C is for Chimera

Our C word for today is chimera, a rare and interesting intersex condition.  Chimeras occur when fraternal twins fuse together in utero at an early stage of development.  The result is one individual with two different sets of DNA.  Some groups of cells in their body have one set of DNA, and other groups will have another set.

It is important to realize most chimeras are not intersex.  If both twins are the same sex, obviously they will not be.  Even if the twins where different sexes, chimeras DNA tends to stay within different organs and systems, having a male liver and female kidneys for example.  Thus even if they genetically have male and female cells, they usually develop along the lines of whichever genetics their reproductive system is.  That being said, there are rare cases where a chimera will have ambiguous genitalia and a mixed genetic reproductive system.

It is interesting.  Many people assume this is how all intersex people came to be.  My mom even said when I was a baby, people hypothesized that I was twins (I’m not).  Chimeras seem to play into an old cultural myth that a “hermaphrodite” must essentially be two people, or have some sort of soul or essence of two people (look up two spirit).  Obviously this doesn’t reflect reality at as most intersex persons are not chimeras and most chimeras are not intersex (in fact most chimeras don’t know they are chimeras).

C is for Congenital Adrenal Hyperplasia

Our first C word is congenital adrenal hyperplasia, more commonly known as CAH.  CAH is one of the more common, and most dangerous intersex conditions.  It is a term for several different recessive genetic mutations that affect the enzymes that convert cholesterol into cortisol in the adrenal glands.  This throws adrenal hormone production off kilter 

CAH is dangerous because the lack of aldosterone causes salt wasting.  Dehydration will set in within the first week after birth.  Vomiting, severe dehydration and circulatory collapse can happen within the second or third weeks after birth.  The good news is with hydrocortisone and a saline drip, most infants are out of danger within a day.  They will have to take glucocordicoids for the rest of their life to supply cortisol.  This is one of the few intersex conditions where I agree that immediate medical intervention is essential.  When a baby is born with ambiguous genitalia, the first thing doctors do is check hormone levels to see if it is CAH and immediate treatment is needed.

The adrenal glands of CAH patients put out more testosterone, genetically female patients will have ambiguous genitalia, and often more masculine hobbies and interests.  Because they do not produce mullarian duct developing hormones, they retain their ovaries and uterus.  They will have some diminished fertility, but could become pregnant.  Because of the excessive hormones, they often start puberty in mid-childhood and can lose several years of growth because of this.

This post is fairly simplistic because all the hormones involved with the CAH mutation are too complicated to get into here.  There are different kinds of CAH but they tend to have similar symptoms.

5 Reasons why Genital Surgery on Intersex Infants is Wrong

Today I am creating a buffer post between B and C.  I will continue blogging my way through the alphabet next week.  This is a list (who doesn’t love lists) of the top 5 reasons why genital surgeries on non-consenting intersex babies is wrong.  This may seem somewhat redundant, but people tend to pay attention when things in list form.

5.  It is done for the parents, not the child.  The baby cannot express a gender preference or a desire for genital surgery.  The parents discomfort is given priority over the child’s future identity and sexuality.

   

4.  It is not needed.  There is no reason to operate on an infant, ambiguous genitals are not a medical emergency.  If as an adult they decided this is what they want, fine, but there is no need to force it on babies.

3.  It forces us into a role we may not accept.  There is no way to tell how an intersex baby is going to identify.  If they grow up and identify opposite of the way the surgery made them, you will have created a whole new set of problems. 

2.  It robs us of sexual sensation.  We should have the right to sexual pleasure.  Surgery permanently robs us of this.

1.  We have the right to decide what happens to our bodies.  Unless it’s a matter of life and death, any surgeries that were non-consensual and purely cosmetic are ethically questionable at best.  What happens to our bodies is our choice not our parents or doctors.  

B is for Butch and Femme

Today B is for butch and femme.  Butch and femme are gender identities within the LGBT community.

 

Butch usually describes a lesbian with a very masculine gender presentation and identity.  It is not uncommon for women with a butch appearance to meet with social disapproval.  A butch woman could be compared to an effeminate man in the sense that both genders are historically linked to homosexual communities and stereotypes.

Femme usually describes a lesbian with a feminine gender presentation and identity, often one who is attracted to butches.  Femmes are often accused of being straight.   They also have to deal with issues of invisibility since they are not socially read as lesbians.

Up until the 70’s most lesbian relationships were organized with a butch/femme dynamic.  In the 60’s and 70’s second wave feminists accused butch/femme relationships of mimicking straight relationships, and thus being politically incorrect.  Many lesbians have countered that while butch/femme relationships usually appear straight, they also challenge and undermine heteronormative gender expectations.  Today butch/femme is a small lesbian sub-community.

There are many kinds of butches and femmes such as:

Boi: a young masculine lesbian who behaves and dresses like a teenage guy.  Considers “butch” an older “man of the house” role.

Hard Butch: also called a diesel dyke or a bull dyke, is a very masculine butch.

Lipstick Femme: a very feminine femme.

Soft Butch: also called a chapstick lesbian, they are more masculine lesbian but don’t fit the butch stereotype.  They are usually pretty androgynous and are more socially accepted then hard butches.

Stone Butch: an extremely butch, possible transman who is the sexual initiator and does not like to be touched genitally, prefers pleasing femme.

Stone Femme: also called a pillow queen, a femme who does not like to touch others genitals, only wants to be pleased.  Usually dates stone butches.

 Butch and femme are very rarely applied to gay men.  A masculine gay man is called a bear and an effeminate gay man is called a twink or, somewhat pejoratively, a flamer.

You might ask, what does all this have to do with intersex issues?  The honest answer is not much.  I do think it is important to be aware of the vast array of gender identities and presentations.  An intersex person could of course identify and present any way they want, including being butch or femme.

B is for bisexual

Today our B word is bisexual.  For those of you who have been living in a cave on mars, a bisexual is someone who is sexually attracted to both men and women.

Dr. Alfred Kinsey invented the famous Kinsey Scale.  The scale rates everyone from 0 (exclusively heterosexual) to 6 (exclusively homosexual).  3 would be a balanced bisexual with as much interest and experience with both sexes.  Kinsey believed that while most people gravitate toward one side of the spectrum or the other, almost no one is a perfect 0 or 6.  Almost everyone is just a little bisexual.

 

Bisexuals often feel that they are being erased or not taken seriously, they are often accused of experimenting or just being curious.  There is also a trend of bisexual chic, with culture encouraging young women to experiment with each other as a trendy thing and celebrities who are straight having public same sex kisses for attention and shock.  Most bisexuals don’t like this as it insults their sexuality.

What does all this have to do with intersex?  Intersex people come in all sexual orientations.  If you believe sexual orientation is biologically determined (no evidence to support this) then you might believe all intersex people are bisexual (not true).  In any case I thought it would make an interesting post. 

B is for Bathroom

Our B word for today is bathrooms.  I have written about bathrooms before, but it is an issue that many parents of intersex children are concerned about, so a short review is in order.

There is no reason parents should be concerned about public bathrooms.  There are privacy walls around the stalls (and in locker rooms, I changed this way all through high school).  There is no reason anyone has to find out you are intersex from a public bathroom. 

Sex segregated public toilets are required in all jurisdictions using the Uniform Plumbing Code.  The code does not ban additional unisex toilets, which are becoming more common.  This is good news for intersex, transgender and gender nonconforming people who are afraid or uncomfortable in a public bathroom.  Don’t sweat the bathrooms, you have every right to be there.  If you are uncomfortable for some reason, use the buddy system and bring a friend for protection.  

B is for Birth Certificates

Today is our first B word, birth certificates.  I have written about this before but a refresher course is a good thing.  In most of the world, a birth certificate requires checking a box indicating whether the child is male or female.  This unfairly pressures parents to label their intersex child.  The truth is, in most states, you have some time before you have to turn the certificate in, time to think things over.  If you are new parents of an intersex baby, please don’t let the birth certificate make you feel rushed, you really do have a few weeks.   

The good news is the gender on birth certificates can be changed.  The bad news is this not easy and most jurisdictions require documentation that you are undergoing gender reassignment.  This is good for transgender people, but an intersex person may not have such documentation if they are simply living as a gender other than the one they were raised in.

There are only four countries in the world that issue gender neutral birth certificates, Australia, Germany, Nepal and New Zealand.  This is ideal.  The worst part about the birth certificate conundrum is it forces intersex erasure.  Legally we cannot exist until we have an artificial label forced on us.  It legally disenfranchises us.  It also perpetuates the attitude that we must to be hidden, we must “really” be male or female.  We have to lie on legal documents to deny and hide a biological reality, and that is just ridiculous.  

Review of Golden Boy by Abigail Tarttelin

I will be getting back to the alphabet later on this week.  As buffer between A and B, I will be writing a review of the novel Golden Boy by Abigail Tarttelin (spoiler alert).

Golden Boy is an excellent book, well written for teenagers and adults.  It explores the difficulties of growing up intersex.  It explores the coming of age of Max, a teenager who is intersex.  He strives to be a perfect guy, but is secretly intersex.  The story is ultimately about how he accepts this.  Golden Boy is a pretty realistic portrayal of an intersex life told in a simple, nonthreatening way.  I highly recommend it to anyone who wants to better understand basic intersex issues from a personal/social perspective.  Max was concerned about being accepted, finding love, something I think all intersex people struggle with.  We should take heart that Max did find love and was accepted in the end. There are many people who can accept and love us as we are.

Golden Boy also shows the darker side of being intersex.  Max was raped in the beginning of the book.  I have always felt that intersex people are at greater risk for rape.  We are the object of fetishes, and in Max's case, seen as a non-gay alternative for deeply closeted self loathing people.  I hope Golden Boy will start a conversation about safety in the intersex community.

 

I learned something important from Golden Boy, I believed that if intersex people didn’t undergo surgery and could make that choice for themselves with their anatomy preserved, their lives would be better.  I still believe this, but Max was left intact and struggled with the idea of identity choice.  He desperately hoped his doctor would tell him is “real” sex is.  He was also resentful toward his parents for not making that choice for him.  Even when given autonomy, it is still difficult to be intersex in the world, but slowly we find our way.

A is for Ambiguous Genitalia

Our last A word is ambiguous genitalia.  Roughly 1 in 2000 people are born with genitals that are neither here nor there.  Ambiguous genitalia is the most obvious sign of intersexuality and are caused by a number of intersex conditions.  Ambiguous genitals come in many shapes and sizes.  Most doctors treat ambiguous genitals with surgery, though this is becoming more controversial (I don’t want to make this post another anti-surgery rant).    

Ambiguous genitalia are not medically dangerous, but are often shocking and catch the family off guard.  The family worries about their child being bullied or having sexual trouble (most ambiguous genitals are not well designed for giving or receiving penetration).  Children pick up on their parent’s attitudes.  I believe if the parents are ok with their children’s genitals, the children will be ok with their bodies and define intimacy for themselves.

Even “normal” unambiguous genitals are the most visually diverse part of the external human body.  Penises come in all lengths and girths, scrotums may or may not be lopsided.  The inner labia and/or clitoris may or may not be visible from the outer labia.  With all the diversity of genitals, ambiguous ones should not be difficult to accept.  They are normal for the person who has them.  We should learn to love ourselves and not try to erase human diversity.        

P.S.  There is an unfortunate fetishizing and fantasizing about a kind of ambiguous genitalia with a functional penis and vagina (see Japanese futanari, if you dare).  This does not actually happen in nature.  Ambiguous genitalia is not both male and female genitals, it is somewhere in between, and usually leans one way or the other (more male will mean less female and vice versa).  Fully formed genitals of both sexes on one body is pretty much impossible.  I hate to burn your bubble, but the genre of "hermaphrodite porn" is actually women wearing a prosthetic penis.  If you are trying to date an intersex person because this is a fetish you have I urge you to stop.  You will be disappointed, and their feelings will be hurt that you were only after them for some fantasy genitals.