The surgery you never wanted

The woman giving the presentation at the front of the room is as curvy as can be. So imagine my surprise when she reveals that she has XY chromosomes and has not had surgery to create those curves! And yet, she did have surgery at birth to remove her undescended testes, long before she was capable of authorizing the surgery. What in the world is going on here?

Welcome to the world of intersex people. The Intersex Society of North America (www.isna.org) describes an intersex condition as being “born with an anatomy that someone decided is not standard male or female.” Many intersex people have “normalizing” surgeries imposed on them when they are too young to grant permission, and then spend the rest of their lives struggling to heal from those surgeries.

In that struggle they often encounter issues based upon their gender identity and gender expression, and those struggles sometimes result in intersex people being included under the transgender umbrella. Whether or not that is appropriate, their situation is certainly worth a few words. (And if you ever see “LGBTI,” this is the I.)

There are many different types of intersex conditions. These conditions can result in women without ovaries, clitorises, and/or inner labia, and men without testes. They include people whose genitals are ambiguous, and people with chromosomes that are neither XX nor XY. And they include any baby with testicles whose penis is too short, and any baby without testicles whose clitoris is too large.

Feminist biologist Anne Fausto-Sterling has estimated that 1 or 2 in 1,000 have surgery to “normalize” genital appearance long before the children understand what is going on. Parents authorize the surgeries, desperate to avoid the “shame” of a child who does not conform to the gender binary, and the medical profession is only too happy to comply. Parents are then instructed to socialize the child as the gender that the child was made into, which, as you might guess, is disproportionately female. Parents are told to never tell the child about the surgery. Call it “Spin Control, Home Edition.”

This flawed treatment protocol is based largely on work done at Johns Hopkins University in the 1950s and 1960s that purported to show nurture was more important than nature in raising a child. We have since learned that people have a very strong perception of the gender they are—their “gender identity”—regardless of their upbringing. And a high-profile case that initially served as support for the Hopkins work—of a boy raised as a girl after a botched circumcision—later took a dramatic turn to make it convincing evidence to the contrary.

The story of David Reimer is documented in John Colapinto’s recent biography As Nature Made Him. All the while that David was being referred to as a success story by psychologist John Money at Johns Hopkins, David was clearly uncomfortable living as a girl and was refusing the recommended subsequent surgery to create a vagina. When David learned the truth about his botched circumcision at age 14, he quickly transitioned to live as a boy.

A 2004 study, conducted by another scientist at Johns Hopkins and published in The New England Journal of Medicine, offered more proof to the contrary. The study followed 16 cases of children who were genetically and hormonally male but were born with a very small or absent penis. Of the 16, 14 were given female hormones and raised as girls. Years later, researchers found all 16 to be behaving as boys no matter how they were raised, with eight of them now declaring themselves male.

What causes intersexuality? It’s often just the normal course of nature—-there’s much more gender and sex diversity in the human species than we were taught in school. But there is also evidence showing that exposure to certain chemicals while in utero can alter physical and genetic sex. Deborah Rudacille explores this possibility at length in her excellent book The Riddle of Gender. In one example she cites the surprising tendency of the sons of moms who took the synthetic estrogen supplement DES during pregnancy to have intersex conditions.

Intersex people who ultimately learn (and most do) that they underwent “normalizing” surgeries are left to feel as if they are anything but normal as a result. They feel rejected as the people they were at birth. They are also hindered in developing intimate relationships because the surgeries usually damage sexual sensation. And should the gender imposed on them in their early years turn out to be the wrong one, they often feel no choice but to undergo a gender transition to undo a choice that their parents and the medical community made for them.

Yes, intersex people show us a compelling example of how a strict, unwavering adherence to the gender binary can cause far more damage than good.