Source of book: I own this
It is hard to believe it has been
a decade since I wrote my series on the Bathroom Wars™, aka the demonization of
transgender people, which has become the favorite hobby horse of the
hate-obsessed right wing in the Trump era.
In that series, I talked about the
issues
facing intersex people, and the perceived necessity of right wingers to
deny that they exist - and to force them into a rigid gender binary. Later, I
talked about how denialism
about queer people is fundamentally driven by misogyny and the need to
preserve a hierarchy of power that justifies male violence against
women.
I link both of these for different
reasons. The first in part is because I talk about an intersex client I had
over a quarter century ago. Representing that client opened my eyes to a lot of
things, including the legally sanctioned genital mutilation that continues to
be done to intersex people. The second is because it really ties in with some
of the things that Hermaphrodites and the Medical Invention of Sex
points out.
One thing I will note is that, not
only have I learned a lot more since I wrote the first post, there has been a
definite shift in my understanding of white evangelicals in the intervening
time.
I used to think that they could
respond to an appeal to some combination of facts, empathy, and human decency.
I no longer believe that. Most white evangelicals are driven by terror of and
vicious hatred for people different from them - and while that includes people
with different beliefs, skin colors, and national origins, what they hate the
most are people who are outside of their rigid gender and sexuality binary. Can
some change their mind? Yes. But most of those who can already have, now that
Trump has revealed the evil that lies at the core of white
evangelicalism.
Okay, so, that out of the way, I
want to talk about what this book is and isn’t.
This is not a book about intersex
variations. You are not going to learn about the various causes of intersex
traits, their challenges, fertility options, or other scientific
specifics.
Rather, this is a book about the
modern history of how medicine has responded to the existence of
intersex people.
The author is a historian, as she
makes clear with a fun Star Trek reference:
I often wanted to retreat to a paraphrase of Star Trek’s
Dr. McCoy - “Damn it, I’m a historian, not a doctor or an ethicist or a
sociologist!”
Intersex people are nothing new.
They have always existed. St. Augustine talks about them. They are a part of
many ancient mythologies. We have evidence of their existence dating back to
the dawn of human writing about humans. They are a natural and normal part of
nature.
This has, historically, been
recognized - it really is a modern affectation to believe in only two
sexes, and a rigid binary.
The Hippocratic paradigm assumed that sex existed along a
sort of continuum from the extreme male to the extreme female and that the
hermaphrodite therefor was s/he who lay in the middle.
This is because of how organisms
develop. Rather than create two completely different templates for male and
female, we have a lot of overlap in the DNA assembly instructions. It’s as if a
motorcycle and a helicopter were made using mostly the same parts, and the
parts that differed were variations on the same parts.
This is literally the case for
male and female. It is why male mammals have nipples. It is why the same
structures in early development can become either male or female genitalia and
gonads.
Because of this development
process, wherein genitals and brains develop on different schedules and in
different environments, not only can genitals and gonads not fit the pattern of
“male” or “female” development, brains too can develop in a way that they do
not match genitals. (This is very likely why transgender people exist - they
are intersex at a level that we do not currently have the technology to
understand.)
Again, most of this isn’t
addressed in the book, other than to give enough background to understand a bit
of the why. The book focuses on how doctors (nearly all of them white
and male) dealt with the obvious existence of people who didn’t fit
classifications.
I will get into more detail later
in the post, but I will give the big spoiler: because of societal
pressure for there to be a gender binary, doctors spent their time and efforts
not in bettering the lives of intersex people, but in “determining” what the
“true” sex of their patients were, then forcing them into living as that
supposed “true” sex.
That this led - and continues to
lead - to much suffering and even suicide should surprise nobody.
The Procrustian approach has
never served humans well.
While there has been some progress
around the world in the treatment of intersex people, the religious right here
in the United States continues to deny that they exist, instead insisting that
everyone is either male or female and can be mutilated to better “match” that
assigned sex.
And that really is what this is
about: giving doctors and governments the right to “determine” what sex a
person is, and mutilate their bodies without consent in order to preserve the
myth of a rigid sexual binary.
Before I get into the book itself,
I want to note that “hermaphrodite” is now considered an outdated and
inaccurate term - it has been used as a slur at times, and few intersex
individuals have both male and female traits. The more usual is a set of
traits that have elements of male and female.
Instead, I will use “intersex” as
the more medically accurate and preferred term when using my own words, and
“hermaphrodite” only when quoting the author or especially the 19th Century
doctors who are quoted extensively in the book. The book was published in 1998,
and a lot has changed since then in terms of terminology, so understand that
Dreger will seem a bit dated at times.
The book opens with the story of
Sophie, a Belgian woman whose case came to the attention of a doctor named
Dandois when she consulted him regarding a difficulty her husband had in
penetrating her vagina.
Further examination revealed that
Sophie’s genitals were a bit unusual. She had an incomplete opening, and a
phallus-like organ that was too big to be a typical clitoris, and too small to
be a typical penis. The urethra did not go through it. Her labia had at least
one testicle in them - at least as far as the doctor could tell through
feel.
In what is a theme of the book,
the doctor decided that Sophie wasn’t a woman at all, despite being raised as
one, identifying as one, and being otherwise happily married to a man.
Sophie was furious to find out
that the doctor considered her a man and wanted her to change her name and mode
of living to reflect that.
Far better would have been for the
doctor to have understood how intersex traits work, and educated Sophie (and
her husband) about the nature of her body.
The author explains how sex (and
not just gender) is complicated.
The sexual development of any individual is a complicated and
amazing event, involving the working of chromosomes, the action of
self-produced and/or ingested hormones, the effects of environmental agents
like toxins and nutritional substances, social norms like those that dictate
circumcision or clitoridectomy or certain levels of physical prowess, family
dynamics, individual sexual encounters, accidents, and so on. What it means to
be a male, a female, or a hermaphrodite - or what it means to become a male, a
female, or a hermaphrodite - goes far beyond the “sex chromosomes.”
Dreger continues:
Indeed, when we focus on hermaphrodites, as this book does,
we sometimes forget how much variation in sexual anatomy there is among
undoubted males and females. Clitorises and penises, for instance, come in a
wide range of shapes and sizes even in people labeled “normal” in terms of
their sex.
The same is true for secondary
sexual characteristics, as the author points out.
Also important to the discussion
is that our society is structured around a sex binary, which includes
everything from pronouns to bathrooms to clothing. And our understanding of
what makes one “male” or “female” is so culturally conditioned that any supposed
“test” for sex will be inadequate at best.
Although it seems not so difficult to recognize that some
bodies look fairly unusual in terms of the genitalia, it is difficult to answer
the question of what exactly a hermaphrodite is, because to do so one must
first decide what trait or traits are so important to femalehood and manhood
that the possession of a combination of those traits by any single body would
necessarily designate that single body hermaphroditic.
The author talks about the history
of “sex testing” for athletes, which itself led to great difficulties in
defining what made one male or female.
In contrast to the increasing
difficulty of drawing a rigid line as we have learned more about human sexual
development, the trend noted in the book regarding how male, female, and
intersex were defined has been to exclude more and more people from
being “true hermaphrodites” and instead assign them to “male” or “female,”
consequences be damned.
Hermaphrodites get reduced in number (by being sorted and
surgically made into “boy/man” or “girl/woman” types) chiefly because we have
many social distinctions that depend on their being (only) two sexes.
And this is also about compulsory
heterosexuality.
Even a cursory study of the phenomenon of sex-sorting, one
soon discovers that a significant motivation for the biomedical treatment of
hermaphrodites is the desire to keep people straight. That phrase - keep people
straight - should be taken figuratively, but literally as well: medical
doctors, scientists, hermaphrodites’ parents, and other lay people have
historically been interested in sorting people according to their sexes to
avoid or prevent what might be considered homosexuality.
The author, in her class on this
topic, finds that students will ask her in exasperation what the real
key is to male, female, and other.
But, as I tell them, and as we shall see, the answer
necessarily changes with time, with place, with technology, and with the many
serious implications - theoretical and practical, scientific and political - of
any given answer. The answer is, in a critical sense, historical - specific to
time and place…What it means to be a male, a female, or a hermaphrodite - and
how you know you are a male, a female, or hermaphrodite, and what will happen
to you if you are identified as a male, a female, or a hermaphrodite - is
specific to time and place.
Throughout the book, the author
uses “medical men” and similar gendered terms, and notes that the reason for
this is that they were all men. This is problematic in many ways, and
not just in the sense of obvious sexism. Without the perspectives of women and
intersex people, the decisions made tended to reflect the need to maintain
patriarchal norms, not do what is best for individual humans.
Indeed this classification system developed in direct
response to the exigencies of hermaphroditism and especially in response to the
pervasive interest among medical and scientific men in keeping social sex
borders clear, distinct, and “naturally” justified.
There is in fact one woman in this
book, Clemence Royer, and it is interesting that she very often had a different
perspective on matters than the men she worked with.
Just one example of a questionable
path history took as a result was that of looking at sex as being determined by
one single trait, that of gonads. This is expanded on in a later chapter. This
had the effect, particularly in the United States, of shifting power away from
intersex people, their families, and their partners, to doctors now tasked with
the mandate of “assigning” the sex of newborns to one pole of the binary.
Many authorities existed in the lives of hermaphrodites in
the late nineteenth century, from midwives to grandmothers, to surgeons and
physicians, to lovers and friends, to the hermaphrodite him/herself. Today, by
contrast, especially in the United States, physicians possess the vast share of
the say in what a person’s sex is and/or will be.
As the author gets into the meat
of the history, she notes that the medical and scientific establishment - once
exclusively male - has all too often tried to justify current social conditions
as being “natural” and those advocating for social change as “unnatural.”
[M]any medical and scientific men in France and Britain
vigorously tried to argue and to evidence that the existing social sex
boundaries in their cultures reflected and were therefore necessitated by
“natural” sex boundaries - that (most) women did what (most) women did because
they were female, that (most) men were manly because of their manhood, that to
do otherwise would not only be unusual, and perhaps immoral, but also
unnatural. Never could the two sexes meet in ideas, talents, or roles, for they
had parted so long in the past.
As part of the discussion of one
of the more common intersex variations, Androgen Insensitivity Syndrome, there
is a really interesting point that the author makes that I hadn’t thought of,
but now seems obvious.
Generally AIS individuals do not develop very much noticeable
body hair, and they grow tall with long arms and legs. Indeed, with these
features - tall, smooth-skinned bodies with rounded hips and breasts and long
limbs - they seem to fit the dominant feminine idea in the United States today
better than most medically “true” females.
The author notes the rumor (not
conclusively evidenced but plausible) that many fashion models may in fact be
intersex.
One of the scientists quoted a lot
(for good and bad) is Pozzi, who contributed a great deal to the understanding
of embryonic development. One particular good line is this one:
“Up to a certain age the foetus has potentially the organs of
both sexes, and it is only by the ascendant development of the one set that the
other is suppressed. Nor is the suppressal [sic] in either sex ever absolute,
for every male has mammary glands and every female has a clitoris, organs which
definitely belong to the other sex, and which persist only because the
suppressal has been incomplete.”
Later in this chapter, the author
again comments on the various case studies these scientists wrote.
Often these texts contained background information on the
types or likely origin of hermaphroditeism (and as already noted, a few amusing
anecdotes). The implied “morals” of these narratives usually included some or
all of the following: that the anatomy is the locus of truth; that the doubtful
patient really had a single true male or female sex; that men and women were
fundamentally different and that they should (and would) be true to their sexed
natures; that if they were not, bad things would happen; that the medical man
must do what he could, with theory and practice, to solve hermaphroditism.
The next chapter gets into the
shift toward looking at genitals as determinative - and assigning sex based on
fairly arbitrary measurements. Which again disregards the actual needs and
experiences of intersex people.
Socially and psychologically the resolution of these cases of
“mistaken sex” could be rather sticky, but medically it seemed a cinch.
This chapter also has an
interesting discussion of the intersection of sex, gender, and sexuality. We
now think in terms of this “tripartite division,” but not that long ago, they
were lumped together a lot more. So everything from who a person was sexually
attracted to, to their aptitude for culturally gendered activities could be
considered evidence of being a “hermaphrodite.” By this measure, my wife could
be considered more male than I am, even though she is a cis female.
But of course, the pressure on
physicians was to fit everyone into a binary, and to conclusively and
confidently state that they knew what sex any individual “really” was.
[I]n any single instance of doubtful sex, medical
practitioners searched the person in question for every possible sign of sex,
within and without the doubtful body, in its anatomy, physiology, demeanor,
tastes, and talents. The idea here was that the “true sex” of every body would
ultimately be found and settled.
…
This again reinforced the hopeful belief that there really
could be no true hermaphroditism in humans, no truly profound mixing of the
male or female - since all anomalous signs were only “apparent” or
“false.”
This is the lie that the religious
right clings to in their desperate need to keep male and female completely
separate - and women subordinated to men.
Oh yeah, and I should also mention
yet another false belief of the religious right (and anti-trans people in
particular) that still poisons our politics.
On both sides of the Channel, male sexuality was thought
naturally, frightfully insidious, and the possibility (and occasional
incidence) of masked males placed among unsuspecting females caused medical men
terrific anxiety. Indeed, the pernicious character of male sexuality
constituted a major reason for raising doubtful children as males: if a masked
male were raised among females, the logic went, his sexuality was bound to
erupt, forcing him to behave “like a wolf in a sheepfold.”
And, of course, the related fear
that a “feminine” man might lure men into homosexuality.
Obviously a general fear underlay all these anxious
pronouncements, namely a fear of all sexual encounters that did not conform to
particular kinds of socially sanctioned heterosexual relations.
Part of my deconstruction from
fundamentalism was driven by my realization that so much of the doctrine wasn’t
grounded in anything positive, but a fear - a terror - of human sexuality. My
discovery that intersex people existed pretty much ended any delusion that
there was anything “natural” about a particular form of heterosexuality, and I
realized that any ethical discussion of sexuality really needed to be based on
universal ethical precepts such as consent and responsibility for consequences.
There is also a great discussion
of the intersection of culture, sexuality, and sexed traits. One of the best
bits comes from Karl Ulrichs, who considered himself (in the 19th century!) to
be non-binary, a third sex, with both masculine and feminine traits, despite
not being intersex. It was this kind of thought that led to a push to
liberalize laws related to sexuality and gender. As I tend to think these days,
I believe that being
LGBTQ is essentially on the intersex continuum - you can read my thoughts
about that here. This was already being discussed 150 years ago.
A quote by Xavier Mayne is also
forward-looking:
“By what right have we gone on insisting that each specimen
of sex in humanity must conform absolutely to [one of] two theories [the
“normal” male or “normal” female], must follow out [one of] two programmes
only, or else be thought amiss, imperfect, and degenerate[?] Why have we set up
masculinity and femininity as processes that have not perfectly logical and
respectable inter-steps?”
Indeed. Even if those intersteps
are as cultural as my wife being a natural leader and me playing violin and
loving cats.
But all of this is primarily cultural,
not biological. They are the product not of observation of how nature exists,
but of human organization. The author has a great line about this.
What I soon realized about these taxonomies was that they
were incredibly interesting. They were, in an important sense, where half the
action played. Figure out how someone organizes his world, and you will
understand how he sees the world. You will also see how the organization system
likely arranges the world in such a way as to reinforce that system maker’s
idea of the world - how what seems important gains in importance, how what
seems unimportant fades from view.
This took on great importance once
those doing the organization settled on gonads as the determining factor for
“male” and “female.”
Now a practitioner could also, as we have seen, by a single
criterion decide who was “truly” a man and who a woman. This very strict
conceptual order was imposed on any being who seemed otherwise likely to
threaten the borders between males and females.
And as far as that goes, why
choose gonads over other markers? Most of us will never see most other people’s
genitals, let alone examine their gonad tissue under a microscope.
I think it more likely that the choice of gonads as markers
of true sex derived from the late nineteenth-century idea that the fundamental
difference between men and women lay in their reproductive capabilities.
Or, more crassly, the belief that
female humans exist primarily to make babies and serve men.
I therefore suspect that the widespread adoption of the
gonadal definition of sex was driven not by a strictly “scientific” rationale
but instead for the most part by pragmatism: it accomplished the desired
preservation of clear distinctions between males and females in theory and
practice in the face of creeping sexual doubt. The practical result of the
adoption of the gonadal definition was that most bodies, no matter how
ambiguous looking or acting, were entitled only to a single sex, and “true”
living hermaphrodites were - by definition - impossible.
You can see this belief still
acting as the governing basis for the religious right’s insistence that there
are only two sexes, and everyone can be forced into one category or other. In
other words, intersex people don’t really exist, despite all evidence
that they do. And we all know why this is so important to them.
In trying to understand the revision of true hermaphroditism
as a concept, it certainly would be a mistake to neglect the inevitable
importance of the concurrent rise of social challenges to sex borders.
As women and LGBTQ people demanded
more social, economic, and political equality, the white males who gatekept
medicine insisted on increasingly rigid categories - and tied gender
essentialist beliefs to those categories.
For a medical man to admit a living, doubtful subject to true
hermaphroditism would have been potentially to add to the threat of social sex
confusion fomented by people like feminists and homosexuals.
Even as medical practice moved
away from a purely gonadal view of sex later in the 20th Century, the idea that
humans needed to be forced into the sexual binary, with nonconsensual surgery
if deemed necessary, endured.
So true sex would, perhaps, no longer be dictated exclusively
by the anatomical nature of the gonads. But only two true sexes would still
exist, with a limit of one to each body, and the medical man would still be the
interpreter - and now, when necessary and possible, the amplifier - of true
sex.
This - the assignment to and the surgical construction of a
single, believable sex for each ambiguous body - was the way of the
future.
This idea is crucial to
understanding the terms used regarding both intersex and transgender
individuals: “assigned male at birth” and “assigned female at birth.” Because
what has happened is not that a person is male or female, but that they were assigned
the designation of male or female when they were born, by a medical
professional, and were then expected to conform to that assignment, regardless
of whether it fit them or not.
Notice that once again, the person
who actually exists is treated as irrelevant. They are not asked what they
think would be best for them. Instead, it is society’s need to classify humans
within a caste system that wins.
The epilogue is truly fascinating,
and I took a lot of notes. The author makes the argument that the missing
ingredient in the history are the voices of intersex people themselves.
Instead, cisgender doctors and often parents have forced infants into nonconsensual
genital mutilation that often results in functional problems later. She
addresses three issues, which she lists as follows:
The present-day medical treatment protocols for
intersexuality, which call for the creation, as soon after birth as possible,
of a “believeable” masculine or feminine anatomy via plastic surgery and
hormonal therapy, and a silencing of any doubt parents or others might have.
How these protocols, however well intentioned, maintain many
vestiges of nineteenth-century medical theory and practice.
The present moment in which intersexuals are finally
themselves challenging medical treatment protocols and the rigid cultural
categories that impel those protocols.
Two quotes open the epilogue, and
they are both worth reading.
“One of our most difficult duties as human beings is to
listen to the voices of those who suffer…These voices bespeak conditions of
embodiment that most of us would rather forget our vulnerability to. Listening
is hard, but it is also a fundamental moral act; to realize the best potential
in postmodern times requires an ethics of listening.” (Arthur Frank)
This cuts to the heart of the
issue, and also to why I believe the religious right is evil. Fundamentally, if
we are to show basic human decency to our fellow humans, we must listen to
those who suffer. And that is the one thing the religious right utterly refuses
to do.
It is why they lecture the poor,
dismiss racism as a myth, insist on the subordination of women, and deny that
LGBTQ people actually exist.
True morality requires listening,
not lecturing. And “listening with” as the author puts it.
The second quote is all about this
specific issue.
“Genital ambiguity is “corrected” not because it is
threatening to the infant’s life but because it is threatening to the infant’s
culture.” (Suzanne Kessler)
Intersex people and how we have
treated them are evidence that what we have is a cultural problem. Our refusal
to accept that not everyone fits the binary is rooted in misogyny, the belief
in the inferiority of women and the necessity of their mistreatment. It is this
that fuels the anti-transgender panic and hate. And why the religious right
insists on silencing the voices of the hurting. As hemophiliac Donald Bateman
noted:
“[T]he social history of medicine is usually recorded by its
practitioners, by social workers, or researchers. Not much of it is chronicled
by its victims or the recipients of treatment. The sick, like the poor, leave
very few archives behind them.”
One of the benefits of the 21st
Century and indeed the internet, for all its faults, is that the voices of the
sick, the poor, and intersex people are finally being heard. (There are several
intersex vlogers on YouTube that I have followed over the years as part of my
ongoing work to stay current on LGBTQIA issues for both personal and
professional reasons.) This in turn is, of course, leading to further cultural
panic and pearl clutching by the religious right, as they see their false
narrative crumbling, and young people, particularly women, fleeing their
churches.
Rather than address their own
appalling lack of empathy and ethical behavior, right wing bigots choose to
cast empathy itself as a “sin,” and maintenance of social hierarchies as the
sole measure of morality. Is it any wonder so many of us left?
Ethical behavior means recognizing and respecting the
imperatives embedded in stories of suffering.
I grew up being warned of the
dangers of Postmodernism, mostly by people who had no idea what the hell they
were talking about. As an adult, I have come to realize that Postmodernism,
while as incomplete as any other lens through which to view the world, has one
brilliant insight.
[P]ostmodernism has brought with it the recognition that
there never can be a single, self-evident, “true” story to be told about a
life, disease, or condition. In the past, if a relatively disempowered person’s
story conflicted with the dominant story, the socially weaker individual’s tale
was likely to go unheard or discounted. Postmodernists like Frank recognize,
however, that the decision to call one story “true” or primary is a complicated
one involving many value choices. With this recognition, intersexuals and
others are now able to tell and “hear” stories about intersexual life that
challenge or conflict with the classic modernist medical story about relatively
simple, containable, attacking invader “diseases” and heroic, purgative
“cures.” Postmodernist intersexuals refuse to take their doctors’ stories about
them, their “problems,” and their treatments as primary; instead they reject,
change, or incorporate medical narratives into their own narratives and make
their own stories primary - at least in their own lives.
And more:
Finally, postmodernism, in its appreciation of the social
construction of concepts like sexual identity and normality, has given
intersexuals the opportunity to see their plight as contingent to social times
and places - to see their experiences as culturally, historically specific and
therefore not inherent in or necessary to their bodies. Cultural histories such
as the one presented in this book have demonstrated the cultural dependency of
the categorization and treatments of males, females, and hermaphrodites.
Awareness of the “social construction” of these categories has enabled
intersexuals to object to their treatment as “freaks” or “problems” to be
corrected and disappeared. Intersexuals have also looked beyond the history of
hermaphrodites to the history of the medical treatment of homosexuality and
have noted that, until very recently, gay and lesbian people were also widely
regarded as troubling and troubled “freaks” to be “fixed.” The history of the
biomedical construction of womanhood reads similarly. Intersexuals have
realized that, like straight women and gay people, they need not be treated as
fundamentally unacceptable or flawed - that it is not their bodies that make
their lives difficult, but the cultural demands forced upon their bodies.
This is ultimately why the right
wing HATES Postmodernism so much. Instead of white conservative males getting
to cram their preferred narrative down everyone else’s throat, all of a sudden
the perspectives of women, racial minorities, sexual and gender minorities, the
poor, and more are given a more equal weight, and the gatekeepers of white male
wealth privilege are losing their shit, and take their terror out on those they
see as the easiest targets. (Currently immigrants and transgender people are bearing
the brunt of this.)
But despite all of this,
marginalized voices insist on being heard, and the right wing’s scream of rage
at cultural change, while dangerous when combined with political power, will
ultimately be self-destructive. Because no ideology can give the middle finger
to reality forever.
Part of telling that story -
indeed of telling any story from a marginalized point of view - is to correctly
call out the abuse that those with power wish to inflict. As intersexual
advocate Cheryl Chase said:
“The time has come for intersexuals to denounce our treatment
as abuse, to embrace and openly assert our identities as intersexuals, to
intentionally affront that sort of reason which requires that we be mutilated
and silenced.”
Sven Nicholson is also quoted,
talking about the mutilation of his genitals that left him damaged in his
ability to urinate.
“In retrospect, I wish that the operations had never
happened, that I had simply been allowed to live out my life with the plumbing
system originally given to me by my creator.”
Although progress has been made in
some areas, the perceived need to find a “true” sex of a child continues to
lead to poor care. Following the gonadal theory, there was a shift for a while
to the idea that a child’s gender identity was socially formed, and that one
could raise a child as either sex and they would be fine conforming to that
sex. (Spoiler: it doesn’t work.)
That psychosocial gender-identity theory, established by John
Money in the 1950s, holds that all children must have their gender identity
fixed very early in life; that from very early in life children’s anatomy must
match the “standard” anatomy for their gender; and that boy’s primarily require
“adequate” penises with no vagina, while girls primarily require a vagina with
no noticeable phallus.
So, surgical intervention became
standard, regardless of the need. And, in practice, this usually meant
assigning intersex infants to “girl” as happened to my client.
The logic behind the tendency to assign the female gender in
cases of intersexuality rests not only on the belief that boys need “adequate”
penises, but also on the opinion among surgeons that “a functional vagina can
be constructed in virtually everyone [while] a functional penis is a much more
difficult goal.”
More colloquially, “it’s easier to
poke a hole than build a pole.”
Horrifyingly, this determination
is done by measuring the phallus. “Too small,” and it gets cut off. “Big
enough” and you are a man. A few millimeters difference…
But also, the sexism -
phallocentrism - is evident here as well. A “functional” vagina need only be a
hole big enough to be penetrated by a typical penis. It does not need to
lubricate, feel pleasure, or give any benefit to the person who has it. It is merely
a “penis house” as the gross patriarchy bros put it.
This surgical approach to a
non-problem continues to be used, even though the justification for it has
proven again and again to be false.
Remarkably, the medical-technological approach reigns in
intersex medicine despite the fact that intersex experts readily confess that
intersexuality is not primarily a medical problem but is instead a social
problem.
Exactly. We should not be trying
to “fit” humans to perceived social standards. We should change society to
accommodate the reality of intersex humans.
Intersexual, feminist, and “queer theory” critics of today’s
dominant treatment protocols point out a number of problems with the modernist
medical approach to intersexuality. Most objectionable to many feminist and
queer critics is the presumption inherent in these protocols is that there is a
“right” way to be a male and a “right” way to be a female, and that children
who are born challenging these categories should be reconstructed to fit into
(and thereby reify) them.
This is a problem that goes far
beyond intersexuals but affects any person who fails to conform to the rigid
demands of culture. In our own political moment, this is at the core of our
problem: the right wing demands that there is in fact only one “right” way to
be male or be female, and that one right way demands female subservience, male
dominance, and the erasure - and perhaps extermination of LGBTQ and intersex
people.
And not only that - many of us who
think of ourselves as cishet men are also outside of this “right” way to be. A
German study found that a mere 55% of males had what they considered “normal”
genitals. All except for one of the men studied had fathered children. (And the
one who didn’t was gay.) But, not “normal” enough apparently.
Intersexual activists also question whether anyone should
have her ability to enjoy sex or physical health risked without her personal
consent just because she has a clitoris (or a penis) which statistically falls
outside the standard deviation.
Just saying.
At the end, Dreger circles back to
the history - and the cultural expectations that led us where we are.
The roots of the one-body-one-sex rule and medical doctors’
role in it were laid down in the late nineteenth century. In spite of all the
cultural changes that have occurred, we still have the one-body-one-sex rule,
and that rule continues to be driven largely by the same engines that drive it
in the nineteenth century: an interest in keeping clear male/female gender
distinctions, and a concomitant interest in retaining a clear division between
heterosexuality and homosexuality and in supporting what is seen as
heterosexuality…The way intersexuals are treated today has much of the same
effect intended by the conceptual and practical treatment of the last century:
to keep two clear sexes and to retain the notion that heterosexuality is normal
and that homosexuality is not.
And finally:
The hermaphrodite was and continues to be a person whose body
gets caught up in cultural “border wars” - wars over the borders separating
males and females, men and women, boys and girls, borders separating the
acceptable heterosexual and the disfavored homosexual, borders separating those
with authority from those without.
The book closes with a call for a
better approach to human variety. We need not police the boundaries of sex and
gender, mutilate bodies to make them “normal,” or marginalize people who don’t
fit easy categories.
Nature is diverse. Nature
is queer. Get over it. And start treating people with love and empathy,
even if their bodies or experiences make you uncomfortable.
This book is an excellent look at
history, and provides inspiration to do better in the future.
