Wednesday, September 7, 2011

Intersex Fertility

My daughter was not of woman born. That is a concept that has fascinated people through the ages.

My daughter's gestation was perfectly “natural,” I should point out--but I carried her, and I was never of the female sex; I am diagnosed as "true gonadal intersex.” I was assigned female at birth, and was living as such when I gave birth to her, but I never identified as a woman, and am now legally male.

A lot of myths circulate around the topic of intersex fertility, many of them perpetuated by doctors. They all relate to the current Western insistence on the ideology of sex dyadism. That ideology holds that there are two and only two sexes, and that this is required by “nature” in order to perpetuate the human species. In fact, sex is a spectrum (see here and here for more information). About one in 150 people has some intersex characteristic. However, in contemporary Western society we are hidden away, medically “corrected,” erased. And often this erasure is bound up in rhetoric about fertility.

One way in which medical textbooks frame intersex people as “tragic” is by presenting us as usually infertile. I'm not going to spend time critiquing the idea that a person must procreate to be a fully mature and valid adult, though I certainly don't believe that to be true. What I want to address from an intersex perspective is the fact that many of us are capable of reproducing. In fact, doctors often take surgical steps to “normalize” our bodies that render us infertile. For example, children born with external testes but absent or very small phalli are often surgically assigned female. The removal of their testes of course renders them infertile. Doctors frame these children as being born “incapable of reproduction” because of their small or absent penises, but this is laughable. Deep penetration is not necessary for pregnancy to occur via intercourse. Size really is irrelevant to the delivery of sperm. In fact, the availability of in vitro fertilization means that intercourse itself is unnecessary. What doctors are doing is conflating having a large phallus with fertility and with male identity. It's magical thinking—but it is used by supposedly rational scientists to justify surgical castration of children with variant genitalia.

In framing intersex individuals as usually infertile, doctors present procreation by intersex people as a medical curiosity, justifying the publication of medical journal articles about a “case.” And they frame facilitating such a procreative act as a sort of “medical miracle,” in which the doctor treating the patient is the hero. Wishing to be seen in such a light, doctors wind up putting a lot of pressure on those of us whom they know to be intersex and potentially fertile to reproduce. This sort of external pressure is uncomfortable and almost coercive, as I myself experienced. I was told by doctors that my fertility would probably decline over time, that my atypical uterus would probably eventually “have to come out,” and I was regularly urged not to postpone trying to have a baby. Though I love my kid immensely, I see the pressure that was put on me to conceive as unethical. My road to parenthood was painful, involving a series of miscarriages, a difficult pregnancy, and a labor, with my atypical uterus, that lasted 53 hours and left me with injuries that took several years to fully heal.

In facilitating an intersex conception or gestation, doctors frame themselves as heroic in two ways. First, they are heros for making this new life possible (as if they were the ones doing the procreating). Doctors present themselves in this way in all sorts of infertility treatments, not just in the case of intersex patients. But the second heroic framing is unique: the prior doctors who chose a dyadic sex for the intersex person are presented as having done a brilliant thing. Doctors treat a successful fertilization as validating the intersex person's sex assignment. If an intersex person assigned female becomes pregnant (or an intersex person assigned male successfully inseminates), then doctors presume they made the “right choice” in the sex assignment. Thus, if an intersex patient expresses unhappiness with their sex of assignment, doctors may put even more pressure on them to procreate. Unhappiness with one's assigned sex implies a critique of the medical professionals who made it, which makes many doctors uncomfortable. Rather than questioning the practice of surgical sex assignment in infancy, doctors want the critique to go away.

This pressure placed on unhappy intersex individuals to procreate in order to validate the medical sex assignment that is causing the person unhappiness is unfair—and also bizarre. It follows the pattern of medically assessing a “correct assignment” through sexual activity. If a person is assigned female, then all is well if they are able to “accept a penis” in vaginal intercourse—and if they can actually become pregnant through this, hark—the herald angels sing the savior doctors' praises. As someone who was assigned female and did eventually have a successful pregnancy, I can tell you that this assumption did not work for me. For me, as for many, what mattered most in my sex assignment is gender identity. I did not identify as female, and thus I was uncomfortable in my assigned sex. Experiencing a pregnancy did not relieve my discomfort. Carrying a child did not “cure” my gender dysphoria with my assigned sex. It didn't make me “feel like a real woman.” It just made me feel pregnant.

I'm glad that I was able to become a parent, but believing that this should have “cured” me of my distress with my assignment is magical thinking along the lines of believing that procreating will “cure” a lesbian or gay man and make them heterosexual. Gender identity, sexual orientation, and procreative status are independent characteristics. Lesbians and trans men and intersex individuals aren't mystically “converted” by pregnancies. Gay men and trans women and intersex individuals who inseminate someone aren't thereby made straight or cis or dyadically-male-sexed.

Sometimes intersex people assigned to the female sex inseminate a partner, or male-assigned intersex people become pregnant. In the first half of the 20th century, when intersex children were rarely if ever surgically sex assigned, and doctors wrote about “cases of hermaphroditism” they encountered as adults, this was a popular topic in medical journal articles, but such is not the case today. Since there is no reason why intersex people should be born with less capacity for fertility that in the past, there are two possible explanations. Either medical interventions are rendering more intersex individuals infertile, or doctors have no incentive to publish about what they would deem “sex assignment failure.” A person a doctor has assigned female is not “supposed” to impregnate anyone, thereby supposedly providing embarrassing proof they should have been assigned male. The idea that someone might actually be happy with a female sex assignment and also pleased to be able to contribute to the conception of a child by providing sperm in the way their body permits does not enter the picture at all. The dyadic gender ideology doctors impose awkwardly onto intersex people is again revealed.

I believe that the framing of sex as dyadic also contributes to the everpresent popular question about fertility and “hermaphrodites”: can we impregnate ourselves? The answer is that it is extraordinarily unlikely, but I believe the reason this tired old query nevertheless comes up again and again is due to how people, having no idea at all of what intersex bodies are actually like, have to use their imaginations. Given the dyadic sex ideology, they figure that if a “hermphrodite” is both male and female, they must have both sets of “organs,” meaning a penis and vagina and testes and uterus and ovaries. Truly, if you ever want to despair of the level of ignorance about intersex bodies, just do an internet search for “hermaphrodite impregnate”. . . I find it hard to decide whether to laugh or cry reading people's musings on this topic.

But I can't really blame people on the street for the depth of their ignorance. People don't know about intersex bodies and experiences because we are hidden from them. Our sex status is erased by the legal requirement that we be declared male or female at birth. Our bodies are redacted by doctors trying to remove the evidence of our physical “deviance.” Information about intersex statuses is not taught in high school biology classes. The fact that sex variation is so common is a fact kept, for some reason, secret. And the large majority of intersex people are well-schooled to keep our “disorders” in the closet.

So I'm less bothered by the tediously-repeated “if you're a hermaphrodite, could you get yourself pregnant” question than I am by magical thinking on the part of medical practitioners. Intersex people are not tragic figures due to infertility. Some of us don't want children, and some of us adopt. Some of us do indeed produce children ourselves. We've done this throughout all of human history, not just recently due to medical miracles. Many of us who do reap the rewards of fertility do this in private, with no medical journal articles trumpeting a star in the east. In fact, some medical “corrections” of our physical differences render us infertile, and I don't see why that's treated as unimportant when doctors are so very willing to write articles about their “cases” who do prove fertile. And the magical thinking behind the idea that doctors can validate a sex assignment through the intersex person contributing the “correct” component, egg or sperm, to a conception just boggles my mind.
It's time for some more sophisticated thinking about intersex fertility.


  1. I'm very curious how you've handled sharing or withholding this information from your daughter. In my own case, my 13 year old daughter doesn't know that the person she has called mom since she was a toddler and has been her primary custodial parent since the age of four, is actually her biological father. It's a double edged sword, not knowing this has allowed her to live a normal life without being tormented for being "different", but the later in life she becomes informed the more shocking it could be. I've made sure that she is very much aware of the facts of the human gender spectrum and how people have fit within it, and she is entirely open minded about peoples sexuality and gender expression, but she doesn't know how close to home the topic is. She just knows that she has two moms that both love her very much and that some day the specific medical details of her birth and parentage will be explained to her in depth. Many people seem to think that when she is finally told, that having waited so long will damage her psyche somehow, but I can't imagine how it could be worse than a life of torment at the cruel hands of other children. Especially since we live in the bible-belt, where even the fact that she has two moms is kept private from most people. Maybe it's cowardly, but I'd prefer to be able to live a normal life than have to fight for my rights all of the time. I know it's a horrible abuse of "privilege", but I don't see any other options as being better.

    1. Very nice post, impressive. its quite different from other posts
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    2. Dear Dr Cary Gabriel Costello I learned late in life I'm intersexuality an mi baby who was surgerically correct without mi consent or knowledge I'm angry an hate drs for lieing about intersexuality correction this is unnecessary this Nazi Christian theology is dillusional idealology is cause death an these anti Christ teaching an practice is a human rights violence against us oh by the way mi beloved idead thx u all intersexuality surgery is unnecessary an kills. Stestefanieannemarie27@gmail.

  2. natasha, if most people dont know she has two moms, how would they know that one of her moms is her biological father? having two moms seems harder to keep quiet about.

    for my part, my partner and i will someday have to figure out how to let our son know that i am not his biological father. we seem like an average cis couple, but i'm ftm, so we used an anonymous donor.

  3. Jack,
    I'm not worried about anyone figuring it out, as I "pass" very well. My concern is that if she ever let that information slip, as kids sometimes do, the repercussions could be devastating, for both of us. It's far easier for her to simply not know than to try and keep that big of a secret. I think that when she is finally told, it will be a relief, not a burden, but for now she's too young to be trusted with the information. I just deal with pressure from some family members and long-standing acquaintances to tell her sooner rather than later. Our current situation is such that she only sees her other mom about once a month, due to her financial/lifestyle instabilities. To most people, we just seem like a regular single-mom and daughter household. I've even had her school teachers react in shock when told that I'm a single parent, as my daughter is so "well adjusted". She's also good at pronoun and terminology adjustment to keep people from knowing too much. All of this is for her own safety and stability, to allow her to have a normal childhood. I’m positive the kids at school would torment her relentlessly if they knew the truth.

    1. Perhaps you should think about relocating to a place where she wouldn't have to keep her situation a secret and you could be honest with her. It's very unhealthy for children to have to hide and be secretive about who they are. I completely understand your point and agree, additional secrets would only make things tiugher. Many places are completely open to situations like yours. I know it may not be possible, but moving would give you both the chance to relax and be yourselves. Think Portland, or Seattle. Good luck.

    2. Perhaps you should think about relocating to a place where she wouldn't have to keep her situation a secret and you could be honest with her. It's very unhealthy for children to have to hide and be secretive about who they are. I completely understand your point and agree, additional secrets would only make things tiugher. Many places are completely open to situations like yours. I know it may not be possible, but moving would give you both the chance to relax and be yourselves. Think Portland, or Seattle. Good luck.

  4. Natasha,

    I talked to my daughter about intersex issues when she was quite small. She had no problem at all accepting the idea. As a toddler, her toy animal families always had to have three babies: a "boy," a "girl," and a "middle." She is fully open to the idea of having an intersex child some day, and rearing them to be happy with their body, which makes me proud.

    When I was making the decision to gender transition, my daughter was 14, and was fully behind me. Having her as my biggest cheerleader made it easy to deal with people's usual "but what about the child" line of concern-trolling.

    I can't advise you as to what to do. I can only say that being open with my daughter has always worked well for me.

  5. Natasha my kids have known that their dad is transgender (formerly known as female) since they were 4. I debated about it for the same reason you do, what if they tell and get into trouble with their peers? I am rather awed by the way they have absorbed and handled the info. They mostly keep it to themselves. They are 8 and 10 now and as far as I know they have yet to run into a problem. They also happen to be intersex (we adopted them) and they manage their own privacy about that with grace and dignity. I think early disclosure has cut out a lot of the second guessing about when it is right. The longer we waited the more I would have wondered when will it be right? I am posting anonymously for their privacy but Cary knows who I am and if you want to be in touch, Cary, you have my permission to connect us via email. <3 S G-R

  6. "It's time for some more sophisticated thinking about intersex fertility." heck yeah. It's time for any thinking about it! I can say with some certainty that both my kids were surrendered for adoption due to the assumption that they could not marry and have children in the traditional sense. There is no reason to assume that about either of my children though it would take some medical intervention on behalf of one of them. So that was their first obstacle to reproductive futures, a simple lack of faith. The next obstacle was the endocrinologist who informed me on no uncertain terms that all intersex gonads are precancerous. He was sure of this because he claimed to have personally examined several hundred. Which he himself removed. I wonder how many possible births went into the dumpster with that tissue. Fortunately for our kids, we did not listen to him. Now the next obstacle will be medical ignorance as they embark on their young adult lives. Having dealt glancingly with fertility specialists when we were trying to give birth prior to our adoption journey, I know how stupid and insensitive they can be. Oy. Anyway, at this point I think they know they can find have value in many possible future roles, among them (but not limited to) parenting by any number of means. I do admit to a wee part of me who hopes to be a grandma. But have learned time and again not to count any unhatched eggs. <3 SG-R

  7. Mirror-image here. Assigned male at birth (I didn't look unusual), and am a biological father (with technical help - puberty didn't follow the usual male course), but biologically more F than M.

    My son was 3 when his unusual father's body started changing. The non-SW 3BHDD form of CAH can have unusual effects that way.

    My gender identity was always female. And I desperately wanted children. That kept me doing the boy act until it became untenable, as it was the only way I had even a remote chance of being a biological parent. For me, it *was* that important.

    As soon as the endo told me the changes had sterilised me, there was no point continuing even if my body hadn't feminised in other ways.

    But that's me, and most people I know don't see fertility as such a momentous issue, be they IS or not.

  8. im tom and im 17. i was assigned female at birth even though i had a separate phallus (which was surgically removed at around 8 days it was aesthetically normal minus testes) i have always identified as male my whole life and even told my parents as young as 3 or 4. last year i had tests done to prove my intersex status because my current boyfriend didnt believe that i was intersex (from the outside i look stereo-typically female). turns out my karotype is actually XY rendering me male, although i also have a fully functioning womb (i believe because my mother gave me female hormones for some time when i was younger because she wanted me to be a girl) and two undecended testes (which are disfuctional because of that hormone treatment - thus presenting me to the world as a really really young boy or a lesbian - not that either bother me).
    my current boyfriend and his family did accept me as a boy where as my mother didnt as she desperately wanted girls.
    2 months ago i gave birth to a surprise baby girl (i didnt have a clue i was pregnant, i found out 3 hours before she came - thats another story)
    now its completely swapped around. his family think we should now be a 'normal' family (he identifies as gay) and i should just become her mummy, where as my mum called me her son for the first time. i feel like im fighting a losing battle... i know who i want to be but im scared that they wont accept me for that choice and will tell my daughter bad things about me if everything ends badly with my boyfriend.
    it just really annoys me that they are just letting my boyfriend lie to himself about being gay. i know that they are trying to protect my daughter from being teased and other bad things happening but i dont think that protection from telling her the truth and being untrue to ourselves is the right way to go. ive tried explaining how i feel to them and that gender identity and physical genitalia are completely different but they seem so be stuck in that ignorant phase of mind. it also doesnt help that the boyfriend is such a mummiesboy...

    1. Thank you so much for sharing your fascinating story. I wanted to write a short story based on an intersex person who grew up female but was genetically / biologically male and was also able to produce offspring - but I wasn't sure if it was possible. Now that I know it is I am inspired.

      Don't give up in trying to make them understand, I'm sure your feelings will get through to them one day. In the mean time enjoy your daughter and don't worry too much about what they will say to her - you will always be her parent no matter what they say and she will always love you.

  9. Wow! Cool!
    Thanks, Cary! I enjoyed the visit.

  10. Hi Cary,
    I just wanted to give an update. Over the holiday weekend, on the Friday after a nice quiet Thanksgiving at home with my daughter and my boyfriend, I told my 13 yo daughter the truth of her parentage. I was very careful and led into the discussion talking about non-standard family configurations and how many people she knows have such a family. After we discussed some general situations, I asked her if she had any thoughts or ideas how she ended up with two moms and no dad. She thought that maybe we had used a sperm donor, but wasn't sure how that could work since she looks so very much like both of her moms. I eventually spiraled in to the facts around her birth and told her that I am her biological father and that I changed gender shortly after she was born. I showed her the wedding album with pictures of me in a tuxedo and looking as masculine as I had ever managed to look. The sum total of her response could be succinctly put in a single word: "Whatever". She literally had no reaction. She said that she was just happy to have two parents that loved her and that she was perfectly fine with how things are. I haven't seen any changes in her behavior or outlook in the least. I'm still amazed at how well she handled it and simply accepted the facts of her existence. She also understands that she is now tasked with the responsibility of holding this little secret in confidence, lest it get out and cause her grief in our bible-belt town. She told me that she's always kept her family details private as she knows how mean and hateful the kids at school can be and that it's none of their business. It has never seemed to cause her any social issues, as she is far more social and popular than I ever was in school, and in many ways is a leader amongst her peers as she will stand up for others and doesn't let the actions of hateful people get to her. In a way it was almost anti-climatic, but I now feel a great sense of pride in how I've raised her. On another note, I've closed my erotica blog down and am thinking of starting a new one about my experiences with love and life, as I think it may give hope to others in my situation who are still struggling. This year has been amazingly transformative for me, and I can only hope someone may find it inspirational. Thank you for writing this blog, as it has helped me greatly in the growth process I've experienced this year.

  11. Natasha, I'm very glad to hear that you've been able to share the story of your transition with your daughter, and that she accepted it easily. So often we feel that there are bridges we cannot cross--and then we do, and find that our fears were the real barrier. I'm glad you've experienced growth this year, and wish you all the best.

  12. What a wonderfully informative post. I have been researching this topic for years because my daughter appeared to not have a vaginal opening for a long time and the doctors didn't seem to have a lot of information about anything at all. God bless you dear.

  13. I wish there were more articles about this. Parents hide this and most people are ignorant it. This is also a great article.

  14. Congrats to the participants in this blog: Dr. Costello and followers. You are so full of light and love. May it always be that way. Also, thank you for putting information out there for everyone to see (including us non-intersexed people).

    With gratitude,


  15. This comment has been removed by a blog administrator.

  16. Sorry for my bad English, it's not my native language :)

    It's very interesting information right here!
    I'm transgender and a intersex. I was assigned a male sex at birth, but at puberty it comes some "strange things", like female menstrual cycles (no blood, but other symptomes a very clear), gynecomastia, very high estradiol and progesterone (and testosterone too) in hormonal analyze, and so on. And very uncertain gender indentity at all. But my girlfriend has a pregnancy, and I can be a father. But she done an abortion, because of my "unclear biology", in fear of genetic disorder of our child :(

  17. Thanks for great information you write it very clean. I am very lucky to get this tips from you
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  18. I dated a woman born intersex. I couldnt figure it out during our 2 year relationship but when I asked her some questions about her body she immediately left me and wanted no contact. Only then did I start to put it all together and realized Andrena was an intersex. Coincidentally; her name is associated with the intersex condition. My question is this: when we had sex she seemed to have orgasms that produced sperm like mine. Does a female assigned intersex produce male sperm? Also do any intersex women use a tampon everyday to keep the vagina open? I'm still learning and trying to figure it out.

  19. @Anonymous - I'm not intersex, but I imagine some complications (toxic shock syndrome, primarily) might be involved with using tampons all day, every day. It might be worth looking into some trans* literature. I believe some post-op women use dilators.

  20. Hello, it is really amazing story about the fertility. The girl has two mothers. I think she is IVF baby. Yes or not?

  21. uh, hello. I don't want to offend anyone with what i say, but some of the terminology is a bit confusing, so i might use it incorrectly.

    hermaphroditism always seemed an interesting topic to me, but only after i saw a story with a very manly intersex person, who got pregnant later on, did i start to do some research.
    i knew that it was possible to get pregnant per se, but i wasn't sure about the "manly" part. i, of course, stumbled across the "can you impregnate yourself" topics, which i believe to be pretty bullshitty and the only manly guy with a vagina seemed to be buck angel, who is a transperson and doesn't really count, i think.

    after reading a somewhat medical approach to the topic, i was more confused than ever, because the fertility of most cases was stated as "none". i don't know if it is actually possible for a manly man to get pregnant, but i think it is not that easy, because the uh womb produces hormones, which make you look more female?
    is there a word limit btw?

    Another thing that bugs me and led me to this site is "true hermaphrodites". i saw a futa(nagi?) picture, where a woman had a penis above the vagina and one commented said that he liked it and wasn't into transpeople, but real hermaphrodites, who are generally women with penis. (+vagina not necessary?)

    wasn't it super rare to be a woman with an average acceptable penis? And is it even possible to have a fully fledged penis and vagina at the same time?? I understood from one of your posts, that intersex is kind of like a transformer. the female is the optimus prime robot thing, the male is the fire truck and intersex is somewhere along the transformation. so, to have penis and vagina, you need two optimus primes, right?
    This is all very confusing, especially because of some commenters here, who say they gave birth to children and impregnated a woman as well, and i can't decide whether they are lying or not.

    and i have to say i like the term hermaphrodite from the mythological point, because i always believe hermes and aphrodite to talk about their future child "it will get named after you, in case of a girl/boy" and once it pops out the go "oh dang, we'll just take both." always makes me think about britney spears sister, jamielynn, who is named after her parents.
    oh well.
    i feel kind of shitty to post yet another question, but while i read about herms, i stumbled across fish that could change their gender, but only once. does that mean they were like an embryo and could decide and had to discard one sex?
    ok, sorry for the long post.

  22. Oh, btw. I listened to a recorded lecture on youtube, where the lecturer said that straight men prefer 4 body parts: breasts, butt, penis and feet.
    So they kind of expect intersex people to have big boobs and a massive penis.

  23. Could a transgender (FTM) produce sperm if there's a possibility they are intersex with hidden testes? Would the testosterone injections ignite the production of sperm?


    This is a link to my intersex partners real life story and i think it might interest quite a few of you.

    I prefer to stay anonymous but you may call me S.

  25. I am doing research on this subject to see if I can get pregnant I love to get pregnant an have a/mi baby if I can I will. Where do I start?

  26. Hi , I want to tell my story because I'm really filled with many doubts about my sexuality ... I have a larger clitoris than normal , for all the research I 've done on the internet is a case uncommon , called or known as clitoromegaly and I need more information respect fertility in fact I had doubts if I can get someone else pregnant girl, am America any information respect please write is a serious issue and I hope no jokes and bad jokes just need to know more about the theme.

  27. Hello...
    its Amazing
    i like this post
    Even though you may be embraced and feel if infertility in male or woman

  28. I am male, but also have an intersex condition. I have read this article all the way from a year ago, and it intrigued me to say the very least. I fathered two children, but always wondered if it were possible to get pregnant myself. Besides the point, this blog is very helpful and truly educating. Many people out there do not understand truly what intersex means, and it is frustrating. Most people do not even think intersex people can reproduce. It is nice to see a blog that truly is dedicated to breaking the stigma on intersex people in general.

  29. Thank you so much for writing this. It means a great deal to me to hear this from someone who knows about this both personally and from a medical/scientific point of view.

  30. In facilitating an intersex conception or gestation, doctors frame themselves as heroic in two ways. First, they are heros for making this new life possible (as if they were the ones doing the procreating). Doctors present themselves in this way in all sorts of infertility treatments, not just in the case of intersex patients. But the second heroic framing is unique: the prior doctors who chose a dyadic sex for the intersex person are presented as having done a brilliant thing.

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  31. Grateful for this post and this blog I just came across. As a non intersex person, I try my best to not be intolerant towards this biological different and as you said, there's still a lot of ignorance since you all are hidden from society. This one was a nice read.