Continuing on in our reading by Anne Fausto-Sterling’s “Sexing the Body”, Chapter 3 concentrates on how decisions about a child’s gender at birth are made and how they can affect their future. Once a child’s body exhibits sexual ambiguity, there is a multitude of issues that they, as well as their parents, face, both physically and psychologically. For parents, doctors use the most medically-technical vocabulary as possible, in order not to bring about the thought that their child is not male or female, rather that they show signs of unusual physiology. There are also many different diseases that can cause this, that are mentioned, such as CAH, AIS, gonadal dysgenesis, Klinefelter’s or Turners.
Doctors felt that their patients “required medical treatment because they ought to have become either a male or female” and warned that “freak hood” (as a result of sexual ambiguity) “will, indeed, be the baby’s fate should the case be improperly managed” (pages 46-47). The author continues with saying that the general agreement today is that intersexual children should be corrected as soon as possible, though practices for taking care of this surgically are quite variable, because there are not yet any regulations for this practice. Though it seems that doctors do want to help, they often are unaware of resources that can help both themselves and parents in better dealing with this circumstance, that occurs in 1.7% of all births (though this varies across the world and across different ethnic/racial populations), and might be on the rise as a result of environmental pollutants and in vitro fertilization. All of this technology available to “fix” these problems, has led to an even further emphasis on the fact that people fall into one of the two categories, male or female, even though there is a fairly high frequency of it.
The author describes the ways in which prenatal treatments can attempt to eliminate gender ambiguity, but these have many side effects for both mother and child, and have not proven to be actually effective. Thus, as the author refers to it, “doctors must decide, as they would put it, nature’s intention” (page 56), and surgically assign a newborn’s gender. Many of these decisions are made on social means as opposed to medical, as many families prefer male children, “you can make a hole but you can't build a pole,” etc.
The psychological piece arises with a discussion of a new “gender doublespeak” in which parents are discouraged from telling their children that they are part male and part female, and rather that they are the sex that they “became”. These doctors feel that medical honesty is of no benefit of the patient, but this is at odds with “sound medical practice”. Amongst the parents having issues dealing with this, obviously the patients themselves have exhibited problems, most notably with the John/Joan/John incident, in which a boy had a problem when circumcised, underwent surgery to become a girl, began identifying as a girl, then had difficulty fully adjusting as a female, at which point he underwent corrective surgery to become male once again. Clearly, it isn’t easy.
There has been an ongoing feud between Money and Diamond, in their theories of how humans became sexual. While Money argued that humans were sexually neutral at birth and the environment played a part, Diamond argued that it was hormones that determined sex. This led to a debate that “individuals are psychosexually neutral at birth, and that healthy psychosexual development is intimately related to the appearance of the genitals” (page 70). One more debate that has surfaced among this question of intersexuality is the issue of homosexuality versus homosexuality. “When doctors chose to assign a definitive sex to an ambiguously sexed child, then it was not enough that the child become psychologically male or female. For the treatment to count as successful, the child had to become heterosexual” (page 72), believed some scientists. Was a girl who still had testes and an XY chromosome, who fell in love with a man homosexual or heterosexual? These issues still are questioned, but Diamond argues that nature permits more than two normal types of sexuality, and diversity is okay.
Finally the author talks about the fact that “the rules for living as a male or female are strict” (page 75), that there are contradictory practices and views in our world, and our current cultural system of gender is constantly called into question.
“Should there only be two sexes?”, Chapter 4 in Fausto-Sterling’s book, begins with an anecdote about how she wrote a proposal that we change our two sex system to a five sex one, and the multitude of reactions she received as a result. Some were positive, some were not (such as the Catholic League for Religious and Civil Rights, who believe that there are “but two sexes, both are which are rooted in nature” (page 78). At the very least, however, she seemed proud that the debate had started, and the lines between male and female were becoming harder to define. Fausto-Sterling states her wishes for the future of intersexuals, that being:
1. Let there be no unnecessary infant surgery
2. Let physicians assign a provisional sex to the infant
3. Let the medical care team provide full information and long-term counseling to the parents and to the child
She further talks about a utopia in which gender hierarchies have been abolished, and intersexuals have only major/life-threatening medical concerns.
Continuing on, the author makes a point about how the surgeries/“cures” for intersexuals often cause more harm than good, and includes many statistics and stories about horrific experiences of real life people. Many of these stories contain people who have gone further to try and help those in situations similar to their own, like Cheryl Chase who founded the Intersex Society of North America, and Helena Harmon-Smith who started the Hermaphrodite Education and Listening Post. These advocates support truth and nothing but the truth when discussing gender identities, amongst patients, doctors, and parents. Along with physical pain associated with the surgeries, the Fausto-Sterling once again reiterates the psychological suffering that intersexuals deal with. These surgeries have an incredibly high failure rate, and often times patients must actually undergo several surgeries. This chapter also includes many pages of a chart detailing “outcomes of reduction clitoroplasties”, including the number of subjects, age at first surgery, results, and comments.
“Dogma has it that without medical care, especially early surgical intervention, hermaphrodites are doomed to a life of misery. Yet, there are few empirical investigations to back up this claim” (page 93). There are many examples, actually, in which hermaphrodites have lived happy and productive lives, and many have assumed normal role and activities of whichever “sex” they have chosen. The author brings up an interesting (and not surprising) point that males appear more anxious to change their feminized bodies than vice versa.
The last major topic in the chapter has to do with transsexuality, and the fact that many transsexuals feel extremely strongly about having their bodies “conform with his/her psyche” (page 107), and thus often end up having surgery. However, it is the exact concept of our two-gender system that allows transsexuals to have this surgery- they are choosing one sex, versus falling into one of Rothblatt’s “shades of gender”. Although “no woman or man fits the universal gender stereotype” (page 108), transsexuals and transgenders have difficulties in their daily lives; obtaining passports, licenses, etc. An International Bill of Gender Rights was written by transgenders, and things are currently in the works to help the legal statuses of intersexuals, transsexuals, etc.
At the end of the chapter, Fausto-Sterling leaves the reader with glimmers of hope. “Perhaps we will come to view such children as especially blessed or lucky” (page 113), and there is a “general trend toward greater tolerance for gender multiplicity and ambiguity” (page 114).