Monday, March 22, 2010

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.

Wednesday, March 17, 2010

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.

Monday, March 8, 2010

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.

Tuesday, March 2, 2010


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.