Cheryl Chase is Absolutely Right

Yesterday’s New York Times Magazine contained an article by Elizabeth Weil titled, “What if It’s (sort of) a Boy and (sort of) a Girl?” that outlined the debate about whether or not doctors should surgically change the genitals of intersex children to better match the gender assignment they are going to be given. The article doesn’t do a great job of really addressing the nuances of that question. For one thing, a large block quote spanning the first two pages of the article asks:

“Will a child grow up to have a better life if he or she has surgery? Or will that child be better off if he or she is loved and accepted, at least at home, exactly as he or she is?”

And then, unfortunately, it spends nearly no time actually describing the adult lives of intersex people, the difficulties in measuring the quality of life, and nearly escapes entirely without addressing the role of sexual pleasure in adult life, something which the genital surgeries being debated most certainly impact.

But the article does a nice job in its profile of intersex rights advocate Cheryl Chase and her work as founder of the Intersex Society of North America. Chase, and intersex adult herself, has spent the past decade talking to groups of doctors, parents, genetic counselors and anyone else who will listen, trying to convince them that they ought not surgically alter children for cosmetic reasons, and that children should be raised with love, and with a gender assignment, no matter what their genitals look like. She argues that these surgeries are most often done to make parents more comfortable, and that parents’ comfort should not come before the child’s chance at a healthy adult life. (Again, sex lives are not very explicitly mentioned, but that is certainly part of what’s at stake here.)

This would seem to be common sense. You can imagine the voice of the intersex infant if only it had a voice. Please don’t cut off my clitoris or reduce its size without my consent. Please don’t cut off my penis because it appears too small or my genitals are ambiguous, and please don’t try to create a vagina for me out of intestinal tissue. Please wait until I’m old enough to decide whether I’m happy as I am or want to change my body. But the infant doesn’t have a voice and the adults who will determine her care are prone to thinking about gender and sexuality and bodies in ways that are pretty inflexible and pretty bound up in the idea of that bodies and identities and labels must all neatly align themselves and they must fit a too-narrow two-category system.

I wrote a few months ago questioning the idea that gender is binary (that there are only two options and that they are opposites) and the idea that it is biological. Gender is about much more than genitals. And the appearance of genitals seems to take on a special kind of significance that the appearance of other body parts does not take on which is especially puzzling given how infrequently we show our genitals to others in this society.

There were a couple of things that I think the article missed and that I want to put out there. They sort of run underneath the narrative of the article in an unspoken kind of way, but fears about them are obvious in the framing of the article.

  • Transgender and transsexual identity occur in people regardless the external appearance of their genitals, regardless their chromosomal makeup. Surgery on an infant is not necessarily going to suit the identity that is formed as the child grows up.
  • There are no “perfect” genitals. The fact that we have a medical definition of the acceptable length of an infant penis should be shocking to us! Does the length have anything necessarily to do with the sexual function of the organ? Can it still get erect? Can it still transmit pleasure sensations? Can it still be a conduit for sperm, should that be so desired?
  • Attitudes can be changed and people can be taught how to challenge bigotry, so that the fear of what will happen to this child in the locker room at school, for example, should not be cause for early and potentially devastating surgical reshaping of the body.
  • Sexual health and sexual pleasure are important parts of human life and should not be relegated to some low or unspeakable status when determining a person’s health care options. This is true for adults (we should always be willing to ask how a given treatment is likely to affect us sexually, and then to consider those effects carefully before giving our consent to a treatment) but it is also true for children who are even more vulnerable because it is so difficult for us to acknowledge that they are sexual creatures.

For more information on intersex the ISNA web site’s FAQ page is a good place to begin.

For information on transgender, try the Gendertalk web site.

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3 Comments

Filed under Gender, News and politics, public discourse, sex, sex and health, sexuality

3 responses to “Cheryl Chase is Absolutely Right

  1. Very interesting post, raises alot of issues.

    You say:
    “Attitudes can be changed and people can be taught how to challenge bigotry, so that the fear of what will happen to this child in the locker room at school, for example, should not be cause for early and potentially devastating surgical reshaping of the body.”
    This is the kind of comment that i am definatly for in principle but sometimes i wonder how realistic it is. Though Education can change views to some extent, i find it almost impossible to imagine a child at a school not being bullied for having a problem like this. As much as we try and educate people there will always be a bulk group of idiots/bigots who will do all they can not to be educated and maintain there pregudice. Realisticly the child in question might be better off being normalised not because there is anything wrong with being intersex but because otherwise they may suffer at the hands of morons in later life.

  2. Thanks for bringing this topic up, Elizabeth.

    I briefly got into the intersex issue a few years ago when there was a sort of convergence of issues — a medical conference in my town, the death of… um… (can’t remember his name but he was once the poster child for gender “assignment”), and finally a conversation with a friend who’s an MD.

    Anyway, the shakeout at the time was that roughly 1% of newborns fit the intersex criteria, that parents should be councelled not to freak out, that doctors should be councelled to wait at least till the child’s teen before considering assignment surgery, and that, of course, the child should be consulted as to his or her preference or whether he or she would prefer to be left as is.

    One big considerations being that the old “nurture” theory where gender is just a matter of upbringing and hormone supplements fell by the wayside when (sorry I can’t remember his name) the poster-child revealed that although his testicles had been amputated and his penis altered into sort of a clitoris, and he’d been raised as a girl he’d never felt like one. Eventually, he’d “transgendered” himself into a (married but obviously childless) man. The point being that you can’t be sure what an intersex child’s determination is going to be till puberty. Another consideration, that really shouldn’t have been controversial, is that adolescent and adult genitals are much, much easier to perform (successful!) surgery on.

    I’m not sure what the status is these days but, again, it’s a big deal for the children and they should be given a chance for *self* determination.

    Take care,

    figleaf

  3. The young man that figleaf refers to is David Reimer, and the doctor was John Money. See this post for my brief comments on Dr. Money’s death, on David Reimer’s life and death, and some links to a Slate piece about Reimer.