Showing posts with label ideology. Show all posts
Showing posts with label ideology. Show all posts
Sunday, April 6, 2025
Banning Biological Reality is Ridiculous!
What could be more ludicrous than declaring biology to be against the law?
Over the past few months, since Trump was inaugurated again, information has been disappeared by the administration. Datasets have been taken down, historical images removed from archives, websites have been removed or revised, research defunded, and books have been purged from libraries. In just one example, the United States Naval Academy--a college--has removed 381 books from its library thus far, having been so directed by Pete Hegseth, our current Secretary of Defense. Hegseth may be incompetent at actual military leadership, spilling secrets on Signal, but he's great at imposing his ideology that the military should be the preserve of cis straight white men. . .
The books removed include studies on the KKK and lynching, on women in the Holocaust, on trans issues, on 19th century masculinity, on slavery. Maya Angelou's I Know Why the Caged Bird sings was removed. All of these were framed as violating federal executive orders on "DEI" or "gender ideology," and thus figuratively to be burned.
You know what else was removed? Books on intersex statuses. Intersex statuses are inborn, and are found in all animal species-- humans and dogs and songbirds and mice and tropical fish. This is how nature works: sex is way more complicated and interesting than some singsong child's story!
But on his first day in office, Trump signed an executive order written by Project 2025 authors--radical Christian nationalists--titled "Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government." The media reporting on this was shallow. (So much media reporting now is shallow, because there's so much chaos going on that nobody can keep up.) The EO was framed as an anti-trans statement, often with some discussion of popular opposition to the participation of trans women in sports. Then the story sank in the flood of developing news.
But that EO continues to have a powerful impact, being the basis of a huge, ongoing wave of purges of books and research projects and federal employees. So you should know what the EO declares to be law under President Trump. The EO states that is that there is no such thing as gender, only biological sex. And biological sex is stated to be a binary of male and female that is set at conception.
Thus, the EO does not just declare that people cannot gender transition, that nonbinary gender identity does not exist, that trans people must be detransitioned on their passports, that schools and prisons and scientific studies etc. etc. must not recognize gender transitions, and all the other transphobic discrimination it requires. It also declares that intersex statuses do not exist.
This is ridiculous and bizarre! You can no more erase the fact that intersex babies are born all the time than you can erase that curly-haired babes are born all the time by making a proclamation. The authors' vision of physical sex--that at the moment of conception, we're all either XX or XY, which will determine which of two gonads we develop, which in turn will determine what our genitals look like, is that singsong child's myth. Some embryos are XXY, some are XXYY, some are XX/XY. Some embryos that are XX develop into fetuses that look typically male, with phallus and testes. Some that are XY develop into fetuses that look typically female, with vulvas. Fetuses of any genotype can develop intermediate ovotestes. Fetuses of any genotype can develop intermediate genital configurations. That's how biology works!
But the EO declares this biology to be intolerable, to be ideology, to violate the Trump-declared reality of the singsong children's myth. And the federal government is taking action to impose this inversion of biology and ideology on the nation--for example, by banning books on intersex from the US. Naval Academy library.
All book bans are evil. But banning books on biology as "denying biological reality" has the cherry on top of being ridiculous.
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Wednesday, August 10, 2016
The Problematic Ideology of Natural Sex
What is human nature?
In the Western world today, science and religion are often
understood to be enemies. It’s believed they offer two competing explanations
of how the world works. What I want to show you is how when it comes to
understanding human nature, Christianity and Science are in fact complete
bedfellows. They both are deeply invested in a belief system, which I will call
the Ideology of Natural Sex. And both have been shoring up that ideology,
enforcing it brutally, and imposing it by force on others around the globe, for
centuries.
What is this Ideology of Natural Sex? What do authorities
from the Pope to our medical and scientific textbooks jointly believe, and
insist we believe, about sex? It’s their unified theory of sex, gender and
sexuality, and it goes like this:
“As ordered by God/evolutionary biology, humans come in two
and only two physical sexes. This is the nature of things because a male and a
female make a reproductive unit. The purpose of sexual interaction is
reproduction. Thus, the determinative factor in dividing men from women is
genitalia. Genitalia determine gender—the way society organizes people through
gender roles, and the way people should properly identify and understand their
place in the world. And this world is one in which men are (by God’s design or
by biological imperative) the dominant sex, the sexual “aggressor,” while
women’s interests center on nurturing families and offspring.”
Four things that are central to my own life pose challenges
to this ideology. The first is that the empirical reality of physical sex is
that it is a spectrum, and people, like myself, have always been born intersex.
The second is that people around the world and throughout history have
identified with genders other than male or female, and/or have been assigned to
one sex at birth, and felt called to move to live in another. The third is that
people engage in sex all the time that is not procreative. This is true of
people who are infertile, people in same-sex pairings, and fertile men and
women who do not wish to conceive with one another at the time of their sexual
interaction. And the last is the reality that gender inequality is not
inevitable. Patriarchy, the privileging of men over women, is a form of
inequity that is successfully being reduced.
How have religious and scientific authorities dealt with
these challenges over the past several centuries? They have periodically declared
them to be “unnatural.”
Now, if ever you want to know when to suspect an ideology is
at work, you can be sure it is the case when someone tells you something is
unnatural and should not occur. Because here’s the thing about true natural
laws: they function whether you want them to or not. Nobody needs to urge or
force anyone else to obey them. Consider gravity. It’s a natural law, so nobody
needs to enforce it. No religious tracts or psychological textbooks have been
written urging people to obey the principle of gravity and refrain from floating
about bumping into ceilings. Or consider this example: people may argue over
vegetarianism, and whether it is healthy. But you have never seen a letter to
the editor or an internet comment war complaining about how kids these days are
engaging in the unnatural practice of giving up both meat and vegetables and
choosing to engage in photosynthesis instead.
There is no #PhotosynthesisIsUnnatural hashtag because it
truly is unnatural for people to turn green and live off sunlight directly
instead of eating things for energy. Truly unnatural things do not occur, so
they generate no outrage squads decrying their transgression.
As for the “laws of natural sex”—well, it’s another story.
Around the world, over the past four or five hundred years,
people have been cajoled, threatened, forcibly re-educated, beaten, imprisoned,
locked in mental hospitals, put in the stocks, publicly humiliated, mutilated, and burnt at the stake for violating one or more of the precepts of
“Natural Sex.” That’s the sure sign of enforced ideology, not a true natural law.
And it’s not just a story of superstitious, ignorant days
gone by. There is a war being waged over the ideology of “Natural Sex” today.
And in that war, religion and science stand hand in hand on the same side. Who
stands on the other?
Intersex people whose genitals are surgically mutilated
without their consent to force their bodies to resemble binary sex
expectations.
Trans people who are treated as having a mental illness, as
delusional, as perverted, as pariahs.
People in same-gender relationships, who have made great
strides in the West recently in terms of a right to secular marriages, but who
are still not permitted to marry in many religious denominations, and who are
not protected from perfectly legal discrimination of many sorts in many places.
Oh, and women pursuing sexual pleasure. Religious
authorities frame women in particular as ruining themselves through seeking sex
outside the context of marriage. Meanwhile, scientists continue to frame female
orgasm as a puzzle as they state it is “unnecessary,” since women can conceive
without it. Women, according to both religion and science, should want babies,
and only engage in sex to make them, not for fun.
The extraordinary thing is, with so many groups fighting and
suffering for recognition denied them under the ideology of “natural sex,” how
incredibly powerful that ideology is, how amazingly resilient. We are taught the
Ideology of Natural Sex so early, by parents and media and schools and
churches, that we believe in it at the same fundamental level that we believe
in things like gravity.
And even when individuals are persecuted in some way under
the Ideology of Natural Sex, very often it never occurs to them to challenge
the whole, as that seems unthinkable, but only one small part of the ideology
impacting them particularly. Thus we have women who decry female genital
mutilation as cruelly enforcing the belief that women should not have sex for
pleasure, yet who see similar surgeries being performed on intersex babies as
appropriate, as heroically “correcting malformation.” We have gay men and
lesbians who frame themselves as natural and normal, wanting only to marry and
reproduce like anyone else, while disdaining trans people as "crazies" who
are making gay people look bad by association under the LGBT umbrella. We have
people born with sex-variant bodies who reject the label intersex, and wish only to
be referred to as “people affected by disorders of sex development.” Why?
Because they are worried that the term “intersex” will make others associate them
with trans people or think they have nonbinary identities or otherwise find
them disturbingly transgressive of the Ideology of Natural Sex, and God forbid,
they don’t want any of those things to be thought of them.
And everywhere, everywhere, we have ignorance of the long
and violent history of the imposition of the Ideology of Natural Sex under
European colonialism.
The genius behind framing an ideology as “natural” is that
its history erases itself. Why would anyone study the history of something
natural and eternal? We don’t study the history of covalent bonds in chemistry
or cumulus clouds in meteorology. And so
we don’t study the spread of European binary sex ideology under colonialism. If
you do, you’ll find that all over the world before European colonialism there were
societies recognizing three, four, or more sexes and allowing people to move
between them—but that’s a subject for another post. Suffice it to say that
societies were violently restructured under European colonialism in many ways,
and one of those was the stamping out of nonbinary gender categories and
stigmatization of those occupying them as perverts.
Meanwhile, missionaries and European scientists spread the
word that nonprocreative sexual practices—same-gender relationships, oral sex, masturbation—violated God’s
will or the scientifically known purpose of sex, and were thus both sinful and
sick. Christian missionaries even taught that the only acceptable intercourse
involved a married man atop his wife, other positions being “unnatural.”
Scientists concurred, saying that only in the missionary position would gravity
lead semen to the uterus. Nature, colonized peoples were taught, requires men to be on top--of society, and in sexual activity, literally.
Most people today are ignorant of this history of the ongoing struggles to impose the Ideology of Natural Sex on reluctant nations and social groups. This ignorance allows each generation to believe that those who do not fit under the ideology, such as intersex and trans people, are rare freaks—or, if there are many challenging the ideology at that time, such as feminists demanding access to birth control and abortion, or the gay pride movement, as a brand new threat to an until-then-eternal system.
And for a system that is presented as eternal and inevitable,
the Ideology of Natural Sex is also strangely framed as fragile and endangered,
requiring vigorous defense. One example: the 20th century claim that
“homosexuality is unnatural, and if it is tolerated, the human species will go
extinct as procreation will stop.” This claim was made by opponents of the so-called
gay liberation movement, many of them religious conservatives, but using the
language of science. And after all, for many years, scientists had been
claiming that homosexuality was a medical disorder that must be cured.
The really weird thing about the end-of-the-species claim,
if you think about it, is that it presumed that if same-gender sexual activity were
tolerated, then nobody would ever have mixed-gender sex again. Why would people
who presumably happily identified as heterosexual think something like that?
Well, it’s because each of the precepts of the Ideology of Natural Sex are seen
as inextricably linked. The purpose of sex is reproduction; this requires men
and women; people must accept their assigned gender roles. Allow two men or two
women to have sex, and the other precepts will fall as well. Society as we know
it will collapse, and in fact, we’ll die out as a species as we won’t reproduce
anymore. Our nature will be destroyed and humans will suffer an apocalypse.
Today, in the early 21st century, intersex and
trans issues are coming to the fore. And the same patterns emerge, as they have
in the past of which we are unaware.
From science and medicine, what we see is the framing of
bodies, identities and behaviors that fall outside the Ideology of Natural Sex
as disorders to be classified and treated. The goal is to restore the “natural
order” through techniques developed by science: eugenic programs, surgical
“normalization,” and psychotherapies. Consider intersex status right now. There
is a growing social movement of intersex people to put an end to the nonconsensual
genital surgeries that have been imposed on intersex children since the 20th
century. But doctors are extremely resistant to this movement. Living with a
sex-variant body is presented by doctors as a fatal condition. It will lead to
social death, which may lead in turn to suicide. Without a body that conforms
to binary sex expectations, it will be impossible to find a mate, so even if
one lives, it will be an empty life, a painful one full of strange
nonconforming behavior and self-loathing. Surgeons claim they are
compelled to continue intersex genital mutilation to preserve life and quality
of life, dismissing the cry of intersex advocates that these “treatments”
in fact degrade their quality of life.
From the religious side, what we see is an assertion that
Natural Law created by God must be affirmed by all human laws. To do otherwise
is not only an offense to God, but will destroy humanity. Speaking recently of
the supposed danger of the trans rights movement, Pope Francis said, "We
are experiencing a moment of the annihilation of man as the image of God."
Natural law, understood as decreed by God, requires binary sex, and that gender
conform to that binary sex. Worldly laws must not be enacted to acknowledge and support people's gender identities. In fact, say religious conservatives, to speak of
gender at all is to offend God. There is only sex, and never before have humans
suggested that one also has a gender identity and should express its inner
truth! (The fact that gender identity recognition and gender transition are as
old as humanity is a history that we’ve already seen has been erased by the
“natural law” framing.) And fascinatingly, the Catholic church evokes science
to “prove” its position. Sex, the Church states, is determined by DNA. DNA,
unlike clothing or hormones or genitals, cannot be changed. Thus, one can never
change one’s “true” sex. Gender transition is a wicked lie, a deception, and
according to Pope Francis, as dangerous to humanity as nuclear weapons. It must
be stopped and “nature” defended.
So science and religion walk arm in arm, trumpeting the
ideology of the Natural Law of Sex. This gives everyone in the general
population something to latch onto in framing the oppression of some group as
necessary and good. Are you a socially conservative religious person who finds
trans people disgusting? Claim that the statement “male and female created He
them” in Genesis is not a generalizing poetic phrase but a morally prescriptive
statement that must be socially enforced. Are you a radical cis feminist who
disdains the Pope, but shares with him disgust for trans people? Claim that DNA determines sex, that gender
identity is a delusion, and that trans women are thus sick male threats to the
safety of “biological women.”
There’s something for everyone.
What makes the Ideology of Natural Sex so powerful is that,
like all deeply effective belief systems, it is so taken-for-granted that it is
like water to a fish. Most people are unaware of the very concept of a
sex/gender ideology. And therefore, merely to ask the question “How many
genders are there in your society?” strikes them both infantile and very
offensive. Show them a drawing of intermediate genitalia and they gasp in profound
shock. Present them with a visibly trans body and they laugh or gag or feel
incited to commit violence. These strong
negative reactions occur because having your ideology challenged is bad enough,
but when you didn’t even know it was an ideology in the first place, it makes
you question everything. And sadly, most people don’t want to do that at all.
But we have to do it.
If we truly believe in science, in a rational world where we
look objectively at what is, rather than impose our beliefs onto reality, then
we need to reject the Ideology of Natural Sex. We need to see the reality of
the sex spectrum and stop framing intersexuality as a rare disorder that
somehow violates natural law. We need to understand that different societies
have divided the sex spectrum up into different numbers of social sexes, and
that binary sex is no more or less arbitrary than trinary or quartic sex
systems. We need to give up the silly idea that sexual interactions only serve
reproductive purposes, when it is massively evident in nature that
nonprocreative sex is everywhere in social species. We need to become aware of
the omnipresent world history of gender transitioning, and let go of the myth
that not until the 20th century introduced modern surgical
transition procedures did “real” gender transitions occur.
And if we truly believe in religion, then we must adhere to
the precepts of compassion that all religions teach, and stop using religion to
oppress minorities or spread hate.
Intersex people, trans people, queer people, lusty women. .
. we don’t violate natural law. In fact, we’ve always been a part of human
nature. And accepting and respecting us as we are will not cause the end of the
world. At all.
It could, however, spell the start of a kinder and fairer
world. So please, just let go of the Western Ideology of Natural Sex.
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Wednesday, February 20, 2013
Hypospadias: Intersexuality and Gender Politics
If you are looking around for information about intersexuality, one of the first things you're likely to read is that "most intersex children are assigned female at birth." This is in fact false.
In the U.S. today, according to the CDC, one in 125 children assigned male at birth is surgically modified to fit that binary sex status. The percentage of children assigned female at birth who are genitally altered in infancy to feminize their genitalia seems to be lower. Exactly how much lower is very difficult to determine, since nobody is gathering the data we'd need to have. The reason we know the 1-in-125 figure is because these children assigned male are all given the same diagnosis: hypospadias. Hypospadias is the diagnosis given to most children born with intermediate genitalia who have external testes. Rates of hypospadias have been increasing, and the CDC is collecting data due to concern about that.
The reason people continue to say that few intersex individuals are assigned male is that doctors term hypospadias a "penile malformation" rather than an "intersex condition."
I've written about this before in this post. I noted there, "medical diagnostic categories are not logical, despite our ideology that they should be so. The majority of individuals born with intermediate sexual anatomies [and surgically assigned male] are not given an intersex diagnosis. I believe that what underlies this is gender ideology. And that gender ideology is this: masculinity is fragile, especially when it comes to what a man has in his pants. To live as a man with an inadequate penis is seen as intolerable. To have one's status as a 'real man' challenged is viewed as psychologically crushing. Thus, doctors feel, if they were to categorize someone as intersex and then assign them male, they would be acting cruelly. Women, on the other hand, are perceived as more gender-flexible. After all, it's reasoned, a woman isn't shamed by wearing pants or taking on a power career. [Doctors view] female-assigned people as more comfortable with androgyny and as better at dealing with emotional challenges." Because of assumptions about fragile masculinity and flexible femininity, doctors feel more at ease assigning children they designate as intersex female. Those they regularly surgically alter to conform to binary male sex norms, they wish not to label intersex.
I was contacted by some people after writing that prior post challenging my assertion that hypospadias is an intersex condition. They countered that it was simply a minor displacement of the male urethra. So I wanted to make my case more clearly.
Let's start with some illustrations.
All children start out in the womb with the same set of genitals, an intersex form. As a rule I will not post photos of children's actual genitalia because it is exploitative, but in this case, I feel a medical image of the standard genital form of a fetus isn't going to cause additional emotional trauma to any particular child, so here's a photo:
Our society expects this intermediate genital form to differentiate before birth into two "opposite" binary sex forms (penis and testes, or vulva), but in fact, babies are born with genitals on a full spectrum between these two socially idealized poles. Let's look at how medical professionals illustrate this sex spectrum.
When a child is diagnosed as having some form of XX, CAH, congenital adrenal hyperplasia, the sex spectrum is described by the "Prader scale," and the "stages" of the "condition" evaluated using this chart:
When a child with XY chromomes is diagnosed as having a form of AIS--partial or complete Androgen Insensitivity Syndrome--the sex spectrum is termed the "Quigley scale," and is illustrated like this:
You can see that both of these illustrations include 6 forms, although they number them in reverse order and with different numerals. What they both show is that between a genital form considered typically female and one considered typically male, there is a common spectrum of intermediate forms.
This is equally true for children who are diagnosed as having hypospadias. But medical illustrations of hypospadias are very different. They do not picture the genitals as intermediate in form.
Instead of picturing the same range of in-between forms shown in the Prader and Quigley scales, medical illustrations of hypospadias variations show something odd: a carefully illustrated "normal penis" with a series of dots superimposed upon it to indicate the level at which the urinal meatus/ vaginal opening are located.
The penis is always illustrated as erect, and often with a lot of illustrative detail to emphasize the "reality" of this imaginary ideal penis existing instead of the intermediate genitals actually present in intersex individuals who have external testes.
Let us be clear here. A child diagnosed with hypospadias of an "advanced degree," be it termed perineal or posterior or scrotal, will have an intermediate phalloclitoral form with a substantial invagination, not a large, erect phallus with a dot at the bottom. They'll look more like the Prader 2 or Quigley 4. I'd illustrate such a child's genitals more like this:
Why would medical illustrations of intermediate genitalia be representationally accurate in the case of intersex children diagnosed under the rubrics of AIS or CAH, but inaccurate if highly detailed in the case of intersex children diagnosed under the rubric of hypospadias? Only gender ideology can explain this. Children diagnosed with CAH and AIS are routinely assigned female. But children with hypospadias are surgically "corrected" to male, and to undermine the "adequacy" of a male's phallus is treated as untenable. Parents (and doctors!) must be reassured by looking at the erect, large, ideal penises drawn in the hypospadias illustrations that the genitally intermediate flesh of the child they see is illusory, and that an excellent penis will soon be revealed by the scalpel.
So: medical illustrations of hypospadias, and the medical assertion that it is not really an intersex condition, relate to our ideologies of masculinity.
The differences in medical approaches to intersex children routinely assigned female and routinely assigned male extend further than illustrations and terminology. They also determine all the tests and evaluations the child will receive. If an intersex child lacks external testes--the determining characteristic of a hypospadias diagnosis--that child is routinely subjected to a battery of tests: genotyping, endocrine screening, medical imaging scans. This is not the case when an intersex child has external testes. In fact, even suggesting that a child with intermediate genitalia but palpable testes receive any sex-related tests at all is considered "controversial" by doctors. Since hypospadias is defined as a penile malformation that is not an intersex condition, why would anyone wish to test sex chromosomes, hormone levels, or internal reproductive structures? It's presented as an unacceptable waste of time and money, in an affronted tone.
In fact, individuals born with hypospadias do commonly have other sex-variant characteristics. An example is the presence of what is termed a substantial "prostatic utricle," a uterine structure that may be small or full-sized that connects to the vaginas present in these children at birth. While the "pseudovaginae" are removed and closed during infant genital "normalizing" surgery, doctors do not test for the presence of a uterine structure. People diagnosed with hypospadias and their doctors generally only become aware that there is a utricle present if something goes wrong, such as the development of uterine cancer or painful cysts--and then usually by accident during imaging scans for some other presumed cause of the patients' symptoms.
I want to note that many intersex people assigned female at birth complain of all the invasive tests and screenings and procedures to which they are subjected in childhood, so the fact that intersex children with hypospadias diagnoses avoid these is not necessarily a bad thing. But not even thinking of checking for a uterine structure in someone born with hypospadias who presents to a doctor with pelvic pain could have very negative health consequences.
It is clear is that intersex children diagnosed with hypospadias are treated very differently than children with other intersex diagnoses. Rather than being treated as bizarre and interesting medical cases that require a lot of medical study and intervention, they are treated as normal boys with a little urethral displacement issue.
The thing that children diagnosed with hypospadias have in common with other intersex children is that they are subjected to genital normalizing surgery that can have many negative consequences. Medical texts list as unwanted consequences of hypospadias "repair" surgery urethral fistulae, strictures, and diverticulae, recurrent urinary infections, "excess skin," hair-bearing skin, persistent chordee, erectile difficulties, erectile persistence, chronic inflammation, and a condition called balanitis xerotica obliterans. Textbooks are oddly silent on the issues of loss of genital sensation that are very common, and the fact that children born with genitals in the middle of the sex spectrum are particularly likely not to identify with the sex they are surgically assigned at birth.
Some children who are diagnosed with hypospadias have genitals that are quite close to the binary male ideal in our culture. For them, medical interventions may be fairly minor, and the side effects may be modest. They are very likely to see themselves as typical males, and are probably unlikely to wish to be identified as intersex because they share our society's pattern of fragile masculinity. I am empathetic with their position. But we should be able to support the gender identities and dignity of people born with hypospadias who identify as men without resorting to inaccurate medical illustrations and illogical medical taxonomies.
Hypospadias is an intersex condition. The surgeries we perform on unconsenting intersex children without their consent have lifelong consequences. These can be profoundly negative for children whose genitals are dramatically altered--something that intersex advocates decry all the time. But we should also question why we routinely risk the loss of sexual sensation in the glans of the male-assigned child whose urethra is in a slightly atypical place.
All of us born intersex deserve to be recognized as such, and to be granted autonomy to make our own decisions about what "normalizing" surgical alterations we wish, if any. Putting an end to the routine genital reconstructive surgery performed on the many thousands of children diagnosed with hypospadias each year should be considered an important point of intersex advocacy.
In the U.S. today, according to the CDC, one in 125 children assigned male at birth is surgically modified to fit that binary sex status. The percentage of children assigned female at birth who are genitally altered in infancy to feminize their genitalia seems to be lower. Exactly how much lower is very difficult to determine, since nobody is gathering the data we'd need to have. The reason we know the 1-in-125 figure is because these children assigned male are all given the same diagnosis: hypospadias. Hypospadias is the diagnosis given to most children born with intermediate genitalia who have external testes. Rates of hypospadias have been increasing, and the CDC is collecting data due to concern about that.
The reason people continue to say that few intersex individuals are assigned male is that doctors term hypospadias a "penile malformation" rather than an "intersex condition."
I've written about this before in this post. I noted there, "medical diagnostic categories are not logical, despite our ideology that they should be so. The majority of individuals born with intermediate sexual anatomies [and surgically assigned male] are not given an intersex diagnosis. I believe that what underlies this is gender ideology. And that gender ideology is this: masculinity is fragile, especially when it comes to what a man has in his pants. To live as a man with an inadequate penis is seen as intolerable. To have one's status as a 'real man' challenged is viewed as psychologically crushing. Thus, doctors feel, if they were to categorize someone as intersex and then assign them male, they would be acting cruelly. Women, on the other hand, are perceived as more gender-flexible. After all, it's reasoned, a woman isn't shamed by wearing pants or taking on a power career. [Doctors view] female-assigned people as more comfortable with androgyny and as better at dealing with emotional challenges." Because of assumptions about fragile masculinity and flexible femininity, doctors feel more at ease assigning children they designate as intersex female. Those they regularly surgically alter to conform to binary male sex norms, they wish not to label intersex.
I was contacted by some people after writing that prior post challenging my assertion that hypospadias is an intersex condition. They countered that it was simply a minor displacement of the male urethra. So I wanted to make my case more clearly.
Let's start with some illustrations.
All children start out in the womb with the same set of genitals, an intersex form. As a rule I will not post photos of children's actual genitalia because it is exploitative, but in this case, I feel a medical image of the standard genital form of a fetus isn't going to cause additional emotional trauma to any particular child, so here's a photo:
Our society expects this intermediate genital form to differentiate before birth into two "opposite" binary sex forms (penis and testes, or vulva), but in fact, babies are born with genitals on a full spectrum between these two socially idealized poles. Let's look at how medical professionals illustrate this sex spectrum.
When a child is diagnosed as having some form of XX, CAH, congenital adrenal hyperplasia, the sex spectrum is described by the "Prader scale," and the "stages" of the "condition" evaluated using this chart:
When a child with XY chromomes is diagnosed as having a form of AIS--partial or complete Androgen Insensitivity Syndrome--the sex spectrum is termed the "Quigley scale," and is illustrated like this:
You can see that both of these illustrations include 6 forms, although they number them in reverse order and with different numerals. What they both show is that between a genital form considered typically female and one considered typically male, there is a common spectrum of intermediate forms.
This is equally true for children who are diagnosed as having hypospadias. But medical illustrations of hypospadias are very different. They do not picture the genitals as intermediate in form.
Instead of picturing the same range of in-between forms shown in the Prader and Quigley scales, medical illustrations of hypospadias variations show something odd: a carefully illustrated "normal penis" with a series of dots superimposed upon it to indicate the level at which the urinal meatus/ vaginal opening are located.
The penis is always illustrated as erect, and often with a lot of illustrative detail to emphasize the "reality" of this imaginary ideal penis existing instead of the intermediate genitals actually present in intersex individuals who have external testes.
Let us be clear here. A child diagnosed with hypospadias of an "advanced degree," be it termed perineal or posterior or scrotal, will have an intermediate phalloclitoral form with a substantial invagination, not a large, erect phallus with a dot at the bottom. They'll look more like the Prader 2 or Quigley 4. I'd illustrate such a child's genitals more like this:
Why would medical illustrations of intermediate genitalia be representationally accurate in the case of intersex children diagnosed under the rubrics of AIS or CAH, but inaccurate if highly detailed in the case of intersex children diagnosed under the rubric of hypospadias? Only gender ideology can explain this. Children diagnosed with CAH and AIS are routinely assigned female. But children with hypospadias are surgically "corrected" to male, and to undermine the "adequacy" of a male's phallus is treated as untenable. Parents (and doctors!) must be reassured by looking at the erect, large, ideal penises drawn in the hypospadias illustrations that the genitally intermediate flesh of the child they see is illusory, and that an excellent penis will soon be revealed by the scalpel.
So: medical illustrations of hypospadias, and the medical assertion that it is not really an intersex condition, relate to our ideologies of masculinity.
The differences in medical approaches to intersex children routinely assigned female and routinely assigned male extend further than illustrations and terminology. They also determine all the tests and evaluations the child will receive. If an intersex child lacks external testes--the determining characteristic of a hypospadias diagnosis--that child is routinely subjected to a battery of tests: genotyping, endocrine screening, medical imaging scans. This is not the case when an intersex child has external testes. In fact, even suggesting that a child with intermediate genitalia but palpable testes receive any sex-related tests at all is considered "controversial" by doctors. Since hypospadias is defined as a penile malformation that is not an intersex condition, why would anyone wish to test sex chromosomes, hormone levels, or internal reproductive structures? It's presented as an unacceptable waste of time and money, in an affronted tone.
In fact, individuals born with hypospadias do commonly have other sex-variant characteristics. An example is the presence of what is termed a substantial "prostatic utricle," a uterine structure that may be small or full-sized that connects to the vaginas present in these children at birth. While the "pseudovaginae" are removed and closed during infant genital "normalizing" surgery, doctors do not test for the presence of a uterine structure. People diagnosed with hypospadias and their doctors generally only become aware that there is a utricle present if something goes wrong, such as the development of uterine cancer or painful cysts--and then usually by accident during imaging scans for some other presumed cause of the patients' symptoms.
I want to note that many intersex people assigned female at birth complain of all the invasive tests and screenings and procedures to which they are subjected in childhood, so the fact that intersex children with hypospadias diagnoses avoid these is not necessarily a bad thing. But not even thinking of checking for a uterine structure in someone born with hypospadias who presents to a doctor with pelvic pain could have very negative health consequences.
It is clear is that intersex children diagnosed with hypospadias are treated very differently than children with other intersex diagnoses. Rather than being treated as bizarre and interesting medical cases that require a lot of medical study and intervention, they are treated as normal boys with a little urethral displacement issue.
The thing that children diagnosed with hypospadias have in common with other intersex children is that they are subjected to genital normalizing surgery that can have many negative consequences. Medical texts list as unwanted consequences of hypospadias "repair" surgery urethral fistulae, strictures, and diverticulae, recurrent urinary infections, "excess skin," hair-bearing skin, persistent chordee, erectile difficulties, erectile persistence, chronic inflammation, and a condition called balanitis xerotica obliterans. Textbooks are oddly silent on the issues of loss of genital sensation that are very common, and the fact that children born with genitals in the middle of the sex spectrum are particularly likely not to identify with the sex they are surgically assigned at birth.
Some children who are diagnosed with hypospadias have genitals that are quite close to the binary male ideal in our culture. For them, medical interventions may be fairly minor, and the side effects may be modest. They are very likely to see themselves as typical males, and are probably unlikely to wish to be identified as intersex because they share our society's pattern of fragile masculinity. I am empathetic with their position. But we should be able to support the gender identities and dignity of people born with hypospadias who identify as men without resorting to inaccurate medical illustrations and illogical medical taxonomies.
Hypospadias is an intersex condition. The surgeries we perform on unconsenting intersex children without their consent have lifelong consequences. These can be profoundly negative for children whose genitals are dramatically altered--something that intersex advocates decry all the time. But we should also question why we routinely risk the loss of sexual sensation in the glans of the male-assigned child whose urethra is in a slightly atypical place.
All of us born intersex deserve to be recognized as such, and to be granted autonomy to make our own decisions about what "normalizing" surgical alterations we wish, if any. Putting an end to the routine genital reconstructive surgery performed on the many thousands of children diagnosed with hypospadias each year should be considered an important point of intersex advocacy.
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Wednesday, January 2, 2013
Just-So Stories about Hermaphrodite Fish
A central issue that makes life hard for intersex people is
invisibility. Most people are unaware of
how common intersex individuals are, something I’ve often discussed on this
blog. But there’s a larger setting in
which the fact that sex is a spectrum gets erased, and that’s in descriptions
of biology and the animal kingdom as a whole.
One way this happens is when biology textbooks fail to mention the fact
that instances of intersexuality are found in all animals. Another way it happens is through what
we’re taught about those species in which hermaphroditism is the norm. It’s the latter that I want to illustrate for
you today, by examining about how we talk about a fish, the bluebanded
goby.
The bluebanded goby is a small and colorful fish, bright
orange-red with iridescent blue stripes.
Bluebanded gobies are hermaphrodites, with the ability to produce either
eggs or sperm. Each bluebanded goby can
switch from producing eggs to sperm or vice versa in the space of about two
weeks; externally, there’s very little difference between an egg-laying or
sperm-producing bluebanded goby. They
have a “sexual papilla” through which they can release egg or sperm, and it is
a bit pointier when in sperm-producing mode and a bit wider in its opening when
in egg-laying mode. Most bluebanded
gobies spend most of their lives in egg-laying mode. They live in mating groups, and typically
only one member of each group produces sperm, with the rest laying eggs,
maximizing the number of offspring the mating group can produce. It’s a neat arrangement. It’s also not one that you’re likely to hear
about if you are visiting an aquarium or keeping fish.
The intersex nature of the bluebanded goby is erased or
distorted in most descriptions of the fish, because our society is so invested
in the idea that sexual dyadism is natural and universal that we can’t see
evidence to the contrary right in front of our eyes. We don’t hear about it in our educations. Say, for example, you’re a schoolchild going
for an educational trip to an aquarium, and you see the pretty gobies
there. Here’s all you’d learn at the
Cabrillo Aquarium in San Pedro, California about the sex of bluebanded gobies:
“Recognized by an elongated robust body and two dorsal fins, males have longer
dorsal spines and a suction-like disc that is formed by the connection of its
pelvic fins.” (See here.) You’d hear yet another example of the “natural,
universal fact” that all animals are male or female, not evidence of the sexual
diversity of the natural world. Not only
does the hermaphroditism of the gobies go unmentioned, the “masculinity” of
bluebanded gobies in sperm-producing mode is exaggerated—they are said to have
“longer dorsal spines,” a phallic and aggressive description of a nonexistent
difference. In fact, scientists
determining whether a bluebanded goby is in egglaying or sperm-productive mode
do not look for any difference in dorsal spine length, only at the shape of the
sexual papilla. (Generally, a
sperm-producing bluebanded goby will be on the large side for the species, and
hence will have largish fins—but egglaying bluebanded gobies that are large
have the same size dorsal spines, and the dorsal fins on a given fish do not
change size when it moves between egglaying and sperm-producing modes.)
When popular educational sites do mention sex variance in the
bluebanded goby, they don’t explain the fact that all bluebanded gobies are
hermphrodites, capable of producing eggs or sperm. They instead tell a story of rare and
fascinating “sex changes” in fish that are otherwise binary in sex: “Males and
females are similar in coloration, however, males have a longer dorsal fin than
the females do. One interesting fact about blue-banded gobies is that if there
is no male present, the dominant female in a group of blue-banded gobies has
the ability to change her sex to that of a male.” (See here.) This description frames bluebanded gobies as
sexually dyadic, existing as males and females, except for the occasional
female who goes through a “sex change” in desperate times. The fact that all of the bluebanded gobies
are hermaphrodites, and that each time they move from group to group they have
the ability to move from egglaying to sperm-producing mode or vice versa, goes
unmentioned. Rather than undermining the
ideology of a natural sexual binary, the story of the rare “sex change”
actually bolsters it. “How bizarre and
rare is this deviation, a one-time move between natural binary sexes!”
Not only do educational sites teach that bluebanded gobies
are almost always “normal males and females” rather than always hermaphrodites,
the way they present goby “sex changes” reflects ideas about human gender
roles. The BBC Science and Nature
website states that bluebanded gobies “live in small groups with a single male
and multiple females. If the male leaves
or dies, the largest female changes sex.”
(Link here.) The story is one of a large, dominant male
with his harem of smaller females, and a burly female fish changing sex to
“rise” to male status and take over the harem.
This is how the story is told by most scientific articles about
bluebanded gobies that’s I’ve seen. Let
me quote a passage from a 2005 article in the Biological Bulletin on “sex reversal” in bluebanded gobies, so we
can examine this in more detail:
“Larger size often equates with increased success in
aggressive encounters and therefore social dominance, providing a proximate
mechanism for the size advantage hypothesis. In protogynous sex changers, the
most reproductively significant resource that dominance affords is “maleness”;
thus the reproductive payoff for dominance is extremely large, and females
would be highly motivated to increase their aggressive behavior in times of
social instability (i.e., in the absence of a dominant male).” (See here.)
I’ll now restate that passage in clearer English and make
overt its hidden assumptions: “Sex is binary but in some rare species ‘sex
reversal’ can occur. When it does occur,
it is from female to male, because everyone knows it’s better to be male. To be male is to be dominant and aggressive,
which is good. Usually in species where
‘sex reversal’ can occur, males keep the females in their place, but if there’s
no male around, the females will all want to battle because the winner will get
to be the male.” This just-so story
reaffirms all sorts of human gender stereotypes—and in so doing vastly distorts
the objective reality of bluebanded goby life.
The first way the scientific fable distorts reality is by
calling hermaphroditic gobies “males” and “females,” imposing binary sex
language on fish that are born hermaphrodites and can shift back and forth
between egglaying and sperm-producing modes multiple times in the course of
their lives. The term “sex reversal”
also implies two opposite sexes rather than one sex continuum. It would be much more reflective of objective
reality to speak in terms of shifts in reproductive modes among hermaphrodites
than about sex reversals between females and males.
The term “protogynous” used to describe gobies in the
article means “starting out female,” which not only implies that the fish are
not really intersex by nature, but also frames shifts in reproductive mode as
only occurring in one direction: from “female” to “male.” In fact, bluebanded gobies shift just as
easily from sperm-producing to egg-laying modes when entering a group with
multiple sperm-producing fish. (See here.) The idea that every bluebanded goby “wants to
be the male” is a projection of human ideologies onto fish behavior. The majority of bluebanded gobies at any
given time are living in egglaying mode because this conveys a reproductive
advantage for the group. One could just
as easily say that it’s obvious that most gobies “want to be female” since
that’s what most of them do, but that one of them has to make the sacrifice and
“be male” for the good of the group.
That would also be projecting emotions and motivations onto the fish, of
course. In fact, bluebanded gobies are
just hermaphrodite fish reproducing in the most efficient way possible by
operating in egglaying mode more often than sperm-producing mode. But the story we read is one of enforced,
devalued feminization and aspirational maleness, because that affirms sexist
human gender ideologies.
Entwined with these male-privileging gender ideologies is a
story about dominance and submission. As
the story goes, high status fish are dominant; low status fish are
submissive. The most aggressive and dominant
bluebanded goby “gets to be the male,” while the rest have lower status that
accords with their more timid female nature.
This narrative is so familiar in patriarchal society that scientists
seem not to notice it’s an ideology they’re imposing on nature in their
research and writing.
Here is what we do know about bluebanded goby reproduction,
stripped of human gender ideologies. In
this hermaphroditic species, the greatest number of offspring are produced when
most of the fish are laying eggs. So
they form mating groups or families, typically of 3-7, in which one of the
gobies’ bodies shifts to sperm-producing mode, and the rest shift to egg-laying
mode. The fish that takes on the
inseminating mode needs to be robust, because it must continuously mate with
the rest of the fish. When mating groups
form or change, the members all swim about actively, zipping toward one
another. (Actually, this behavior is
quite common, and regularly occurs between all of the bluebanded gobies,
including the egglaying ones in established groups.) What determines which goby in a new group
will take on the sperm-producing role is the behavior of the other fish. A goby being zipped at by a zippier fish will
dodge out of the way. This gets called
“submission” by scientists, but could just as well be termed “peacekeeping,”
and would most accurately be simply called “getting out of the way.” By engaging in this dance of zipping about, a
new group of gobies determines which of the fish is the most energetic and
robust. Often it’s a large fish, but
that’s not always the case. That fish
shifts to sperm-producing mode (unless it is already in that mode), and the
others shift to egg-laying mode (unless that is already the case).
Oh, and by the way, bluebanded gobies that are in
sperm-producing mode don’t “fight harder” to stay in that mode because they
“don’t want to be female.” If a group of
bluebanded gobies is assembled completely out of fish that are in
sperm-producing mode, all but one of them shift to egglaying mode. This takes the same amount of time as it does
for one sperm-producer to emerge from a group that is assembled out of gobies that
are all in egglaying mode, and leads to the same rate of fertility. (See here.)
So: by nature, bluebanded gobies are intersex fish that form
efficient mating groups of multiple egglayers and one inseminator, and shift
reproductive modes as they move from group to group. This is an interesting part of the wide
diversity of sexual arrangements in nature.
I believe that teaching people about this natural diversity would make
the world a better place for intersex people, as it would make it less likely
for us to be perceived as “unnatural” and “disordered.” But instead of teaching children about sexual
diversity, educational sites either completely deny that bluebanded gobies are
hermaphrodites, or only mention it as a story of rare and odd sex changes from
dyadic female to dyadic male. And
scientists, educated like the rest of us in this context, impose all sorts of
ideologies about binary gender roles onto what they observe about the fish,
perpetuating the problem of distortion.
Nature is so much more interesting than the stories we tell
ourselves about it. It’s time to stop
obscuring the objective fact of sexual diversity.
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