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July 23, 2018 | by  | in Features |
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The Elusive History of Intersex

As many as 2% of the population may be considered intersex. You have lectures with intersex people, you’ve sat next to intersex people on the bus, hell, you probably have three or four people who could identify as intersex among your facebook friends. But if it’s that common to be intersex, why aren’t we aware of them?

Firstly, let’s find out what intersex means. In our binary
sex model, a male or a female has these characteristics,
shown in the table above.
While the definitions for what is and isn’t classed as intersex are controversial, the general idea is if someone can’t tick all the boxes in one column, or ticks boxes from both columns, they are intersex. Intersexuality can be the result of differences in sex chromosomes (for example XXY or XO) exposure to hormones during development, or due to mutations in genes associated with sex hormones (for example Androgen Insensitivity, or Congenital Adrenal Hyperplasia).

The term intersex has taken nearly a century to gain traction within the medical community. However, accounts of intersexuality exist all throughout history, from the mythic to the mundane. Ancient Greece had the god Hermaphroditus, from whom we gained the word hermaphrodite, depicted as a figure with broad hips, breasts, and a penis. Worship of Hermaphroditus possibly originates from an even more ancient worship of Ardhanārīśwara, a composite of the Hindu deities Śiva and Pārvatī, with a body comprising of both male and female halves.

The word “hermaphrodite” used to describe intersex people goes back at least as far as Pliny the Elder’s Naturalis Historia, published in 79 AD. “There come into the world children of both sexes in one, whom we call Hermaphrodites”. Pliny also wrote that an older term existed: “androgyni”, from which we derive the word “androgynous”. Around this time Buddhist texts describing “napumsaka-pandaka”, or those not male or female were written; as well as the Indian medical journal Caraka-Samhitā’s description of both “dviretas” (people with ambiguous genitalia) and “vatikasandha” (likely to mean XY individuals with undescended testicles or streak gonads).
The term “intersex” was coined in 1917. Prior to that, intersex people were referred to as “hermaphrodites”, which is now considered an offensive term. In England until the mid-1800s, intersex people were considered a separate sex, and the law applied to them depending on the “kind of sexe doth which prevaile”.
If we’ve known about intersex people for so long, and they are so common in society, why is it that the existence of these people comes as a surprise to so many today? The answer lies in science and medicine during the 19th and 20th century.
It was only after French zoologist and developmental biologist Isidore Geoffroy Saint-Hilaire’s 1837 work Histoire Générale et Particulière des Anomalies de l’Organisation Chez l’Homme et les Animaux, a foundational treatise on birth defects, that intersex conditions really received any kind of thorough medical description in the west. Saint-Hilaire described sex as consisting of three physiological components: the first being gonads, (either ovaries or testicles); the second being the internal accessory glands, (uterus or prostate and seminal vesicles); and the third being the external genitalia, (a penis and scrotum, or vulva and clitorus). This essentially allowed for several distinct categories of sex, of which two are the most common. Sounds like a fantastic and inclusive description right? It is, until you realise that “hermaphroditism” was one of his six major teratological classes. The word teratology coined by Saint-Hilaire himself, literally means “the study of monsters”. Framing intersex people as aberrations was entirely unnecessary, as many conditions allowed people to live relatively normal lives. While Saint-Hilaire’s intentions were to demonstrate that people who were born “monsters” were not supernatural, but natural, in origin, the name did little to reduce the stigma against people who were born with deformities or uncommon body types.
About forty years later, Edwin Klebs reduced the number of intersex categories to three: True hermaphrodites were those with both ovarian and testicular tissue, female pseudohermaphrodites had only ovarian tissue, and male pseudohermaphrodites had only testicular tissue. These classifications were regardless of what a person’s body looked like, and was based entirely on the gonads. Klebs believed in absolutes when it came to biology, and so he defined sex in such terms, declaring that if someone has ovaries they must be some form of female, even if they were in fact born without a uterus, and had genitals similar to a penis. This also meant the majority of people that could be classed as hermaphroditic by Saint-Hilaire were now classified as abnormal males or females by Klebs. As more was discovered about sex determination throughout the late 19th and early 20th century, the new findings were defined in such a way to reinforce this idea that there exists two sexes, and that uncommon physiology should still be adapted to fit within this binary framework.
Around this time, the European colonists were arriving throughout Asia, Africa, the Americas, and the Pacific. A broad range of cultural perspectives on sex and gender, as well as medicine as a whole, were replaced by the dominant Western approach to medicine. Western medicine, particularly in this era, while moving away from religious teachings, was still very heavily influenced by the Christian cultural values inherent to much of Europe. Systems like Navajo’s five gender and three sex model, or India’s Hijra, were replaced by the binary ideologies of Christian missionaries and Western colonists.

In the early 20th century, Hugh Hampton Young, and his team at John Hopkins Hospital were pioneering surgery techniques for the genitals and urinary tracts. Initially these kinds of surgeries were only performed on adults wishing to improve genital function, but soon the techniques were being performed on children with urogenital conditions.
One case in particular made “normalization” surgeries more common. David Reimer, who had a surgically formed vagina created after a botched circumcision, was “successfully” raised as female. New Zealand born sexologist John Money, who oversaw the conversion of David Reimer and referred to him as John/Joan in his reports, used the case to argue his theory of gender neutrality, that gender is largely the result of how one is raised. If a person is given certain genitals, and raised in accordance with that genital configuration, they will develop a healthy gender identity.
This idea persisted for decades, leading to thousands of unnecessary procedures. Doctors were telling parents that their children needed surgery, and that the children should not be told that they received the surgery, instead being raised as the “gender” assigned by the surgeon. This gender was usually “female” because surgically it was easier to form a vagina, than attempt to create a penis, or as the popular quip among urogenital surgeons at the time goes, “It’s easier to dig a hole, than build a pole”.

Oftentimes, normalisation surgery has detrimental effects on the recipients, including gender dysphoria, body image issues, and a decreased sensitivity in the genitals, leading to sexual dysfunction. The sensitivity of the genitals was not of major concern to many surgeons at the time, with patients sometimes receiving complete clitorectomies, essentially a “female circumcision”. The reasoning, as put by a Lancet medical journal article in 1984 is as follows: “We recommended a change to the female sex, because the penis was so tiny that a normal sexual life in the male role seemed most unlikely, whereas ‘fertile’ life in the female sex was clearly possible”. The sexual role of women, and thereby intersex people assigned female, was a receptive one, rather than an active, pleasurable one.
The case of David Reimer was eventually revealed to not have been the success that John Money wrote about in his reports. Despite being raised as female, David reverted back to a male identity, received a number of re-reassignment procedures, and lived his entire adult life as male. The damage was already done though, and thousands of surgeries had been performed based on the glowing success story that was the John/Joan case. Money’s ideas about surgery and gender identity had changed substantially since his reports.

Today paediatric normalisation surgery is discouraged, unless the formation of the genitals is likely to cause pain, discomfort or disease; and intersex advocacy is gaining traction. However there’s still a long way to go. In practice, a lot of these surgeries still take place. Intersexuality is still a bit of a medical secret – something hidden from general society, by doctors and parents, leading to shame among intersex people for not looking like the rest of the world.
Science is a cultural endeavour, as much as we would like to think it isn’t. What we study is based on what our existing beliefs about the world are. Science exists as a way to observe the truth, but how we interpret it, and our definitions based on those observations are entirely human constructions. If our scientific and medical definitions are subjective, then we need to consider how they affect the world. We can incorporate intersexuality into our definitions of sex, and in doing so benefit everybody. It’s not an abandonment of biological “truth”, because intersex people’s existence is biological truth.

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