The socialized gender binary is imposed on us starting when the doctor exclaims “It’s a boy/girl!” But the sex binary (as opposed to the more fluid self-defined experience of gender) is generally thought to be relatively concrete, less socialized, and more biological. The births of children with ambiguous or abnormal genitalia are therefore most often a huge shock to both the child’s parents and to physicians.
Although reactions to intersex people vary between cultures, our American social system seems to leave little to no room for ambiguity. A child must fall into one of two categories, and if he/she does not, surgery and hormone therapy are generally seen as necessities, not as options. Assumptions about the progressive nature of science and the omniscience of physicians combine with prejudices about social acceptance and the perceived importance of heterosexual penetrative sex to drive a disturbing pattern of genital surgeries for intersexed infants, far too young to provide consent.
How are intersex babies categorized into the sex binary, even though their genitalia may be ambiguous? One excellent book on the subject is called Sexing The Body by Anne Fausto-Sterling. In the book, Fausto-Sterling explains that genetic (XX) females are usually kept female at all costs, preserving their ability for reproduction. Males, however, are usually not classified based on their genetic identity, but rather the size of their penises. This type of thought is evidenced in the typical treatment of children with Congenital Adrenal Hyperplasia (CAH) as compared with those children with Androgen Insensitivity Syndrome (AIS). CAH children are XX but are born with or develop masculinized genitalia and can become physically masculinized at puberty. AIS patients are XY, but are born with feminized genitalia. At puberty, these children can become feminized in body shape. These two seemingly opposite “disorders” do not typically have opposite medical treatments. Both types of children are typically initially classified as female.
To be fair, studies have shown that most AIS patients tend to later develop a female gender identity despite their XY genetic makeup. However, we cannot know whether our decision to raise these children as female affected their gender identity. Generalizing these findings to a decision to classify AIS children as female is highly problematic. The decision to categorize intersex children as female often has quite a bit to do with penis size. If a male child cannot stand up to pee, the child is not considered to be adequately male.
Potential For Penetrative Sex
One major assumption governing decisions about the “sexing” of intersex babies regards the ability to engage in penetrative heterosexual sexual activity. The penis must be large enough for penetration; the vagina mustn’t be too large or too small. The clitoris most certainly cannot be too large, lest its unsightliness or resemblance to a penis cause confusion or disgust! Little regard is paid to pleasure, as intersex child’s genitals are snipped, clipped, and remolded to look and function in a way consistent with heterosexual penetrative norms. Scarring and sensitivity from “corrective” surgeries can take away these people’s potential for sexual pleasure.
Clitoral reduction and recession are particularly disturbing, especially when many of us have just begun to realize the fallacy of the myth of the vaginal orgasm. Still, intersex babies assigned as girls have their clitorises cut and tucked, often purely for cosmetic purposes. Society dictates that girls must look and act like girls, even down to their most intimate areas. It is assumed that a penis should look like the ideal penis, and a clitoris should by no means resemble a penis. Physicians routinely alter the size of intersex vaginas and clip intersex and non-intersex babies’ clitorises in the name of necessity, thus implicitly throwing female pleasure out the window and giving precedence to penetrative sex. A successful intersexual is a “heterosexual,” that is a person whose sexuality matches with what is deemed appropriate for his/her gender assignment.
Science and Medicine
Science and medicine have brought countless advancements, but it seems that often there is an over-reliance on medicine and science as un-objectionable fact. We are taught to trust our doctors and other “experts,” but this blind trust could be extremely damaging in cases of intersexual surgery. Parents of intersexual children may not consider the physicians’ biases, seeing the doctors as infallible. The doctors, on the other hand, are equally as eager to do what they see as right, and to send the parents away with a sure-sex baby. Families are thus often swayed by a surgeon’s advice without being given the chance to properly consider potential outcomes of their decision and without being able to talk to families and individuals who have been faced with similar decisions.
Studies again and again refute each other in attempts to prove biological differences between the two sexes. Very few of us have ever considered that these two sexes may not be as different as we think. Even fewer have considered that the two sexes or genders may not just be two in number.
The discovery of hormones has been one of the most fascinating discoveries in science and medicine. Hormones suggest a biological basis for gendered behavior and even sexual preference, and the use of hormone therapy can influence one’s appearance, physical traits, behavior, and perhaps even desires. But it is also important not to discount societal influences or, even worse, assume that hormone therapy is a sure-fire “fix” to a masculine female or feminine male. And why on earth do we need a “fix” anyway?
A sincere belief in the necessity of social acceptance motivates any decision to operate on an intersexed child. Not only the social acceptance of the child is at stake, but the pride of the entire family. “Pink or blue?” The potential embarrassment of having an ambiguous youngster must be extremely frightening to the parents. Discrimination would affect not only the child, but the entire family. It is most likely easiest to make a decision as to the sex of the baby as quickly as they can, and avoid as much social discomfort as possible. And since it is often assumed that until a certain age, the parent’s opinion is the same as the child’s, it is often not considered that the child’s right to choose is being co-opted.
The parents and doctors are of course motivated by a genuine concern for the child’s welfare. In the classroom, the locker room, and even in the work world, there is no room for ambiguity. Social expectations define gender, and we assume the necessity of a clear gender identity for a happy life. All too often, if the child fulfills expected gender roles, then the “corrective” surgery is deemed to have been successful. Our society teaches us to believe that ambiguity is a lack of identity. There is typically no thought given to the fact that ambiguity may actually be part of an identity. Most people, when confronted with the suggestion that there may be infinite genders, or even infinite sexes, are completely taken aback. Intersexuality doesn’t have to be seen as a disorder afflicting normal males and females. Intersexuality could simply be more variation on the infinite varieties of people.
But raising an intersex child as a “third gender” might just not be practical or fair in our current social system. The Intersex Society of North America asserts that:
• Intersexuality is primarily a problem of stigma and trauma, not gender.
• The child is the patient, not the parents.
• Professional mental health care is essential.
• Honest, complete disclosure is good medicine.
• All children should be assigned as male or female, without surgery.
Why not raise intersex babies in a “third gender?” Well, ISNA argues that in fact most intersex children do grow up to identify as male or female, and relatively few identify in adulthood as a third gender or gender queer. And ISNA believes that raising intersex children in a “third gender” would just further stigmatize these children and set them apart as “abnormal.” ISNA argues that children should be given hormonal, genetic, and radiological tests as infants to determine the most likely gender that they will identify as as adults. ISNA argues that these children should be raised in the most likely gender assignment, and then should make the decision as to whether to obtain surgery when they are of age and fully informed about the risks of surgery and their own gender identity. ISNA states:
In cases of intersex, doctors and parents need to recognize, however, that gender assignment of infants with intersex conditions as boy or girl, as with assignment of any infant, is preliminary. Any child—intersex or not—may decide later in life that she or he was given the wrong gender assignment; but children with certain intersex conditions have significantly higher rates of gender transition than the general population, with or without treatment.
But whereas incorrect gender-assignment of intersex babies is a concern, incorrect surgical “correction” of intersex babies is downright terrifying. In my opinion, it is crucial for patients to make informed decisions as to their gender identity and desired genitalia when they are able to voice their own opinion about their bodies (NOT when they are newborns).
If a boy cannot pee standing up, does that make him less of a boy? If a woman’s clitoris is enlarged, has her womanhood been diminished? How de we define womanhood, anyway? These questions are imperative to the treatment of intersexed people. I realize that many people might disagree with me that infant intersex genital surgery is genital mutilation. But surgery on another’s genitals without their agreement is in fact abuse. It is critical to recognize the difference between when surgery is actually necessary for intersexed people for health reasons and when the surgery is cosmetic. We need a more fluid understanding of gender. I hold a firm belief that there are as many genders as there are people. (We are ALL to some extent, Gender Blenders) “Normality” cannot be defined. The very attempt at definition holds us back from individuality.
In some of these situations, operations are necessary for the health of the child. But intersexed children should not be operated on unnecessarily until they reach an age at which they can choose for themselves, at which time they should be provided support and connections with other intersexed people and their families. They must be made aware of the risks, and also must be celebrated for their own beauty and uniqueness. Science and society define intersexed bodies as mistakes, imperfect versions of a true male or female. In a society in which gender and sex are so rigidly defined, it will always be a struggle for anyone who deviates from what is seen as the norm. But, our society cannot change without our help. We must stop putting penetrative sex ahead of pleasure, putting cosmetics ahead of choice, and putting science ahead of compassion.