All choices, whether to treat with chemicals, perform surgeries, or let genitally mixed bodies alone, have consequences beyond the immediate medical realm. What might the phrase ‘‘social construction’’ mean in the material world of bodies with differing genitals and differing behavior patterns? The feminist philosopher Judith Butler suggests that ‘‘bodies. . . only live within the productive constraints of certain highly gendered regulatory schemas.’’135 The medical approaches to intersexual bodies provide a literal example. Bodies in the ‘‘normal’’ range are culturally intelligible as males or females, but the rules for living as male or female are strict.136 No oversized clits or undersized penises allowed. No masculine women or effeminate men need apply. Currently, such bodies are, as Butler writes, ‘‘unthinkable, abject, unliv — able.’’137 By their very existence they call into question our system of gender. Surgeons, psychologists, and endocrinologists, through their surgical skills, try to make good facsimiles of culturally intelligible bodies. If we choose to eliminate mixed-genital births through prenatal treatments (both those currently available and those that may become available in the future), we are also choosing to go with our current system of cultural intelligibility. If we choose, over a period of time, to let mixed-gender bodies and altered patterns of gender-related behavior become visible, we will have, willy-nilly, chosen to change the rules of cultural intelligibility
The dialectic of medical argument is to be read neither as evil technological conspiracy nor as story of sexual open-mindedness illumined by the light of modern scientific knowledge. Like the hermaphrodite h/herself, it is neither and both. Knowledge about the embryology and endocrinology of sexual development, gained during the nineteenth and twentieth centuries, enables us to understand that human males and females all begin life with the same structures; complete maleness and complete femaleness represent the extreme ends of a spectrum of possible body types. That these extreme ends are the most frequent has lent credence to the idea that they are not only natural (that is, produced by nature) but normal (that is, they represent both a statistical and a social ideal). Knowledge of biological variation, however, allows us to conceptualize the less frequent middle spaces as natural, although statistically unusual.
Paradoxically, theories of medical treatment of intersexuality undermine beliefs about the biological inevitability of contemporary sex roles. Theorists such as Money suggest that under certain circumstances the body is irrelevant for the creation of conventional masculinity and femininity. Chromosomes emerge as the least important factor, the internal organs—including the gonads—as the next least important. The external genitalia and secondary sex characteristics obtain status for their ability to visually signal to all concerned that one should behave in certain gender-appropriate ways. In this view the society in which the child is reared, not mysterious inner bodily signals, decides which behaviors are appropriate for males and which for females.
Real-life medical practitioners, however, concerned with convincing parents, grandparents, and nosy neighbors about gender choices made for intersex infants, develop a language that reinforces the idea that lurking inside the mixed-sex child is a real male or female body. Thus they also encourage the idea that children are actually born with gender and contradict the idea that gender is a cultural construction. The same contradiction emerges when psychologists appeal to prenatal hormones to explain supposedly higher frequencies of lesbianism and other desires deemed inappropriate for a psychologically healthy female.
Within these contradictory practices and views there is room for maneuver. Scientific and medical understandings of multiple human sexes bring with them both the means to disrupt and the tools to reinforce dominant beliefs about sex and gender. Sometimes feminist analyses of science and technology present these enterprises as monolithic behemoths against which all resistance is powerless. Feminist accounts ofreproductive technology have been particularly susceptible to this view, but recently the philosopher Jana Sawicki has provided a more empowering analysis. She writes: ‘‘although new reproductive technologies’’ can sustain the status quo for ‘‘existing power relations,’’ technology also offers new possibilities for disruption and resistance.’’138 Not only is this also the case for the medical management of intersexuality, I suggest it is always the case. Feminists must become comfortable enough with technology to ferret out the points of resistance.
Our theories of sex and gender are knitted into the medical management of intersexuality. Whether a child should be raised as a boy or girl, and subjected to surgical alterations and various hormonal regimes, depends on what we think about a variety of matters. How important is penis size? What forms of heterosexual lovemaking are ‘‘normal’’? Is it more important to have a sexually sensitive clitoris—even if larger and more penile than the statistical norm—than it is to have a clitoris that visually resembles the common type? The web of knowledge is intricate and the threads always linked together. Thus we derive theories of sex and gender (at least those that claim to be scientific or ‘‘nature-based’’) in part from studying intersexual children brought into the management system. When needed we can, as well, appeal to animal studies, although those too are produced within a social system of sex and gender beliefs (see chapter 8).
This does not mean, however, that we are forever stuck—or blessed, depending upon your point of view—with our current account of gender. Gender systems change. As they transform, they produce different accounts of nature. N ow, at the dawn of a new century, it is possible to witness such change in the making. We are moving from an era of sexual dimorphism to one of variety beyond the number two. We inhabit a moment in history when we have the theoretical understanding and practical power to ask a question unheard of before in our culture: ‘‘Should there be only two sexes?’’