A specter is haunting medicine—the specter of homosexuality. What seems to be a recent focus on the connection between gender and sexual orientation only makes more explicit concerns that have long motivated scientific discussions of gender and intersexuality. It is impossible to understand the continuing arguments over the treatment of intersexuals without putting them in the historical context of highly charged debates over homosexuality. In the 1950s, as one historian writes, ‘‘The media and government propaganda associated homosexuals and other ‘sex psychopaths’ with communists as the most dangerous nonconformists—invisible enemies who could live next door and who threatened the security and safety of children, women, the family, and the nation.’’110 Joseph McCarthy and Richard Nixon saw homosexual Communists under every pumpkin leaf. When doctors chose to assign a definitive sex to an ambiguously sexed child, then, it was not enough that the child become psychologically male or female. For the treatment to count as successful, the child had to become heterosexual. The Hampsons, who understood homosexuality as a psychopathology, a ‘‘disorder of psychologic sex,’’ stressed that properly treated inter sex children posed no threat of homosexuality.111 They advised medical practitioners that parents of intersexual children ‘‘need to be told that their child is not destined to grow up with abnormal and perverse desires, for they get hermaphroditism and homosexuality hopelessly con — fused.’’112
One can hardly blame the parents for feeling confused. If intersexuality blurred the distinction between male and female, then it followed that it blurred the line dividing hetero — from homosexual. Might one, in the course of treating an intersexual, end up creating a homosexual? It all came down to how you defined sex. Consider an AIS child born with an X and a Y chromosome in each cell, testes and ambiguous but primarily female-appearing external genitalia. Because her cells are insensitive to the testosterone her testes produce, she will be raised as a girl. At puberty her testes will make estrogen, which will transform her body into that of a young woman. She falls in love with a young man. She still has testes and an XY chromosome composition. Is she homosexual or heterosexual?
Money and his followers would say she is blessedly heterosexual. Money’s logic would be that this person, raised as a female, has a female gender iden — tity.113 In the complex trek from anatomical sex to social gender, her male sex chromosomes and gonads have been ruled unimportant because her hormonal and assigned sex are female. As long as she is attracted to men, she is safely heterosexual. We have chosen, medically and culturally, to accept this kind of person as a straight woman, a definition she probably accepts as well.114
Money and his collaborators developed their treatment programs for intersexuality in the 1950s, when homosexuality was defined as a mental pathology. Even so, Money himself is quite clear that the designation ‘‘homosexual’’ is a cultural choice, not a natural fact. In discussing matched pairs of hermaphrodites, some raised as girls and others as boys, he and Ehrhardt write that such ‘‘cases represent what is, to all intents and purposes, experimentally planned and iatrogenically induced homosexuality. But homosexuality in these cases must be qualified as homosexuality on the criterion of genetic sex, gonadal sex, or fetal hormonal sex. Post surgically, it is no longer homosexuality on the criterion of the external sex organs nor of the sex of replacement hormonal puberty.’’115
More recently, the gay liberation movement has inspired a change in views that has helped medical practitioners see, to some extent, that their theories are compatible with a more tolerant view of sexual orientation. Diamond, who in 1965 spoke of ‘‘effeminacy and other sexual deviations,’’ today writes that ‘‘it is our understanding of natural diversity that a wide offering of sex types and associated origins should be anticipated.’’ ‘‘Certainly,’’ he continues, ‘‘the full gamut of heterosexual, homosexual, bisexual and even celibate options. . . must be offered and candidly discussed.’’116 Diamond continues to argue that nature is the arbiter of sexuality, but now, he believes, nature permits more than two normal types of sexuality. Today, he (and others) read from nature a story of diversity. Of course, nature has not changed since the 1950s. Rather, we have changed our scientific narratives to conform to our cultural transformations.