid the issues of shaming or disrespectful use of our bodies. Ideally, they would be nonidealized. They could be warm rather than clinical, human rather than dehumanized.

I'm going to try my hand at it. I'll see if posting a drawing turns my blog from the intersex roadshow to the intersex peepshow--I certainly hope not. But it does seem like an important project to me.

The image in this post is a manipulation by me of a photograph provided under a Creative Commons license by just.Luc here.

On Being Called a "True Hermaphrodite"

2009-05-14T08:54:00.020-05:00

I was born with an ovotestis, which is a gonad that is intermediate between an ovary and a testis. The medical terminology for a person born with an ovotestis is "true hermaphrodite." Today I'm going to post on what I hate about that term, and what I don't.

The Reality of Intersexuality

The reason people with ovotestes were termed "true hermaphrodites" by doctors was explicitly to categorize all other intersex people as not "truly" intersexed. Most intersex people were medically deemed to be "pseudohermaphrodites." This was based on an fundamental (and, to my mind, fundamentally evil) impulse to erase our existance.

The medical "logic" basically went like this: nature makes things male and female. Laypeople might doubt this when they see a person with intermediate genitals, but doctors know better. With Science they can tell the "true sex" of these people, and eliminate the challenge to sex dyadism.

It's a strange exercise, looking at people whose bodies are neither male nor female, and deciding you can tell what they "really are." Let's say you're looking at someone who has breasts, a menstrual period, and a penis. What are they "really"? You can come up with a rule and apply it, but that rule will be arbitrary. It's just like looking at the color purple and saying, "Purple is not a real color, so this must be either blue or red. I have a Scientific Rule I can apply to determine whether this is blue or red." Sure, you could create a rule, and apply it consistently, but that does not eliminate the fact that purple exists as a color people experience.

This belief that intersex people "really didn't exist" when they were standing right there was like some oddly theoretical genocide. At the time that the terms "male pseudohermaphrodite" and "female pseudohermaphrodite" were coined, sex assignment surgery had yet to be developed, so it was a purely verbal move to erase us.

Harmful Practices

Today, sex assignment surgery does exist. And the persistance of a medical belief that doctors can run tests on an intersex baby and determine hir "real sex" has harmful effects. Children are subjected to profoundly lifealtering surgeries without their consent. Imagine if someone cut your penis off without your consent, or removed your ovaries and chance for fertility. . . and when you cried, "What did you do to me!?" they said, "Oh, our tests showed you didn't need those."

Intersex advocates of every stripe are vehemently opposed to infant sex assignment surgery. They say, we say, that no surgery should be performed until a child grows up and can say what surgery (if any) zie wants. The foundational principle should be an individual's gender identity. A baby with CAH can have a penis, ovaries and uterus. If that baby grows up and identifies as a boy, then he may choose to have his uterus and ovaries removed. If the baby grows up and identifies as a girl, she may choose to have sex assignment surgery to change her penis into a clitoris.

Or how about this? The child could grow up with a gender identity that matches hir body. Zie could say, "I'm not 'really a boy' or 'really a girl,' I'm really intersex, and I don't want any surgery. My body is fine, lovely, just how it is, thanks."

As it now stands, that option isn't on the medical table. Doctors are still assuming that all of us must have a true sex, or "best sex" in the terms of the day, and that they are heros because they can fix us.

The Term "True Hermphrodite"

I hate the term "true hermphrodite" for two reasons. One, it deems most intersex people "false," not really intersex, which both leads to harmful practices and undermines people's ability to identify with their bodies as intersex. And secondly, it gives me some sort of privilege I don't want. I'm deemed the "real intersex," I'm "true." I certainly don't see myself as "more intersexed" than other intersex people, and I don't want to be seen as special or better.

The reason I'm termed a "true hermaphrodite" is because the arbitrary rule that doctors came up with when they developed the terms "true hermaphrodite," "male pseudohermaphrodite" and "female pseudohermphrodite" was that true sex was determined by gonads. A person with testes is "really" male, even if she has breasts, labia, clitoris, and vagina, even if she was raised female, wears dresses, identifies as a heterosexual female, and is married to a man. A person with with ovaries is "really" female, even if he has a penis, scrotum, and just won the Mr. Olympus bodybuilding contest. Only people with one ovary and one testis, or intermediate gonads, ovotestes, are "really" intersex. This rule is arbitrary and says nothing about our lived experience.

So I hate the "true" and "pseudo" terms for classifying intersex people. On the other hand, I, personally, don't object to being called a "hermaphrodite." I realize this is a very atypical position among intersex people. Most intersex people who are politically aware hate being called hermaphrodites because of the baggage the term carries. It evokes greek mythology, and we're not creatures of myth. It is used a lot by fetishists, who get off on the idea of having sex with a body that has breasts and a penis, and we're not volunteering to be sex objects for every kinkster out there. I agree that this baggage is a real problem. But I myself don't blame the term. I like that it shows how we've been around forever, and that in some societies, we've been considered specially blessed by the gods, rather than freaks.

In any case, I don't identify with the term "true hermaphrodite," and always put it in quotes. I'm intersexed.

Transphobia and Intersex Experience

2009-05-12T09:58:00.039-05:00

I woke up this morning to a set of transphobic comments on my last blog post. Rather than mope (OK, I did mope, but rather than continuing to mope), I thought I'd use this as a teaching moment.

Transphobia 101

Transphobia is the disrespecting of people who are transgendered--considering trans people to be pitiable or disgusting or evil or deluded or just plain weird. It is usually expressed by cis sexed people--those whose gender identity matches the sex they were assigned at birth. (Note that my definition of cis sex treats an intersex person assigned female at birth in the same sex category as a person with normative-appearing female genitals and gonads.) But other people can be transphobic.

Like all biases born of privilege, transphobia assumes that the marginalized identity needs explaining while the privileged identity does not. For example, homophobia works this way. Homophobic people often ask where queer identity comes from ("How do you know you're gay? Are you sure? What made you gay?") without asking where straight identity comes from ("How do I know I'm straight? Am I sure? What made me heterosexual?") Transphobic people expect trans people to have to explain and prove our gender identities when they cannot do the same for themselves.

Transphobes usually assume that our transtitions are about them: that we are doing this to gain access to their spaces. The favorite bugaboo here is the idea of "a man in a woman's bathroom, horrors!" Look, if some male-assigned creep wants to harass and assault women by peeping at them in bathrooms, he can just walk in and do it for free. But to medically transition from male-assignment to female status, a person must invest thousands of dollars over a period of years, endure social stigma, violence, employment discrimination, etc.--and be vetted by a series of medical professionals, all of whom are constantly ready to slam down the gate and stop the process if they catch any whiff at all of the transition being related to kink rather than identity. That's not a plausible route for peepers.

There is a transphobic double-bind that relates to how well trans people "pass"--that is, whether a trans person looks to observers like hir sex of assignment or hir sex of destination. When transphobes recognize a person as visibly trans, they mock hir: "Look! An ugly chick with mascara on her moustache HAHAHA!" or "OMG--dude in a skirt!" If they encounter a person they cannot assign to binary sex categories, they confront the person and demand a binary identification: "Hey! Are you a guy or a girl? What's wrong with you?" And if they take a trans person as their identified sex after a "successful" transition, and then discover the person is trans, they read this as deception, especially (it all being about them) as some attempt to sneak into their pants.

There are particular feminist-transphobic tropes as well. The second-wave feminist transphobic line is well-encapsulated by my morning commenter: "In case you forgot, the majority of transgender people are males to begin with. They still have their male power, male privilege, male upbringing and male experience. Even though they are trying to claim female, womanhood and female privilege, when in reality, they are still male." This transphobic vision imagines a cabal of men whose goal in life is to infiltrate the Michigan Womyn's Music Festival by any means necessary. Trans men are the dupes of this cabal, as my commentator states: "[Y]ou have been taken and hijacked by the tranny (male) mentality."

There is a third-wave feminist transphobic alternative reading of trans people. In this vision, gender is not an essentialist dichotomy that cannot be altered, but a repressive socially-constructed binary that must be subverted to liberate people. (The language is very High Theory, I know, I know. . .) Here the "crime" in transitioning is subscribing to gender stereotypes and strengthening the myth of dyadic gender, opposite sexes. If you were female assigned at birth, not believing that you are "really a woman" is great, but believing you are "really a man" is regressive, unenlightened, idiotic. You should subvert gender and be genderqueer but not transition.

Intersex Transphobia

To many people, the fact that intersex people can be transphobes comes as a surprise. If you are born obviously neither male nor female, people reason, any identity you have must make you an ally of trans people. You could identify as intersex, which is a very odd thing to do since it queers dyadic sex, and which puts you (in their minds at least) in the same box with gender transgressors like trans people and genderqueers. Or you could identify with your sex of assignment, which usually involves surgical assignment, and so you should approve of people having surgery to live in the sex with which they identify. Or you could be assigned to one sex and identify with the (binary) other, in which case you are trans gendered by definition.

However, intersex people can be quite transphobic. The dynamic is very similar to that of lesbian, gay and bisexual cis individuals who hate trans people and blame homophobia on the transgendered: "When I came out to my mom, she panicked and thought it meant I was going to start/stop wearing skirts to church and humiliate her--it's all your fault!" Intersex transphobes believe that they are treated as freaks by society because society thinks they are trans people. They see trans people as making a perverse choice while intersex people's misfortune is biological and "not their fault." If they could just purge the world of trans people, society would finally be nice to intersex people. It's a sadly common dynamic in all sorts of marginalized communities: instead of uniting to fight oppression, people direct their anger at some other marginalized group they see as nastier.

Another way in which intersex transphobia emerges is in relation to a myth held by some trans people. That myth is the belief that society must be kind to intersex people (since it's a biological condition), which leads a good number of trans individuals to wish for intersex status. Society is not in fact so kind--take a walk in my shoes, please--and I empathize with interfolks being upset at the denial of our pain implicit when trans people want to claim intersex status. But this doesn't justify transphobia. Consider a parallel dynamic: in the 1980s a lot of (white) gay men and lesbians said "Society is fair to black people because it's biological and not their fault, so we need to find the gay gene so homophobia will disappear like racism has." This totally denies the pervasive continuing racism that African Americans face, and is stupid and wrong--but this fact doesn't justify homophobia.

My commentator of the morning subscribes to this practice, and taught me a new slur. Zie says, "You see intersex as a 'blame free' group. It's fairly obvious that your a trans and your just another one of those transjackers, who want to hijack the intersex community for your own perverted gain." Transjacker, woo. Well, I am trans gendered, but I am also intersexed, and I can't see how one can hijack oneself.

Who's Erasing Whom?

It seems that my morning commentor believes that no intersex person is trans gendered. Maybe zie is asserting that all intersex people identify with the sex they're assigned at birth. Or maybe zie means that whatever sexes intersex people are living in, and whatever medical interventions they employed to arrive there, this does not constitute "transitioning," and hence thay are not trans gendered. I'll quote what zie says:

"I also find that by you claiming that intersex has a link with trans, you are in effect erasing the history, upbringing and experience of those who are born intersex and intersex born intersex people. You are erasing not only my intersex experience, upbringing and history, but you are erasing every other intersex person's experience, history, and upbringing as well. So I hope you like what you did, by erasing mine and every other intersex person's shared experience, upbringing and history because you and every trans out their are doing that to women, lesbian and intersex people out their."

I thiink that my commentator believes that I was not born intersex. Either that or zie's saying that since no intersex people are trans, and since I identify as trans gendered, I am by definition (no longer) intersex. Whichever is the case, my commentator is projecting hir desire to erase onto me. Zie is saying I don't exist. I am not part of the "every intersex person out there" who is being destroyed by my saying that intersex and trans gender experiences have a lot in common.

I'm Not Going to Disappear

Sorry, my lived experience as a female-assigned-at-birth "true hermaphrodite" who is transitioning to somewhere on the interboiside is not going away.

My commentator says, "Their is no one within the science, medical and academic community who will back your warped logic and claim [that there is a linkage between intersex and trans experience]." Well, I am a professor, I study medical sociology, and I used to work at a genetics lab, and I can assure you that my commentator is incorrect.

The Moral of Today's Post

My conclusions are simple. Intersex people suffer from transphobia. Intersex people can be transphobes. And trans people who think that they'd be safe from bias if they had intersex status are sadly wrong. But none of that is going to stop me from speaking my mind.

Intersected, Transsected: The Intersex / Trans Nexus

2009-05-06T16:45:00.014-05:00

A troubled alliance

Intersex and trans people share some deep common experiences. Yet we often find ourselves prickling at comments made by people in the "other camp." As an intersex person assigned female at birth and transitioning to the male side of androgyny, I consider myself both intersex and trans, and I'd like to speak to what both groups share, and what divides them. Divides us.

Commonalities

The most fundamental thing intersex and trans folk share is that we suffer because we belie the ideology that dimorphic genitals determine gender. This is the belief that people are born with one of two possible genital configurations ("It's a boy!"), and that gender identity is inevitably bound to this genital configuration. Penis = boy; vulva = girl. This is an ideology so basic that most people in our Western society rarely if ever question it. Then we intersex and trans people come along and call a fundamental belief into question. Genitals come in a spectrum of possibile flavors. Gender identities are not determined by genitals. We are girls born with penises, or androgynes born with vulvae, or boys born with both testes and a vagina. And we freak people out.

Freaking people out when it comes to sex and gender turns out to have serious consequences. We evoke shock and horror, distate and tittering, fetishistic dehumanizing desires. People fail to treat us as. . . people. Doctors poke and prod us, employers find excuses not to hire us, and idiots bash us. So: we share a common enemy. We suffer from the enforcement of the ideology that dyadic genitals determine gender.

Another thing intersex and trans people share is that we have a difficult relationship with doctors who have power over our lives. For people with intersex conditions, this often starts at birth, when doctors label us as defective and in need of surgical "correction." We are subjected to sex assignment and "corrective" surgeries without our consent. Then many of us, perhaps half, join with our trans siblings in facing gatekeeping from the other side. People who identify with a gender that does not match our bodily sex characteristics often want to alter our bodies, to reduce feelings of tension, and to get other people to recognize our deep internal sense of self. And we face a lot of hurdles. Medical insurance generally doesn't cover sex transition services--and they are expensive. Worse, to get access to them we have to run a gauntlet of medical gatekeepers. We need psychologists and doctors to grant us access to the hormones and surgery we want, and they make it hard for us, very hard. At every step we may find ourselves confronting, if not outright bigotry, a strange assumption that to want to do what we want to do, we must be mad. We have Gender Identity Disorder, considered a mental illness. Gatekeepers act as if we might well be utter psychos, and need to be tested, cautioned, challenged, as if anyone decides to face discrimination and violence on a whim.

Another thing trans and intersex people share is the way in which we are sexualized in a society with both Puritan and Dionysian strains. This is complex enough to rate its own post, so I'll set it aside for now.

Tensions: Intersex Complaints

Something that makes a lot of intersex people grouchy is encountering trans folk who think we have it easy. There's a belief some trans people hold that doctors and people on the street are understanding of intersex people's needs. More particularly, these trans people think that if they had an intersex diagnosis, they'd get easy access to medical transition services, and have their transition honored by employers, schools, the DMV, and other institutions.

Well, it ain't so. Doctors and families make decisions on behalf of infants with visible sex variance, and having subjected us to surgery without consent, they don't want to hear that we're ungrateful. As for schools and employers and DMVs, we have the same relationship to them if we want to undo a sex assignment that trans folk do when they seek sex reassignment. In fact, while some intersex people are granted more easy access to medical transition than the average trans person, others find the hurdles actually greater, because of the way that psychologists classify us (something I'll adress in a later post).

Nobody wants to hear their suffering dismissed. Intersex people feel hurt when trans people treat living with intersex status as a walk in the park. It is true that *some* doctors and families and coworkers are more comfortable treating intersex people as tragic victims than they are when they look at trans people and see them as having "chosen" to be freaks. But it's not true of others, and focusing just on reassignment issues glosses over all that intersex kids often suffer in childhood, with multiple surgeries, humiliation, and familial silence.

Another thing that bugs intersex people is when trans people try to latch onto intersexuality as a way to explain their identities. This is especially common among people just coming out of the closet. Trans folk who've been living in denial and are reaching the point where they can't bear it any longer often search the internet, find one of the few intersex support sites, and start posting about how they must be intersex: "I must have some intersex hormone imbalance--I hate sports and cry easily." "People have told me my clitoris looks kind of big and I want to have sex with girls, so I must be intersexed." It makes it hard for intersex people to use the boards at times. Interfolk get tired of explaining the difference between intersex conditions, sexual orientation, and gender dysphoria.

Intersex people who don't identify with binary gender options can find the dichotomous understandings of gender that many trans people express (girls don't like sports, boys don't cry) irritating. Of course, this is a frustration experienced by genderqueer trans people as well.

Tensions: Trans Complaints

Trans people are less likely to feel irritated by intersex people's actions, because they usually aren't aware of meeting any except the occasional transitioning interperson at a trans meeting. Intesexed people are instructed from youth to go stealth, and we're often invisible. But there are legitimate gripes that trans people can have with intersex folks.

Intersex people can be transphobic. Those who identify with their sex of rearing can reject people of any bodily configuration who are interested in transitioning. Interpeeps who want to transition can consider their need more justifiable than the need of trans people born with more normative genitalia. This is wrongheaded, wronghearted.

Just as genderqueer intersex folks get irritated by trans people who hold to highly dyadic, sex-sterotyped gender ideologies, genderqueer trans folk can find stereotypical dyadic gender presentations from intersex people very disappointing. If anyone should be enlightened about the force of gender-regressive ideology, it should be intersex people. And I can certainly understand why genderqueer trans people, suffering the slings and arrows of social bias against androgyny, would want intersex people to identify outside the gender dyad. But while I myself present as androgyne, genderqueer trans people should have empathy for the fact that the majority of intersex people do identify as women or men. Given the extraordinary pressure intersex people are under to genderconform--from the medical profession, their families, even intersex advocates, above and beyond the social pressure everyone faces--genderconforming presentations are unsurprising. And everybody's gender identity deserves respect, whether it aligns with sex of rearing, against it, or ourside the binary.

Alliances

As an intersex person who is transitioning, I see clear common cause between inter- and trans folk. Many intersex people deal with transition, and live as a bridge between the inter-cis and the trans community. Those I've just termed the inter-cis--people with intersex conditions who identify with the sex assigned to them at birth--could gain support and community if they'd come out of the closet and identify as siblings of people who sex transition. Intersex advocates could gain the support of a large pool of trans people and work together on a general campaign for the individual right to choose to use or avoid medical intervention in sex characteristics ("My body, my sex, my right!"). Trans people could gain allies whose very existance undermines the genitals-determine-gender ideology that binds people.

There are issues to address. Intersex transphobia and trans intersex-fetishizing are both highly problematic. But our commonalities far outweigh our differences, and we should be allies.

Intersex 101

2009-04-28T16:19:00.011-05:00

What is intersex?

OK, it's important that I get the basics out for blogreaders unfamiliar with intersex conditions. In our society, it’s common to think that all people are born either male or female. But the biological truth is that sex is a spectrum. It’s typical for people to lie near the male or female ends of the spectrum, but many people are born with bodies closer to the middle. Sometimes this fact is immediately clear at birth, because a baby has intermediate genitals. Sometimes a person may look male or female on the outside, but have different internal organs than would usually be expected. And sometimes a person may have a body with typical female or male organs, but have chromosomes that do not match expectations.

How common is intersexuality?

About 1 in 1000 babies are classified at birth by doctors as having a disorder of sex development or DSD because their genitalia appear atypical. This is more babies than are born with Down’s Syndrome. But many more people have intersex conditions that are not obvious at birth. It is commonly estimated that 1 in 200 people has an intersex condition. Some find out because they encounter fertility problems, or have a medical scan done for some unrelated reason. Some people never know--do you know if your chromosomes are XX, XY, XXY, or some other variation?

What is the gender of an intersex person?

The way to tell the gender of an intersexed person is to ask them. Often intersexed people identify as either male or female, because that is how contemporary Western society understands gender. Some of us do not identify as male or female, however. You can’t tell by looking at an intersex person’s body what their gender identity will be—different people with similar looking intermediate genitals will have different identities. Simply respect each individual’s sense of self.

What are central concerns for intersex people?

Intersex status has been treated as a source of shame in the U.S., which means that most intersexed people are in the closet about their status. We have been called “freaks” and “monsters,” have been treated as sexually titillating, have been excluded from international sporting competitions, and have been subjected to medical treatment without consent. Intersex people deserve to have their bodies, their gender identities, and their choices respected.

A major complaint of many intersex people is that they were subjected to childhood surgery that they are unhappy about. Every day in the U.S., 5 babies are given sex assignment surgery to “correct” intermediate genitals to look more typically female or male. Doctors choose the sex they see as appropriate for the infant based on appearance or surgical ease—and quite often, their choice is wrong. In addition, many cosmetic surgeries are given to try to “normalize” children’s genitals. Although doctors say they have gotten better at these surgeries over time, they usually produce loss of genital sensation. I don't know about you, but I and many others would rather have sensitive genitals than somewhat-more-average-looking ones. Advocates for the intersexed urge that no sex assignment or cosmetic surgery be performed on children. Instead, intersex children should be allowed to grow up to make their own decisions about what surgery, if any, they would like.

Intersex people may suffer from gender dysphoria if they were assigned by doctors to a sex but do not identify with it. If so, they should be assisted in securing hormonal and/or surgical treatment so that they can transition to the sex that is the same as their gender identity. Intersex people who develop at puberty in ways that conflict with their sense of identity should be given access to hormonal treatment to suppress unwanted periods, beard growth, etc. In dealing with managing our bodies with surgery and/or hormone therapies, intersex people share experience with trans people, and that commonality should be respected.

Intersex people and their families may also need supportive therapy. When a mother gives birth to an intersex baby, the family may be thrown into distress. It is especially important that the family receive support so that hasty decisions about “normalizing” surgery are not made. Adults who discover that they are intersexed may also be thrown into an identity crisis and need support. And since all intersex people have to face lack of understanding and pressure to hide our sex status, many of us need access to counseling.

There is a myth that intersex people are almost always infertile. Sadly, many of us are infertile not because of how we were born, but because of surgical intervention in infancy. In fact, intersex people can have children (I did it. . .), but we may need fertility treatment and supportive medical assistance during pregnancy and birth.

What are some common types of intersexuality?

There are many conditions that lead to intersex status. I have no interest in getting overly clinical and showing the sort of medical photographs of dehumanized children with their genitals exposed that are so common in discussions of intersex. We are people, not . . . bits for display. However, I'll do a quick run through of some of the most common flavors of intersex people, with physical description, in the name of education.

People with Androgen insensitivity syndrome usually have a clitoris, labia, and partial vagina, with testes internally. They develop breasts at puberty, but no periods. People with Partial androgen insensitivity syndrome are born with intermediate genital appearance and internal testes.

People born with Congenital Adrenal Hyperplasia or CAH are born with a phallus, empty scrotum, a uterus, and ovaries. At puberty, people with CAH will develop breasts and get a period.

Hypospadias refers to a range of conditions in which a person has phallic tissue, but does not have the urethral opening at the tip. This can be a small displacement in an otherwise typical penis, or can occur with an intermediate genital appearance.

People who have Klinefelter Syndrome are born with XXY chromosomes. Individuals with Klinefelter’s usually have a penis and small testes, wide hips, small breasts, and are usually tall and long-limbed.

People who have ovotestes are termed true hermaphrodites by doctors. Ovotestes are gonads which combine ovarian and testicular elements. Those of us with ovotestes may also have an ovary or a testis, and often have a uterus and a menstrual period.

What can other people do to be allies for intersex folks?

There are plenty of things allies can do, and I'll post more about them later. But the single most important thing allies can do is to refuse to treat intersex status as something shameful and freakish. Allies can help educate people about the fact that intersex happens and is not some sort of medical emergency requiring cosmetic surgery on infant genitals. Only an intersex person can determine what hir gender is, and what surgery if any zie wants--doctors and parents can no more decide what gender a person will have than they can pick hir sexual orientation or taste in music. Educating people about this will help lead to a day when parents welcome an intersex baby as a happy rather than tragic addition to the family.

Intersex Roadshow: A Personal Introduction

2009-04-26T16:46:00.020-05:00

Intersex by birth, honest by choice.

I'm Cary, and my sex is neither male nor female; I'm intersexed. I was born that way. Because my nonstandard set of parts included an ovotestis, which is a gonad that's in between an ovary and a testis, I'm classified medically as a "true hermaphrodite." But doctors don't get to decide who I am.

I'll explain more about the sorts of bodies that get one classified as intersex in a later post. I'll also go into more detail about how we get treated by doctors, institutions, families, and people on the street. The simple story is this: we live in a society that acts as if there are two sexed flavors of people--male and female--but reality is more complicated and more interesting. Intersexed people are all around you, though often you'd never notice us. We live in a culture that treats intersex status as shameful, and most of us born this way have been told all our lives to hide it. I'm not hiding anymore.

I am not defective. I am not disordered.

It is a simple fact of nature that sex is not dyadic, not black-and-white, not limited to two categories. Real bodies come in a rainbow of possibilities. But our medical establishment today insists on allowing for only two, male or female. Intersex conditions are deemed "birth defects" that must be "corrected" surgically, as soon as possible--even though the surgery leaves us with scarred genitals that don't look typical and have limited or no sensation. The idea is that somehow the surgery will make us have "normal" identities as men or women, and that this is vital for everyone's wellbeing.

The power of the medical establishment is so great that what limited intersexed advocacy there is focuses on doctors. The aims of advocacy are basically two: one, to stop infant genital surgery, and two, to get access to medical resources to undo earlier medical interventions. To try to reach these goals, our advocates have been forced into bizarre postures. Again, I'll explain more in a later post, but in brief, doctors dismissed intersex advocates' calls to end infant genital surgery, saying, "What?! You want to keep us from doing surgery so these poor infants will grow up to be some third-sex intersexed freaks? Never!" To placate the doctors, these advocates said, "Oh no! We just want to delay surgery a bit, but we'd never want people to grow up to be unsexed freaks! In fact, we'll never use the name 'intersexed' again. We're just people with Disorders of Sexual Development who are a bit miffed because you cut off the parts we wanted, so please give us more surgery and hormones so we can be normal men and women living with well-managed DSDs."

Well, I am not defective. I am not disordered. I am an intersexed person. And if both doctors and people who speak in my name recoil in horror when I say that I don't indentify as a man or as a woman, too bad for them.

United we stand.

A couple of years ago, something happened to me that changed my life: I met my partner, Beta. I was doing research on embodiment in virtual worlds and was interviewing people with gendertransgressive avatars. In the course of interviewing Beta, I found myself in the presence of someone smart and appealling. . . and openly intersexed. As I've said, most intersexed people have been well-schooled in stealth, so this was a rare treat. One of the joys of having Beta in my life is how things that seemed implausible in isolation became possible in tandem. Like coming out, and being honest about my birth status, or using neutral pronouns (like the pronoun "ze" instead of "he" or "she"). Like being able to assert my masculine gender identity, my intersex sex status, and a femme flair to my style of gender expression all at once, unapologetically.

Lots of people live genderqueer lives, though it' not easy for anyone, given the gender role policing commonplace in American society. Oddly enough, though, it's particularly hard for an intersex person to step outside the confines of dyadic gender, and it wasn't until Beta entered my life and lent me hir support that I was really able to do it myself.

Don't fence me in.

Something that really frustrates me is hearing advocates tell the world that "real people with DSDs" almost always identify as male or female and conform to gender norms. They say that exploitative academics want to use the idea of intersex to subvert gender, against the wishes of "real people with DSDs." They say, "Of course we have nothing against transgendered people who don't want to go all the way and like confusing others with their odd gender presentations, but really. . . people with DSDs are usually quite happy with normal male and female labels."

I was female-assigned, female-reared. I never identified as a "real woman" and wanted out of that box, but it just seemed implausible for me to do anything about it. When you're facing not only the usual transphobia, but the voice of Intersex Authority saying you shouldn't attempt to escape the dyadic gender boxes, it's hard. All I can say is that when I finally, finally came out, it was such an extraordinary relief.

So, I'm an academic, and I do think acknowledging intersexuality presents a strong critique of dyadic gender ideology. I'm not going to keep quiet about that just because it freaks out doctors with regressive gender beliefs. I am profoundly concerned that those doctors are performing lifealtering cosmetic genital surgery on unconsenting infants, but I don't think my keeping silent and closeted helps matters.

The intersex roadshow. . .

What I think will help is just the opposite. I want to take my intersex, androgynously masculine, gendertransitive self public. I want to talk about things I've been thinking about for many years, personally and academically. I want to reach out to my intersex sibs, and to genderqueer folk, and to thoughtful, interested people of every stripe. Hence this blog . . . Hope you enjoy.