Until the early nineteenth century, the primary arbiters of intersexual status had been lawyers and judges, who, although they might consult doctors or priests on particular cases, generally followed their own understanding of sexual difference. By the dawn of the twentieth century, physicians were recognized as the chief regulators of sexual intermediacy.36 Although the legal standard—that there were but two sexes and that a hermaphrodite had to identify with the sex prevailing in h/her body—remained, by the 1930s medical practitioners had developed a new angle: the surgical and hormonal suppression of intersexuality. The Age of Gonads gave way to the even less flexible Age of Conversion, in which medical practitioners found it imperative to catch mixed-sex people at birth and convert them, by any means necessary, to either male or female (figure 2.3).
But patients, troubling and troublesome patients, continued to place themselves squarely in the path of such oversimplification. Even during the Age of Gonads, medical men sometimes based their assessment of sexual identity on the overall shape of the body and the inclination of the patient—the gonads be damned. In 1913, the British physician William Blair Bell publicly suggested that sometimes the body was too mixed up to let the gonads alone dictate treatment. The new technologies of anesthesia and asepsis made it possible for small tissue samples (biopsies) to be taken from the gonads of
|
FIGURE 2 .3 : A cartoon history of intersexuality. (Source: Diane DiMassa, for the author) |
living patients. Bell encountered a patient who had a mixture of external traits—a mustache, breasts, an elongated clitoris, a deep voice, and no menstrual period—and whose biopsy revealed that the gonad was an ovo-testis (a mixture of egg-producing and sperm-producing tissues).
Faced with a living and breathing true hermaphrodite Bell reverted to the older legal approach, writing that ‘‘predominating feminine characteristics have decided the sex adopted.’’ He emphasized that one need not rely wholly on the gonads to decide which sex a patient must choose, but that ‘‘the possession of a [single] sex is a necessity of our social order, for hermaphrodites as well as for normal subjects.’’37 Bell did not abandon, however, the concepts of true and pseudo-hermaphroditism. Indeed, most physicians practicing today take this distinction for granted. But faced with the insistent complexity of actual bodies and personalities, Bell urged that each case be dealt with flexibly, taking into account the many different signs presented by the body and behaviors of the intersexual patient.
But this returned doctors to an old problem: Which signs were to count? Consider a case reported in 1924 by Hugh Hampton Young, ‘‘the Father of American Urology.’’38 Young operated on a young man with a malformed penis,39 an undescended testis, and a painful mass in the groin. The mass turned out to be an ovary connected to an underdeveloped uterus and oviducts. Young pondered the problem:
A normal-looking young man with masculine instincts [athletic, heterosexual] was found to have a. . . functioning ovary in the left groin. What was the character of the scrotal sac on the right side? If these were also undoubtedly female, should they be allowed to remain outside in the scrotum? If a male, should the patient be allowed to continue life with a functioning ovary and tube in the abdomen on the left side? If the organs of either side should be extirpated, which should they be?40
The young man turned out to have a testis, and Young snagged the ovary. As his experience grew, Young increasingly based his judgment calls on his patients’ psychological and social situations, using sophisticated understandings of the body more as a guide to the range of physical possibilities than as a necessary indicator of sex.
In 1937, Young, by then a professor of urology at Johns Hopkins University, published Genital Abnormalities, Hermaphroditism and Related Adrenal Diseases, a book remarkable for its erudition, scientific insight, and openmindedness. In it he further systematized the classification of intersexes (maintaining Blackler and Lawrence’s definition of true hermaphroditism) and drew together a wealth of carefully documented case histories, both his own and others’, in order to demonstrate and study the medical treatment of these ‘‘accidents of birth.’’ He did not judge the people he described, several of whom lived as ‘‘practicing hermaphrodites’’—that is, they had sexual experiences as both men and women.41 Nor did he attempt to coerce any of them into treatment.
One of Young’s cases involved a hermaphrodite named Emma who grew up as a female. With both a large clitoris (one or two inches in length) and a vagina, s/he could have ‘‘normal’’ heterosexual sex with both men and women. As a teenager s/he had sex with a number of girls to whom she was deeply attracted, but at age nineteen s/he married a man with whom s/he experienced little sexual pleasure (although, according to Emma, he didn’t have any complaints). During this and subsequent marriages, Emma kept girlfriends on the side, frequently having pleasurable sex with them. Young described h/her as appearing ‘‘to be quite content and even happy.’’ In conversation, Dr. Young elicited Emma’s occasional wish to be a man. Although he assured her that it would be a relatively simple matter, s/he replied, ‘‘Would you have to remove that vagina? I don’t know about that because that’s my meal ticket. If you did that I would have to quit my husband and go to work, so I think I’ll keep it and stay as I am. My husband supports me well, and even though I don’t have any sexual pleasure with him, I do have lots with my girlfriend.’’ Without further comment or evidence of disappointment, Young proceeded to the next ‘‘interesting example of another practicing hermaph — rodite.’’42
His case summary mentions nothing about financial motivations, saying only that Emma refused a sex fix because she ‘‘dreaded necessary opera — tions,’’43 but Emma was not alone in allowing economic and social considerations to influence her choice of sex. Usually this meant that young hermaphrodites, when offered some choice, opted to become male. Consider the case of Margaret, born in 1915 and raised as a girl until the age of 14. Whenhervoice began to deepen into a man’s, and her malformed penis grew and began to take on adult functions, Margaret demanded permission to live as a man. With the help of psychologists (who later published a report on the case) and a change of address, he abandoned his ‘‘ultrafeminine’’ attire of a ‘‘green satin dress with flared skirt, red velvet hat with rhinestone trimming, slippers with bows, hair bobbed with ends brought down over his cheeks.’’ He became, instead, a short-haired, baseball — and football-playing teenager whom his new classmates called Big James. James had his own thoughts about the advantages of being a man. He told his half-sister: ‘‘It is easier to be a man. You get more money (wages) and you don’t have to be married. If you’re a girl and you don’t get married people make fun of you.’’44
Although Dr. Young illuminated the subject of intersexuality with a great deal of wisdom and consideration for his patients, his work was part of the process that led both to a new invisibility and a harshly rigid approach to the treatment of intersexual bodies. In addition to being a thoughtful collection of case studies, Young’s book is an extended treatise on the most modern methods—both surgical and hormonal—of treating those who sought help.
Although less judgmental and controlling of patients and their parents than his successors, he nevertheless supplied the next generation of physicians with the scientific and technical bedrock on which they based their practices.
As was true in the nineteenth century, increased knowledge of the biological origins of sexual complexity facilitated the elimination of their signs. Deepening understandings of the physiological bases of intersexuality combined with improvements in surgical technology, especially since 1950, began to enable physicians to catch most intersexuals at the moment of birth.45 The motive for their conversion was genuinely humanitarian: a wish to enable individuals to fit in and to function both physically and psychologically as healthy human beings. But behind the wish lay unexamined assumptions: first, that there should be only two sexes; second, that only heterosexuality was normal; and third, that particular gender roles defined the psychologically healthy man and woman.46 These same assumptions continue to provide the rationale for the modern ‘‘medical management’’ of intersexual births.
з