by ALICE DREGER
“When I was born, the doctors couldn’t tell my parents what I was: They couldn’t tell if I was a boy or a girl. Between my legs they found ‘a rudimentary phallus’ and ‘fused labio-scrotal folds.’ They ran their tests, they poked and prodded, and they cut open my belly, removed my gonads, and sent them off to Pathology. My parents sat in the hospital cafeteria, numb, their hearts as cold as the Manhattan February outside.” In the photo above, Max Beck (in tuxedo) and (on the left) as he appeared in college, when he was known as Judy. “Beck died of mullerian/vaginal cancer at age 42 in early 2008, leaving his wife Tamara and two children.” PHOTO/TEXT/PBS/Wikipedia
Children born with in-between sex development are subject to surgeries that many believe violate their human rights
People tend to assume that everyone is born simply male or female. But nature shows us otherwise. About one in 2,000 babies is born with genitals roughly halfway between male and female types. Their genitals might include what looks rather like a penis along with what appears to be a vaginal opening. More subtle forms of in-between sex development are much more common than that. In fact, with modern science, we find that as many as one in 100 of us might have some sex-development type other than the standard male or female, although some will never have occasion to find out.
Nevertheless, cultural attachment to the idea of a clear, simple division between (only) two sexes runs deep. Many physicians believe that there’s nothing we can do about that cultural anchor – You can’t change society, they say. So they think that, for the children’s sake, it’s sometimes necessary to do ‘corrective’ surgeries to make children who are born intersex look more typically female or male. Although statistics can be hard to pin down, it appears that in the United States today, at least one in 300 children is born with a difference of sex development (DSD) evident enough to the naked eye that a paediatrician might recommend an expert consultation.
Variations on typical sex development occur most commonly in boys, and most commonly in the form of hypospadias. Hypospadias is a condition in which the urinary opening is not on the very tip of the penis but lower down the head, or on the shaft of the penis, or, more rarely, at its base. Girls can be born with atypical sex development, too. For example, during foetal development, the clitoris might grow larger than average and can sometimes look like a small penis.
Quite simply, these sex variations occur because the typical male and the typical female represent two ends of a developmental continuum. The clitoris and the penis grow from the same proto-organ in development. In the same way, the labia majora and the scrotum grow from the same tissue. Most newborns have developed genitalia at one end of the developmental spectrum or the other. But not everyone.
And genitals are by no means the only component of sex biology that can vary. What we call simply ‘biological sex’ is in fact a many-factored trait involving various hormones, hormone receptors, external genitals, internal reproductive organs, and much more. Consequently, there are dozens of different ways for what we could call ‘intersex’ development to occur.
Some intersex types are not noticeable at birth. This happens, for example, when a baby is born appearing typically male or female, but has some internal organs of the other sex. Some people don’t find out that they have a relatively uncommon form of sex development until they hit puberty and don’t develop according to expectations. Some don’t find out until they are older, when they run into trouble trying to have children and, through medical diagnostics, find out that their sex is more complicated than they expected.
Detecting intersex at a late stage comes with an advantage: it gives the person a chance to be informed and make a choice about whether to change her or his own body. Babies born with genital anomalies usually have the choice made for them. In paediatric medicine, when a child has a visible intersex condition, since at least the 1960s, standard practice around the world has been to surgically change the child’s body to look and function in accord with cultural standards.
Hypospadias ‘repair’ surgery involves moving a boy’s urinary opening to the tip of the penis. It is today so common that paediatric urologists in the US refer to it as a ‘bread and butter’ operation. It’s performed not only because some adults believe that a hypospadic penis looks wrong, but also because they believe that, if you want to grow up to be a normal man, you have to urinate standing up.
Every day, in children’s hospitals around the world, doctors do these and other ‘normalisation’ surgeries. But controversy over them has been steadily increasingly over the past 20 years, and has now reached almost fever pitch. That’s because intersex patients’ rights activists have been effectively reframing paediatric genital ‘normalisation’ surgeries as a violation of human rights. They argue that children should be allowed to grow up and decide for themselves whether to have optional sex-altering surgeries.
Aeon for more