Let’s Talk About Sex


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As I was filling out Kate Bornstein’s My Gender Workbook, doodling in the box that says “Draw a perfectly gendered person,” taking the quizzes to find my Gender Aptitude, and learning to adjust my definition of “transgender” to include anyone who breaks with the traditional portrayal of gender, which would include everyone from drag queens to boys in eyeliner, I started wondering how the me of five years ago would answer these questions. Obviously, I would be drawing “my gender” a bit differently. In my present drawing my gender has a cloche and a fur stole. But five years ago I was in the final throes of my Boy Phase (or, giving my current tendency towards glammed-out femininity, what a friend has recently titled my Pre-Op Period), a span of several years of dressing in men’s clothing and cutting my hair short. Even when I was forced to put on a dress for a work function, I was frequently called “sir,” no one noticing the dissonance created by my skirt.

The last century of gender theory has expanded the idea of binary masculine-or-feminine gender: It’s more of a spectrum — not one on which you are assigned a place to occupy for the rest of your life, but one on which you can shift like a be-socked child sliding over a newly waxed floor. From tomboy to cheerleader, from boy drag to girl drag, there are myriad influences on your gender expression, some more socially palatable than others.

But what about the idea of sex itself being a spectrum, rather than the binary of male or female? If you try to write out the criteria for the sexes, it quickly gets complicated. What makes someone male? The first obvious answer is genitalia. But take that away, due to a birth defect or an accident, and is the person still male? Of course, but why? Next answer probably goes to the chromosomes. But there are physical reasons why a child born with XY might have female genitalia and think of herself as female. Is maleness then caused by androgen exposure in the womb? Testosterone production? All fetuses start out as female, and things can happen during the pregnancy that prevent masculinization, or will masculinize a fetus with XX chromosomes. Currently, the word used to describe people born with physical traits both masculine and feminine, or with gender variations like Congenital Adrenal Hyperplasia (CAH) or Partial Androgen Insensitivity Syndrome (PAIS), is “intersex.”

Some, like Thea Hillman, the author of Intersex (For Lack of a Better Word), are not diagnosed until early childhood, some not until puberty. Hillman was four when she began to grow pubic hair. After a battery of tests, she was diagnosed with a mild form of CAH and put on hormonal treatment in an attempt to inhibit the growth of body hair and to allow her to grow to a normal height. The mildness of her CAH means she will not have the infertility, dwarfism, hermaphrodism, or facial hair that can occasionally result. But she is still poked and prodded her entire life, and every doctor’s visit begins with her pulling down her pants. It is a childhood of feeling ashamed of her body, of feeling there is something wrong with her.

In her collection of short autobiographical pieces, Hillman recounts a youth in and out of doctor’s offices, her parents’ acceptance of her coming out as gay, and her later involvement with intersex activism. After a lifetime of regulating her gender with hormones, she begins to wonder, what are the costs, and what are the benefits?

My whole life, my CAH has been discussed as a health problem. But now I realize it’s a sex problem as well. To what degree have I taken medication to maintain girl chemistry, to attain girl attributes and keep boy ones suppressed? To what degree have doctors done this, and in what ways have I become complicit? My medication suppresses the overproduction of 17 hydroxy progesterone, a precursor to testosterone. What else is being suppressed?

For others, these questions are not even possible. Many intersex children are born with ambiguous genitalia, meaning that a doctor cannot visually determine whether a child is a boy or a girl. The labia might be fused, or a baby may be born with a micropenis or an enlarged clitoris. Doctors may do chromosome testing to assign a gender, or they might use the presence or absence of internal sexual organs to make a decision. But the standard for years has been to assign a gender at a very early age with surgical intervention.

It’s a controversial issue. Doctors and parents think they are sparing children embarrassment and pain. But now intersex activists are fighting to create a new protocol, one that waits until the child can participate in “hir” (forgive me — I know the pronoun is a clumsy compromise, but one that comes up a lot when you start reading about gender theory) own treatment.

Katrina A. Karkazis opens her new book Fixing Sex: Intersex, Medical Authority, and Lived Experience at a speech by Intersex Society of North America founder Cheryl Chase. Chase proclaims, “[Early genital surgery] is wrong. It’s torture. These children are subjected to involuntary surgery. Intersex people are not sick, they are not in need of care, but so-called rational medicine is coming after these kids with knives in their hands.” No one is arguing against treating quality-of-life or fertility-affecting maladies like hypospadias, in which the opening of the urethra might be located between the penis and scrotum. But if a child is born with an enlarged clitoris, which might look like a small penis, what exactly is the harm in waiting until puberty to decide whether to operate for cosmetic reasons?

Not all questions about surgery on intersex children are quite so simple, but the fact that surgery that is mostly cosmetic is still performed on infants — despite the fact that it usually requires follow-up surgery, that puberty will alter the appearance of genitalia anyway, and that it can elimination sensation or even make arousal painful means — that this is an issue beyond functionality or health alone. Doctors and families are using a scalpel to enforce what is acceptable for a female and what is acceptable for a male. Karkazis writes, “The debates over when to perform surgery and how best to decide gender assignment obscures the fact that in trying to make infants with intersex diagnoses ‘normal’ boys and girls, physicians and parents are necessarily drawing on cultural ideas about what constitutes male and female.” That includes assigning sex by guessing future sexual orientation in the hopes of avoiding any homosexuality.

Gender was once believed to be very easily influenced by rearing, as was sexuality. Therefore it seemed perfectly reasonable for a child born with a micropenis to be surgically reassigned as a female because the “assumption is that it would be better to be a woman without a vagina and no reproductive capacity than a man with a small penis.” Girls’ enlarged clitorises were sometimes removed altogether, despite the loss of sexual pleasure, to save them and their future partners (always assumed to be male) any discomfort. One of the most horrifying parts of Fixing Sex (and between stories of penile reconstruction gone wrong and stories of young girls being forcibly held down while their newly built vaginas are dilated, there is a lot to choose from) is the surgeons’ justifications for clitoral removal or reduction. Dr. P, when asked, stated, “Most of the ones we see have significant clitoral enlargement, and I can’t leave that. These girls don’t look right. It’s unsettling. It’s repulsive. You just cannot leave them looking like that!” Dr. P was hardly alone in his “repulsive” opinion, and while reassigning boys as girls is significantly less common, clitoral surgery is still seen as a legitimate treatment.

Kate Bornstein was born a man, surgically transitioned into being a woman, and is now “gender neutral.” “Ze” rejects the idea of gender and sex as a binary and prefers Martine Rothblatt’s idea of gender being a color wheel. The three primaries are “activeness (or aggression), passiveness (or nurturing), and eroticism (or sex drive).” The three elements blend together and create your specific color, which can change and blend. As we learn more about how hormones, chromosomes, natal environment, and society alter and shape our gendered selves, science seems to agree. Remember a few years ago when everyone was measuring their ring fingers to see how much testosterone they were exposed to in the womb? Testosterone doesn’t just alter your finger length, of course — it influences traits like aggression and has possible correlations with homosexuality in women. Allowing for variation both psychological and physical is gentler than cutting and gouging children to fit a strict binary system. And for the men and women now living not only with their diagnoses but with the aftermath of surgeries, who fill Fixing Sex with stories of rage and shame, it might seem like a better option. • 19 November 2008