Born in between
August 6, 2015 8:06 AM   Subscribe

 
Roughly 1 in every 2,000 babies in the U.S. are born, like M.C., with a range of traits that fall somewhere along the wide spectrum between male and female. Some doctors argue that the number of these so-called intersex babies is even higher — as many as 1 in 100 — depending on what biological markers are used to draw the line where nature hasn’t.
cf. that dinner party conversation I had a few months ago with a family doctor, who is otherwise very liberal-leaning and open minded, in which I noted this statistic. He was simply unwilling to accept it. He can always tell, you see, and never saw an intersex baby. Yep, never. In his 60 years of practice.

The dominant medical establishment violently refuses to depart from a binary view of sex and gender, and the conflating of the two, and unspeakable harm is the result.
posted by odinsdream at 8:11 AM on August 6, 2015 [5 favorites]


BTW, I really urge y'all to refrain from commenting solely on the headline. The thrust of the article is not so much "should doctors ever operate on babies who are intersex" and more "Are doctors fully informing parents of options and outcomes when they recommend surgery for babies who are intersex? Are they even capable of doing so?"
posted by muddgirl at 8:14 AM on August 6, 2015 [19 favorites]


BTW, I really urge y'all to refrain from commenting solely on the headline.

Thanks for the advice--my knee-jerk, cranky response was to snap "No. Next question." I will go read the article now.
posted by sciatrix at 8:15 AM on August 6, 2015 [1 favorite]


It seems like the cost of getting things wrong means that there shouldn't be operations.

I think one question that the parents profiled in this article tried to raise is, what does it even mean for doctors to "get it right?" Even if doctors could, say, determine future gender identity based on brain chemistry or neural imaging, does that mean it's acceptable to decide that a female baby's clitoris is too large? Especially since it's clear that the studies just have not been done to show that the social and medical outcomes of surgery are better than not intervening.
posted by muddgirl at 8:25 AM on August 6, 2015 [7 favorites]


Interesting point, from the article: Pam, for example, says that she and Mark would have sued regardless of whether M.C. had turned out to be a boy or a girl. “I feel very strongly about that,” she said. “That’s the thing that seems to grab people — ‘They got it wrong!’ But that’s besides the point. Nobody had the right to make that decision.”
posted by roomthreeseventeen at 8:26 AM on August 6, 2015 [22 favorites]


Why is the perspective of those not operated on at all never presented in these articles?
- Are there simply no such individuals?
- Have absolutely ALL intersex babies been operated on in the past?
posted by mary8nne at 8:42 AM on August 6, 2015 [1 favorite]


I found it interesting that the doctor chose to go with female as the baby had more male stuff going on, at least as listed in the article. Seems an odd choice that i hope is explained further in the article.
posted by sio42 at 8:42 AM on August 6, 2015


Not saying I agree or disagree just that if they're gonna do it, that decision seems weird.
posted by sio42 at 8:43 AM on August 6, 2015


mary8nne: "Why is the perspective of those not operated on at all never presented in these articles?"

The article includes the perspective of Hida Viloria, who grew up intersex without surgery.
posted by Rock Steady at 8:46 AM on August 6, 2015 [11 favorites]


There are a lot of really complex questions kind of being ruled on here, which may be part of the problem. It's hard to make bright lines for one case, but not for others.

Traditionally, parents have been allowed a lot of autonomy in deciding medical decisions for their kids. In this case, the state was the guardian, but what if it wasn't? You run the risk, of, say, new stepparents suing the original parent for medical decisions they made in good faith.

They make some great points about informed consent though, in particular which doctors really need to be involved in a decision like that, and I think that's actually maybe a solution that could be well implemented - have AMA best practice standards shift to involving not just surgeons but the endocrinologist, social worker, ethicist, etc, as happens for some other life changing decisions.
posted by corb at 8:50 AM on August 6, 2015 [2 favorites]


BTW, I really urge y'all to refrain from commenting solely on the headline.

Having read the article, my response is sciatrix': Nope. Next question?

Kids figure out their gender identity sooner or later, and I have yet to see any reasonable argument for performing any surgery on children that is not actually medically necessary.

Kudos to Buzzfeed for solidly respectful use of pronouns, too.
posted by feckless fecal fear mongering at 9:00 AM on August 6, 2015 [7 favorites]


I read the article, and it came across as being informative and non-judgmental. Kudos.

That being said, I'm a little troubled at our culture's recent "turn" on gender: namely, that sex and gender are not social constructs, that they are in some way bio-essentialist.

This idea is present in the article. "MC" starts to grow up and suddenly discovers that he likes trucks, cars, flannel and short haircuts. Well-meaning parents conclude that he must have always been a boy. But is this really what makes a boy, a boy?

I don't disagree with the parents -- MC isn't my kid, after all -- but I'm troubled by the idea that my biological structure determines my personal likes, dislikes, attitude and overall role in society. And that, really, is what feminism is about: rebelling against the idea that your biology means that you are either the breadwinner or you get to stay at home and take care of the kids, cook, clean, sew and wear high heels.

My sense is that eventually this kind of bio-essentialism is going to backfire and reignite a new anti-feminist movement. If your genes (or hormones, or sex organs, or whatever immutable aspect you want) determine your social role, then feminism is pointless.

"Girls like dolls because girls are made that way", "Girls can't math because hormones", "Girls can't be soldiers because genes", all become a rational arguments once again, and then we're right back in the 1950's (or 2050's?).
posted by Avenger at 9:10 AM on August 6, 2015 [10 favorites]


This idea is present in the article. "MC" starts to grow up and "suddenly discovers" that he likes trucks, cars, flannel and short haircuts. Well-meaning parents conclude that he must have always been a boy. But is this really what makes a boy, a boy?

....but if you read the article, the parents explicitly did not take MC enjoying trucks as a sign that he was a boy--after all, so did their daughter. Rather, it was when MC kept placing himself in "male" categories that they went "...okay, MC is probably a boy." Look at these excerpts:

"When boys and girls divided into teams for sports, M.C. wanted to be on the boys’ side."
"Pam talked to him about how people might think he was a boy. M.C. said that was fine, and he got a buzz cut."
"He wanted to go as a boy, and he really wanted a boy name."
"A few months later, while in the first grade, M.C. decided he wanted to be a boy all the time."

This is not painting a picture of gender essentialism because MC likes trucks and flannel to me. It's also not remotely painting a picture of "biological structure denotes interests," especially since the parents repeatedly disclaim that perspective throughout the article.
posted by sciatrix at 9:16 AM on August 6, 2015 [26 favorites]


What the what is up with the too large clitoris remark by then be doctor? What is a baby had a too large penis? Are the male doctors and nurses going to high five each other?
posted by sio42 at 9:23 AM on August 6, 2015 [5 favorites]


It's much easier to make the large clitoris into a smaller clitoris than a bigger penis. That's why intersex babies were/are often assined "female" no matter what's already there.
posted by ZeroAmbition at 9:29 AM on August 6, 2015 [6 favorites]


Wow. The part where the author uses the pronouns Viloria uses made me verklempt for a moment.

That is beautiful. Because yeah it might be confusing for a second but whatever.

I like how they just say this is what s/he uses and then just uses those. Without any explanation about why Buzzfeed is doing it. Just going right on with the article.

That is really great.
posted by sio42 at 9:30 AM on August 6, 2015 [12 favorites]


"When boys and girls divided into teams for sports, M.C. wanted to be on the boys’ side."
"Pam talked to him about how people might think he was a boy. M.C. said that was fine, and he got a buzz cut."
"He wanted to go as a boy, and he really wanted a boy name."
"A few months later, while in the first grade, M.C. decided he wanted to be a boy all the time."

This is not painting a picture of gender essentialism because MC likes trucks and flannel to me. It's also not remotely painting a picture of "biological structure denotes interests," especially since the parents repeatedly disclaim that perspective throughout the article.


I'm glad that they disclaim it, but the issue remains: how does a child "know" that they want boy names, boy haircuts and play on boy sports teams in the absence of some kind of bio-essentialist viewpoint?

If that idea isn't inborn somehow, from whence does it come?
posted by Avenger at 9:30 AM on August 6, 2015 [1 favorite]


I have a friend who was born intersex and his family refused all "corrective" surgery. He had mostly male characteristics so he was raised male, then when he hit puberty he began to develop breasts. His family asked him what he wanted, he choose male, and he's been on hormones ever since. 20 years down the line he's a fantastic person and a loving father to his adopted son.

I don't know what his life would have been like if the doctors choose female or if he wasn't asked what he wanted. I doubt it would have gone so well.
posted by lepus at 9:31 AM on August 6, 2015 [24 favorites]


Re the too big clitoris... I get that... But if the only deal is a too big clitoris, what about a too big penis? They aren't lopping those off.

I guess this is making me be on the side of wow just let things alone and see what happens.
posted by sio42 at 9:32 AM on August 6, 2015 [2 favorites]


That baffled me too. In my comparatively limited experience with female genitalia, clitorises (clitorii?) have been all kinds of shapes and sizes. What exactly is the limit for 'too big'?
posted by feckless fecal fear mongering at 9:33 AM on August 6, 2015 [1 favorite]


how does a child "know" that they want boy names, boy haircuts and play on boy sports teams in the absence of some kind of bio-essentialist viewpoint?

I'm not sure what you're getting at. How does a child know what they want?
posted by roomthreeseventeen at 9:37 AM on August 6, 2015 [2 favorites]


To that, I'd say that gender identity is not the same thing as gender performance. I'm a woman, and I have short hair and I don't wear dresses and I suck at nurturing and I find babies slightly alarming. I'm good at math and science and analysis. I can probably list other stereotypes if you want. I'm still a woman.

I'm still a woman. If you make everyone go to the side of the wall where they feel most comfortable, I would go and spend my time with other women. I fit my experiences among those of other women. I feel weird and uncomfortable when/if people call me male for more than a few seconds as a time. That's not as sensitive for me as it is for trans women who get people misgendering them much more frequently, but it's definitely uncomfortable on the odd few cases where it's happened. When I am asked to create an avatar to represent myself, I default to creating one as female--I don't create one of random gender.

There is more to being a woman than my gonads, you know? And that "align self with men" or "align self with women" (or in some cases "align self with something else entirely") feeling may be inborn--actually there's a lot of reason to suspect it is--but that doesn't mean that has anything to do with how I perform the gender I identify with, or my skills and likes and dislikes.
posted by sciatrix at 9:41 AM on August 6, 2015 [15 favorites]


Avenger, I am a female. Maybe the following can help...

When i was little I loved my daddy.

I wanted to put my shirt on like he did. He put his arms through and then pulled it over his head. My mom would put my head through and then poke my arms out.

I liked to play outside and do daddy stuff. I liked dirt and mud and trucks and tiny toy cars.

I threw a serious protracted battle when they wanted to change my bedroom from blue to pink. The only major fight I had prior to teen years.

However, I never wanted a boy name or boy haircut. I didn't want to be on the boy team. I didn't want to be a boy. I didn't feel like a boy. There was never any conflict.

I may use some wrong terms here but children who are transgender or intersex or whatever where the presentation and the feelings in the head don't match up, they want everything in the previous paragraph with regard to what they feel inside. It's a conflict. Not a whim. They just know.
posted by sio42 at 9:45 AM on August 6, 2015 [5 favorites]


It may help some people in this thread to remember that at one point in one part of the world, this was considered the height of heterosexual cis-male power and achievement. We pile a lot of meaning onto symbols, but they are not the things they signify.
posted by rum-soaked space hobo at 9:53 AM on August 6, 2015 [6 favorites]


"Boy names" and "boy haircuts" and "boy toys" are NOT inborn desires - they are clearly socially constructed. But that doesn't make them less real, and if a child is growing up and referred to as a 'girl' when they know they are a boy (or neither, or both, or somewhere in the middle), taking on these social markers of gender is a way they can assert power over that aspect of themselves. Of course not all children who want short hair are boys, but those who want short hair as an expression of their gender seem like they are.

I don't expect little kids, cis or trans, to understand complex gender performance. Heck, most adults don't seem to understand it, either.
posted by muddgirl at 9:59 AM on August 6, 2015 [20 favorites]


Yes what muddgirl said... "those who want it as an expression of their gender"

That is what I was very muddily trying to say.

I have a lot of trouble knowing the right words but so many here are very good at explaining.
posted by sio42 at 10:08 AM on August 6, 2015 [1 favorite]


(I really liked your comment, sio42! I'm just trying to explain it the way it makes sense to me)
posted by muddgirl at 10:13 AM on August 6, 2015 [2 favorites]


Awesome! Really felt like I was fumbling....

In the article, the professor says how parents are scared and "do nothing" isn't presented as an alternative.

I think that's why the s/he pronouns used made me so happy. The more that s/he is used (or cis or other ok terms) the less scary it will become. BF didn't make it scary... It was just there.

Sometimes I still trip up over Caitlin but I care enough about others like her, of either gender, that I trip up because I catch myself and realize oops and say the right thing and move on. Nbd.
posted by sio42 at 10:25 AM on August 6, 2015 [1 favorite]


To the posters with the confusion about clitoris size being a thing, a clitoris in the presence of more than typical testosterone can become enlarged. This can happen during development or well into adulthood. Thus an enlarged clitoris may be a sign of ambiguous gender by itself (exceptionally big clitoris) but is also as an indicator of something that is not visible (likely elevated testosterone levels).
posted by telegraph at 10:26 AM on August 6, 2015 [3 favorites]


Also I realize cis is not the same as s/he as it used in the article... I was including to illustrate that the more the vocabulary becomes commonplace and there are good solid inoffensive words, it makes things less scary for everyone.
posted by sio42 at 10:28 AM on August 6, 2015


I made a previous post on intersex issues y'all may want to check out. A lot of first-person narratives are included from a diverse group of intersex youth.
posted by Juliet Banana at 11:11 AM on August 6, 2015 [7 favorites]


Good article.

I find myself wondering if many intersex people who were surgically assigned a sex at or near birth are ever fully happy with that, even if the doctors did "get it right". Why do people feel such a need to cast things one way or the other immediately? It seems because of a sickness in society, not the individual - the insistence on sexual binary categorisation. We're still sadly a very long way from a time when a doctor might say, "congratulations, it's an intersex baby"
posted by iotic at 11:28 AM on August 6, 2015 [2 favorites]


Read the full article. Still a definite "nope." Unless there's a medical necessity, there's always time to wait and see.
posted by The Underpants Monster at 11:52 AM on August 6, 2015 [3 favorites]


Yeah, same. I get that no one wants to get dragged into court, but when the medical establishment is this resistant to change, when "loss of sexual function, scarring, loss of male fertility, gender misassignment, and a potential lifetime of psychological distress" are considered acceptable risks to avoid theoretical future locker room teasing, I don't know what else there is to do.
posted by Juliet Banana at 12:07 PM on August 6, 2015 [18 favorites]


buzzfeed longform stuff has been pretty consistently good as of late but i'm still pleasantly surprised to read well-written pieces like this (especially when they get all the pronouns right), and also proud that the author is one of my friends from college!!
posted by burgerrr at 12:43 PM on August 6, 2015 [3 favorites]


I'm glad that they disclaim it, but the issue remains: how does a child "know" that they want boy names, boy haircuts and play on boy sports teams in the absence of some kind of bio-essentialist viewpoint?

If that idea isn't inborn somehow, from whence does it come?


Addressed already some but I want to make very clear: the answer, of course, is it comes from everyone else, from society at large.

People who aren't trans (or intersex, but I'll speak from my own experience here) often have a weird view of how gender socialization works, and I think that's where you're coming from. The focus is on overt socialization: girls are socialized to like dolls because if people think you're a girl they give you dolls, tell you to play with them, etc. On this level, trans girls don't get socialized to like dolls, because no one knows they're girls, and it can seem like some kind of bullshit essentialism to claim liking dolls as part of part of their girlhood.

I get that. Feminism has worked hard against that essentialism, and it'd be a fair objection if that was the whole story of how socialization works. But that's missing important aspects of how children are socialized into their gender.

Children are instinctive learners, who love to model what they see. You don't have to tell a kid a thing - they take in everything they see, they pick up on all the little messages, toxic and otherwise, that are floating around in our culture and our society. They sort through these messages and grab on to the ones that seem to apply to them. What makes a trans girl a girl is some kind of internal sense that the cultural messages marked "girl" apply to her. How does that happen? Nobody has a clue. But it really really does. She doesn't have to realize what's going on for it to happen. It's not a conscious thing, it just happens automatically. The only difference between trans and cis kids is that for a cis kid the general messages they're picking up are reinforced by what people tell them directly. For a trans kid, acting on your internalized messages is punished or at least contradicted by direct messages.

A lot of cis people miss the other part of socialization, because it can be subtle and if it's pointing in the same direction as what people are telling you directly it's easy to miss.

So how does the kid know he wants a boy haircut? It goes something like this:

Society to no one in particular: Boys have short hair and girls have long hair
Society to child in particular: You are a girl and should have long hair
Something inside the kid, mysterious and subconscious: things that apply to "boys" apply to me
Something inside the kid, mysterious and subconscious: Boys have short hair, and that should apply to me
Kid: this feels more important than what I'm being told directly by those around me
Kid: I want a short hair cut

Things this is not:
- an essentialist statement about the types of haircuts kids should have
- dependent on some kind of special inborn male or femaleness
- dependent on a fixed and immutable gender identity
- dependent on the kid realizing what's going on
- dependent on anyone around the kid realizing what's going on
- somehow invalidating or contradicting the experience of gender non-conforming people who nonetheless identify with their assigned at birth gender/sex.

Okay? Okay. I trust this is now settled once and forever and we never have to deal with this particular derail on metafilter ever again.
posted by vibratory manner of working at 1:16 PM on August 6, 2015 [44 favorites]


I have a friend who was born intersex and his family refused all "corrective" surgery. He had mostly male characteristics so he was raised male, then when he hit puberty he began to develop breasts. His family asked him what he wanted, he choose male, and he's been on hormones ever since. 20 years down the line he's a fantastic person and a loving father to his adopted son.

Its odd that later in life "corrective" assertion of gender roles through hormone treatment is then seen as necessary. not really "breaking down the gender binary" at all - just reasserting it later in life. Why couldn't they just continue to live with breasts and parts of male /female anatomy?
posted by mary8nne at 2:52 PM on August 6, 2015


Because he didn't want to?
posted by feckless fecal fear mongering at 2:56 PM on August 6, 2015 [12 favorites]


vibratory manner of working: "Children are instinctive learners, who love to model what they see. You don't have to tell a kid a thing - they take in everything they see, they pick up on all the little messages, toxic and otherwise, that are floating around in our culture and our society. They sort through these messages and grab on to the ones that seem to apply to them."

I think this is kind of obvious to most parents, especially ones who try to impart messages and teach lessons to their kids that are in opposition to what society tells them. "How did my little feminist daughter decide she wants a pink princess birthday party? Why does the son I kept away from violent games and media bite his sandwich into the shape of a pistol and shoot his brother with it?" You do the best you can, but kids have an amazing way of subconsciously picking up the subtlest signals and running with them.
posted by Rock Steady at 3:01 PM on August 6, 2015 [1 favorite]


Why couldn't they just continue to live with breasts and parts of male /female anatomy?

Have you been a dude with breasts, out amongst people in the world? Or a woman with broad shoulders and an adams apple? Even if a person is perfectly okay with having an ambiguously gendered appearance, it's stressful. This guy, lepus' friend, is male. He's (apparently) not okay with appearing ambiguously gendered. His physical body does not match his self-conception or how he would like others to perceive him. In his case, hormones give him a masculine appearance that he apparently desires.
posted by desjardins at 6:34 PM on August 6, 2015 [6 favorites]


I think the operations necessary for gender assignment are aggressive enough to count as general mutilation. I really think it's better to wait for a child to reach adulthood, and let them figure out their gender for themselves, and decide if they really want any operation or intervention.
The only reason ambiguous genitals are an issue is because of times at school when basic bodily privacy rights are violated. Showering in communal or shared showers, all going to the bathroom at the same time. If no one can see what you have, it would be better all around.
posted by Katjusa Roquette at 6:48 PM on August 6, 2015 [3 favorites]


Any non-medically-necessary (eg, no urethral opening) operation on a baby's genitals is mutilation.
posted by feckless fecal fear mongering at 8:13 PM on August 6, 2015 [1 favorite]


I think we have to be realistic and also admit that even if we as parents want them not to, teenagers are going to be having sex or wanting to have sex or some sort of sexual activity. So I think that the problems involved could come up even without someone violating their privacy, otherwise you're asking teens to go without a major part of what is really a big part of being a teen.
posted by corb at 9:28 PM on August 6, 2015


So, I'm intersex by birth, as is my spouse. And I want to center what my friend Hida Villoria, one of the rare people in the U.S. born genitally-intermediate and not surgically altered in childhood, says in the article:

“I feel compelled to let the public know that you can grow up intersex and be perfectly fine and happy,” said Hida Viloria, the executive director of the U.S. affiliate of Organization Intersex International. “It’s not as hard being intersex as everyone assumes it will be — at least that’s my belief.”

Physical sex has always been a spectrum, and children have always been born intersex. Surgery intended to reconstruct our genitals to make them approximate a binary has been around for less than a century. So until very recently, intersex children have lived their lives genitally intact, and societies have dealt with it. Some world societies with more than two social sex categories assigned genitally intermediate children to a third or fourth or fifth sex. But even in Western societies with binary social sexes, we've always been there, and muddled through despite our physical nonbinary status. In medical journal articles written in the 19th and early 20th century, Western medicine did treat us as a medical problem, but one of classification rather than treatment. And if you read those old articles, you find that the intersex individuals being studied were often married, some with children. They were respected members of their communities. So it's just stupid to me when M.D.s like Dr. DiSandro in the article justify what amounts to forced sex changes on unconsenting intersex children by saying,

“Forcing children to be raised with ambiguous genitalia is really tough — that’s almost unethical.”

To me, it's like doctors saying that it's really tough to be a person of color in the U.S., and then giving drugs and surgery to infants to make them look white. The answer to racism is not to eliminate physical diversity in color or eye shape or what have you via surgery and drugs. It's a social campaign of antiracism.

We need a social campaign to make people aware that intersexuality is part of human diversity, not a medical condition. The problem is not bodies, it's bias. We can indeed be happy, find partners, raise families, and be respected by our communities while being genitally variant.

But if we've lost sexual sensation due to surgery, and have been treated as freakish and problematic by doctors, and have been given the message that our bodies are "deformed," and have been told to keep our birth status a secret at all costs, and warned that if we do not, we will be harassed and die alone and unloved, we're not going to be happy, whatever gender identity we grow up to have.

It's way past time for this genital mutilation campaign to stop.
posted by DrMew at 9:29 PM on August 6, 2015 [30 favorites]


I think we have to be realistic and also admit that even if we as parents want them not to, teenagers are going to be having sex or wanting to have sex or some sort of sexual activity. So I think that the problems involved could come up even without someone violating their privacy, otherwise you're asking teens to go without a major part of what is really a big part of being a teen.

In what universe is anyone telling intersex kids they can't have sex?
posted by feckless fecal fear mongering at 5:12 AM on August 7, 2015 [1 favorite]


Sorry, I may have been unclear- I was responding from my phone so couldn't excerpt what I was responding to, which seemed to be a suggestion that all genital alterations should wait until after 18, and that it wouldn't be a problem because no one would see genitals except for school privacy violations. I was trying to point out that given sexual activity among teens, some might not want to wait that long.
posted by corb at 6:16 AM on August 7, 2015


And who's saying they have to?
posted by feckless fecal fear mongering at 6:22 AM on August 7, 2015


Like, seriously, why would intersex teens have to wait for surgery in order to get nakie with someone? Especially in this day and age where the kids are super fluid about sexual identities?
posted by feckless fecal fear mongering at 6:23 AM on August 7, 2015


I'm not saying they have to at all. If they don't want modification, that's totally fine. I'm saying some teens might want modification because of that, and so it would be an error, as Katjusa Roquette suggests, to force those teens to wait until adulthood for those decisions. I don't think we should change AMA standards to adults only - I'm not in any way trying to body police people's sexual activity.
posted by corb at 6:30 AM on August 7, 2015


Corb, if the concern is that intersex youth get to have a healthy sex life if they choose to, then permanent and irreversible nerve damage and loss of sensation in the genitals is the biggest issue most intersex people are facing right now.

I highly recommend reading Nthabi's story; she went through a period when she was ashamed of the ways her genitals were different in appearance from her peers, but after hearing horror stories from other intersex people, she is grateful that she was not operated on as a child.

On the flipside, I've heard an intersex writer perform a piece about the difficulty of connecting to someone with sex when you simply don't feel anything, when you feel like a piece of wood, and how difficult it is to grieve that loss, of something taken from you without consent.

No one is trying to fight to keep teenagers from accessing medical services they've requested and consented to. They're trying to keep babies, who cannot possibly consent or understand to cosmetic surgery, safe to make those decisions later in life.

I think you may be overestimating how many would choose to make the decision for genital modification later in life. But that option's still going to be there for them.
posted by Juliet Banana at 6:37 AM on August 7, 2015 [8 favorites]


> and so it would be an error, as Katjusa Roquette suggests, to force those teens to wait until adulthood for those decisions.

I took Katjusa Roquette's comment to mean more "until they are of an age to understand and participate in their own medical care" and not "no surgery till 21 ever."
posted by rtha at 6:51 AM on August 7, 2015 [4 favorites]


I believe the fundamental principle in considering medical alterations to the sexed body should always be individual autonomy. Right now in the U.S., this principle is violated all the time when genital "normalizing" procedures are imposed on children, who cannot give or withhold consent. But it's also violated when people do wish medical interventions into the sexed body, and cannot access them.

I can tell you as an intersex gender transitioner that while trans people often and rightly complain that the T in LGBT is often overlooked, and trans rights lag far behind those based on sexual orientation, at least there is a T in the standard acronym, and most people have some idea of what trans people are calling for, even if it is limited to the false belief that what all trans people want is "the surgery." Based on this very limited understanding of trans issues, when nonintersex people are told that intersex people really do exist, and that we are unhappy, the way they frame our distress is often as "They were given the wrong surgery instead of the right one, which is tragic."

But what intersex advocates are arguing against is any imposition of sex-altering medical treatment. And this doesn't just happen to children. For example, adult women international athletes who come from parts of the world where surgery has not been imposed on children with "clitoromegaly" have had to submit to genital "normalizing" surgeries as a condition of participating in international sporting events. Or, considering trans people who are not intersex, a substantial number of countries and states require orchiectomy, hysterectomy, and/or genital reconstructive surgery as a condition of legal gender transition, giving the individual no choice in the matter.

People who are endosex (non-intersex) and trans gender generally think of young people and hormonal or surgical treatments in the context of youths who have long trans-identified being denied access to puberty-blocking meds or chest reconstruction or the like by parents or institutions who say, "They're too young to make such a decision!" And I wholeheartedly agree that young people can know themselves and their gender identities and should be allowed to demonstrate their full informed consent and access those services. With so much social unease arrayed against them, there's little chance that endosex trans kids will be coerced into allowing medical interventions they don't want. The chance that they would be forced into getting genital surgery is virtually nil--nobody is taking 10-year-old, let alone 3-year-old, endosex kids who assert a trans identity and scheduling them for genital reconstruction. The social outrage this would cause would be tremendous, because of concerns regarding full informed consent.

But this is exactly what is done to intersex kids, and it's not causing outrage.

And this is why it is not transphobic or socially regressive for intersex advocates to demand a lot of caution and counselling and before an intersex child is deemed to have consented to a sex-altering medical treatment. In the case of endosex trans kids, with social forces opposing their access to medical transition services, these kids need advocates helping them expresses their gender autonomy by accessing services. For intersex kids, with social and medical forces strongly pushing for "normalization," what is needed are advocates helping them resist this pressure so that they can make fully autonomous decisions for themselves.

All that said, of course there will be intersex youths who do decide they want to access hormonal or surgical or other treatments to their sexed bodies--and they should be allowed to access them, at whatever age they are able to demonstrate the capacity for full informed consent. This will vary by individual, but surely takes place for most well before they turn 18.

But it sure doesn't happen when they are two.
posted by DrMew at 12:12 PM on August 7, 2015 [13 favorites]


In what universe is anyone telling intersex kids they can't have sex?

It's not quite saying "don't have sex" but more "don't have enjoyable sexual activity that isn't centered in a binary view of sexual experiences" when genital mutilation occurs routinely with the express purpose of "aligning" the genitals with one of two binary outcomes, knowing full well that damage to nerves will result.
posted by odinsdream at 12:31 PM on August 7, 2015 [1 favorite]


Something inside the kid, mysterious and subconscious: things that apply to "boys" apply to me
Something inside the kid, mysterious and subconscious: Boys have short hair, and that should apply to me


Ummm. That... that is an example of gender essentialism?
I.e. something natural and inherent in an individual that qualifies them as a particular gender?

It is a conception of mild gender essentialism, I guess.
But same net effect. I guess in that construction, girls and boys act in ways that are, incidentally, entirely culturally specifically gendered, not because of relentless social pressure and shaming, but because they want to act in those ways, because of a mysterious and subconscious drive?

Most people are gender essentialist to some degree, those who discard that concept entirely have been, well, 'radicals' at every step of the way.


But, to take a shot at the Social Construction model of gender, that dialogue would be more like:

Society to no one in particular: Boys have short hair and girls have long hair
Society to child in particular: You are a girl and should have long hair

Society...: Further, boys get to have short hair and climb trees, and play sports, and don't have their hair continually knotting, and being painfully brushed, tugged and braided. GIRLS in theory can also play sports, but in practice, will always be praised for looking pretty, and neat, and tidy, and told they 'Good' when they do nothing but stand around like objects instead of having fun.
The kid: Screw this, I want to have short hair like a boy.
Still the kid!: In fact, if I was a boy, I would get to do the fun boy things, AND wouldn't be judged for 'failing' at being a girl. That boy/girl thing is so unfair. Adults be crazy.


Actually, I can't really speak for social constructionism, that above was actually my experience of asking to get a boys haircut as a kid. And yes, being identified as a boy. That wasn't a problem. Kids getting embarrassed and running away when they realised I was a girl? That was a problem.



My personal conception of gender is that some individuals may be very strongly internally gendered, because, well, they tell me so? But hell, like most things, it's probably on a spectrum.
I don't think we can tell to what extent an internal gender might be true for most people, because it's pretty hard to distinguish against the background radiation of our culture super strongly trying to gender us one of two ways, from birth, and conforming or rebelling. At best, you get to choose which ill fitting box you want to sit in.
What I find scary, is that the generations after mine, have had a lot MORE social pressure to identify with a particular gender, when it comes to the clothes, tv, toys they grew up with.
Unisex for children just faded right out as a category from the 90s to now.
I think we are now seeing the tide turning on that at least.

It does feel like genderqueer is still the most socially threatening* kind of queer. In gender conservative areas, gender reassignment and even marginal acceptance of trans people, is often driven by the need to make sure people fit in one of the two gender boxes, and if you don't fit in one, then you'll have to be the other - as long as you don't try and sit between the two boxes.

*For values of 'social' that deserve to be destroyed, of course.
posted by Elysum at 9:20 PM on August 20, 2015 [3 favorites]


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