On Sex/Gender Checkboxes

Day in and day out, sex and gender minorities are boxed in by being confronted with sex/gender checkboxes. This starts the moment we are born, when a binary sex must be checked on our birth certificates: “male” or “female.” For individuals who are born with visibly intersex bodies, this requirement causes a crisis. Families and doctors make hasty decisions about which box they'll force us into, and we have to live with the consequences all of our lives. Having checked off a binary “M” or “F,” those with authority over our infant bodies often feel that trying to reshape our bodies conform to the box they've picked is unavoidable. Thus, genital surgeries are routinely performed, despite the deep unhappiness so many intersex people voice about the results as adults. Great pain might be avoided if parents were allowed to acknowledge our physical truth on birth certificates which included an intersex checkbox, or if the gender marker requirement were simply removed.

For people who are trans gender, gender transitioning is made traumatic in large part due to the checkboxes we must face daily. Binary gender markers are everywhere: on our drivers' licenses and passports, on loan applications and job applications, and on websites everywhere (from Facebook to shopping sites to online radio stations). Once you've checked off one box, changing it is bureaucratically and legally difficult—and sometimes there's no way to change it at all. This leads to all sorts of hassles and embarrassment, as we're “outed” in odd contexts. Worse still, if the gender we're living in doesn't match the marker on our ID, we're subject to being banned from flying, arrested by bigoted police officers, and denied employment.

For folks who don't identify with a binary gender, the world of checkboxes constantly denies our very existence. We go institutionally unrecognized, with no way to even try to say “I am here!”

Sex and gender minorities have some protection in institutional settings that bar discrimination on the basis not only of sex, but of gender identity or expression. But often, such policies are adopted with no follow-through on what it really means for a university or company or city to protect gender identity and expression. Unaware of our needs, administrators think only of ensuring that trans people aren't being kicked out just for gender transitioning. While this is certainly important, there are many more needs that must be addressed. And central among these are that sex/gender checkboxes protect the rights of sex and gender minorities.

I have written a Best Practices guide that is under discussion at my university. It lays out a plan for rewriting sex/gender checkboxes that is meant to address the needs of intersex, trans gender, and gender variant people, in this case, in a university setting. There are some inevitable compromises in it between institutional desires for simplicity and brevity, and our desires as individuals to have our identities recognized in all of their fullness and uniqueness. But I wanted to share it here so that other people who are looking for a guideline to use in seeking to better the way institutions around them limit sex/gender choices would have something to start with. It doesn't address the problem of birth certificates, for example, since universities don't issue them. It does, however, address the question of how sex and gender and sexuality should be measured in research in some detail.

Please feel free to share and employ at will.

Best Practices for Identification of Sex/Gender

Compiled by Dr. Cary Gabriel Costello

I. Foundational Principles

Institutions which commit themselves to protecting against discrimination on the basis of sex and of gender identity or expression (GIE) must give individuals the right to self-identify their sex/gender.

Whenever data are gathered about sex/gender, the rights of GIE minorities (intersex individuals, trans men, trans women, and individuals with alternative gender identities) must be protected.

II. Definitions

“GIE minorities” include intersex individuals, trans gender individuals (trans men, trans women, and individuals with alternative gender identities), and people with variant gender expression.

Intersex Persons

While it is common to believe that sex is binary—that is, that all people are born either male or female—in fact, sexual characteristics exist as a spectrum. There is a great deal of variation in chromosomes (XX, XY, XXY, XYY, etc.), hormones (relative levels of estrogen, progesterone and testosterone), secondary sexual characteristics (breasts, hair distribution, etc.) genital configurations, and gonads (ovaries, ovotestes, testes). Intersex people are individuals whose sexual characteristics fall toward the middle of the spectrum. Approximately 1 in 150 people are intersexed according to medical diagnostic criteria. Most are very private about this status, though some are public about it.

Trans Gender Individuals

Individuals whose gender identity does not match the sex they were assigned at birth are deemed trans gender. A trans man was assigned female at birth but identifies as male; a trans woman was assigned male at birth but identifies as female; a genderqueer individual may identify as neither male nor female. Trans gender individuals often transition to their sex of identification, though they may do so in different ways. Some transition socially by changing name, pronoun, and dress. Others also take hormones (testosterone or estrogen/progesterone) to alter their bodies. In addition, some get surgery to change their chests or genitalia. Because surgery is quite expensive, may not be covered by insurance, and because it carries serious risks, many trans gender individuals in the U.S. do not seek or are unable to access surgical transition services.

Variant Gender Expression

People of any sex or gender may have an atypical gender presentation—male femininity, female masculinity, or androgyny.

III. Best Practices in Collecting Data about Sex/Gender

The best practices for collecting data about sex/gender depend on context. If collecting data about sex/gender serves no purpose for the individuals from whom it is collected, then eliminating the question is the best practice. If data are being gathered to protect the rights and well-being of individuals, then individuals should be given self-identification options that allow GIE minorities to self-identify. These options include a shorter form for ordinary uses, and longer forms to be employed in research contexts.

Eliminating Unnecessary Requirements for Individual Sex/Gender Identification

There are many institutional contexts in which people are routinely asked to identify their sex/gender based on common marketing practices or institutional tradition rather than an intent to protect the individuals from discrimination on the basis of their sex/gender. (For example, this is a common requirement in registering to use website services.) In this situation, the best practice is simply to eliminate the unnecessary requirement of declaring sex/gender.

Standard Best Practices Short Form for Sex/Gender Identifications

In contexts in which data is collected order to ensure equal treatment and respect for all, information about sex/gender should be collected in a manner that protects GIE minorities. The goal in implementing sex/gender categories for general data collection is to protect the rights of all people, whatever their physical sex status or gender identity, including intersex individuals, trans men and trans women, and individuals with alternative gender identities. Thus, the inappropriate single question (“Sex: Male__, Female__”) should be replaced with a three-stage approach.

1. Gender identity: Woman __, Man __, Alternate Self-identification (please write in) ______________.
2. Do you have an intersex condition (disorder of sex development)? Yes__, No__.
3. Are you trans gender? Yes__, No__.

In order also to ensure nondiscrimination on the basis of sexual orientation, best practices add a fourth question unrelated to GIE:

4. Sexual orientation: Heterosexual __, Lesbian__,  Gay__, Bisexual__, Queer__, Pansexual__, Asexual__, Alternate Self-identification (please write in) ______________.

AVOID poor practices which undermine individuals' identities instead of protecting them. A common poor practice is to use a single additional checkbox: “Male__, Female__, Transgender___.” This is inappropriate for several reasons. First, it does not allow intersex individuals a way to identify themselves. Secondly, it discriminates against trans men and trans women by framing trans gender identification as incompatible with “real” male or female status. And thirdly, it does not allow for recognition of the distinct needs and identities of individuals who identify as neither male nor female.

Best Practices Long Forms for Research Contexts

Data about sex and gender are often collected in the course of research. If data are to be analyzed along the dimensions of sex and/or gender, two sets of needs must be met. The first relate to the rights of research subjects, who must be protected from harm, including the harm of discrimination on the bases of sex, gender identity or gender expression. In conducting research with human subjects, researchers will inevitably recruit research subjects who are intersex, trans gender, or variant in their gender expression, and are ethically obliged to treat them with respect. The second issue relates to the need of the researcher to have research questions carefully worded in a manner that subjects will understand and respond to in a reliable and valid manner.

Many scientific studies today continue to use “sex” as an independent variable, and measure this in a binary fashion. This is a methodological flaw, as well as discriminating against GIE minorities. It does not allow the researcher to measure what actually accounts for observed variance in the dependent variable: is it physical sex status, internal gender identity, gender-conformity or nonconformity? Just as a study that uses religion as an independent variable is improved when it not only identifies subjects as “Christian,” but allows the subjects to identify a more specific denomination, asks them how religiously observant they consider themselves, and inquires as to how often they attend church, increasing the sophistication of sex/gender questions improves study results.  The following measures are suggested:

1. What gender do you identify with? Man__, Woman__, Other (please write in the identity)________________.
2. What sex category were assigned at birth? Male__, Female__.
3. As far as you know, were you born with an intersex or sex variant body? Yes__, No__.
4. Please indicate how masculine or feminine you are in your dress and manner on the following scale: (1) very masculine, (2) moderately masculine, (3) a bit masculine, (4) androgynous, (5) a bit feminine, (6) moderately feminine, (7) very feminine.

In order also to ensure the study is not discriminating on the basis of sexual orientation, and to gather better data, best practices suggest that subjects also be surveyed on their sexual identity. Problems are often raised by the traditional method of asking subjects if they are “heterosexual, homosexual, or bisexual.” For example, people who are gender transitioning or who identify as neither male nor female are often unable to use these sexual orientation categories to classify themselves. Furthermore, it is well established that there is a difference between how many people identify their sexual orientation and the sexual activities in which they actually engage. This may be addressed through questions such as the following:

1. To whom are you attracted, sexually and romantically? (1) only men, (2) mostly men, (3) a bit more toward men than toward women, (4) equally toward men and women, (5) a bit toward women than men, (6) mostly women, (7) only women.
2. With whom have you been sexually involved? (1) only men, (2) mostly men, (3) a bit more men than women, (4) equally men and women, (5) a bit women than men, (6) mostly women, (7) only women.
3. Are the people to whom you are attracted (1) very masculine, (2) moderately masculine, (3) a bit masculine, (4) androgynous, (5) a bit feminine, (6) moderately feminine, (7) very feminine.
4. Consider the idea of a partner who identifies as neither male nor female, but as some other gender such as “genderqueer.” Do you find that (1) very appealing, (2) moderately appealing, (3) a bit appealing, (4) I feel neutral about it, (5) a bit unappealing, (6) moderately unappealing, (7) very unappealing.

Researchers who choose specifically to study GIE minorities should consider them a vulnerable subject pool for IRB human subject protection purposes. In cases of studies recruiting intersex, trans gender, or gender-variant subjects, procedures should be set in place to protect these vulnerable subjects, and the questions asked about sex and gender carefully designed to accord all subjects with full respect for persons. Confidentiality should be strictly protected, data collected in a location where subjects will not be at risk of having others see or overhear their responses, and information sheets listing appropriate support groups and links to mental health resources distributed to those recruited to participate.

The Phalloclitoris: Anatomy and Ideology

This is a diagram of our shared heritage--yours and mine. It is a drawing of the genitalia we all start out with in the womb.

The Western medical establishment is deeply invested in the ideology of sexual dyadism: the idea that there are two very different sexes with two very different sets of genitalia. When children are born with genitals that are intermediate between the two, it is called a "malformation" and treated as bizarre and in need of immediate "correction." My earlier posts explain how this causes great suffering for intersex people. What I want to write about today is how the language we use and the diagrams doctors draw to illustrate genitalia hide the similarities between everyone's genitals. I believe that if we use more accurate language and diagrams, not only will we all understand eachother's bodies better, but the treatment of intersex individuals will improve.

Everyday Understandings of Genitalia

In the U.S., we live in a society that believes in two "opposite" sexes, men and women. Tell average Americans that sex is actually a spectrum of differences, and that there are societies which divide this spectrum into three or more sexes, and they'll just look at you funny. This is not because Americans are ignoramuses--it's just what we learned at home and were taught at school. Men have penises and testicles, children are told. Women have . . . well, women are presented as more complicated. Often children are told, "men have penises, women have vaginas." But then they learn at school (or in schoolyard talk) that the vagina is "the hole where a penis can go," but there are more parts to the female anatomy, and the most sensitive bit is the clitoris. By high school biology class most of us have dutifully learned that the technical term for the female genitalia is the vulva, made up of not only clitoris and vagina but labia minora and majora, the inner and outer lips, and that inside women have ovaries and uteri. What we are taught about male anatomy remains simple: men have a penis and testes. From this anatomical distinction we are taught to understand people as falling into two camps: straightforward, goal-oriented, insensitive men and complicated, vulnerable, sensitive women. That's gender dyadism, American style--the fodder for endless TV sitcoms.

What we are not usually taught is that that all humans start out in the womb with the same initial genital structure. This is certainly studied by embryologists, if not familiar to the general public, and I will give a basic tour in this post. I'm not going to use the language embryologists do, though, because I find it very odd. They refer to the initial human form as the "indifferent stage," often say that the genitals "appear female," yet term the sensitive end of the genital structure the "phallus." The truth is that we all start out appearing neither female nor male, and we certainly don't start out with penises. We all start out intersex. Our initial form (which some of us retain) is pictured at the top of this post. Let's examine it.

Human Genital Development
We all begin life with genitals that have four basic external elements. At the top is the part numbered 1 on my drawing: the sensitive end of the phalloclitoris, which can differentiate into the head of the penis or clitoris. In the center is structure 2: an inset membrane that can widen or can seal as the fetus develops. It will form the urethra, and the vagina, if any. Around it is structure 3, which is capable of differentiation into either a phallic shaft, or clitoral body and labia minora. And at the outside is the fourth part, the labioscrotal swellings, which can develop into labia majora or a scrotum.

There is a lot of variation in how each of the four basic parts of the genitalia develop from person to person in all of us. For example, we acknowledge with a lot of rib-elbowing the variation in penile size. Variation in the size and shape of genitalia, and in other parts of the body, is part of human diversity. Surgeons are well aware that livers and lungs and blood vessels vary a lot between individuals, and may look quite different from an iconic anatomical diagram. But we rarely care about having an unusually shaped liver. The shape of genitals, however, is given huge cultural weight, because we pin our commitment to dyadic gender roles on them. We look at the shape of a newborn's genitalia and project a future of dresses and diets and talking about emotions, or sports and strength and getting under the hood of a car. We do know that people are complicated. Most of us want to be more than walking gender stereotypes. Still, we understand people through the lens of dyadic gender difference, and intersex people call that into question. When we see a baby born with intermediate genitalia, and can't project a future for them based on our well-known gender narratives, people in our society--including doctors--freak out.

Part of the reason our culture reacts so poorly to intersex people is that doctors have spent the past 75 years or so erasing the bodies of people like me. I'm referring not only to the fact that doctors surgically alter our genitals, nor only to the fact that we're given an "M" or an "F" on our birth certificates, but to the fact that anatomical illustrations don't illustrate our anatomies. Medical drawings and medical language obscure our existence. And since I want doctors and parents and society at large to stop freaking out and erasing us, I want that to change.

Anatomical Illustrations of Adult Genitalia
Variation in the shape of genitalia is a fact of nature. Some genital variations are labeled intersex conditions by doctors, and considered unacceptable malformations that must be "corrected." Other variations doctors insist with equal vehemence not to "really" be intersex. There is little logic to this if you look at it from the perspective of physical health or function. Instead what seems to matter are ideologies: first, an insistence that all people must be "really" male or female; and second, an anxious commitment to associating men with big penises. And this is visible when you examine anatomical drawings.

Let's look at how doctors portray adult genitalia. Anatomy drawings in Western medicine present two and only two types of "normal" genitals. I don't have permission to post copyrighted medical illustrations, but a sample female genital diagram can be see here, and an example of a male genital diagram here. These drawings of dyadic sexual anatomy could be critiqued in many ways, but for now let's consider just one thing: the way the phalloclitoris is portrayed. In the female drawing, it's presented as a tiny clitoral dot, with the label pointing at a spot the size of a small pea. In the male drawing, it's presented as a huge penis, shown in the illustration I've linked as extending beyond the testes, apparently 8 inches or more in length even in its flaccid state. To put it plainly, the "normal penis" in this medical drawing is porn-star sized rather than average, and massive in comparison to the petite "normal clitoris."

Not only do these medical illustrations exaggerate sexual differentiation, they obscure rather than illuminate shared anatomy. Note that only the tip of phalloclitoral structure protruding from the foreskin or "hood" is labeled "clitoris." In fact, the phalloclitoris is similar in size between people at all points on the sex spectrum. In people with genitals that conform closely to the male end of the sex spectrum, the structure I've labeled #3 above merges into one erectile column. "Men" get a "penile shaft." In people with genitals that conform closely to the female norm, the two sides of the structure spread apart and surround the labia majora. "Women" get . . . well, what do you call that? Anatomists call these two feminized sides of the phalloclitoris the "clitoral crura," a term that most laypeople have never learned at school. Just like the penile shaft they are made of several inches of spongy tissue that fills with blood and erects during sexual excitement. You can see an anatomical illustration here (look at the part labeled "crus clitoris," the singular of "crura" in Latin). As you can see, the phalloclitoris is actually quite similar in men and women. The tip bends down in women and the two sides are joined together in men, but the basic structure is the same.

You would imagine that anatomical drawings would illustrate all of our genital structures to increase understanding. But do a Google image search for "female genital anatomy" and you'll see hundreds of images that look like this--and just one image in the first 10 pages that shows the crura. The anatomical illustrations that are used on educational and medical websites conceal rather than illuminate the similarities in everyone's phalloclitoral anatomy.

Do a Google search for just "genital anatomy" and you see dyadic illustrations of two very different types of genitalia. You don't see the shared embryonic anatomy from which we all develop, you don't see how all people have similar phalloclitoral structures as adults, and you don't see the wide spectrum of adult genital forms that exist. You see the ideology of sex dyadism, rather than the fact of the sex spectrum.

The Moral of the Anatomical Fable

In my next post I will discuss the common variations on the human genital theme, and why some and not others are called intersex conditions by doctors. What I want to conclude with today is the fact that language and the images scientists and doctors use exaggerate the differences between "normal" male and female genitalia. In a culture where people believe genitals determine gender, this makes men and women seem in general more different, more alien from one another, harming us all. And for intersex people, anatomical drawings and language present us as bizarre, inexplicable freaks who require medical "correction."

We need to change the language we use. Yes, sexual differentiation of bodies happens. The average person who was assigned male at birth has smaller nipples than the average person who was assigned female at birth. But we call the erectile tip of the areola a "nipple" whatever the sex of the person it adorns. A phalloclitoris is a phalloclitoris, erectile and sensitive--no matter if the person possessing it is deemed male, female, or intersex. In simple terms, some of us are more "outies" and some are more "innies" and some right in between--but we all share the same genital structures. You have a phalloclitoris, and so do I. We are all variations on the same bodily theme, and there is no need to react to intersex bodies with pity or horror.

Do I Have the Right to Marry Anyone?

On Sexual Identity and Intersex Experience

I'm married. I wonder if I'll be sent to jail.

DOMA, the Defense of Marriage Act, states that the U.S. federal government defines marriage as a legal union between "one man and one woman." My home state of Wisconsin goes further, providing that residents other than "one man and one woman" who go out of state to marry can be fined up to $10,000 and/or imprisoned for up to 9 months.

My spouse and I got married out-of-state.

The law scares me--because I'm intersex by birth.

My spouse, for whom I thank my lucky stars, is also intersex. We have very different bodies, different "conditions," but we share key experiences that bind us closely. And one of those shared experiences is a constant feeling of unease with regulations and categorizations--marriage laws, for example. If you were born neither male nor female, and you were looking at laws banning marriage unless it joined "one man and one woman," how would you feel? Unacknowledged, uncomfortable, socially unmoored? The people who wrote these discriminatory marriage laws had other aims--the existence of intersex people probably did not cross their minds when they were putting the bills together. But that's how a million regulatory regimes impact us. You are required to declare a dyadic sex, supposedly to protect your identity or serve your needs. That's why you have to check off an "M" or an "F" box to get a driver's license, or open a credit card account, or fill in a Facebook survey. True, these checkboxes conflate together physical sex and gender identity. I'm intersex, but my gender identity is masculine, so I can just check the "M" box on the Facebook survey about blue jeans.

But marriage is different. There's an inquiry into your "true sex"--supposedly to protect society at large.

The furor focuses on "same-sex marriage."

Conservative opposition to "homosexual activism" is what has driven the enactment of DOMA and the 29 separate state laws limiting marriage to "one man and one woman." I'm sure you're familiar with the rhetoric, which tends toward Biblical one-liners: "Male and female created He them;" "God created Adam and Eve, not Adam and Steve." There's the constant quotation from Leviticus, "You shall not lie with a male as with a woman. It is an abomination" (with the constant nonquotation of other passages from Leviticus, like the prohibition against wearing fabric mixing linen with wool, or eating pork, or trimming one's beard).

According to this simplistic interpretation of the Bible, God made men and women to be opposite and distinct, intended for procreative marriage, with a husband leading the household and a wife practicing submission to him. Heterosexual marriage based on these principles is said to be the foundation of society. Straying from it, we are warned most stridently, will undermine both morality and social order.Advocates of same-sex marriage have written many eloquent defenses of allowing gay- and lesbian-identified couples to wed. I certainly agree with them that male couples and female couples should be able to marry.

But where do I fit in this picture, as an intersex individual?

Last year I had a conversation with the leader of a proselytizing Christian group that had taken over the central plaza on my college campus. They were holding up signs saying that any sex outside the context of a marriage between one man and one woman damned a person to hell. I'll give them this: they were coherent in their sexual beliefs. They were also holding up signs about masturbation earning one eternal damnation (an assertion that did not win them a lot of converts in the college audience).

I stepped aside with the leader, and asked him respectfully what his religious precepts would advise for me. I explained that while I lived as a man, and he saw me as one, I was born with an intersex condition and was assigned female at birth. Since I was neither male nor female, how was I to follow a command that marriage only be contracted between a man and a woman?The religious leader stared at me for a bit, then rallied. He said that he wanted to tell me that he had great pity for me, and that God did not intend that I be born intersexed. "Birth defects," he explained, "exist because of Adam's fall. Original sin warped God's creation, and that's why tragedies such as the birth of a baby with crippled legs or like you occur." He explained that when Jesus came again, all of this disorder would be purged, and there would be no more people like me. I mustn't be angry at God but at sin for putting me in my position.

I told him that I believed that I was born exactly as the universe intended, and was not angry at God. What upset me was how I was treated by my fellow human beings. In any case, given that I did exist as an intersex person, whom did he believe I was permitted to marry?

He asked me what the doctor had put on my birth certificate, and I said "female." He gave me a grave face, and told me, "I'm sorry, but then that is what you are. You may look like a man but you are not, and you can't marry a woman. It's like the case of a transsexual, even though it is not your choice." So, according to this religious leader, sex assigned at birth governs marriage law, and there can be no sex transitions, for intersex people or for those born with normative genitalia. (Nonintersex trans people get the extra distasteful twist of the lip for a "choice," but the end result is the same.)

I then asked the religious speaker if he thought I should marry a man. He looked very uncomfortable and just shook his head. I said, "So you don't think I can marry anyone?" He suggested that I dedicate myself to God's will and eliminating sin rather than dwelling on my personal situation.

I guess that's what monks and nuns do: dedicate themselves to God, and live a life of celibacy. And since he didn't think I could marry anyone, and sex is only allowed in marriage between a woman and a man trying to procreate, celibacy is what he felt God required of me.

In the parlance of my Jewish ancestors, Feh.

I did ask him one more thing: why did he think that the doctors had picked the "right" dyadic sex for me? Couldn't I be trusted to look into my heart and know myself better than they? He just said that doctors are the ones who know, because they have the technology and the tests.

I don't know when or how doctors became the oracles of divine will for good Christians. In fact, I'm sure that when doctors declared that masturbation was healthy, the members of the group I encountered rejected that promasturbation prescription vehemently. . .

The majority of Americans would see the group I encountered as rather extreme. Yet the majority of Americans have enacted marriage laws that reach the same conclusion for intersex people: marriage is only acceptable between a "man" and a "woman." The fact that I'm neither by birth is some sort of unfortunate, bizarre accident. Doctors can be relied upon to pick the right sex for intersex babies, and that should clear the whole problem up.

But even doctors aren't so sanguine.

Doctors warn of a "risk of homosexuality" for babies born intersex.

Yes, you heard that right. Just read about some "DSD" or other and you'll see it there. Take congenital adrenal hyperplasia, or CAH, which is often manifested in the birth of a child with a penis outside and uterus and ovaries inside. Medical texts regularly state that "even with surgical and pharmacological treatment, CAH girls are at risk of homosexuality." In fact, there is now a highly controversial prenatal treatment program led by endocrinologist Dr. Maria New, intended to influence genital growth in CAH XX infants, so that they're born looking more like a typical female--and it is being reported not as an attempt to prevent intersex births, but as an attempt to "prevent homosexuality." You can check that out here. What a confusion of intersexuality and homosexuality! (And how eugenic. . .)

I have to ask you, from the perspective of birth sex, how can an intersex person be homosexual--unless they only have sexual relationships with other intersex people? Of course, birth sex does not dictate how sexual orientation is experienced . . . but doctors misapprehend how this works.

What the doctors really mean with regard to children born with XX, CAH is this: they take babies born with what are often totally average-looking penises, but internal "female" organs, and they cut their penises off. (The call this "clitoral reduction" nowadays.) They prescribe the children testosterone-suppressant drugs. They tell their parents, "See, you have a girl!" But the parents know the children are intersex--they saw them born with phalli. The children know they're intersexed--they bear the scars, they take the daily meds, and are forced to show their genitalia to doctor after doctor. Of course these children often grow up with gender identities and behavior that differ from "normal girls."

Apparently we intersex people often freak doctors out once we're not cute little tots over whose bodies they have vast power. They take an intersex baby with CAH, give hir sex assignment surgery, and want to believe that having sculpted a vulva-shape in hir flesh they'll have guaranteed hir a future of "normal womanhood," stereotypically defined as involving no great interest in sports, but lots of interest in fashion and boys. Sometimes their patients grow up into the pink feminine heterosexual icons of the doctors' imagination, expressing nothing but gratitude for the removal of those embarrassing "pseudophalli."

And sometimes CAH intersex patients show up in the doctors' office as depressed or angry teens in short hair and jeans. Maybe they identify as male, or as genderqueer, or as tomboys--doctors don't seem to ask about gender identities or if anyone wanted to keep that penis they had been born with. What they do ask about is sexual activity, and if the patients are involved with boys or girls or both.

The data they collect is pointless.

Without knowing gender identity, you can't tell someone's sexual orientation. Take two people with the same CAH bodily configuration, and one can grow up to identify as female and the other as male. If a person identifies as male and only wants female partners, his sexual orientation is heterosexual. But the doctors will label this person "homosexual," because they assigned him to be female, and they don't ask if that's the gender identity he actually grew up to have.

Doctors are acting just like the Christian sectleader I spoke with at my university. Intersexuality is a mistake, they say, unintended by nature. Doctors have the godlike power to divine the "right" dyadic sex for intersex babies, and correct their faulty bodies. And the "normal" thing for these intersex children to grow up and do is to marry a person of the sex other than the one the doctors picked for the child.

What does this all mean for me?

My spouse and I were both born intersex. I was assigned female at birth, and she was assigned male (I escaped surgical intervention but she was surgically misassigned, to her lifelong regret.) According to the sexes doctors put on our birth certificates, we are a "heterosexual" couple, though we share a physical status. Had we both grown up to identify with the sexes we were assigned, our intersexuality would be invisible to society--as both doctors and Christian antigay activists would wish it to be. We could have married and disappeared into the suburbs. Biologically speaking, we would not qualify as "one man and one woman" for marriage, but nobody would ever have raised a stink, so long as we accepted our lot and kept quiet about our birth status.

But we did not identify with our sexes of assignment. Eventually, we both found the strength and resources to enter the gender transition process. This has come as a great relief to us both, though it hasn't made our lives easy (read my last post to hear more about that). If transphobia were not the huge barrier that it is, and gender transition services could be easily accessed, and insurance covered the medical expenses, and the legal hurdles weren't so high, my spouse and I could have done a simple if ironic do-si-do and would now be married as a man and a woman.

Gender transition being the long, drawn-out, expensive, legally-convoluted process that it is, however, according to our birth certificates, we're both "male." No matter that my spouse was never biologically male. No matter that she has breasts and gets a menstrual period. No matter that she has identified as female since the age of 3 or 4. No matter that her driver's license reads "F."  Because she already had genital surgery in infancy, and is considered a "poor candidate" for further surgery, and wouldn't want it in any case, given the sensation she already lost in the first round, she can't change her birth certificate, and in Wisconsin, sex for marriage purposes is based upon birth certificate sex.

So: one thing we're dealing with now, despite the fact that we live as a married man and woman, is we are currently, according to our birth certificates, in a same-sex marriage. At the time we got married, my legal documentation still listed me as female, so getting hitched was unproblematic--but at the moment we look different on paper. And since we went to San Francisco to get married, someone could now threaten us with that $10,000 fine and/or 9 months in jail Wisconsin law allows. We share this unhappy situation with other LGBT couples in Wisconsin who found routes to marriage, and I have great sympathy for them all.

Even if we were able to change my wife's birth certificate some day, and we're no longer a same-sex couple on paper, we won't be safe. Because we're open about having been born intersex. Because we gender transitioned, and people know that. Because we're visible, we'll always be vulnerable to harassment by some bigot who wants to argue we're not "one man and one woman" and try to invalidate our marriage.

Intersex people having to deal with marriage restrictions is not some abstraction or game.

It's nervewracking stuff, and it's my lived experience. Sometimes well-intentioned people who want to construct arguments against "same-sex marriage bans" bring up the idea of intersex people like some sort of abstract theory. Take, as just one example, this post entitled "Common Arguments Against Gay Marriage." A section titled "Hermaphrodites" poses intermediately-sexed bodies as a hypothetical and asks how "feminized" a "hermaphrodite" must be to be permitted to marry a man. The blogger gets excited about this just-so story, and states, "This is a type of sorites paradox. Traditional sorites paradoxes involve asking how many grains of sand you have to remove from a pile before it stops being a “pile,” or how many pounds a fat person has to lose before they are no longer “fat.” These are paradoxes because they involve characteristics which are vague — it’s not clear where a pile or fatness begins and ends."

Yes, this hypothetical of the Incompletely Feminized Hermphrodite follows the slippery slope, sorites paradox argument format. But we are not mythic creatures in some ancient Greek story Zeno might tell of arrows that get halfway to their targets. We are not some illustrative fable. In writing about intersex experience and one-man-one-woman marriage limits, I have to raise this issue, because I know there are other intersex people who are livid at how people who are supposedly our allies treat us--so angry that they think the intersex community should refuse to enter public discussions about how marriage restrictions affect us. I agree that we have been treated rudely, our bodies seized upon as fodder for arguments by people ignorant of our painful real life experiences. It's depressing.

But the fact that our lives have been appropriated by others should not silence us. And so I am speaking out, and asking for something simple.

I am a human being, and I ask for respect.

All bodies deserve respect. Intersex variations are not lusus naturae, medical defects, the wages of sin, or mistakes unintended by God. Sex is a spectrum by nature, and everyone's body is a gift.

All loving relationships deserve social support. To believe that it is ungodly of me as an intersex person to get married to a man or to a woman because the sex I was assigned at birth did not match the gender identity I developed--that is a failure to understand and embrace a God of Love. To grant or deny people the right to marry based on their sex or their gender is simply wronghearted. All people--straight and queer, trans gender and cis gender, intersex and dyadically sex-normative--should be treated with dignity when they commit to love.

For a person to be threatened with imprisonment for daring to marry . . . now that is moral evil.

Interphobia--Not Cured by Hiding Us Away

This terribly disrespectful cartoon depresses me.

It's from a blog entry entitled "10 reason why Caster Semenya is a man. . . she set to run in June anyway," posted this April by a guy named Anthony. Here's a link, if you really want to see.

When Caster Semenya's name first became an international headline, I wrote a blog post about her situation, and I'm not going to revisit the specifics of her case now. Read the older post here if you wish. What I want to address now is the problem of bias against intersex people, which, following the conventions of the terms homophobia and transphobia, I'm terming interphobia. The cartoon of Caster Semenya standing to urinate from a presumed male phallus is an example of interphobic humor.

Caster Semenya's case has served as a lightening rod for interphobia.

If you wander the world of internet humor, you'll find plenty of other examples like the post by Anthony I discuss here. Internet mockery of Caster Semenya draws its vitriol from a variety of sources--you'll find it laced with sexist insecurities about women with athletic prowess, transphobia from authors who presume that Semenya is an MTF trans person, racism in the form of assertions that if she were a "real woman" she'd have straightened her hair--there's a whole banquet of bias being served up. But there are specific elements of interphobia that lie front and center. There's a lot of prurient har-har speculation about her intersex genitalia, framing Semenya as someone whose genitals are on freakshow display. And there's castigation of Semenya for identifying with her sex of rearing.

What the cartoon I've shared from Anthony's blog post illustrates is rage at Semenya for identifying as female, iconically represented by which bathroom she uses. Thus Caster Semenya is shown both in a vulnerable position, at the toilet, and as smirking at the viewers as if daring them to do anything about the fact that she knows she is not a "real woman," illustrated by her standing to urinate. The text of Anthony's blog post is a list of body parts that he claims prove Semenya is "really a man," including even the shape of nostrils (!), but focusing most obsessively on the flatness of her breasts. "NO breast...naada, not even 1% breast, not even fat man breast...," he declares, and, making fun of a photo of Semenya in a dress, he says "they dress up the person into a woman....but they failed to give it a cleavage or breast."

It.

What Anthony concludes is that Caster Semenya is a man and should be running in men's races. He declares her a cheat by virtue of her intersex status, the sex she was assigned at birth wrong, and her gender identity as a woman unacceptable. Basically, Anthony wants to force Semenya to undergo gender transition against her will.

And Caster Semenya followed the rules.

There are rules we live under in our contemporary Western societies that I and many, many other intersex advocates have criticized. The rule that the spectrum of physical sex characteristics we are born with must be forced into dyadic sex assignments, often accompanied by unconsented-to infant genital surgery. The rule that we are supposed to grow up to identify with our sex of assignment. These rules, we are told, are for our own safety.

Doctors tell the families of genitally variant babies that without surgical sex assignment we will be treated as freaks, but surgery will protect us from pariah status. Some of us face traumatic "gender therapy" as children in an attempt to cause us to identify with the sex we were assigned, and again, our families are told this is for the best because it will protect us from ostracism. Our families are told to keep our status a secret. We're told to keep silent, fit in. Our intersex status will thus be erased, and we'll be safe.

Well, Caster Semenya was assigned female at birth, raised as a girl, and identifies as a woman. Her intersex status wasn't known to anyone at all--it wasn't even diagnosed until she was forced to undergo "gender verification testing" when some sore-losing competitors demanded it.

What this proves is that having one's intersex status secret is no protection at all.

We may pass as our assigned sexes--but at any time we may run into a circumstance under which our intersex status is revealed. We get in a car accident. We find ourselves with an ex with a grudge. We're thrust into the limelight, perhaps by winning a race. And we're outed--and thrust into the path of vicious interphobia. We face ER staff who take cell phone photos of our genitalia to send to their friends while we're unconscious, exes telling all of our Facebook circle that we're freaks, and random bloggers mocking us and declaring that we should be forced to gender transition.

The "solution" that doctors pose to the fact that intersex happens--to hide us all in the closet--does nothing to stop interphobia. In fact, it encourages it by making us vulnerable, isolating us from support, keeping us ashamed. The real solution is to fight interphobia directly. We need to come out, accept ourselves, and demand that others do the same.

Deaf Children, Intersex Children, and DSDs

I want to explain a division in our community, between intersex advocates and partisans of the terminology of "DSDs."

Every day, intersex children are born to parents who are shocked, lost at sea. "How can this be happening," they cry, "I've never even heard of such a thing." And this, this is the crux of the problem. It's this problem of being born as strange little changelings to our parents that perpetuates infant sex assignment surgery, despite the ever-mounting evidence that the results are frequently unsatisfactory. And it is the issue of how to approach infant sex assignment that lies behind our division into two warring camps: those who say the term "intersex" is overpolitical and imprecise and that the "proper" term is "Disorders of Sex Development," and those of us who say we are not disordered, and take pride in calling ourselves intersex people.

The intersex and DSD camps are constantly battling now, at least in the U.S. The thing is, this is not unique to our community. It is something we share with others. Similar controversies erupt around Deaf children born to hearing parents, for example, or, in some cases, children of color adopted by white parents. This commonality is very instructive--controversy arises when children of marginalized status are born or reared by parents who are privileged along that axis of identity.

Consider the organized Deaf community, which centers around institutions and locales where signing, ASL, is the norm. This Deaf community experiences itself as a linguistic minority, rather than "disabled." Members of such Deaf communities are not impaired in their daily lives. Able to communicate in their rich language with those around them, they are enabled to study and grow, and develop a strong culture, literature, and traditions.

The problem is that children who cannot hear are born to hearing parents all the time. And those parents are shocked, at sea. Some hearing parents don't want to give up on the future they had imagined for their children, and say, "I just want my child to be normal!" And "normal" for them means having their child live and go to school in a "mainstream" hearing context, and focus on learning to speak. It means getting cochlear implants and focusing everything on trying to make sense of a bit of sound. It means that these deaf children spend their days isolated, surrounded by people who can't understand them, and spending countless hours both in school and out trying to learn how to speak words they cannot hear, instead of quickly and easily learning a visual language they have the sensorium to perceive, and spending their hours at school learning math and history.

The signing Deaf community aches for these isolated children. They see the children as disabled by their parents, failed by the professionals who surround them, misunderstood by doctors. And the Deaf community pleads: please, parents, accept that your child cannot hear. Make them part of the Deaf community by allowing them to learn Sign from infancy; become part of the community yourself by learning Sign. Some parents take the message to heart and find their lives much enriched; others resist--but at least the message is out there, and Deaf children become aware of it soon enough. You can see a person born without hearing as defective, disabled, in need of medical alteration. Or you can see them as simply different, Deaf, members of a rich minority culture.

The split between the medicalized and cultural approaches to Deafness are parallel to the split between the advocates of DSD terminology and intersex activists, but the context is different, because there are no organized intersex institutions, no consolidated intersex neighborhoods. We have no Gallaudet (the excellent Deaf university in D.C.). The situation for intersex children is more like. . . well, imagine if all Deaf children were given forced cochlear implants and their families told to hide the equipment, never to let anyone know their children couldn't hear, and to avoid even acknowledging to the children themselves the issue of their not hearing. The parallel's not exact--it's harder to conceal sensory impairment--but it does give a sense of where we stand.

Most intersex/DSD advocates of any stripe share something in common: we want infant sex assignment surgery to be curtailed. We want intersex children to be allowed to retain their sexual sensation, any chance at fertility, and the right to have the gender identity that they develop be respected and recognized. Let the babies grow up, we plead, and decide what surgery, if any, they want. But the intersex advocacy community is small and diffuse, as compared to the Deaf community, and so far, we haven't gained much traction. Parents of intersex babies have never heard of us, and doctors dismiss us as a few disgruntled outliers. So every day in the U.S., babies continue to receive sex assignment surgery. Most of us continue to be raised in shame and utter secrecy, our genitals never looking "normal" after surgery anyway, but insensate, in pain, and often being reared as a sex we don't feel is ours.

The situation is bad, and something needs to be done about it. And this is where the small pool of intersex advocates splits. Who should we turn to for help? How can we improve the lives of intersex people? Will professionals save us? Or do we save ourselves, through community building and selfadvocacy?

Those of us who identify as intersex activists, in those terms, follow the route familiar to all civil rights' movements (and a fair number of us have been involved in LGBT politics). The basic model for improving marginalized lives, in the civil rights vein, is to take pride in one's identity, however stigmatized by the majority, and then to take action to get the majority to treat one's community better. The route to social change is rooted in embracing selfhood, and then moves on to a familiar array of tactics: be visible; protest; write letters to the editor, one's senator, one's pastor or rabbi; seek protective legislation, etc. etc..

So we act up. And one of the things we do is let people know we are very dissatisfied with how we have been treated by doctors. Unsurpisingly, many doctors have not appreciated this. It's damaging to one's selfimage, to listen seriously to a person who says, "You were not my savior or my hero--you hurt me, you did me wrong." Far easier for a doctor to dismiss our small if vocal group as a radical fringe, or perhaps to see us pityingly as the victims of older forms of surgery, very unlike the babies they now save from freakish lives with their newer, shinier surgeries.

And here's where advocates of DSD terminology chime in. They say, "We simply cannot afford to alienate the doctors, because it's the doctors' actions that make or break us. We need them to stop performing unnecessary surgery on babies' genitalia. And the only way to do that is to convince doctors that we are sane and not crazy. We need to be respectful to them, so that they will listen to us, and we can appeal to their desire to improve treatment." And so the advocates of "people with DSDs" are the political advocates of depoliticization. They argue, "Intersex activists are too far out there. Doctors see red when they hear the term 'intersex' now. Parents, too. Parents don't want to hear that their kid is some other sex, like permanently. In fact, lots of people in our own community are uncomfortable with the term. They don't want to be part of some group lumped together with queer activists, they just want to be seen as people."

I don't want to be seen as oversimplifying the DSD advocacy position--there are more nuances to it. You can read an eloquent defense of the terminology that is respectful to intersex-identified people here. But basically, the position is one of not rocking the boat. We should look to professionals, to doctors, to save us. If we're rational and polite and deferential and apolitical in our presenting of our case to doctors, then in time they will change the treatment regimens, and parents will listen to the medical professionals.

The thing is, similar lines of argument have been raised in the past. I recall in the 1980s, when many quiet, marginalized gay-identified people, living without protection from any nondiscrimination policies, looked to professionals to save them. Political activism, they argued, just alienated the populace. They looked to scientists to save them by finding the "gay gene." But it has been the brave actions of masses of LGBT people coming out at home and work and being politically active that have led to the gains in protection for LGBT people and same-sex couples, not some scientific discovery.

Or consider Dr. Martin Luther King, Jr.'s famous 1963 "Letter From a Birmingham Jail," an impassioned defense of nonviolently confrontational civil rights activism. The letter was addressed to a collection of moderate clergymen who had appealed to King to stop pushing sit-ins and to wait patiently for the legislature to produce civil rights protections. In due time, these clergy argued, if you are polite and trusting, these professionals will act. Just stop agitating, stop alienating them, be patient. But King was right--it was continuing civil rights activism that led to the enactment of the Civil Rights Act of 1964. I believe the lessons of our history are clear: if you want your people to be treated better, then take pride in who you are and demand your rights. And that is what I intend to do.

It's for this reason that I do not identify with the term "DSD." I am not disordered. I was born as nature intended me, and I feel no shame in that. I am an intersex person, and I personally have no interest in having my genitalia surgically altered. I shall not sit meekly by and wait for professionals to quietly change their minds about how to treat the young members of my community. I am going to be noisy and public in my demands, and I am going to work with our nascent social movement. My goal is to make the public aware that we are here, and that infant sex assignment surgery is making things worse rather than better for so many of us. It's public pressure and a shift in public opinion that will finally end the era of attempting to erase us medically. We will be recognized, respected, and no changes to our genitalia will be made unless and until we reach an age where we can request them, uncoerced.

In the future, I hope, when intersex babies are born, their parents, though probably still feeling shocked intially, will know that we are out here, leading happy lives. They can embrace their children--see them as members of a minority, yes, but also as lovely, not defective. They can learn from their children, about privilege and marginalization, to be sure, but also about the vibrance of human diversity. And these children will be able to connect with our community, help build our culture as a people, and contribute to the enrichment of our nation's web of identities, as today's Deaf community does.

Five Myths that Hurt Intersex People

I've had conversations with some intersex acquaintances recently about painful situations in which (nonintersex) people have accused my friends of not "really" being intersex. Besides revealing how rude people in our society can be about policing sex and gender, what these conversations have illustrated are some central myths about intersex status that come up over and over again. It's these that I will address in this blog post.

Myth 1: Intersex people all have intermediate genitalia

Imagine this: you're an intersex person, nervous about dating and finding a partner. You work up your courage to disclose your status to people you're interested in, and after a series of them seeming polite but disinterested in dating, you finally meet a guy who expresses interest. You date for a while, and get to the point where the clothes come off. Your boyfriend gets a good look at you naked, accuses you of "making up that story of being intersex" because your body looks female to him, and breaks off the relationship, leaving you feeling misunderstood and ill-used.

Many people are intersexed in ways that are not visible to their partners. For example, an individual with AIS (androgen insensitivity syndrome) is born with internal testes but genitalia that look typically female. Intersex people born with visibly intermediate genitals are often subject to infant sex assignment surgery, another reason why our bodies may not appear visibly intersex to others.

What disturbs me about incidents in which a partner seems interested in dating an intersex person until the clothes come off is that it generally reveals that the partner was fetishizing the intersex person--only interested in them for their "exotic" body. In the situation described here, the boyfriend wanted to have sex with someone who looked genitally intermediate generally. I've also heard stories from intersex people whose genitals are visibly atypical about how a partner lost interest in them when the clothes came off because they didn't see the kind of "hermaphrodite" genitals they'd dreamt of, with a big penis and a vagina (a configuration almost unheard of in real life, but popular in pornographic fantasy). It's depressing to find out your date wasn't really interested in you, but in playing with some fantasy set of genitalia.

Myth 2: Intersex conditions are always diagnosed in infancy

Here's another unfortunate scenario: a person is having infertility problems, so they visit some doctors. They receive a diagnosis and turn in shock to an online gender forum to post "I was just diagnosed as intersex." Somebody responds, "Stop trolling this blog. You're not really intersex--intersex people all know what they are from childhood. You probably have sick fantasies or think saying you're intersex will give you an excuse to gender transition without controversy." The non-intersex person is accusing the intersex individual of being a non-intersex person exploiting intersex individuals, which is pretty ironic.

As noted above, many intersex conditions aren't obviously visible in external genitalia. That means that people may not find out about their intersex status until quite late in life. While the experiences of late-recognized intersex people are different from those of intersex folks diagnosed in infancy, they are not "less" intersex, and have to deal with physical and psychological ramifications for which they need support.

Myth 3: All infant sex-assignment surgery is aimed at creating "female" genitalia

Imagine this situation: you were born with intermediate genitalia but surgically assigned male at birth. However, you grew up hating your male sex assignment, and so you transitioned to female. Your experience has given you a lot of empathy for people viewed as gendertransgressive, so when you notice that a friend of a Facebook friend identifies as genderqueer, you write her a nice message and offer her friendship. She refuses your offer and writes you a nasty note back about how she knows you are lying about being intersex, since "all intersex children are made into girls." She accuses you of being a stalking, posing, creepy man-in-a-dress. Ironic and sad, isn't it--that a woman who identifies as breaking down the boundaries of sex and gender is policing those boundaries so rabidly and wrongheadedly?

It is true that intersex infants are disproportionately surgically assigned female, based on the appalling medical aphorism, "it's easier to make a hole than a pole." But some intersex infants are surgically assigned male--usually when they have at least one external testis, but sometimes under other conditions. The myth that this "never happens" leaves intersex people assigned male at birth open to constant suspicion and exclusion, increasing the difficulties they have to face.

Myth 4: Intersex people should be genderqueer

This myth comes up again and again in academic, activist and feminist circles: that intersex people, being neither male nor female in physical sex, must be genderqueer and androgynous. We're supposed to be standard-bearers for the fight to subvert artificial dyadic gender categories. Encountering an intersex person with an ordinary and "boring" masculine or feminine gender identity who doesn't look at all androgynous, these activists express puzzlement and disappointment--and in private, speculate that the person must have some minor, mild intersex condition, so they are not "intersex enough" to be insightful.

Intersex people face pressure from doctors and families and society at large to genderconform. Facing the opposite pressure to gendertransgress--subversivism-- is just as unfair. Yes, most intersex people open enough to disclose our sex status agree that it is damaging for our society to insist that everyone must identify as male or female. But we live in a society that understands gender dyadically, and like non-intersex people, we commonly identify as masculine or feminine.

Myth 5: "Real" intersex people are not genderqueer

Frustrated and upset by pressure from gender activists to gendertransgress, as descibed in Myth 4, some intersex people have created a reactionary opposite myth: that "real" intersex people have no interest in subverting dyadic gender understandings of male and female. These genderconservative individuals often don't actually identify as "intersex" but as "people with DSDs (Disorders of Sex Development)." And they go around arguing to institutions that "real" intersex people don't identify as genderqueer--that people who say they are intersex and argue for third gender categories and the like are posers, probably crazed feminist zealots or deceptive trans people.

What makes the myth that intersex people are never genderqueer particularly painful to me is that it is spread by members of our community. To undermine your own intersex siblings and deny their identities is counterproductive, pathetic, and cruel. Many intersex people identify as typically masculine or feminine people, but there are plenty who do not do so, and like all genderqueer people, they face a lot of social bias. We have no duty as intersex people to be genderqueer, but I see a strong moral imperative for us to support people who do have genderqueer identities and manners of selfexpression. There are enough hurtful myths circulating about intersex people already. We don't need to add one of our own to the mix.

Caster Semenya - An Intersex Perspective

Controversy and a lot of prurient interest exploded into the news this week when South African Caster Semenya outran her competition in the 800m world championships by a more than two second lead, only to be accused of cheating by being intersex. As an intersex person following this story, I've felt . . . well, largely appalled by what spews from the mouths of competitors, sport officials, news commentators, bloggers, and eyebrow waggling, head-shaking people on the street. It's hard not to feel depressed encountering innumerable snarky statements such as this one: "South African runner Caster Semenya (hehehe...she has semen in her name...hehehe) won the gold in the women's 800-meter at the World Championships in Berlin last night, but officials may snatch (peen, I mean, pun intended) away her victory if it turns out she's really a dude." (That one can be found here, if you're really inclined to read it.) So I wanted to share my perspective on this story. I do apologize to Caster for joining the pile of people giving her no privacy, but as the media are overflowing with details of her life already, I at least wanted to step in to defend her.

The basic outline of Caster's situation, as best as I can understand it through news reporting which is mediocre at its best, is that she was born intersex, assigned female sans surgery based on her predominant genital appearance, and raised as a girl. However, like lots of us whose genitals are visibly intermediate, she grew up knowing she was not a typical female, which liberated her from gender conventions. She was a classic tomboy, refusing to wear dresses and competing with boys in sports. From what I can gather from the news, Caster did not, however, question her female sex assignment, only gender role limitations. An excellent athlete, chances are that she was defined by her physical abilities, as are many tomboy athlete girls with typical female anatomy. When she began to compete in major sporting events, her status as a woman was questioned, and Athletics South Africa "cleared her," declaring her female. Now that she has proven her remarkable running ability on an international stage, her international competitors want her disqualified for "cheating" by not "really" being a woman. The International Association of Athletics Federations has stepped in and is investigating her status, in what most news sources are oddly calling "gender testing." Generally, the news media assume that they will be able to issue a definitive answer on what her "true" (dyadic) sex is.

The main thing that saddens me about this story is the emotional tone of the commentaries. Other athletes, people on the street, and low media blogs are full of sneers and winks and nosewrinkled disgust. The major media bring in scientists and voice patronizing sympathy for how humiliating this must be for Caster, meanwhile capitalizing on the prurient interest in the story to gather viewer attention. Underneath it all is a widespread impulse to yank down Caster's pants and let everyone have a good look. It's a freakshow, with an intersex person the object of millions of prying eyes.

Some basic themes that will be familiar to anyone intersex arise over and over in the news coverage. There's ignorance of the very existence of intersex people, evinced in frequent speculation by laypeople that Caster must have had a sex change or engaged in doping. There's confusion of physical sex with gender identity, with detractors, including some of Caster's competitors, referring to her with male pronouns and speaking disparagingly of her butch appearance. There's racist scientific hubris, with Western sports scientists asserting that they can determine Caster's "true" dyadic sex after doing an exhaustive investigation of her chromosomes, hormone levels, anatomy, gonadal tissue, and psychology, while speaking derisively of the ASA's investigation as being unsophisticated. And most of all, there's the overwhelming belief in the myth of dyadic sex. Caster must be female or male; intersex cannot exist as a sex category.

One depressing sideline of this insistence that Caster must have a definitive dyadic sex is the regularity with which the term "pseudohermaphrodite" is raised by detractors. I've posted on how this term emerged in Western medical science to try to define away the existence of intersexuality ( see here.) Basically, in trying to erase the challenge intersex people place to the medical ideology of sex dyadism, doctors in the 20th century decided to call all intersex individuals who did not have ovotestes as their gonads "pseudohermaphrodites," no matter what their anatomy or experience. Somebody can be raised female, with average-looking genitalia and secondary sexual characteristics such as breasts, living a typical valorized heterosexual life, femme as can be (housewife, reader of romance novels, cookie-baker), yet all unaware, have internal testes and androgen insensitivity syndrome. If she goes to a doctor for treatment of infertility, suddenly she'll find herself labeled a "male pseudohermaphrodite." The medical term defines her as "really a man," not even intersex, let alone a woman. Anyone with testes is "really a man" according to this scheme of classification--which reveals the sex politics and semantics in supposedly "objective" science.

Those same politics emerge from the mouths of Caster's detractors. She is a "pseudohermaphrodite," they claim--not a woman, not even intersex, but a man trying to cheat honest female competitors.

Here's an irony for you. According to Western medical practice, the majority of infants discovered to be intersex are assigned female. This is done for surgical convenience (it being considered easier to remove an "inappropriate" penis than create an "appropriate" one), and due to a covert assumption about gender psychology, that women can deal better with gender ambiguity than can men. So we're assigned female, told we are "really women," subjected to mutilating infant surgery, expected to identify as female, not intersex, told to keep our medical history, if we know it, a secret, and sent out to live dyadic female lives. Many of us carefully live by the rules. But it turns out that if we do as we are told, we are still subject to being outed, discredited, mocked, and returned unceremoniously to the status of intersex oddity, as Caster's life illustrates--accused of breaking the rules.

What Caster's situation illustrates, from an intersex perspective, is that we exist. Dyadic sex is a myth--sex is a spectrum. Hormones, chromosomes, genitals, gonads--they are all arranged in many complex ways, and imposing a binary onto them is arbitrary. It's as arbitrary as saying all fruit is either sweet or sour. Sure, ripe cherries are sweet and ripe limes are sour, but most fruit gets its savor from both tastes, and some fruits balance at the tangy sweet-and-sour midpoint. You can measure all the fructose and ascorbic acid you want, scientifically. You can create a rule that divides all fruit into sweet and sour categories using precise measurements of sugars and acids. But that will not eliminate the fact that the experience of tasting fruit is complex, and that this complexity is what makes eating fruit delicious.

Given that sex is a spectrum, and that some of us live near its center, being obviously intersex, society needs to deal with us in better ways than by denying our existence, hiding us medically, and then reasserting our existence to disqualify us from participating in sports. And let us acknowledge that this disqualification is based on the insulting assumption that "real women" are categorically inferior to "real men."

Really, what Caster's case makes us consider is the strange fact that athletics are divided along dyadic sex lines. Sensibly, if one is looking at any particular sport, advantages exist according to physical distinctions--tall, long-legged people do better as hurdlers, for example. But millions of female-assigned people are taller and have longer legs than a typical male-assigned person, so why is gender and not leg-length used to create categories of competitors? There are significant differences in average height by race/ethnicity--would you therefore suggest that we divide people by race for sports competition? That would be no less arbitrary than dividing competitors by gender, though today it would be much more controversial. A much more sensible approach would be to create competitor classes by relevant physical category--as weightlifters are divided into weight classes. Then the question of "true" dyadic sex would be as irrelevant as the question of "true race" for athletic competitors.

My heart goes out to Caster Semenya, an intersex sibling caught in an impossible position--required to live in a dyadic gender, and then accused of wrongdoing because the assignment suits poorly.