Monday, May 25, 2009

Viewing Intersex Genitalia (Note: Explicit Artwork Included)

Disclaimer

This is a drawing I did of the genitals of an intersexed person. If you don't wish to see explicit material, please skip this post. If you are an intersexed person or an ally of ours who is concerned that posting images of intersex people's genitalia is abusive, please read my previous post. I discuss at length the many ways that photographs of us are exploited by medical practitioners and others, and why I believe humane images are necessary. Thanks.

Does a Picture Paint a Thousand Words?

When you look at the drawing above, what do you see? I see a set of external genitalia, an intersexed set that falls pretty near the center of the spectrum of male-to-female genital arrangements. Most people in our particular culture and historical moment apparently see something else. They see. . . something wrong. They want to know what it means. They want to be told whether these bits belong to someone who is "really a man" or "really a woman." And the authority they turn to to answer this (impossible) question is not the person possessing the genitals, nor regious authority, nor social scientists, but the medical profession.

Doctors get a lot of prestige from being the people who get to interpret life's mysteries for the masses. And they have an answer. I'll tell you what that answer is in a little while, but first, before what you see gets filtered through the medical lens, let me describe the structures you see depicted.

Anatomy of an Intersex Person

There are a great number of intersex bodily configurations, both internal and external. Our genitals come in many shapes and sizes--as in fact do those of people who are not categorized as intersex. What you see in this set of intermediate genitalia includes a phalloclitoris of intermediate size. Apparently many people experience something similar to a foreground-background illusion looking at the phalloclitoris (you know, like the illusion that looks either like two faces or a vase, which you can see here). They see a little penis, then a big clitoris, then a little penis. This flickering view has nothing to do with the genitals themselves, but with the lens of dyadic sex we've been trained to expect. This illustrates how we don't just see the world-in-itself out there, but a filtered view that imposes cultural understandings onto what we see.

The shaft and glans of this individual's phalloclitoris are mostly covered by a sheath of sensitive skin that we learn to call a clitoral hood or penile foreskin--again, dyadic terminology. The sheath of skin is bound down on either side, and the underside of the phalloclitoris is attached to the individual's body. Thus, when this person's phalloclitoris erects, it does not stand out from hir body but stays tucked close, pointing rearwards, as is typical for a clitoris.

At the center of this person's genitalia you see an invagination. It is fairly shallow, unlike the deeper vagina of someone with a classic female genital configuration. It is lined with delicate, lubricating skin. The urethral meatus ("pee hole") is in the central slit of the invagination.

Around the shallow invagination you see structures which are intermediate between labia majora (in female anatomic terms) or scrotum (in male terms). In this individual, there are testes that have descended and are held within the labioscrotum.

What Doctors See

As I've explained in an earlier post (here), doctors are the enforcers of sexual dyadism, and see all people as having a "true" or "best" sex, either male or female. Most often they like to assign intersex people to be female, and they remove or "reduce" our phalloclitori. They believe, though they tend not to say this, that it's better to be a female-assigned person with a surgically-constructed clitoris that feels nothing than to be a male-assigned person with a small penis. What they say, I kid you not, is that "it's easier to make a hole than a pole."

Doctors still take the "hard route" and attempt to construct a penis at times, and it's in individuals like the one whose genitals I've drawn here that they are most likely to do it: those with external testes. Internal ones they generally remove, claiming they pose a risk for cancer, but external ones they tend to leave in place. Finding external testes, doctors proclaim an intersex person to be "really male." Therefore, doctors looking at these genitals don't see a person of intermediate sex, they see a male with a "disorder of sex development" that they would term "perineal hypospadias with chordee."

On Hypospadias

As I've said, genitals exist on a spectrum. People with hypospadias run along the spectrum from maleformed genitals to the smack-dab center illustrated in this post. In people with what doctors call "first degree hypospadias," the genitals include typical testicles and a penile form that varies from the average male's only by having the urethra open, not at the center of the head of the penis, but on the underside of the head. Generally, the further down the shaft or perineum that the urethra opens, the more intermediate the genital form (doctors would say "the more severe the malformation").

Doctors almost always propose surgery for infants with hypospadias, even when there is only a small shift of the urethral opening. This causes scarring and loss of sensation, perhaps very mild, or perhaps leading to full numbness of the penile head and underside of the shaft. Constricted areas, holes that leak urine ("fistulas"), and recurrent bladder infections are common side effects, but are all deemed by doctors to be outweighed by the benefit of surgery. That benefit is basically avoiding the social mockery doctors presume is unavoidable for people with atypical genitals--the "locker room factor." Many male-identified people who had childhood surgery for minor hypospadias are very critical of the decision that was made for them, and, like intersex advocates, argue that no genital surgery should be performed unless and until a person grows up and chooses it. They'd rather have a penis with an off-center urethral opening that is fully sensate than a numbed phallus with an on-center urethra.

For people with perineal hypospadias, the consequences of surgery are more severe. Instead of having the functional genitals with which they were born--atypical but sensate intersex genitals that lubricate, erect, and experience pleasure--they wind up with small surgically-constructed penises that may be severely scarred and mostly numb. Instead of simply sitting down to pee, they may deal with multiple fistulas, a stuttering urine stream, and frequent bladder infections. In individuals with chordee, as in the drawing, since the clitorophallus is joined with the body, part of the glans and/or shaft will be cut off, left buried in the perineum or excised completely. Often there are multiple repair surgeries over the course of childhood--which is a source of stigma, not a shield from it. And significant numbers of these individuals grow up not identifying with the male assignment they were given, and in deep distress over the loss of genital forms they wish they had been permitted to retain.

The Moral of The Post

If people could look at intersex genitals and actually see them for what they are, a great deal of pain and suffering would be avoided. What you see in the image is an intermediate genital form, not warped female genitals or disordered male ones. When a child with intermediate genitals grows up, zie may identify as female, or male, or intersex, and should be allowed to decide what surgery if any is appropriate--but few get that chance. Wrong decisions are made for us all the time, and this happens in large part because our families have never seen genitals like ours before. They don't know how to interpret what they see because they have no context. So they turn to the doctors, who get a lot of prestige (and money) out of diagnosing us, selecting a dyadic sex for us, and surgically altering us without our consent. And not knowing anything about intersexuality, families go along. It's for this reason that I think it's so important that people see images of the full genital spectrum.

Artwork by Luminis, marker on paper, digitally manipulated. Copyright retained.

Wednesday, May 20, 2009

The Intersex Peep Show

No, You Can't Look in My Pants

Since I started coming out publicly as intersex, I've been asked by some people I've barely or never met to show them a photo of exactly what I keep between my legs. This is a very odd question--consider how you'd react if you received this request from some stranger. It can be disconcerting and creepy to realize that someone you don't know is thinking about your genitalia, requesting a photograph.

So no, I don't spread my legs for strangers. And motivation doesn't matter much to me in answering requests. Some people ask because they're kinksters. Don't get me wrong--I support everyone's right to their consensual kink--but I have not consented, and they don't get to play. Other people ask because of simple intellectual curiosity, and I support intellectual curiosity too. But I am not a specimen any more than I am a porno spread. I'm a person, entitled to my dignity.

Recently somebody contacted me wanting me to describe my genitals and my surgical history so zie could feel confident I was really intersex and not some poser. And while I empathize with intersex people feeling used or misrepresented, the answer remains no, you don't get to look in my pants to perform your gatekeeping.

But How Can We Not Discuss Intersex People's Genitalia?

This is an entirely different question than asking to see my. . . jonk. You're right, it seems odd to discuss intersex status without discussing genitals. I do want to point out that we discuss male experience, female experience, and the experiences of androgynes and genderqueer folk all the time without discussing their genitals. We don't ask to verify what they've got down there before discussing their gendered lives. And what defines intersex experience isn't genitalia but the social reaction to our bits--the way our very existence seems to create a crisis for medical professionals, families, and ordinary folk. There's no need to discuss our genitalia to address that social reaction.

But. I do think we should, as a society, discuss genitalia. How they come in a wide variety of configurations, a spectrum not a binary. We need to be aware of variation, not just in the genitalia of those of us labelled intersex, but those considered unproblematically male or female. Lots of nonintersex people feel anxiety about whether their genitals are "normal," or too small, or too loose, or too asymmetrical. We should know what genitals really look like. And a picture does paint a thousand words.

What's Wrong with Pictures of Genitals

The photos and illustrations of genitals most people see are highly problematic. They do injury both to the viewer and the person being viewed. Mostly, we're exposed to two sorts of pictures: either pornographic images, or medical ones.

I'm strongly opposed to censorship, and I stand up for the right of people to produce and view porn, but most of it is terrible. I'll mention two of the reasons why: first, most porn does harm to the viewer by showing a single "idealized" vision of the human body, and secondly, it harms the models (especially the female-assigned ones) because they are viewed by our sexnegative society as whores and perverts. From an intersex position, the representations of "us" as "hermaphrodites" in most porn are actually usually photos of nonintersex male-to-female trans people financing their transitions by filling the demand for images of "chicks with dicks." In a world where sex transitions are both costly and not covered by medical insurance, and where trans people suffer profoundly from employment discrimination, I empathize with the "herm" porn models. But the fetish market that they feed gives people a very skewed perspective on the lives of intersex and trans folks, and this peep show teaches people very little about what intersex people's parts look like.

Then there are clinical medical images, of two varieties. One are the sort of illustrations we see in educational contexts. For example, buy a package of tampons or condoms, and you'll find instructional illustrations included. Intersex genitals are never pictured, but really, few people's genitals look like the images you see. The illustrations in the tampon packages are almost always hairless with tiny symmetrical labia minora--they look prepubescent, and prepubescent people don't get menstrual periods. The penises in the condom illustrations are all circumcized, erect at a high angle, and look more like a hot dog than a human. Clinical educational illustrations seem designed to make ordinary people feel anxious about their genitals, their small penises and large clitori,
their veins and moles and asymmetries and hair.

Still, at least nonintersex people see illustrations that somewhat approximate their bits.

If you want to see what intersex people's genitals look like, you have to turn to another sort of medical image: the clinical photograph. And the photographs range from depressing to truly appalling. Generally they're photos of children, taken without their consent. Sometimes you can see that the child is being held down. Orifices are stretched open by adult hands, foreskins are pulled up in the jaws of forceps, and ruler scales cut into delicate skin. The photographs are utterly dehumanizing--people reduced to "disordered" genitals and treated as specimens, with as much consideration as a doctor would show a biopsied sample of a tumor. It's as much horror show as peep show. Intersex children are treated as freaks, forced to spread their legs, and hurt without their consent--and because it's done in the name of Science, it's supposed to be OK.

It's not OK.

My Complicity, My Shame

The lack of education about intersex genitals is harmful in multiple ways, and one of them is that it makes us into peepers, and collaborators in the abusive treatment of intersex children.

I grew up knowing I was genitally different, but unsure of what it might mean. By my early teens I was looking through medical journals for pictures that might tell me more. I'll post sometime on my academic research on teratology, the branch of medicine that deals with "birth defects"--suffice it to say for now that I've looked at a lot of medical images of intersex people. And I can try to justify it in terms of personal need and academic critique, but in the end, I'm complicit. Not that I've ever sent a stranger an email saying "Can you send me a photo of your privates?" But I've contributed to maintaining the market for exploitative and abusive medical photography of intersex people.

What Can Be Done?

It seems to me that there is a real need for a collection of cruelty-free, nondistorted images of intersex people's bodies, including our genitals, for people to view. I imagine that illustrations would be best. There may be people out there with various intersex conditions or "DSDs" who would be willing to be photographed by a respectful ally for a public image gallery, but I suspect most people, like myself, would be very wary of the idea. Drawings would avoid the issues of shaming or disrespectful use of our bodies. Ideally, they would be nonidealized. They could be warm rather than clinical, human rather than dehumanized.

I'm going to try my hand at it. I'll see if posting a drawing turns my blog from the intersex roadshow to the intersex peepshow--I certainly hope not. But it does seem like an important project to me.

The image in this post is a manipulation by me of a photograph provided under a Creative Commons license by just.Luc here.

Thursday, May 14, 2009

On Being Called a "True Hermaphrodite"

I was born with an ovotestis, which is a gonad that is intermediate between an ovary and a testis. The medical terminology for a person born with an ovotestis is "true hermaphrodite." Today I'm going to post on what I hate about that term, and what I don't.

The Reality of Intersexuality

The reason people with ovotestes were termed "true hermaphrodites" by doctors was explicitly to categorize all other intersex people as not "truly" intersexed. Most intersex people were medically deemed to be "pseudohermaphrodites." This was based on an fundamental (and, to my mind, fundamentally evil) impulse to erase our existance.

The medical "logic" basically went like this: nature makes things male and female. Laypeople might doubt this when they see a person with intermediate genitals, but doctors know better. With Science they can tell the "true sex" of these people, and eliminate the challenge to sex dyadism.

It's a strange exercise, looking at people whose bodies are neither male nor female, and deciding you can tell what they "really are." Let's say you're looking at someone who has breasts, a menstrual period, and a penis. What are they "really"? You can come up with a rule and apply it, but that rule will be arbitrary. It's just like looking at the color purple and saying, "Purple is not a real color, so this must be either blue or red. I have a Scientific Rule I can apply to determine whether this is blue or red." Sure, you could create a rule, and apply it consistently, but that does not eliminate the fact that purple exists as a color people experience.

This belief that intersex people "really didn't exist" when they were standing right there was like some oddly theoretical genocide. At the time that the terms "male pseudohermaphrodite" and "female pseudohermaphrodite" were coined, sex assignment surgery had yet to be developed, so it was a purely verbal move to erase us.

Harmful Practices

Today, sex assignment surgery does exist. And the persistance of a medical belief that doctors can run tests on an intersex baby and determine hir "real sex" has harmful effects. Children are subjected to profoundly lifealtering surgeries without their consent. Imagine if someone cut your penis off without your consent, or removed your ovaries and chance for fertility. . . and when you cried, "What did you do to me!?" they said, "Oh, our tests showed you didn't need those."

Intersex advocates of every stripe are vehemently opposed to infant sex assignment surgery. They say, we say, that no surgery should be performed until a child grows up and can say what surgery (if any) zie wants. The foundational principle should be an individual's gender identity. A baby with CAH can have a penis, ovaries and uterus. If that baby grows up and identifies as a boy, then he may choose to have his uterus and ovaries removed. If the baby grows up and identifies as a girl, she may choose to have sex assignment surgery to change her penis into a clitoris.

Or how about this? The child could grow up with a gender identity that matches hir body. Zie could say, "I'm not 'really a boy' or 'really a girl,' I'm really intersex, and I don't want any surgery. My body is fine, lovely, just how it is, thanks."

As it now stands, that option isn't on the medical table. Doctors are still assuming that all of us must have a true sex, or "best sex" in the terms of the day, and that they are heros because they can fix us.

The Term "True Hermphrodite"

I hate the term "true hermphrodite" for two reasons. One, it deems most intersex people "false," not really intersex, which both leads to harmful practices and undermines people's ability to identify with their bodies as intersex. And secondly, it gives me some sort of privilege I don't want. I'm deemed the "real intersex," I'm "true." I certainly don't see myself as "more intersexed" than other intersex people, and I don't want to be seen as special or better.

The reason I'm termed a "true hermaphrodite" is because the arbitrary rule that doctors came up with when they developed the terms "true hermaphrodite," "male pseudohermaphrodite" and "female pseudohermphrodite" was that true sex was determined by gonads. A person with testes is "really" male, even if she has breasts, labia, clitoris, and vagina, even if she was raised female, wears dresses, identifies as a heterosexual female, and is married to a man. A person with with ovaries is "really" female, even if he has a penis, scrotum, and just won the Mr. Olympus bodybuilding contest. Only people with one ovary and one testis, or intermediate gonads, ovotestes, are "really" intersex. This rule is arbitrary and says nothing about our lived experience.

So I hate the "true" and "pseudo" terms for classifying intersex people. On the other hand, I, personally, don't object to being called a "hermaphrodite." I realize this is a very atypical position among intersex people. Most intersex people who are politically aware hate being called hermaphrodites because of the baggage the term carries. It evokes greek mythology, and we're not creatures of myth. It is used a lot by fetishists, who get off on the idea of having sex with a body that has breasts and a penis, and we're not volunteering to be sex objects for every kinkster out there. I agree that this baggage is a real problem. But I myself don't blame the term. I like that it shows how we've been around forever, and that in some societies, we've been considered specially blessed by the gods, rather than freaks.

In any case, I don't identify with the term "true hermaphrodite," and always put it in quotes. I'm intersexed.

Tuesday, May 12, 2009

Transphobia and Intersex Experience

I woke up this morning to a set of transphobic comments on my last blog post. Rather than mope (OK, I did mope, but rather than continuing to mope), I thought I'd use this as a teaching moment.

Transphobia 101

Transphobia is the disrespecting of people who are transgendered--considering trans people to be pitiable or disgusting or evil or deluded or just plain weird. It is usually expressed by cis people--those whose gender identity matches the sex they were assigned at birth. (Note that my definition of cis sex treats an intersex person assigned female at birth in the same sex category as a person with normative-appearing female genitals and gonads.) 


Like all biases born of privilege, transphobia assumes that the marginalized identity needs explaining while the privileged identity does not. For example, homophobia works this way. Homophobic people often ask where queer identity comes from ("How do you know you're gay? Are you sure? What made you gay?") without asking where straight identity comes from ("How do I know I'm straight? Am I sure? What made me heterosexual?") Transphobic people expect trans people to have to explain and prove our gender identities when they cannot do the same for themselves.

Transphobes usually assume that our transtitions are about them: that we are doing this to gain access to their spaces. The favorite bugaboo here is the idea of "a man in a woman's bathroom, horrors!" But the fact is that if some male-assigned creep wants to harass and assault women by peeping at them in bathrooms, he can just walk in and do it for free. To medically transition from male-assignment to female status, a person must invest thousands of dollars over a period of years, endure social stigma, violence, employment discrimination, etc.--and
be vetted by a series of medical professionals, all of whom are constantly ready to slam down the gate and stop the process if they catch any whiff at all of the transition being related to kink rather than identity. That's not a plausible route for peepers.

There is a transphobic double-bind that relates to how well trans people "pass"--that is, whether a trans person looks to observers like hir sex of assignment or hir sex of destination. When transphobes recognize a person as visibly trans, they mock hir: "Look! An ugly chick with mascara on her moustache HAHAHA!" or "OMG--dude in a skirt!" If they encounter a person they cannot assign to binary sex categories, they confront the person and demand a binary identification: "Hey! Are you a guy or a girl? What's wrong with you?" And if they take a trans person as their identified sex after a "successful" transition, and then discover the person is trans, they read this as deception, especially (it all being about them) as some attempt to sneak into their pants.

There are particular feminist-transphobic tropes as well. The second-wave feminist transphobic line is well-encapsulated by my morning commenter: "In case you forgot, the majority of transgender people are males to begin with. They still have their male power, male privilege, male upbringing and male experience. Even though they are trying to claim female, womanhood and female privilege, when in reality, they are still male."
This transphobic vision imagines a cabal of men whose goal in life is to infiltrate the Michigan Womyn's Music Festival by any means necessary. Trans men are the dupes of this cabal, as my commentator states: "[Y]ou have been taken and hijacked by the tranny (male) mentality."

There is a third-wave feminist transphobic alternative reading of trans people. In this vision, gender is not an essentialist dichotomy that cannot be altered, but a repressive socially-constructed binary that must be subverted to liberate people. (The language is very High Theory, I know, I know. . .) Here the "crime" in transitioning is subscribing to gender stereotypes and strengthening the myth of dyadic gender, opposite sexes. If you were female assigned at birth, not believing that you are "really a woman" is great, but believing you are "really a man" is regressive, unenlightened, idiotic. You should subvert gender and be genderqueer but not transition.

Intersex Transphobia

To many people, the fact that intersex people can be transphobes comes as a surprise. If you are born obviously neither male nor female, people reason, any identity you have must make you an ally of trans people. You could identify as intersex, which is a very odd thing to do since it queers dyadic sex, and which puts you (in their minds at least) in the same box with gender transgressors like trans people and genderqueers. Or you could identify with your sex of assignment, which usually involves surgical assignment, and so you should approve of people having surgery to live in the sex with which they identify. Or you could be assigned to one sex and identify with the (binary) other, in which case you are trans gendered by definition.

However, intersex people can be quite transphobic. The dynamic is very similar to that of lesbian, gay and bisexual cis individuals who hate trans people and blame homophobia on the transgendered: "When I came out to my mom, she panicked and thought it meant I was going to start/stop wearing skirts to church and humiliate her--it's all your fault!" Intersex transphobes believe that they are treated as freaks by society because society thinks they are trans people. They see trans people as making a perverse choice while intersex people's misfortune is biological and "not their fault." If they could just purge the world of trans people, society would finally be nice to intersex people. It's a sadly common dynamic in all sorts of marginalized communities: instead of uniting to fight oppression, people direct their anger at some other marginalized group they see as nastier.

Another way in which intersex transphobia emerges is in relation to a myth held by some trans people. That myth is the belief that society must be kind to intersex people (since it's a biological condition), which leads a good number of trans individuals to wish for intersex status. Society is not in fact so kind--take a walk in my shoes, please--and I empathize with interfolks being upset at the denial of our pain implicit when trans people want to claim intersex status. But this doesn't justify transphobia. Consider a parallel dynamic: in the 1980s a lot of (white) gay men and lesbians said "Society is fair to black people because it's biological and not their fault, so we need to find the gay gene so homophobia will disappear like racism has." This totally denies the pervasive continuing racism that African Americans face, and is stupid and wrong--but this fact doesn't justify homophobia.

My commentator of the morning subscribes to this practice, and taught me a new slur. Zie says, "You see intersex as a 'blame free' group. It's fairly obvious that your a trans and your just another one of those transjackers, who want to hijack the intersex community for your own perverted gain." Transjacker, woo. Well, I am trans gendered, but I am also intersexed, and I can't see how one can hijack oneself.

Who's Erasing Whom?

It seems that my morning commentor believes that no intersex person is trans gendered. Maybe zie is asserting that all intersex people identify with the sex they're assigned at birth. Or maybe zie means that whatever sexes intersex people are living in, and whatever medical interventions they employed to arrive there, this does not constitute "transitioning," and hence thay are not trans gendered. I'll quote what zie says:

"I also find that by you claiming that intersex has a link with trans, you are in effect erasing the history, upbringing and experience of those who are born intersex and intersex born intersex people. You are erasing not only my intersex experience, upbringing and history, but you are erasing every other intersex person's experience, history, and upbringing as well. So I hope you like what you did, by erasing mine and every other intersex person's shared experience, upbringing and history because you and every trans out their are doing that to women, lesbian and intersex people out their."

I thiink that my commentator believes that I was not born intersex. Either that or zie's saying that since no intersex people are trans, and since I identify as trans gendered, I am by definition (no longer) intersex. Whichever is the case, my commentator is projecting hir desire to erase onto me. Zie is saying I don't exist. I am not part of the "every intersex person out there" who is being destroyed by my saying that intersex and trans gender experiences have a lot in common.

I'm Not Going to Disappear

Sorry, my lived experience as a female-assigned-at-birth "true hermaphrodite" who is transitioning to somewhere on the male side of the spectrum is not going away.

My commentator says, "Their is no one within the science, medical and academic community who will back your warped logic and claim [that there is a linkage between intersex and trans experience]." Well, I am a professor, I study medical sociology, and I used to work at a genetics lab, and I can assure you that my commentator is incorrect.

The Moral of Today's Post

My conclusions are simple. Intersex people suffer from transphobia. Intersex people can be transphobes. And trans people who think that they'd be safe from bias if they had intersex status are sadly wrong. But none of that is going to stop me from speaking my mind.

Wednesday, May 6, 2009

Intersected, Transsected: The Intersex / Trans Nexus


A troubled alliance

Intersex and trans people share some deep common experiences. Yet we often find ourselves prickling at comments made by people in the "other camp." As an intersex person assigned female at birth and transitioning to legal male status, I consider myself both intersex and trans, and I'd like to speak to what both groups share, and what divides them. Divides us.

Commonalities

The most fundamental thing intersex and trans folk share is that we suffer because we belie the ideology that dimorphic genitals determine gender. This is the belief that people are born with one of two possible genital configurations, and that gender identity is inevitably bound to this genital configuration. Penis = "it's a boy!"; vulva = "it's a girl!"  This is an ideology so basic that most people in our Western society rarely if ever question it. Then we intersex and trans people come along and call a fundamental belief into question. Genitals come in a spectrum of possible flavors. Gender identities are not determined by genitals. We are girls born with penises, or androgynes born with vulvae, or boys born with both testes and a vagina. And we make people nervous.

Freaking people out when it comes to sex and gender turns out to have serious consequences. We evoke shock and horror, distate and tittering, fetishistic dehumanizing desires. People fail to treat us as. . . people. Doctors poke and prod us, employers find excuses not to hire us, and idiots bash us. So: we share a common enemy. We suffer from the enforcement of the ideology that dyadic genitals determine gender.

Another thing intersex and trans people share is that we have a difficult relationship with doctors who have power over our lives. For people with intersex conditions, this often starts at birth, when doctors label us as defective and in need of surgical "correction." We are subjected to sex assignment and "corrective" surgeries without our consent. Then many of us grow up not identifying with our sexes of assignment, and join with our trans siblings in facing gatekeeping from the other side. People who identify with a gender that does not match our sex of assigmnent often want to alter our bodies, to reduce feelings of tension, and to get other people to recognize our deep internal sense of self. And we face a lot of hurdles. Medical insurance generally doesn't cover sex transition services--and they are expensive. Worse, to get access to them we have to run a gauntlet of medical gatekeepers. We need psychologists and doctors to grant us access to the hormones and surgery we want, and they make it hard for us, very hard. At every step we may find ourselves confronting, if not outright bigotry, a strange assumption that to want to do what we want to do, we must be mad. We have Gender Identity Disorder, considered a mental illness. Gatekeepers act as if we might well be utter psychos, and need to be tested, cautioned, challenged, as if anyone decides to face discrimination and violence on a whim.

Another thing trans and intersex people share is the way in which we are sexualized in a society with both Puritan and Dionysian strains. This is complex enough to rate its own post, so I'll set it aside for now.

Tensions: Intersex Complaints

Something that makes a lot of intersex people grouchy is encountering trans folk who think we have it easy. There's a belief some trans people hold that doctors and people on the street are understanding of intersex people's needs. More particularly, these trans people think that if they had an intersex diagnosis, they'd get easy access to medical transition services, and have their transition honored by employers, schools, the DMV, and other institutions.

But this is not the case. Doctors and families make decisions on behalf of infants with visible sex variance, and having subjected us to surgery without consent, they don't want to hear that we're ungrateful. As for schools and employers and DMVs, we have the same relationship to them if we want to undo a sex assignment that trans folk do when they seek sex reassignment.  Intersex people are not "fast-tracked" in medical or legal gender transitions.  Our transitions are not paid for by insurance--only those medical procedures that would make our bodies conform to our assigned sexes are covered.  In fact, intersex people can face higher hurdles in dealing with diagnostic gatekeeping, as the GID diagnosis used by psychologists to green-light a transition is understood by some as excluding intersex people.

Nobody wants to hear their suffering dismissed. Intersex people feel hurt when trans people treat living with intersex status as a walk in the park. It is true that *some* doctors and families and coworkers are more comfortable treating intersex people as tragic victims than they are when they look at trans people and see them as having "chosen" to be freaks. But it's not true of others.  And it doesn't make accessing transition services any easier.  Furthermore, treating intersex people as "lucky" glosses over all that intersex kids often suffer in childhood, with multiple surgeries, humiliation, and familial silence.

Another thing that bugs intersex people is when trans people try to latch onto intersexuality as a way to explain their identities. This is especially common among people just coming out of the closet. Trans folk who've been living in denial and are reaching the point where they can't bear it any longer often search the internet, find one of the few intersex support sites, and start posting about how they must be intersex: "I must have some intersex hormone imbalance--I hate sports and cry easily." "People have told me my clitoris looks kind of big and I want to have sex with girls, so I must be intersexed." It makes it hard for intersex people to use the boards at times. Interfolk get tired of explaining the difference between intersex conditions, sexual orientation, and gender dysphoria to nonintersex people who are looking for an explanation for trans identities..

Tensions: Trans Complaints

Trans people are less likely to feel irritated by intersex people's actions, because they usually aren't aware of meeting any. Intesexed people are instructed from youth to go stealth, and we're often invisible. But there are legitimate gripes that trans people can have with intersex folks.

Intersex people can be transphobic.  Intersex adults who identify with their sex of rearing and don't want anyone to question its legitimacy can reject people of any bodily configuration who are interested in transitioning. Intersex people who want to transition can consider their need more justifiable than the need of trans people born with more normative genitalia. This is wrongheaded, wronghearted.

Just as genderqueer intersex folks get irritated by trans people who hold to highly dyadic, sex-sterotyped gender ideologies, genderqueer trans folk can find stereotypical dyadic gender presentations from intersex people very disappointing. They feel that if anyone should be enlightened about the force of gender-regressive ideology, it should be intersex people. And I can certainly understand why genderqueer trans people, suffering the slings and arrows of social bias against androgyny, would want intersex people to identify outside the gender dyad. But genderqueer trans people should have empathy for the fact that the majority of intersex people do identify with a binary gender category. Given the extraordinary pressure intersex people are under to genderconform--from the medical profession, their families, even intersex advocates, above and beyond the social pressure everyone faces--genderconforming presentations are unsurprising. And everybody's gender identity deserves respect, whether it aligns with sex of rearing, against it, or ourside the binary.

Alliances

As an intersex person who is transitioning, I see clear common cause between inter- and trans folk. Many intersex people deal with transition, and live as a bridge between the inter-cis and the nonintersex trans community. Those I've just termed the inter-cis--people with intersex conditions who identify with the sex assigned to them at birth--could gain support and community if they'd come out of the closet and identify as siblings of people who sex transition. Intersex advocates could gain the support of a large pool of trans people and work together on a general campaign for the individual right to choose to use or avoid medical intervention in sex characteristics ("My body, my sex, my right!"). Trans people could gain allies whose very existence undermines the genitals-determine-gender ideology that binds people.

There are issues to address. Intersex transphobia and trans jealousy of mythic intersex advantages in transition are both highly problematic. But our commonalities far outweigh our differences, and we should be allies.