Loose Lips	Loose Lips Archive

What does it mean to be transgendered? At one end of the spectrum are heterosexual, anatomical males who are drawn to wear women's clothing. In the middle are those who are transitioning from one gender to another, perhaps through surgical means. And finally, there are those born with genitals which are not obviously male or female.

Such people have traditionally been called "hermaphrodites," but most now prefer to call themselves "intersexed" or "intersexual." When intersexual children are born, something about their genitalia doesn't conform to the usual pattern of either a male or a female. In some cases, the result is medically dangerous; surgery must be performed to allow normal urination or to prevent infections. But in many other cases, the only "problem" is that the child's genitalia do not match expectations. The standard medical response to this has been cosmetic surgery to make the genitalia match either the male or the female prototype. But in the last few years we have learned how damaging such an approach can be to the children involved.

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Numerous intersexed adults have reported that they spent their childhood with the sense that something was wrong and that they didn't fit in. Upon reaching puberty, new problems arose. Children raised as males sometimes began to menstruate or to grow breasts; children raised as females sometimes developed facial hair and a deep voice. Their doctors prescribed testosterone or estrogen to force the body into adapting to the assigned gender. When the time for sexual experience came, intersexed individuals often found themselves handicapped in their sexual response, with a surgically constructed vagina devoid of sensation or a penis incapable of achieving an erection. Because medical experts often advised that such genital surgery be kept secret from the children involved, the eventual revelations of such operations often proved traumatic.

Miss Poubelle is no medical expert but understands that any fetus is inherently intersexed: the penis and the clitoris are the same organ for most of fetal development; in most cases a penis develops out of a clitoris when certain hormonal signals are present in the uterus. Similarly, the testes and ovaries originate from the same organ, as do the scrotum and the labia. Intersexed babies are born when the genitals have begun to take on a masculine configuration, but have not completed the transition.

Sally Lehrman, writing in Salon, points out that doctors who perform intersex surgery often relied on a rule of length: If a penis is less than one inch at birth, it doesn't count. And if it's more than three- eighths of an inch long, it can't qualify as a clitoris either. Any child with genitalia between these two lengths was likely to have it cut off and be raised as a girl.

The obvious problem is that if the child grows up to identify as male, he has no penis. If the child grows up to identify as female, then her clitoris has been mutiated. An infant with a indeterminate clitoris/penis may also have no functioning ovaries and no vagina. In such cases, the surgeons may construct a vagina, but it will generally not function well, and other surgical interventions will be necessary as the child grows older.

The theory that supported such surgery on intersexed children was most famously proposed by John Money, of Johns Hopkins. Money believed that a person's self-perception of gender was almost entirely the result of the environment. So if you take a child with testicles and XY chromosomes, remove his inadequate or damaged penis, and raise him as a girl, everything should be fine, right? But the actual results seem to be exactly the opposite. Researchers found that in almost every case, the child reassigned to be a "girl," later showed behaviors more typical of a boy­ even though the whole procedure was concealed from him. Some declared themselves to be boys and refused to wear girls' clothes, despite the fact that they had been raised as girls and looked like girls.

Now the issue of the appropriateness of genital surgery on intersexed newborns has been raised by the Intersex Society of North America (ISNA), formed by Cheryl Chase, who was herself a patient of Money. ISNA has called for a ban on cosmetic surgery on the genitals of children, and advocates letting them make their own decisions when grown. Defenders of the medical profession say that the treatment of intersexed children has progressed enormously in the last 20 years, and now that more advanced surgical techniques are avail able the abuses ISNA complains about are a thing of the past. But it's curious that so many medical professionals in this field seem to discount even the possibility that children might be able to grow up psychologically healthy if they have unusual genitalia.

Intersexuality is a different than homosexuality, of course. But Miss Poubelle sees in traditional treatment of intersexuals many of the assumptions that underlay the medical abuse of homosexuals for so long: the idea that society will never accept deviation from sexual norms, that those who depart from the sexual norms can never be happy in society, and thus deviants must undergo psychological/surgical/hormonal treatment so they will match society's expectations.

The gay rights struggle has taught us that seemingly immovable attitudes can change. Because so many of us couldn't change to meet the world's expectations, we had to change the world instead. Because intersexuality is rare, it will be difficult to teach people to treat intersexuals with dignity. But if it can be done, intersexuals will not need to undergo years of surgery to conform to society's idea of normality. Intersexed people are at the beginning of a long struggle to change the world... again.