Intersex Fertility

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

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

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

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

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

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

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

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

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

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

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

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

It's time for some more sophisticated thinking about intersex fertility.

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.

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.

Viewing Intersex Genitalia (Note: Explicit Artwork Included)

Disclaimer

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

Does a Picture Paint a Thousand Words?

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

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

Anatomy of an Intersex Person

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

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

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

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

What Doctors See

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

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

On Hypospadias

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

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

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

The Moral of The Post

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

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

On Being Called a "True Hermaphrodite"

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

The Reality of Intersexuality

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

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

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

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

Harmful Practices

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

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

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

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

The Term "True Hermphrodite"

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

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

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

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

Intersex 101

What is intersex?

In our society, it’s common to think that all people are born either male or female. But the biological truth is that sex is a spectrum, not a binary. It’s typical for people to lie near the male or female ends of the spectrum, but many people are born with bodies closer to the middle. Sometimes this fact is immediately clear at birth, because a baby has intermediate genitals. Sometimes a person may look male or female on the outside, but have different internal organs than would usually be expected. And sometimes a person may have a body with typical female or male organs, but have chromosomes that do not match expectations.

How common is intersexuality?

About 1 in 150 babies are identified at birth by doctors as having a "disorder of sex development" due to having visibly atypical genitalia. Other individuals are not diagnosed at birth, as their genitals appear fairly standard, but later are found to have an intersex condition. Some find out because they encounter fertility problems, or have a medical scan done for some unrelated reason. Some people never know--do you know if your chromosomes are XX, XY, XXY, or some other variation?

What is the gender of an intersex person?

The way to tell the gender of an intersex person is to ask them. Often intersex people identify as men or women, because that is contemporary Western norms frame gender as a binary. But a growing number of intersex people identify themselves as nonbinary--as do a growing number of people who are endosex (not intersex). You can’t tell by looking at an intersex person’s body what their gender identity will be—different people with similar-looking intermediate genitals will have different identities. Simply respect each individual’s sense of self!

What are central concerns for intersex people?

Contemporary Western medicine frames being intersex as a disorder, and being endosex--having a body that matches expectations of binary sex--as necessary and good. Intersex status has been treated as a source of shame in the U.S., which means that most intersex people are in the closet about their status. We have been called “freaks” and “monsters,” have been treated as sexually titillating, have been excluded from international sporting competitions, and have been subjected to medical treatment without our consent. Intersex people deserve to have their bodies, their gender identities, and their choices respected.

A major complaint of many intersex people is that they were subjected to childhood surgery that they are unhappy about. Every day in the U.S., hundreds of babies are surgically altered to “correct” atypical genitals to match social expectations. Doctors generally choose the binary sex they see as appropriate for an intersex infant based on appearance or surgical ease—and children may not mature to identify with this surgically-assigned sex. Furthermore, although doctors say they have gotten better at these surgeries over time, they often result in loss of genital sensation. I don't know about you, but I and many others would rather have sensitive genitals than somewhat-more-average-looking ones. Advocates for intersex people urge that no sex assignment or cosmetic surgery be performed on children. Instead, intersex children should be allowed to grow up to make their own decisions about what surgery, if any, they would like.

The decision about a binary sex of rearing for an intersex child is often rushed. This is because families are only given a day or two by law to decide whether to put an "M" or "F" on the birth certificate. What intersex advocates urge is that the requirement of listing a sex on the birth certificate be removed.  After all, in most states in the U.S. doctors used to be required to list a race on the birth certificate, but that requirement has been eliminated. The reason given for listing a sex--that it would help to identify an infant who was lost or abducted--is very weak. Footprints and blood samples taken at birth are vastly more identifying, and in any case, the family can give authorities information about the sex, race, hair color and other information about what a child looks like without it being listed on a birth certificate. So, removing the requirement of listing a binary sex of male or female on the birth certificate would not hurt anyone, and would give families of intersex children all the time they like to decide on a provisional sex of rearing.

Often, doctors and families try to keep chidren's intersex status a secret, even from the children themselves. Knowing that there is something deemed "wrong" with your body, but not what that is, is confusing. Knowing that your body is sex-variant, and that this is something that must be kept a secret from others, leaves a person feeling ashamed and isolated.  Advocates ask that children be informed about their bodies in a nonstigmatizing way. Having a body that is atypical can be seen as special--think of how our society celebrates having red hair, another atypical bodily status!

Sometimes an intersex child may be happy living in an assigned sex, but then experience bodily changes at puberty that are atypical for that sex. For example, an individual born with a typical-looking phallus but internal ovaries and a uterus will develop a menstrual period. If that child is happy being raised as a boy, he may find this difficult to deal with. In that case, the child should be given access to hormonal treatments to prevent menstruation and promote a typical male puberty.  If he wishes it, he should be given surgery to remove his ovaries. The decision should be his, and if he is comfortable leaving his body unaltered, that should be the course of action, and he should be supported in his embracing of his sex-variant body.

Intersex people may suffer from gender dysphoria if they were assigned by doctors to a sex but do not identify with it. If so, they should be assisted in securing hormonal and/or surgical treatment so that they can transition to the sex that is the same as their gender identity, if that is what they wish.

Intersex people and their families may also need supportive therapy. When a mother gives birth to an intersex baby, the family may be thrown into distress. It is especially important that the family receive support so that hasty decisions about “normalizing” surgery are not made. Adults who discover that they are intersex may also be thrown into an identity crisis and need support. And since all intersex people have to face lack of understanding and pressure to hide our sex status, many of us need access to counseling.

There is a myth that intersex people are almost always infertile. Sadly, many of us are infertile not because of how we were born, but because of surgical intervention in infancy. In fact, intersex people can have children (I did it. . .), but we may need fertility treatment and supportive medical assistance during pregnancy and birth.

What are some common types of intersexuality?

There are many conditions that lead to intersex status. I have no interest in getting overly clinical and showing the sort of medical photographs of dehumanized children with their genitals exposed that are so common in discussions of intersex. We are people, not . . . bits for display. However, I'll do a quick run through of some of the diagnoses given to intersex people, with physical description, to give some sense of how varied our bodies are.

People with Complete Androgen Insensitivity Syndrome usually have a clitoris, labia, and partial vagina, with testes internally. They develop breasts at puberty, but no periods. People with Partial Androgen Insensitivity Syndrome are born with intermediate genital appearance and internal testes.

People born with Congenital Adrenal Hyperplasia or CAH are born with a phallus of average or small size, an empty scrotum, a uterus, and ovaries. At puberty, people with CAH will develop breasts and get a period.

Hypospadias refers to a range of conditions in which a person has phallic tissue, but does not have the urethral opening at the tip. This can be a small displacement in an otherwise typical penis, or can occur with a fully intermediate genital appearance.

People who have Klinefelter Syndrome are born with XXY chromosomes. Individuals with Klinefelter’s have a penis and testes, are often tall and long-limbed, and may have wide hips and "gynecomastia," i.e. breast tissue in a man.

People who have ovotestes are diagnosed as "True Gonadal Intersex" by doctors. Ovotestes are gonads intermediate between ovaries and testes. Those of us with ovotestes may also have an ovary or a testis, and may develop a menstrual period, or produce sperm.

What can other people do to be allies for intersex folks?

The single most important thing allies can do is to refuse to treat intersex status as something shameful! Allies can help educate people about the fact that intersex happens and is not some sort of medical emergency requiring cosmetic surgery on infant genitals. Only an intersex person can determine what their gender is, and what surgery if any they want--doctors and parents can no more decide what gender a person will have than they can pick their sexual orientation or taste in music. Educating people about this will help lead to a day when parents welcome an intersex baby as a happy rather than tragic addition to the family.