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ON THE ISSUES MAGAZINE ONLINE is a successor to the print publication, On The Issues Magazine, a progressive, feminist quarterly print publication from 1983 to 1999, both published by Choices Women’s Medical Center, Merle Hoffman, President and CEO, located in Long Island City, New York.

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AUGUST 5, 2009 12:30PM

What's in a name? Everything. Intersex: Why Naming Matters

Rate: 12 Flag

by Thea Hillman

from On The Issues Magazine

When I first learned about intersex, it was from a friend of mine who had just completed a training to work at a sex information hotline. I was horrified when she told me about the cosmetic surgery on infants’ genitals. At the time, I had no idea that the term “intersex” had anything to do with me.

Language shapes the way we see the world. It shapes how we see ourselves, our bodies, and can unite or divide a community. I knew as early as four years old that I had a hormone imbalance. A few years later I was able to say the name of the condition I had: Congenital Adrenal Hyperplasia (CAH). And more than 20 years later, I learned that I could use the word intersex to describe that condition, and the treatments and experiences I’d had. I felt comfortable with all the terms, including intersex, because they described my best understanding at the time.

Intersex has been a hotly contested term, referencing identity, classification and gender. Intersex also has been used differently among activists and people with conditions that might be described as intersex, which include Klinefelter syndrome (XXY), ovotestes, vaginal agenesis, hypospadias, and nearly a dozen other bodily variations.

Martha Coventry wrote in her 1998 article "The Tyranny of the Esthetic, Surgery's Most Intimate Violation," published in On the Issues Magazine, that in "seeing a child's body as wrong and by labeling such a child ‘intersexed,’ we turn a simple variation on a theme into a problem that can and should be fixed." She wrote about her own childhood surgery – a clitorectomy. Her incisive article was one of the first personal stories I read about intersex, and her sharp analysis would inform much of my writing and activism over the next decade. Reading her article again recently, it struck me how much the movement has developed and changed since she wrote it, and also how much of the controversy around intersex is based on language and naming.

Today, there are folks who want to change the terminology, and there’s intense debate among intersex, trans folks, activists, reflecting our society’s understanding of sex, gender and the nature of social change.

From Pathology to Community

Since the Intersex Society of North America began in 1993, "intersex" has gone from a relatively unknown medical term to a unifying catalyst aimed at eliminating shame, secrecy and unwanted sexual surgeries. People like me realized that they didn’t just have a medical condition or differently shaped genitals, they also had a right to have their body intact, to consent to medical treatments and to have their body accepted as is. In one way or another, the vast majority of us hadn’t been allowed these rights, and the term "intersex" described that need.

Some of us considered "intersex" to be an umbrella term for a bodily variation that we had. Others considered it a sexual or gender identity on its own. Some intersex folks went as far as to reclaim the term "hermaphrodite," similar to reclaiming the words "bitch" or "queer."

I think most of us considered “intersex” as an invitation to community. In some ways, it kept that promise, and in many ways it broke that promise and the hearts of intersex people who had never felt that they belonged anywhere.

Regardless of how we defined ourselves in relation to the term “intersex,” most of us agreed on one thing: that the primary goal of the intersex movement was to put an end to non-medically necessary, non-consensual sexual surgeries on infants and children.

“Normalizing” and Stigmatizing

The medical community did not seem to be on the same definitional page. I attended a medical conference of endocrinologists and urologists several years ago. These are the doctors who diagnose intersex and do the genital surgeries. I learned two important things at the conference: the doctors considered self-identified intersex adults to be freaks, and they don’t think intersex is very common.

In fact, they consider just a few conditions to be intersex, whereas the activist community believes there are at least a dozen. I believe that the doctors think intersex applies only to those bodies that on visual inspection of genitalia are difficult to determine as male or female. I would say that the term applies to bodies that aren’t standard for male or female, and I think many intersex activists would agree with that.

A huge expanse exists between medical and activist understandings of intersex. It is the difference between believing that intersex is a rare condition that requires surgery on the child and believing that intersex is quite common and requires information, acceptance on the part of family and caregivers, and medical treatment only where necessary to maintain health. In Fixing Sex, author Katrina Karkazis discusses how "the naming and treating of intersexuality represents one aspect of the increasing tendency to turn social issues into biomedical problems."

With access to all kinds of folks dealing with intersex (parents, adults with intersex, physicians, academics), Karkazis is able to demonstrate how culturally complicated intersex is for all of those involved with treatment, or changing minds about it. What I witnessed at that medical conference, however, is that the biggest concern of the doctors did not seem to be the sexual function and sensation of their patients or the well-being of their patients after they treated them, but what gender to assign patients based on the conditions they had.

And here begins the conflation of sex with gender. Surprisingly (to me, at least), I like the World Health Organization’s simple definition of the differences between the two terms.

"Sex” refers to the biological and physiological characteristics that define men and women.

“Gender” refers to the socially constructed roles, behaviors, activities and attributes that a given society considers appropriate for men and women.

To put it another way:

“Male” and “female” are sex categories, while “masculine” and “feminine” are gender categories.

Gender Conflated with Genitals

Intersex isn’t really an issue of gender, although most people hearing about the issue for the first time are most curious about gender. “What if the doctors and parents chose the wrong gender for the baby?” is the question I hear most often about intersex. For those interested in gender activism, I believe this is a question we should ask about calling any baby a boy or a girl, as all such gender assignments are just our best guess at the time. Transgender and transsexual people can attest to that.

I don’t believe that intersex babies should be raised without a gender, or, as some believe, with intersex as their gender or sex. I know that most intersex people identify as a boy or a girl when they are old enough to tell us who they are. To raise children without a gender is to make them a social experiment, which has its own risks. I also know that many non-intersex babies don’t identify with the gender they were raised, and when they can, change that gender and sometimes also their sex. These are transgender and transsexual people.

Conflation of sex and gender is harmful when it comes to intersex because it distracts potential allies. This includes people who promote the concept that intersex is proof that the gender binary doesn’t exist and also the folks who have so much anxiety about gender conformity that they want to surgically erase any visible sex difference.

The Latest Controversy:

Intersex vs. DSD

A new conflict around language has arisen around the phrase “disorders of sex development,” or DSD. Use of this term is being advanced as an alternative to intersex.

This purpose of the term “DSD,” as I understand it, is to focus physicians away from gender and cultural normalcy and back to treating medical disorders related to intersex, if there are any.

There were many factors motivating this change in terminology. Some in the intersex movement felt ghettoized in the gay community; also, intersex activists were stymied in fundraising, and talking to the medical community became difficult when intersex held implications of freakishness. Among the DSD adopters are many intersex people who identify with the name of a condition (such as, hypospadias, AIS, CAH) rather than intersex. Some, if identifying or declaring at all, didn't want sexual orientation to become the focus, even if they are, in fact, gay or lesbian. These folks wanted to be thought of a person with a condition.

Promotion of the term “DSD” by people who had originally spearheaded the intersex movement shocked many who identify as intersex. They believed that the term “intersex” to be integral to who they are, their identity and their healing. To call them “disordered” felt like the ultimate betrayal. Others, including trans activists fighting to depathologize gender non-conformity, objected to what they viewed as coining another gender variation as a pathology.

For me, the term “intersex,” and the fact that it’s an umbrella term bringing together a variety of different conditions and experiences, allowed me to see the psycho-social ramifications of my medical treatment. I was able to politicize what I had thought were individual experiences. I learned that my treatment was good in that it helped me maintain my health and reproductive potential. However, despite the best intentions of my doctors and parents, I still got the message, through numerous genital examinations and myriad tests, that my body was broken in some way that had to do with sex and with genitals. The word “intersex” taught me that I was not alone: a group of people had vastly different bodies from me and different experiences medically, but we all had bodies that didn’t look or act according to the standards for male or female.

What is at stake when it comes to intersex clearly goes deeper than language. Intersex is about culture, human rights, and quite literally, saving lives. No matter who you talk to, the intentions on all sides of the intersex/DSD controversy are good: to end unnecessary medical treatments or to disallow discrimination based on physical variation or to prevent “normalization” of people who, for whatever reason, don’t meet the narrow confines of acceptable male-female and boy-girl. Everyone is just trying to find the right word, the strongest way to say stop. The challenge is to make sure no one is hurt along the way.



Thea Hillman is an activist and author. Her book, "Intersex (for lack of a better word)" won a Lambda Book Award. For Thea’s performance and appearance schedule, visit www.theahillman.com.

 

 

 

 

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Very interesting - I hope to re-read this later, and read more on the subject. Thanks for this.
This is very interesting...I would like to see the mutilation of infant boys by circumcision stopped.

(I am not inter-sex. I identify as butch. Sometimes I use transgender if I think it will help someone...but I call myself a girl with a boy's heart.)
Thanks for an informative post on a subject that still receives too little space in "mainstream" publications. There is still so much to learn and, for people who work with children (I am one of those) it's important to have the latest and best information, so all children may be treated with proper care and compassion.
While reading this post I was struck by the cultural obsession with categorizing the physical in ways that are the least threatening to our fear of diversity. Assigned judgment to a particular physical presentation or function is at the helm, while the essence of a human is often left to flounder in the wake of a destructive course that follows.

My preferred questions would be: How do you feel? What works for you? What can we do to assist in what you want? And I would pose these questions within the context of an open-discovery time line. Of course, those with what are considered "standard" working parts are rarely granted this backdrop of development--we deny it for ourselves, as well. I can only imagine how it must be for the intersex group.

Thanks for the information. Perhaps one day these lines of demarcation will fade, followed by an approach that simply allows the spaces to fill themselves.
I don't know enough of this topic to say much: I'll have to read up on it.

Robin: after seeing my newborn nephew in the NICU (for three days, due to a botched circ and a resulting infection made him VERY ill) I have strong reservations about it, in the event I ever have a son (more less a child period) if he wants to be circumcised, he can have it done when he's of age and make that choice for himself.
Very interesting article and I'm glad to see women questioning circumcision. Any surgery on a baby's genitals that's not necessary to correct some serious malfunction is a crime, including the barbaric practice of lopping off a piece of a baby boy's genitals without anesthesia.
Thank you for opening up this difficult topic. I believe gender dichotomy dictates far too much in our culture. Even for those with so-called "normal" hormones and physiognomy, gender, as you say, is a complex thing, and most of us are somewhere along the continuum.

One thing you don't mention is the so-called Defense of Marriage Act, which stipulates a marriage between a man and a woman. Since far more people are intersex than most of us are aware, the question arises, would the Defense of Marriage Act require the appalling prospect of physical or genetic examinations before marriage?

(I think DOMA has a limited life expectancy anyhow, but it is a question nobody seemed to raise.)
I saw this linked to from one of Salon's articles, and was quite glad to see it... The first person to introduce me to the idea of not surgically altering "abnormal" kids had both my congenital anomalies (VACTERL) and Klinefelter's. She seemed to be getting some parents on-board about not "fixing" intersexed infants, but we didn't have remotely as much luck with the rest of the body.

I don't know if you'd find it useful, but there's an old website with a few short pieces that I've heard are excellent for introducing intersexuality. The original site is gone, but the web archive has a copy:
http://tinyurl.com/28k2pfu
While I'm glad medical/psychological progress is happening, it is way too slow. My novel Holding Patters was published in 1980. A revised version, Secret Choices, came out in 2001 and is based on new information about John Money having lied about his gender research. The story of researching and writing Secret Choices is at my OS blog (http://open.salon.com/blog/hawley_roddick/2010/11/02/how_the_authors_guild_gives_my_books_a_second_life)

You make clear that much of the social change that many of us have known for at least 30 years is needed is still not in place. Luckily you and others are still speaking up.