doctor/patient collaboration for surgical consent

Dr. Katrina Karkazis of the Center for Biomedical Ethics at Stanford University recently published a suggested protocol for parents and doctors to reach a decision about whether to operate on intersex babies genitals. This involves 6 steps:

1. develop an appropriate, multidisciplinary team comprised of a variety of subspecialties such as endocrinology, urology, surgery, psychology/psychiatry, gynecology, pediatrics and social work.

2. Establish preferences for information and roles in decision-making. By gauging parents preferences early in the process, physicians can decrease the risk for misunderstanding patient needs and preferences. Physicians are encouraged to perceive and address parents’ emotions, with an emphasis on open communication.

3. Perceive and address emotions, Parents and physicians are uncomfortable discussing certain topics. One example is the future sexual sensation of the child who is potentially going to undergo surgery. Some physicians do not discuss that, although it is something that parents would need to know in order to make an informed decision.

4. Define concerns and values, common parental concerns include fears of teasing, ensuring that the child looks “normal” and using the least treatment intervention possible, all of these things come into play when deciding about surgery, but families rank them differently and it is integral to understand what they want to achieve with surgery and whether the operation will be able to achieve it.

5. Identify options and presenting evidence. Once an understanding of the parent’s needs and goals are established, a presentation of all treatment options and subsequent consequences should be objectively made to the parents. This should realistically explore the risks and benefits of treatment; examine parents’ ideas and assumptions while correcting their misperceptions; and ensure that they understand the nuances of the complex situation.

6. Share responsibility for making a decision. A shared decision must be made by the parents and the team. At this point in the process, parents should possess a technical understanding of the situation while the team will have an appreciation of the families best interests and hopes.

This decision making process does sound like a very small step forward. At least the parents are not panicking and making a rushed decision without all the options and outcomes made known to them. That being said, this suggested process still misses the most important point, it is NOT the parents or doctors decision to make, the only person who has the right to make such a decision is the intersex individual. Anything else is a serious violation of their human rights and bodily integrity, often with disastrous physical and psychological consequences. The only protocol that is needed is to wait until the child is old enough, and give them all the information to make an informed decision.

anti-intersex drugs

A medical paper published recently in Australia recommends prenatal screening for congenital adrenal hyperplasia female fetuses. The paper recommends treating them prenatally with dexamethasone to prevent "behavioral masculization" including "same sex attraction and tom boy type behaviors" (there is a much higher statistical rate of both in CAH girls).

I find this absolutely disgusting, it is blatantly homophobic and transphobic. So your little girl may not be what you were expecting, so what? No parent-to-be knows what their child will be like, but they adapt and love them anyways. Parents should love and accept their children not drug out who they are, or will be. This non-consensual medical intervention is little better then genital mutilation, it is the strict enforcement of gender stereotypes at the expense of the humanity, individuality and power of choice of the intersexed individual. It also contributes to the view of intersex as a pathology.

I find the thought of prenatal testing for intersex conditions very disturbing. More prenatal intervention could lead to the abortions intersex fetuses for eugenics purposes. Most parents to be want to know the sex of their baby, but when knowing could lead them to medicate or harm the baby, perhaps it is best left a surprise.

Review of "Fool for Love" by Lisa Lees

I just finished the book Fool for Love by Lisa Lees (available at Amazon, or at lulu.com, a self publishing site). The writing style was a rather choppy, and referenced a lot of things that most intersexuals already know, however I enjoyed reading it and would highly recommend it. Its always nice to see yourself in print, which doesn't happen very often for certain minorities.

Fool for Love is a love story between two high school students, an intersex girl, Jamie, and a genderqueer butch lesbian, Carys. What the book covered very well is the emotional complexities of relationships with intersexuals. Relationships are difficult enough for "normal" people; but for intersexuals, they are an emotional minefield.

Look on any intersex forum and you will see that intersex people have a lot of apprehension and angst about relationships. Their genitals have been a source of great emotional anguish, and sharing them with another is sometimes too painful.

This is why I liked Fool for Love, it showed that in spite of all these fears, love can prevail and intersexuals can have a happily ever after.

the amusing risks of ultrasounds

Hello readers, remember a few posts ago when I wrote about using humor at an ultrasound to ease the tensions? Well, I got the results back from the ultrasound and wouldn't you know it, it said I had ovaries, even though my gonads had been removed as a small child. The report went so far as to say my reproductive system was "unremarkable". To say I was shocked by this would be an understatement. There were only four explanations I could think of:

1. The surgeons removed the wrong thing, and I still had my gonads

2. The ultrasound had been misread

3. Like some of my hermaphrodite brethren, the earthworms and sponges, I had the ability to regenerate lost body parts

4. There was a mix up and I was given someone else's ultrasound result (I hoped this was not the case because some poor "normal" lady would be in for an even worse shock then me if she got my ultrasound)

As it turns out, it was number 2. In a case of confirmation bias, the ultrasound tech expected to see ovaries, and thus mislabeled loops of my colon as ovaries. The moral of this story is when things seem weird, ask questions of your doctors. We deserve to know the truth

cultural compromise and genital integrity

a hot button issue for intersex activists lately has been the recent change in the protocol of the American Academy of Pediatrics (AAP). This change is the AAP's recommendation that the US permit doctors to "nick" the genitals of their female patients as a compromise for their African patients seeking their ritual genital cutting. They have said this is justified on three grounds.

1. nicking is very minor, the equivalent to a pin prick or an ear piercing.

2. it demonstrates a cultural sensitivity for immigrant populations

3. it is a compromise that could prevent the parents from preforming more extreme genital cutting.

This is unusual since AAP's previous statement on the subject states (rightly so) that female genital cutting is a form of gender based violence. Even if this nicking sound harmless, it is important to not quibble over severity, if something is wrong, then milder forms of it are still wrong. Many anti-FGM activists fear, rightly so, that this recommendation opens up shades of gray which will muddle and ultimately set back their movement.

FGM is very similar to the way intersex people are treated in America, our genitals are cut up to satisfy a sociocultural requirement. The similar lack of respect for bodily integrity and sexual autonomy due to culture is striking Many intersex activists petitioned congress to add intersex to the Federal Prohibition of Female Genital Mutilation Act, citing these similarities. Obviously Congress was not persuaded. I think it is very important to understand understand other cultures, but it is also important to realize that cultures are not static, they change all the time. There are many African activists working to stop female genital mutlation in their culture. I think the American Academy of Pediatrics did these activists a great disservice by stabbing them in the back with this recommendation. In any case, no child should be put in harms way just because of cultural norms, that is deeply unethical, and suggests a norm that needs to be changed.

American Female Genital Mutilation

If you are standing (at the computer, that would be weird) you should sit down, the news I have to report is shocking.

Dr. Dix Poppas, a pediatric urologist at Cornell University has been surgically shortening the clitoris's of girls who have been deemed to be too big and too sensitive (God forbid a woman actually enjoy sex). Then at follow up examinations he uses a vibrator to test how much sensitivity is lost. I for one am outraged by this. The mutilation and molestation of children is sick. No other pediatric urologist preforms this procedure. What kind of parents would allow this to happen to their little girl? There is nothing wrong with these girls, it is a completely subjective, aesthetic judgment (I shudder to think what these parents would do with an intersex child).

The fact that Dr. Poppas does these vibrator follow-ups shows he is aware of the risks. In spite of this he goes forward with the surgery, violating his Hippocratic oath and demonstrating a disturbing lack of respect for his patients humanity. Look up any intersex discussion board to realize how psychologically devastating genital surgeries and especially the repeated examinations and poking and prodding are on children. These posters are adults who are still not over it. Emotionally they are very much like victims of child sexual abuse.

Even if, as he claims, that he is proving that the sensitivity loss is minimal, it is still wrong. Even if genital surgeries were perfect (they never are, the results are often quite terrible) I would say that it is horribly unethical. Whatever happened to learning to accept yourself, this turning to plastic surgery to solve our insecurities is deeply problematic. It is important to feel at home in your own skin, and when you are implicitly told that you are so unacceptable that we have to operate, it is very difficult to learn that self acceptance.

the importance of humor

Hello all, I'm sorry I haven't done an entry in a while, but I am running out of topics and don't want to become repetitive. Today I'm sending a piece of advice to my fellow intersexuals, or really anyone in an awkward position, that advise is to use humor.

My personal situation where humor was useful was in the doctors office (as these stories often are). I was in for a sonogram to get a better look at my uterus (a small, misshapen organ referred to by doctors as a "shadow uterus" which is in and of itself a funny term). The technician who was doing it did not know that I was intersexed (and I didn't feel like enlightening a total stranger). All she knew was that doctors orders prohibited her from using the vaginal probe. In any case I was feeling very awkward, so while she was looking at the screen, I asked if it was a boy or a girl when I was obviously not there due to a pregnancy. This broke the ice, she laughed and said it was twins, one of each.

Thus my advise to deal with these situations is to never underestimate the power of a joke, a little humor goes a long ways.

10 Myths that Hurt Intersexuals

This list was recently posted on the blog Intersex Roadshow, it is a list of myths that hurt intersexed people, complied from that authors conversations. I think it is a very insightful list, with issues that should be brought to the public attention, so I decided to post it on my blog:

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.

intersex fetishizing

Hello readers, I'm sorry my postings have become somewhat sporadic, but I have been kinda busy. Today I am writing about sexual fetishes and haw they are hurting the intersex community.

Ever since the intersex community formed there has been a discussion about whether there is a fetishized aspect to surgeons doing genital surgeries. Many plastic surgeons have admitted that genital surgery is considered an "art" and since there are statistically few people who have such procedures done, there is not really a set surgical method, but several of them, and it is largely left up to the surgeons discretion. They definitely get excited over the opportunity. Whether or not this is a sexual excitement (fetish) is debatable (some would argue, and I would agree, that anything involving the genitals is inherently sexual). Even if this is not technically a fetish, it still is disturbing.

The more blatant use of fetishs to hurt intersexuals is in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM is the big list of psychological issues and their recommended therapeutic treatment that psychologists use. The most recent edition, the DSM IV, lumps intersexuals who reject their assigned gender into a broad catagory called GIDNOS (gender identity disorder not otherwise stated) which is a sub-branch of GID (gender identity disorder) which is mostly used for diagnosing transexuals (personally I hate the expression, there is nothing disordered about trangender). The sub-branch of GIDNOS not only includes intersexuals, but also cross-dressers, and autogynephilia, a fetish some men have with the removal of their penis. Personally I do not think intersex has any place in psychology, by definition it is a biological, not merely psychological condition, and certainly doesn't belong in GID (by definition an intersexual cannot be transgendered). That aside, I think lumping intersex and autogynephilies shows a great misunderstanding of intersex. We do not get turned on by the thought of being mutilated, the doctors mutilated us. I think that doctors and psychologists have done this because they have seen the writing on the wall (that the intersex community is gaining power and is mad as hell at them) and did this humiliating lumping to protect themselves. If an intersexual who has rejected their gender assignment comes to them, they can say, according to their diagnostic books, that it is not a matter of gender identity, but a fetish to either gain or lose a penis (how Freudian).

parents perspective

I bugged my mom into writing a piece for my blog. This way you can hear other peoples opinions (gasp). So, without any further ado, here's what my mom had to say:

A parent’s perspective;
I was recently filling out our 2010-census form and I realized that once again I had to inaccurately settle on gender for one of our children. I wanted or needed to be able to have more choices on the census form. While I don’t personally like the term “neuter”, I applaud Australia’s willingness to alter Norrie May-Welby’s birth certificate to better represent this person’s gender.

When I hear an expectant parent announce the exact sex of their child prior to birth, I cringe. I wonder how can a picture tell the child’s story?

When our child was born the “sex” was immediately determined to be male. Later, upon further inspection the hospital staff changed their minds and expressed uncertainty of the “sex” of our child. They immediately took the blue blanket away and used a white blanket for swaddling. We were told that this “unique phenomenon” had only occurred one other time in the hospital’s 27-year history. We were led to believe that we needed to change our child so that “society would be kind”. We listened and we trusted that we needed to follow the medical professionals advice. While their advice was well intentioned, they were wrong.

If we had known then what we know now, we might not have listened so intently to the physicians. We still would have needed to determine a gender so that society could acknowledge our child’s existence. Just like today, 20 plus years ago there were only male or female choices on US birth certificates. On paper our child needed to have a gender distinction, but physically probably not.

We followed the professional opinions and physically modified our child to be more female in appearance. Today we would have had more informational tools within our grasp and we would have realized that this ”rare” occurrence wasn’t as unique as the professionals believed.

While we tried never to mislead our child about who they are. We would say things like “nature didn’t make the decision about who you are so we had to”. All that time, while we thought we were keeping the perception of who our child is open to discussion, we were missing the most important fact. There was no perception; nature had in fact made a decision about our child. There was no need to modify the fact that nature had made our child intersex. We didn’t need to have physicians physically modify our child’s appearance. It wasn’t nature’s problem its society’s misunderstanding that gender is not two single points, but actually a continuum.

a hermaphrodite at the OB/GYN

Since I had a few doctors appointments this past week, and Obama passed his health care bill (thank God, or I might have moved Canada) I thought I would write about one of the most uncomfortable repeated experiences I have as an intersex person, trips to the gynecologist.

From the moment I step into the waiting room I can't help but think "the alien has landed." I am lucky, my gyno is actually very kind and understanding. That being said, I find the whole environment of the office and waiting room to be very unwelcoming, surrounded by diagrams and pamphlets of organs I don't have and pregnant women and parenting magazines when I'm sterile (if I wanted children that would be painful). Then, as if I'm not feeling out of place already, the nurse asks routine questions that really don't apply to me (When was my last period? Hmmm, let me think about that). I realize they are just doing their jobs, and I am probably being oversensitive, but it used to really bother me. Now I make a game out of being different, and have probably unintentionally scared a few of the expectant mothers, girly girls and conservatively dressed immigrant women when I swagger in with my short mussed up hair, wearing my Hard Rock t-shirt, jeans, and leather jacket carrying a radical feminist book (thank you Andrea Dworkin).

I think it would be a nice gesture of acceptance to the intersex (and transgender) community if the OB/GYN waiting rooms looked more generic. Even better would be researching there medical files beforehand to realize just how silly, awkward and often unanswerable their questions are to an intersex patient.

gendered documents and third sexes

On May 13th Australia, after going through considerable bureaucratic red tape, changed an adult birth certificate to "gender not specified" and may well change their passports as well. In light of this development, and the US census this year, I think it is important to talk about gender on official documents. Pretty much every document in pretty much every country require us to check of one of two boxes, any variation on that is not an option. For intersexuals, this forces us to lie on these documents. To be recognized on these documents would be a major step forward for intersex rights and greatly legitimize our issues. It would also be interesting if we were counted in the census, the sheer numbers would show we are more frequent then most of the world realizes.

I'm not a huge fan of the term "gender not specified" since it sees intersexuals in term of lacking. This may not seem like a major issue, but the language we use to describe things shapes perception (for evidence of this look at African Americans and homosexuals reclaiming words that were used to hurt them, taking away their power, or the PC push for gender neutral wording for jobs traditionally seen as male).

Using the term "gender not specified" is a cop out. It allows for the existence of intersexuals, but doesn't take that to its logical conclusion, the existence of a legitimate third sex. I think most gender nonconformists would agree with me that a recognized, acceptable category to but them in would be a major step forward for them. I am not suggesting a major social reorganization or revolution, just an honest recognition and acceptance of reality. If it is in our documents, that is a good first step.

a defense of DSD

By far the most controversial topic in the intersex community is the term disorders of sexual development (DSD), an expression that gained much legitimacy when it was used by the Intersex Society of North America (ISNA). I, like most activist intersexuals hate the term and the use of the word "disorder." That being said, ISNA does have a good defense of its use of DSD on its website. Since I am as fair and balanced as Fox News, I have posted that defense for your reading pleasure:

Over the past year, we have begun to use the term “disorders of sex development,” or DSD, in place of “intersex” in these contexts. It’s not our intention to make intersex an entirely medical issue. But we are addressing people working in a medical context. We have found that the word DSD is much less charged than “intersex,” and that it makes our message of patient-centered care much more accessible to parents and doctors. Our aim is to meet them where they are.

Intersex itself is not a disorder, rather a variation. But Congenital Adrenal Hyperplasia, for instance, is an inherited disorder affecting adrenal function. Many women with Androgen Insensitivity Syndrome have become comfortable with the term AIS, which is based on “syndrome.” But “syndrome” is a pattern of symptoms indicative of some disease or disorder. “Disorder” refers to the underlying cause, not intersexuality itself, and certainly not to the whole person.

That said, there is so much more to intersexuality than the medical context. ISNA certainly doesn’t mean to tell intersex adults or support or activist groups what language they should use. If “intersex” is working for you, by all means use it!

We have found that the word “intersex” means many different things to different people. And sometimes it means different things at different moments to a single person! This makes it hard for parents and doctors to really hear what we are trying to say: that all children deserve to grow up free of shame, secrecy, and unwanted sexual surgeries.

The word “Intersex” was not invented by ISNA. It has been used in medicine since at least 1923 to refer to individuals with atypical sex anatomy. But we’ve seen it used with a variety of meanings by doctors, including these:

* there is a question about what sex to assign (so after a sex is assigned, is the child no longer intersexed?)

* there is ambiguity about the “true” sex (itself a problematic notion)

* there is a discordance between any of the sexual characteristics, including genital appearance, gonadal histology, internal reproductive organs, chromosomes

* there are ambiguous genitalia now (thus we have seen some doctors refer to patients after genital surgery as “formerly intersexed”)

* a synonym for the older terms based on hermaphrodite

And, since the advent of intersex activism, some new meanings have arisen, including these:

* an experience of gender identity (obviously very personal, and differs from person to person)

* a political identity (also differs by person and over time)

Parents and doctors are not going to want to give a child a label with a politicized meaning. Nor should they. People born with atypical sex anatomies grow up to have many different kinds of gender identities, and no one can predict for sure what gender identity any particular baby will grow up to have. So it doesn’t make sense to label a child’s anatomy with a term that implies a particular gender identity. Furthermore, many adults born with intersex conditions reject the label “intersex,” some because their experience of gender is typically male or female, some because the word labels the whole person rather than a particular aspect, and probably for a variety of other reasons.

Intersex activist Emi Koyama writes about more of the ways that ‘intersex’ interferes with communication. We share her experience that media, time and time again, want to talk to us only about people who were “assigned the wrong sex,” an important but extremely narrow aspect of what’s wrong with the traditional medical model.

As we were working with adults, parents, and doctors to create documents that provide a detailed explanation of patient-centered care, we came to the conclusion that a medical term would be the easiest way to communicate about medical care, and we began to use the term “DSD.”

Since we began to use “DSD,” we have found many more doors open to us. We are now able to have discussions with doctors in which they begin to understand that paralyzing shame can be a worse outcome than gender dysphoria; that a person may have an atypical gender identity without experiencing that as a problem; that people with gender dysphoria can transition and do very well. The handbooks have found a grateful audience with doctors, parents, psychiatrists, social workers, psychologists, and genetic counselors. We are sure that this information will help medical professionals and parents feel more comfortable and do a better job of caring for children born with intersex conditions.

The fact that intersex people are speaking out is still a very new phenomenon. ISNA’s thinking, our use of language, and the focus of our work has evolved since our founding in 1993, and they will surely continue to evolve.

SECOND interSEX

Second Sex by Simone De Beauvoir is considered a masterpiece of feminist thinking. Her ideas about how women are subjugated are also easily applied to intersexuals.

De Beauvoir's main premise is that women are oppressed by having men define them as 'other' being opposite from men in every way. This is why intersexuals are mutilated, we blur that line between the essential and absolute male who imposes his will on the world, and the inessential incomplete female who waits for the male to rescue her. This is why the majority of us are made to look female, we are seen as lacking that essential masculine quality to earn manhood, and yet we are close enough that we challenge men's authority and thus cannot be allowed to remain as is. The fear these cultural myths creates perpetuates the mistreatment of intersexuals, just as it does to women.

Even though we live in more enlightened times then De Beauvoir, these subconscious paradigms are pervasive, especially when it comes to gender roles. De Beauvoir discusses various mythical representations of women and demonstrates how these myths have imprinted human consciousness. De Beauvoir hoped to debunk the persistent myth of the “eternal feminine” by showing that it arose from male discomfort with the fact of his own birth. Throughout history, maternity has been both worshiped and reviled: the mother both brings life and heralds death. These mysterious operations get projected onto the woman, who is transformed into a symbol of “life” and in the process is robbed of all individuality. In previous blog entries I have written about the many mythologies surrounding hermaphrodites as being mystical, monstrous, and hyper-fertile (ironic since most intersexuals are sterile). these myths create the attitude that intersexuals are somehow subhuman (or perhaps superhuman) and thus robs them of their humanity, making them into something out of legend.

De Beauvoir's most famous quote from Second Sex is that one is not born a women, but becomes one. She claims women are shaped by a thousand external processes. At each stage of her upbringing, a girl is conditioned into accepting passivity, dependence, repetition, and inwardness. Every force in society conspires to deprive her of subjectivity and flatten her into an object. Denied the possibility of independent work or creative fulfillment, the woman must accept a dissatisfying life of housework, childbearing, and sexual slavishness. Some people, on the other hand, are born hermaphrodites and are forced to become a woman by far more rigorous methods. Most intersexuals are also unhappy with what society has forced on them. These changes are done for the same reason, to preserve male domination.

intersex on TV

Intersex has been showcased on a couple of TV shows recently. This can be good and bad since it increases intersex visibility and informs more people that such things happen. The downside is that it can sometimes misinform people, or in the case of humor, be downright offensive.

The most recent case of intersex on a TV show is on the Sarah Silverman show episode The Proof is in the Penis, aired on February 4th, 2010. In the show, Sarah's sister, Laura tells Sarah she was born a hermaphrodite to try to get her to 'man up' and get a job so Laura wouldn't have to pay her rent. The episode is actually more about gender roles with Sarah camping out and acting macho as a part of the comedy. The general moral of the story is a nice anti-sexism message with Sarah realizing she didn't need to be a man to take care of herself. There was some interesting accurate intersex moments. For example she seems genuinely upset and confused when her sister tells her. Her sister finally admits that she got the dismembered baby penis that Sarah found in her medical files from the hermaphrodite trashcan at hospital. This is hurtful, but it also recognizes the medical mutilations intersex infants undergo.

A much better and more accurate portrayal of intersexuality was on House last season in the episode The Softer Side, which actually used the term "intersex". Dr. House and his team are faced with a genetic mosaic teenager who was raised male. It has a very accurate portrayal of the parents with the pain and confusion and second guessing their choice to make the child male. Another very accurate thing is that they kept his condition secret from the child, calling testosterone injections "vitamins." His mother also forced strict gender roles, making him take basketball instead of dance which he preferred. It also shows the doctors points of view. Dr. Hadley (aka Thirteen) was tired of lying to the patient and tipped him off about being intersexed. This leads to his realistic anger and mistrust of his parents. Thirteen then gives him some good advise that all intersexuals can take to heart, saying he can to dance and basketball, and doesn't have to hide behind a mask. There are also other areas of intersexuality that are brought forward such as complications from surgery (strictures of penis, and depression in this case), and a fear on the part of the patient that he is gay, since he likes one of his team mates (homophobia is one of the leading factors contributing to intersex mistreatment. House is notorious in the show for being an asshole, however, gives some advise to the parents that is offensive to intersexuals, but also refreshingly, bluntly honest when he says "you gave birth to a freak of nature, that doesn't mean you have to treat him like one."

Don't Ask, Don't Tell

Former Congressman Duncan Hunter, a Republican from California, was interviewed by NPR's Melissa Block about his opinion on Don't Ask Don't Tell (the law that says homosexuals must stay closeted to serve in the military). He was not even asked about intersexuals, but his answer managed to include them, and was offensive and perpetuated the status quo of intersexuals as invisible second class citizens.

BLOCK: You are not in favor of a repeal of don't ask, don't tell. Why not?

Rep. HUNTER: No, because I think that its bad for the cohesiveness and the unity of the military units, especially those that are in close combat, that are in close quarters in country right now. Its not the time to do it. I think its - the military is not civilian life. And I think the folks who have been in the military that have been in these very close situations with each other, there has to be a special bond there. And I think that bond is broken if you open up the military to transgenders, to hermaphrodites, to gays and lesbians.

BLOCK: Transgenders and hermaphrodites?

Rep. HUNTER: Yeah, that's going to be part of this whole thing. Its not just gays and lesbians. Its a whole gay, lesbian, transgender, bisexual community. If you're going to let anybody no matter what preference - what sexual preference they have that means the military is going to probably let everybody in. Its going to be like civilian life and the I think that that would be detrimental for the military.

The one thing I will say in Hunter's favor is that he realized queer inclusion. All gender and sexual minorities are oppressed by the same sociopolitical forces, and as such, our fates are all intertwined. You can tell, just by his word choice, that he has nothing but contempt for anyone who does not fit into his pseudo-fifties view of gender and sexuality. He might as well have said if gays are allowed to serve, then we'll also have to let the real freaks in. He obviously has very little respect for our troops, both gay and straight and their ability to find common ground. Civilians have adapted greatly these last couple decades to work with gays, and now are working on other gender variants, our military personnel can do the same. Personally, I think anyone who wants to serve their country should be able to. There is no evidence of negative outcomes to a more open acceptance policy. The majority of Americans, both civilian and military support repealing DADT, and other countries that allow open gays to serve, like Great Britain, have not been any worse for it. To unilaterally block a minority group like that is not only discriminatory, it's also hateful and mean spirited. Plato, the father of western thought, would also disagree, he said gays were ideal for the military, because it would make them fight harder to impress their lover. In the case of intersexuals, there are probably several already in the military, we are so hidden, and it is such a taboo topic, they would never know. Intersexuals are already becoming more known in other parts of society, why should the military be any different?

intersex valentines poetry

In honor of Valentines Day, I am going to showcase one of the oldest expressions of love, poetry. In this case poems written by intersexuals. These poems are obviously not about romantic love of another person, but of learning self acceptance, but I think they are still relevant because it is true that you have to love yourself before you can love another, and that goes double for those of us who are different. I hope you all have a wonderful Valentines day with that special someone, or with yourself if you are single or working on that self acceptance. Enjoy the poems.

Ode to a Life
Heidi Walcutt

A little child was born today,
whether it’s a boy or a girl was hard to say.
The poor, innocent mother they quickly sedated,
While the doctors and nurses stood around and debated.

One doctor said “The penis is too small,
this will never, never do at all.”
Another spoke up “No, the clit is too large,
we need a specialist who can come in and take charge.”

So the call went out across the land,
and when a group of specialists was at hand,
A series of tests was the first thing they did,
the result of these, from the parents they hid.

When all of the testing and probing was done,
the doctors said “We can never tell them of their son.”
So the parents were never told of their little boy child,
who by a miracle of nature was born to be wild.

So they sliced and they diced, a new woman to make.
“To hell with the consequences, we’ll fix Nature’s mistake!”

Counseling next became their obsession,
they hounded and pounded into the child their lesson.
“You are a girl, there’s no doubt of that,
trust what we tell you, a fact is a fact.”

So she lived in the shadows, without any life,
she was constantly battered by emotional strife.
Never voicing her fears, her hopes or her doubts,
until she found ISNA and let it all out.

Anger
Michelle O'Brien

I had to let the anger go.
It got in the way of everything.
It did not help.
It still can well up.
But the aftermath is often not good.
It hurt others, and it hurt myself.
I did not want to carry on with my life driven by anger.
It would have destroyed me.
This is the thing with this anger, it is not my anger.
Somebody else put this anger inside of me.
If I allow myself to hang on to that anger,
they are still there, inside of me.
By letting go of that anger, their power is broken.
Only by letting go of the anger could the true healing begin.
To accept the anger took half a lifetime.
To recover from it will take the other half.
I want to love, not hate, for I was born to love.
I will not waste the other half of my life on anger.

What Ails You, Hermaphroditos?
Testika Filch Milquetoast

each day is as a riddle
a giant game of twister
for I won't be your brother
nor shall I be your sister
I won't be your "disorder"
nor a "false" to what is "real"
I'm humyn, all too humyn
because that's the way I feel
your "science" won't define me
no matter how hard you try
nor shall your law confine me
as I breath a heavy sigh
your "faith" can not condemn me
for I have faith in my own
we will turn back your attack
'til we free your heart of stone

intersex fashion

Judith Butler's book "Gender Trouble" is a seminal work in feminism that helped kick start gender studies and queer theory as subjects of study. The book is too esoteric to get into on a blog. That being said, the example she uses in her conclusion, of wearing drag as a way to subvert the gender dichotomy holds great implications for intersexuals, and society at large.

Drag, for those who have been living under a rock, is the wearing of clothes typically associated with the opposite gender. The term was actually coined by Shakespeare, since women weren't allowed to act in his day, men played the female rolls, which old Bill Shaky designated in his manuscripts as "drag" short for DRessed As Girl.

Drag can be done for entertainment like Shakespeare, or "trouser rolls" for women in opera since there is a serious shortage of castrati these days. There are other people who wear drag for personal reasons, such as cross dressers or transgendered people before they transition, either they prefer the other gender's clothing or it better fits their gender identity, or both. Butler, however, was talking about drag and gender performativity for sociopolitical reasons, namely challenging people's assumptions about gender (it could be said that a drag show is political, as well as entertainment).

Drag only exists because of a quirk of human biology and culture. Humans have far less sexual dimorphism then many species (that is to say, human males and females look fairly similar to each other). What differences there are between men and women are covered by clothing, thus clothing and hair style becomes the primary method to tell men from women. What, you may ask, does this have to do with intersex? Since what clothing one is expected wear is connected to biology, what does the discerning intersexual wear to be gender conforming or variant? Many intersexuals feel that they are real men or women and live as such, and for them, what attire is normal and what is drag is self evident. For those intersexuals, like me, who have a more complicated gender identity, this becomes more tricky. There is no hermaphrodite or genderqueer department at the store, therefore, it could be argued that anything an intersexual wears is drag, since none of it was made for their sex. Luckily for those of us who were made into women (a vast majority), androgyny is quite stylish for women, with pantsuits, waistcoats (vests), and even tuxedos (thanks to Yves St. Laurent)are becoming a staple of women's fashion, it is easier to create a more androgynous, intersex style.

It should be remembered, as Butler said, that drag is a performance. Drag artists generally do not see themselves as the gender they are acting, this is why drag has the power to upset gender. This is something intersexuals always need to remember, gender itself is a performance. What you wear will label you as deviant or conforming. Whether or not you are actually male, female or lucky enough to be something in between, what you wear will determine if people see you as male, female, or a drag artist (which they may not like). Always be aware of the message you are sending.

intersex and political parties

One interesting thing about being a member of a very small minority group is that we are only recognized by very small minority political parties. Neither the Democrats nor the Republicans have ever made a stand on intersexuality or made intersex rights a part of their platform or agenda. However the Green and Socialist parties have included intersex on their platforms of issues they would fight for if they ever got into office. This is not to say that intersexuals should become socialists or greens, but that they should be aware of this fact, and encourage Democrat and Republican leaders to support intersex issues. Ideas, like music and fashion, originate on the fringes and become more mainstream. As such, as intersex becomes more well known, it is inevitable that the mainstream parties will recognize us and eventually we will get our full human rights. For your reading pleasure, I have included these parties statements on intersex:

Green Party 2008 platform:
"We support the right of all persons to self-determination with regard to gender identity and sex. We therefore support the right of intersex and transgender individuals to be free from coercion and involuntary assignment of gender or sex. We support access to medical and surgical treatment for assignment or reassignment of gender or sex, based on informed consent.

We support the inclusion of language in state and federal anti-discrimination law that ensures the rights of intersex individuals and prohibits discrimination based on gender identity, characteristics, and expression. We are opposed to intersex genital mutilation."

Socialist Alliance 7th National Conference:
Intersex people are people born with physiological differences that may be seen as being both male and female at once, not wholly male or female or as neither male nor female.

Intersex people are subjected to discrimination in employment, in housing, in the provision of medical services, and the provision of government services.

There are no laws preventing discrimination against intersex people.

Intersex children may be subjected to non-consensual surgery so that their bodies conform to dominant ideas of what constitutes a ‘male’ or ‘female’ body. Non-consensual genital surgery is particularly controversial and where there is little debate against prohibitions on female circumcision, similar procedures on intersex people happen with little community comment.

The Socialist Alliance rejects pathologising definitions of intersex such as “disorders of sexual development”. The difficulty for Intersex is not differences in anatomy but rather how those differences are perceived by the community.

Social prejudice against non conforming bodies such as intersex, are the issues that needs attention. Intersex people should not be compelled to change their bodies, their behavior, or themselves to meet mainstream social expectations.

The Socialist Alliance stands for:

1. All non-consensual surgery on children, where the child is denied the informed and cognizant right to consent or reject) ceasing immediately save for those cases where surgery is life preserving.
2. Children being able to declare their sex, even if that is none, when they are fully informed and able to understand those concepts.
3. Any individual having their passport marked with X rather than sex or gender if they so desire.
4. An affirmative action policy in public housing, work opportunities, education, and the provision of medical and government services.
5. Education campaigns to be conducted in schools and wider society to debunk the myth of sex and gender binaries, informing individuals about sex and gender diversity, and opposing bigotry because of perceived sex and gender differences.
6. Intersex athletes like Caster Semenya not being publicly outed. That there are no compulsory sex testing procedures in sport.
7. Legislation that provides protection against discrimination and vilification and promotes equal opportunities for intersex people.
8. Access to appropriate medication and surgery when and if required based on the needs of the individual and not on the expectations of diagnostic protocols. This includes the abandonment of the diagnosis of “gender dysphoria” for those intersex who reject their birth assignment.
9. All people, particularly legislators and medical professionals, acknowledging that sex and gender is more than men and women , male and female.

more on intersex and the olympics

My last post on the Olympics was in September, with the winter Olympics coming up, I realized I left two important facts, and their frightening potential outcome.

Officially, the Olympics have not done any gender testing since the 1996 games in Atlanta. They now only test on 'questionable' women, like Caster Semenya. One article I read compared this to the old blood quantum standards in anti-miscegenation laws to preserve the separation of the dominant class. They were only applied to blacks who looked too white, not whites who looked to black, just like these standards of women being too masculine, rather then men being too feminine. This is blatantly discriminatory, why should women undergo humiliating tests because some people view their behavior or appearance as being too gender nonconformist? The other fact is that they allow transgender athletes to compete providing they have had genital surgery and have been on hormones for two years. Personally I agree that transgendered people have every right to compete if they qualify, however, they should only undergo surgery if that's what they want (some opt not to).

This creates a disturbing, but logical platform for the International Olympic Committe to mandate that intersexuals simply need to be surgically and hormonally modified to compete. This would be morally repugnant, a continuation of the violation of intersexuals bodily and human rights. There are many alternatives such as simply stopping all sex investigations, or creating a new category for intersexuals to compete in. The basis of gender testing is out of a sense of fairness, so why not divide athletes by ability, like weight classes in boxing and wrestling rather then by sex? In any case the Olympics showcase the physical potential of the natural human body (if this wasn't the case why not use steroids to do better?). To stop intersexuals from competing as they are made hides their physical capabilities from the world.

is the intersex movement radical?

Today I am going to touch on the controversial world of sexual politics. I want to talk about an odd thing I occasionally read about on the web. This is an accusation by social conservatives that the intersex movement is socially and politically radical. This argument is best summed up on the the Wikipedia entry on "intersexuality":

"social conservatives have claimed that the talk about third sexes represents an ideological agenda to deride gender as a social construct, whereas they believe binary gender (i.e. there is only male and female)is a biological imperative"

The crux of their argument rests on the biological necessity of male and female, and they are part right. We need biological males and females having sex or else our species will die out. However this does not mean that they have to cling to the gender roles and expectations associated with their sex. This also does not mean that there can't be a third, or more sexes, many cultures throughout history have had such a system. While intersex does prove visibly that the gender dichotomy is a myth, most intersex people are not calling for its abolition. The most important part of this accusation is that the intersex movement has a radical agenda to destroy gender. This is simply not the case. First it must be said that many, if not most, intersex people identify as male of female. Most are not genderqueer. No intersex organizations are calling for an end to recognizing males and females, and their differences. We are asking for the right to decide what happens to our bodies, our our self identification notwithstanding. Granted, there are radicals out there who do want to destroy the gender binary, but most of them are not intersex. Sometimes these radicals use intersex conditions in their arguments, however what most intersexuals are asking for is far more modest by comparison. A world that does not recognize binary gender may be friendlier to intersexuals. I realize such a thing would never happen and might create more problems then it would solve. I would be happy if society recognized my bodily rights and had a proper category to place me in.

gender versus sex, the ultimate showdown

By far the most difficult concept to get right when it comes to intersex is the difference between sex and gender. This is one area that trips up many people (both gender conformists and non-conformists alike) and prevents them from "getting it."

Let me clear this up with a little Gender Studies 101: sex is biological, whether your gonads, chromosomes and genitals are male, female or intersexed. Gender, on the other hand is social, how other perceive you, and how you see yourself, masculine, or feminine, or, often somewhere in between, like a tomboy or a metrosexual. There is also considerable variation with interests such as a guy who likes to dance or a girl who likes cars, and it can also be situational, like a woman who takes charge when the pressure is on, or a guy who is secure enough with himself to cry. In spite of the incredible variation in gender, most people still see themselves as men or women, and most of society would agree with them (there are some people who consider themselves genderqueer, but they are few and far between).

There are many different ways to look at gender. It used to be "men are from mars and women are from Venus" They are so completely different that they aren't even from the same planet. The more common way now is to look at it as a spectrum. However I think this leaves a very big piece of the puzzle out. The piece is power. It is by domination that gender is defined. Even in a single sex group there is always a dominant leader, usually chosen subconsciously based on a myriad of social status factors(race, (dis)ability, wealth ect.) and personality. This leader is seen as more masculine, the alpha (fe)male.

Now you must be asking yourselves, what does all this have to do with intersex? Well intersex is a sex, not a gender, however there some obvious overlaps. For example most transexuals would be quick to point out that their brain structures resemble that of the sex they transitioned into, not the one they were born with. Also the more older brothers a man has, the greater the odds are that he will be gay. The theory behind this is because the more male babies a women has, the better her body will be at protecting itself from him and their cellular incompatibilities. In short he is bombarded with more female hormones in utero, feminizing him, resulting in a gay guy. These overlaps in gender and sex are especially important to intersexuals. We are no different then "normal" people, many see ourselves as male or female, just a little different then most. However, as I pointed out, there is an overlap with sex and gender, and many other intersexuals have a more complicated sense of their gender. In short, most of the medical abuse against intersexuals are out of fear that they will be "abnormal" or mistreated by others. This shows a remarkable ignorance to how varied gender is as well as strong latent homophobia and transphobia which, is not only wrong, but also stupid since many intersexuals lead mundane male or female lives.

Intersex and Music

Hello readers. I'm going to switch gears for today and talk about one of the great loves of my life, music (don't worry, I'll go back to my usual serious self after this post). It has occurred to me that, as far as I know, there has never been an out intersexed professional musician.

 There was a rumor that Lady Gaga is intersex.  These rumors are based on some jokes she made during and interview and tweeted about, and an 'accidental' flashing during a concert.  Her manager has denied these claims, leading me to agree with the majority of music blogs, that it was a publicity stunt. I find this kinda sad since, at 1 in 2000 births, we are not as uncommon as most people think.  With the very emotional circumstances we undergo, and our unique perspective, we could write some great songs that could increase intersex visibility.  In any case, intersex people should never be used for publicity. If I am wrong, and Lady Gaga is an intersexual, I would hope she would use her position to further our cause, not make jokes and start rumors to further her career. Until I (or another intersexual) starts winning Grammys, there are a few good songs out there that I think really capture the intersex experience. The following songs make up my small, but nice "intersex" playlist on itunes. If you can, you should listen to them and comment this post with your opinions on them, and if you know a song that should be on the list and isn't, let me know, I'd love to hear it, enjoy!

Androgyny by Garbage
Postings on the Bodies Like Ours intersex discussion forum crowned this song the intersex anthem. While it does not directly mention intersexuality, the song is all about gender nonconformity in positive light. I think the refrain really sums it up nicely:
"Boys in the girl's room, Girls in the men's room
You free your mind in your androgyny
Boys in the parlor, Girls getting harder
I'll free your mind and your androgyny
Boys - behind closed doors and under the stars
Girls - it doesn't matter where you are
Boys - collecting jewels that catch your eye
Girls - don't let a soul mate pass you by"

Half Jack by The Dresden Dolls
According to their singer Amanda Palmer, this song is actually about her estranged father. The lyrics are so poignant toward the intersex movement that personally I have trouble interpreting it any other way. It is even used as background music on some pro-intersex videos on You Tube. For example, how could the following lyrics be about anything but intersex:
"its half biology and half corrective surgery gone wrong
you'll notice something funny if you hang around hear for too
long ago in some black hole before they had these magic pills to take it back
I'm half Jill and half Jack
two halves are equal, a cross between two evils,
it's not an enviable lot
but if you listen, you'll learn to hear the difference
between the halfs and half nots"

Hermaphroditos by Frank Black
This song is quite powerful, it can be interpreted to include the issues of surgery, suicide and how intersex people are historically mythologized, but its lyrics are quite strong, not to be listened to by the faint of heart:
Hermaphroditos is my name
"How do you love me
Deeply with your scalpel?
I got a mouthful
Of suicidal drugs
I am a dog
I am a sculpture
You hate my features
You name me for a God"

Herm Aphrodite by Stephen Lynch
Some intersexuals may not like this last song since it is meant to be funny. I like it, and say take it in the spirit it was intended, its all in good fun. It also makes some comments on gender roles in society and one verse has a good (probably unintended) message for keeping intersex people un-mutilated:
"Somethings are white, somethings are black
some girls wear makeup, mine shaves her back
but she is still beautiful, she is still fine
it's too bad her package is bigger then mine"

intersex anger

It has recently come to my attention that some readers consider this to be a very angry blog. I am sorry that it has been interpreted as such. It is true that I (and most intersexuals) are angry about our situation, and sometimes I use this blog to vent. The purpose of the blog is to raise awareness of issues and problems that many people don't even know exist, it is supposed to be a teaching tool, and if my readers don't see it as such, then I have failed in my objective. I am not an overly angry person, It is just frustration over my situation in general and a world that often doesn't "get it". This frustration is not focused at any particular people, no one is to blame. In fact everyone involved in the medical treatment of intersexuals has charitable intentions and feel that they are doing the best thing for the child. We are just victims of groupthink and social views of normalcy. I am sorry if my readers got the wrong idea about me, or intersexuals in general, and I will try to watch my tone more closely in the future.