Fixing Sex: When Your Baby is Neither a "Boy" Nor a "Girl"

The birth of Tamara Dawson's first child should have been a moment of sheer delight. Instead, she describes the shocking and unusual situation that followed: "They took her away, and I had no idea what was going on. I'd never given birth before, so I was thinking ‘They're taking her away to clean her up.' The doctors and nurses came back and said, ‘We don't know if you had a boy or a girl.' We were stunned. How could you not know?"
Dawson's child was born with an unusual and rare condition termed intersex, in which the traditional markers of biological sex (e.g. chromosomes, external genitalia) are neither clearly male nor female. Stanford researcher and medical anthropologist, Katrina Karkazis, interviewed Dawson and others in order to understand how parents, their children, and the medical community cope with intersexuality. Her book, Fixing Sex is the result of meticulous research and in depth interviews with those most closely involved; it aims to help readers understand this unusual condition. I found the book fascinating for other reasons as well - namely how intersex conditions illuminate our taken for granted assumptions about what makes people male or female.

As Karkazis points out, an infant without a sex cannot be issued a birth certificate and usually cannot be named. Therefore, "Physically alive but denied a sex and name, the infant has no social existence. Personhood depends on gender assignment." I alluded to this facetiously in an earlier blog where I point out how we all tend to stare and stare at people whose gender is not readily apparent. We can relate to others without knowing their race, their background, their education level, or any other demographic variable - but we can't relate to others who have no sex. For this reason, the medical community has recommended that intersex babies be assigned to one gender or the other as soon as possible. Historically, most doctors have also recommended genital surgery despite the fact that it can cause a loss of sexual sensation later in life.

Issues surrounding sex reassignment burst into public view with the case of David Reimer, a little boy whose penis was accidentally burned off during a routine circumcision. Reimer's parents took him to see John Money - a John Hopkins psychoendocrinologist - who was well known for his work on the development of sex identity. Money suggested raising Reimer as a little girl. The full account of Reimer's subsequent life has been documented in a book entitled As Nature Made Him by Rolling Stone journalist John Colapinto. I remember reading the book during graduate school and finding the story horrific. Reimer's life as a girl is disturbing to the say the least, and he eventually committed suicide, even after transitioning to live as a man again.

John Money was vilified in the press for the Reimer case. Like many people, I readily believed that he must have been some kind of monster to perform such a Frankenstein-like experiment. However, Reimer's case was horrifying mostly because he wasn't born ambiguous - everyone knew he was a boy. John Money's theories and protocols were not originally intended for random sex reassignment. Furthermore, Karkazis points out that Money never suggested that biology plays no role in gender identity development. Money, along with colleagues in the field, were doing the best they could to rectify a situation where there appeared no good options. In this way, Karkazis paints a more balanced picture of the entire case; she also sheds light on how our society wants so badly to believe in cut and dry biological explanations of gender development.

There is no easy answer yet as to how to help intersex individuals cope with life. If you choose an infant's gender for them, how do you live with the consequences of that decision when things turn out badly? Many doctors who treat intersex patients simply choose not to follow up with their patients. For this reason, we don't really know how most intersex individuals fare over the long-term. Leaving things alone might seem like a good option on the surface. But how does one raise an intersex individual -- or even a boy or girl who is "different" -- in a society that demands everyone conform to certain rules? It's worth pointing out that other cultures do allow for a "third" gender. However, for many, the idea of a third gender is inconceivable.

There are many rare and unusual medical conditions where ambiguity is allowed for. Leading experts must sometimes tell their patients, "We just don't know enough about this yet." But when it comes to intersexuality, ambiguity has not been seen as a legitimate option. Whether pressured by colleagues, parents, affected individuals, political groups, or their own fear of what might happen if they do nothing - medical professionals feel compelled to assign individuals to one sex or another. Instead of putting the blame on those who are forced to make such difficult decisions, we can use these situations to help reexamine our own underlying, implicit rules about what is acceptable and unacceptable when it comes to gender.