Intersex is an umbrella term, and estimates suggest that around 1 in 2,500 children is born with an intersex condition, roughly the same prevalence as Down’s syndrome or cystic fibrosis. Some conditions cause ambiguous genitalia, so that the child cannot be readily identified male or female at birth. Other conditions only become apparent later, perhaps at puberty when a girl fails to menstruate normally. Depending on their condition, an intersexed person’s chromosomes could be XX, XY, XXY, XXXY, OX, XX/XY, OX/XX and so on. Conditions you may have heard of include Androgen Insensitivity Syndrome, where an XY individual has normal male testes but whose external genitalia and secondary sexual characteristics will be that of a female; Congenital Adrenal Hyperplasia, which in XX individuals can lead to an enlarged clitoris and fused labia; and 5-Alpha Reductase Deficiency, where a lack of testosterone in utero followed by a normal surge at puberty leads to apparently female children masculinizing.

Intersex conditions have been understood and treated very differently throughout history. The part I’m especially interested in is the late 19th century onwards. At this time it was believed that the “true marker” of one’s sex was the gonads, and that it was necessary to “strip away” any ambiguity to find what the true sex was. The main motivation at this time, pushed by the clergy, was to avoid the abomination of homosexuality, conscious or otherwise. A person whose “true sex” was hidden could unwittingly cause someone of the same sex to sin by engaging in sexual activity with them. During the first part of the 20th century, particularly after transsexual surgery began to be performed, the emphasis shifted from discovery to assignment: medics accepted that an individual’s “true sex” could not be reduced simply and unequivocally to gonads, chromosomes, genitalia, gender identity or sexual orientation, but was a mixture of all of these. The influence of John Money at the Psychohormonal Research Unit in Baltimore in the 1960s and 70s reinforced a paradigm where sex was plastic, where the sex of rearing had far more effect than chromosomal or hormonal influences. Many feminists also accepted this theory because they favoured the idea that gender - and gender norms - were socially constructed and contingent. However, Money believed that it was crucial that, particularly for children with ambiguous genitalia, once the sex of rearing was decided, the body should be altered to “fit” it, to reinforce the projected gender role. Largely as a result, until the early 1990s it was common for “corrective” surgery on intersexed children to take place as early as possible. Most children were assigned girls, as it was harder to build a penis than hollow out a vagina. Those with large clitorises had them cut back or removed altogether. Any child whose genitals at birth did not fit the arbitrarily-decided measurements (under 0.9cm for a clitoris, over 2.4cm for a penis) were likely to be adjusted – without their consent, but also often without that of their parents. Intersex conditions were classed as a medical emergency, when almost without exception, the real emergency was social. However, as older children and adults, not all these reassigned individuals were happy. Some felt the gender they had been assigned as infants did not fit with what they now knew of themselves – that they either felt like members of the opposite sex, or had a liminal, “third”-sex identity. Others resented the fact that their capacity for orgasm or for any kind of pleasurable sexual activity had been removed for the sake of making their genitals look less unusual. And many were traumatized by having childhoods where a series of curious doctors and medical students poked and prodded at their genitals, inflicted painful and often unsuccessful follow-up surgeries and added to the feeling of freakishness – that, if all this was necessary, the children must have been hideous and monstrous as they were. Many intersexed people have spoken out against being made objects of research first and persons second – being objectified in medical photographs with blacked-out faces. However, some who escaped corrective surgery have made pictures of themselves public to demonstrate just how unshocking and un-world-shattering they really are. I choose to show you some here.

In the early 1990s, the discrediting of John Money and the rise of the first support and advocacy groups run by and for intersexed people who wanted to protest about their treatment by medics led to more of a tendency to delay surgery and hormone therapy until the child could express consent or understanding of their own gender identity. Of course, not intervening also has its disadvantages – doing nothing is, in itself, an active choice - but some medics began to react to calls for outcome data, full disclosure of information, and revisions of homophobic and paternalistic protocols. However, the majority of doctors do still follow the convention that surgery must be early, that children whose bodies do not fit must be corrected. This raises some very interesting questions theologically and ethically about normality, about hegemony, about how real the male-female dichotomy is if we have to chop up anatomy and make arbitrary assignments in order to bolster it. Is the church saying anything about intersex? What are the challenges for us as theologians?

The Church of England’s documents mention intersex here and there - Some Issues in Human Sexuality does not set out specifically to tackle intersex as an issue, but mentions it in the chapter on transsexualism. In fact, there’s some uncertainty about the difference between intersex and transsexualism. However, we should exercise caution in the extent to which we “lump together” intersexuals, homosexuals etc. Many intersexed people resent being considered in the same breath as those who could – arguably – be said to have chosen to be the way they are. Some Issues quotes from a 1998 article on transsexualism by Rodney Holder. Unfortunately, Holder is sweeping in his assertion that “hermaphroditism… is a congenital disorder in which both male and female gonads are present and the external genitalia are not clearly male or female” (in The Archbishops’ Council 2003:223). In fact, only a very few “true hermaphrodites” have both ovarian and testicular tissue; most intersexed people do not have “both male and female gonads”. It is not always true that the external genitalia are ambiguous, which is why conditions such as AIS and 5-ARD sometimes go undetected until puberty. In his original article Holder asserts that surgical sexual reassignment on hermaphrodites is “uncontroversial”, and that “immediate post-natal surgical sex assignment seems to work in that individuals rarely suffer gender identity disturbance” (Holder 1998:90), which suggests a lack of engagement with intersexuals and their experiences. The wisdom of citing such apparently cursory work is questionable.

The report’s desire to reaffirm a hesitation regarding transsexualism has it repeating that human beings are “either male or female”, with no space for a liminal category even for those whose biological sex differs. An Evangelical Alliance report, also quoted by the bishops, refutes the idea that humanity could have a “middle ground” between male and female, claiming that it is not possible for “true sex” to differ from “birth sex as indicated by… chromosomes, gonads and external genitalia” (quoted in The Archbishops’ Council 2003:233). The bishops assert, “To be a human person is to exist bodily as either male or female and to relate to God and other people as such” (The Archbishops’ Council 2003:244). Perhaps it is unfair to try to extrapolate a stance on intersexuality from what is addressing transsexualism, but even if this is the case the bishops are guilty by omission. SIIHS is keen to avoid body-soul dualism, which is positive, but still wants to say that to be made in the image of God, male and female, is fundamentally good. But is the bracketed notion [male-and-female] actually a legitimate way to limit the image of God?

What I want to do in this paper is examine in turn a few of the issues I’ve been thinking about surrounding the implications of intersex for theology and vice versa. If there are people who exist who cannot meaningfully be called male or female even in terms of biology, doesn’t that present a big challenge to biologically-based gender dichotomies, and the “naturalness” of the “differences” between male and female? Bryan Turner reminds us that what we call “nature” is always already a product of human culture, and notes that, for Marx, nature is less and less significant for humans who enculturate the world through their labours.

Why does theology want everyone to be either/or? Can Genesis and Galatians hang together? The Galatians text seems to begin to say that the cosmic significance of Christ was fundamentally changing the nature of the polarity of male and female as it had been understood – though this did not stop Paul’s followers laying down very specific guidelines about what they believed was seemly behaviour for men and for women, as well as slaves and masters. Is our obsession to demarcate and delineate really based on fear of our own identity becoming diluted?

If it is true that it is only possible to know what God is not, then, there is a vast margin for shortcoming in our assertions of what God is. Theology has been desperate to hold together the apparent contradictions of a deity who is at once omnipotent, omniscient and benevolent yet seems to fail to intervene when such a deity “ought” to. We severely limit what we allow God to be. We know that God is not like us; but have we made God unlike us in the most truthful ways? Just as, for Judith Butler in Gender Trouble, it is possible to imagine more gender possibilities than those to which we cling, it must be possible, to conceive of the character and nature of God as Other in a multiplicity of ways. Describing the problems of explaining ideas that go beyond our linguistic boundaries, Butler suggests, “These limits are always set within the terms of a hegemonic cultural discourse predicated on binary structures that appear as the language of universal rationality. Constraint is thus built into what that language constitutes as the ultimate domain of gender” (1990:9). Borrow Butler’s words for conceiving of God, and the necessity of re-examining exactly what it is we mean by Other becomes clear.

Sharon Preves in Intersex and Identity: The Contested Self comments on the social agreement almost invisibly inherent in deciding on normality: “[Bodies] are… classified as aberrant or customary by social agreement. We have, as humans, created categories for bodies that fit the norm and those that don’t, as well as a systematic method of surgically attempting to correct or erase surgical variation” (Preves 2003:3). Since “corrective” surgery on children and adults with ambiguous genitalia became common in the mid-20th century, the issue of what constitutes a normal and/or acceptable body has been highlighted. I believe that much of the fear of bodies which do not “fit” has come from our false conception of the Other: we allow the one to be the “opposite” of the other but only in strictly adhered-to ways. The neat mirroring of “normal” male and female bodies has provided such a handy metaphor for the “complementary” relationship between God and humanity, Christ and his Bride, that we have had little incentive to look beyond it. Far from being recognized as non-medical marvels, variants on the variants in every human body, intersexed bodies are often sensationally regarded as a threat to the very fabric of society (though medics never admit this in so many words, preferring to fulfil their “duty” in creating bodies that are functional socially – on society’s own terms, constructing a male-female dichotomy along with other social norms – as well as physiologically).

Preves links this development to the rise of taxonomy at the Enlightenment, the desire to order, regulate, classify, record. This leads to a craving to curtail those recalcitrant occurrences which cannot be fitted into our categories, but this is to seek control - which is a questionable enterprise, in light of feminist readings of God which emphasize communality and variation rather than authoritarian rule. However, being forced into inappropriate categories has been the fate of intersexed children, and others with related conditions such as micropenis and hypospadias, throughout the last century. Kessler, discussing the language used in medical reports of intersexuals, which seems calculated to be emotive, even moral, comments, “If the clitoris is troubling, offending and embarrassing [as often described in medical analyses], who exactly is troubled, offended or embarrassed and why? Not only are these questions not answered by intersex specialists, they are not even asked” (Kessler 1998:36). As Kessler says, it is not genitals themselves which somehow have the capacity to cause embarrassment, but only how people react to them. The measurements and detailed requirements for penis and clitoris are based more on aesthetics and social expectation than on the welfare of otherwise of the owner. After surgery, a “functional” vagina need not self-lubricate or contain any sensitive tissue, but merely be large enough to receive a penis. The heterosexualist assumptions are manifold. A “functional” clitoris is judged by appearance (the smaller the better) rather than capacity for orgasm.

Of course, since as humans we are destined to exist in relationship, in perichoresis, social expectations are not so easily dismissible as all that. But social expectations are constructed and can be changed. Our culture alters our readings of nature even as we live in it. Discussing the fact that boys born with micropenis are sometimes surgically stripped of their genitalia and given rudimentary “female” parts so they can pass as girls, Kessler says, “What is ambiguous is not whether this is a penis but whether it is ‘good enough’ to remain one” (1998:19-20).  The decision is made on the basis of future experiences projected into the child’s life – how he will cope in the changing rooms, in sexual relationships, in his own self-image. The assumption is that the world could not be other than it is now, so the child must be equipped to function within the status quo rather than existing as an individual who challenges it by [his] very existence. In fact, studies have suggested that boys with micropenis generally grow up to be as psychologically well-adjusted and sexually fulfilled as those with conventionally adequate penises.

Rather than being self-evident, then, the “queerness” of intersexed bodies links in to the existence of the male-female dichotomy which we are trained to see. We read into bodies what we want to say is an incontrovertible fact of existence. Alice Domurat Dreger, in her volume on the history of the treatment of the hermaphrodite in Britain and France, highlights the irony of only some bodies being considered unusual or not up to scratch. She says, “The discovery of a ‘hermaphroditic’ body raises doubts not just about the particular body in question, but about all bodies. The questioned body forces us to ask exactly what it is – if anything – that makes the rest of us unquestionable” (Dreger 1998:6). Can intersex, then, help us to deconstruct what we often fail to see is constructed? The hegemony goes beyond intersex, as seen with the current trend for labia reductions on normal women. This links in with the notion of natural bodies and the theology of disability, as we’ll see in a few minutes.

The ethical issues surrounding intersex are manifold. To what extent can it be legitimate to operate on intersexed infants without their parents’ consent, or to be so economical with the truth that the parents have no idea what they are consenting to? The medical establishment has tended to claim that it would have been worse for the children to be left as they were, and to have to go through life facing a barrage of taunts because of their unusual anatomy; but on the whole this is not corroborated by intersexed people’s reports of their experiences. In fact, on the whole, it was the very secrecy, the act of being lied to, that made them mistrustful of people and wary of their own bodies. Surgery erodes autonomy, and stigmatises just as much as it normalizes. Moreover, it objectifies. Corrected intersexed people suggest that the continual “inspection” by a plethora of medical students leads to the feeling of being an object of research first, a human being second (Preves 2003:67ff) – which is why I thought long and hard about whether to show you the pictures earlier. In contrast, the ideal exemplified in Galatians 3:28 has the potential to surpass what might now be termed heteronormality. All humans are one in Christ, with concomitant human dignity. Is it beyond the bounds of imagining to conceive of intersexuals as those who might be able to illuminate what it actually is to fall outside of the “given” binary of “the way things are”? The notion could help us to challenge what it actually means to say that male and female are made in the image of God. It is the overweening heterosexual norm which contains the “necessary” gender boundaries in the first place, but it seems virtually impossible to get outside that paradigm in order to critique it. Or could it be that this can be found in God Godself?

There are big questions to be asked, then, surrounding the extent to which there is a “natural” division of gender roles – which theologians such as Barth have seen as embodying a fundamental truth of what it is to be human - and to what extent this is mere construction. One reason why doctors are so keen to perform corrective surgery on intersexuals so early is that, they claim, if the child has ambiguous genitalia for too long, the parents will not know how to treat him/her. This betrays assumptions about legitimate differences in how boys and girls “should” be brought up in order to be able to function (socially) “as male” or “as female” later on - which relies upon self-sanctioned decisions about what constitutes “natural” in the first place. If we hold that intersex conditions are “mistakes”, the results of living in a fallen creation, would we also argue for the eradication or eschatological erasure of other mutations? Down’s syndrome, deafness, shortness, tallness, red hair?

A revision of the assumption that there are ‘naturally’ two genders, which ‘naturally’ differ and exactly supervene on two biological sexes, would also force us to reconsider the nature of inequality. To erase a hierarchical, patriarchally-assigned model might allow us to better appreciate the importance of the marginal/non-dominant aspects of creation - animals, children, the poor, the voiceless, the non-heterosexual – and to remember, with Enrique Dussel, that Being is not all. Being-as-divine, the Divine as Being, that-which-Is and all-that-Is, leads to a focus on possession and domination which oppresses and exploits the subject as much as the  other. To denaturalise the male-female dichotomy with its concomitant value-judgements would help to promote a “new otherness” based on actual and not assumed or ideal differences. It thus becomes much harder to say, for example, that a homosexual relationship between two men cannot be ultimately fulfilling because a man cannot “complete” or “complement” his male partner in the same way that a woman – supposedly more authentically his “other” – would do. Is the ownership of a vagina really more significant than the fine amalgamation of same and different in any healthy partnership which has very little to do with anatomy? Barth claims, “As God is One, and He alone is God, so man as man is one and alone, and two only in the duality of his kind, i.e., in the duality of man and woman… In this way he repeats in his confrontation of God and himself the confrontation in God” (Barth 1958:186). Acknowledging that there are really human beings who are really not male or female as we understand these terms forces a re-examination of Barth’s concretised certainty that it is truly and only in our existence as male and female that we reflect Trinitarian community.

This could lead to a complete re-examination of what it means to be a God, what it means to have authority. Can a God “lead” from below/alongside, or is God-authority (and analogous human authority) necessarily a top-down affair? Reassessing the gender assumptions naturalized in philosophy, as Sarah Coakley suggests, would free us to re-engage with characteristics (such as the weakness or non-being of Christ) which are no longer seen as problems for a conception of God, but rather aspects of the nature of God. The significance of a given body for the identification of a given individual can only ever be partial as signs are partial. From the point of view of intersex, this is why a gender dichotomy as fixed as Barth’s seems to fall down. For intersexuals (and transgendered people), identity does not seem tied to sexed bodiliness in the ways we usually expect. Some intersexuals “feel” neither male nor female (as these categories are perceived); others identify with characteristics associated with both binary genders. This, along with our ever-growing genetic and genomic analysis, challenges Barth’s assertion that the duality of male and female is “an inviolable constant of human existence”, that “there is no being of man above the being of male and female” (Barth 1960:289). By implication, then, female is not the “self-evident” completion of male. Adam “freely” recognizes Eve as his counterpart, as different from all the other animals, but this mingling of likeness-and-difference would have been just as potent had God produced Adam a (male) “best friend” or “brother” before the woman. The potency of an individual like myself, who is not myself, who can co-operate with me but not be fully controlled by me, would still be there.

Barth’s theology represents an outworking of a world where cosmic unity and order were vital because earthly order had been shaken. Barth’s God could not be shaken, therefore his repetitions and echoes in the divinely-ordained ordering of Christendom could not be either. But a God who is alongside, who can be discovered, does not compromise but rather throws open the Covenant. The new creation is real, and yet it is not. It is, as yet, not fully known. But the knowing demands new images, new metaphors, new explorations, as well as a grounding in or history-lesson from the shortfalls of the existing ones. These things challenge us and the very basic assumptions on which much of our knowledge is grounded but theology sometimes needs turbulence, a ripping-apart of the old categories. This is crucial for eschatology, or we fall into the capitalist trap of saying “there is no alternative” (Althaus-Reid 2003:45). Queer theologians such as Althaus-Reid, then, make the claim that our single, stable, heterosexual God is not as secure as we would like to think. Disrupting heterosexual norms can disrupt this conception of God. Perhaps the true nature of God is broader than our fixed heterosexualist perspective will allow, but if so, to seek to get beyond it and critique it can only be a positive thing. We should be wary of misrepresenting, endowing with unsought political meaning or claiming as necessarily queer or subversive intersexed or any other persons, but the notion of solidarity, of “thinking with” rather than “thinking through”, is crucial.

Many of the same questions surrounding intersex also link to disability: what kinds and extents of “imperfections” must we stand? Is a disabled or intersexed body as acceptable to God as a “normal” one? Do such bodies reflect the enormous range of creation or are they gross distortions of the male-and-female, able, potent norm? Will they be “perfected” at the eschaton, and if so, to what extent will they truly “be” the persons they have been on earth? – a topic requiring its own paper!

A major issue in disability theology is the notion that the real disability comes not from whatever bodily impairment one might have, but from the way it’s interpreted (or swept under the carpet) by society. Imposed views or treatments can be more “crippling” than the absence of legs. Physical “abnormalities” are only a disadvantage if society is structured so that buildings are only accessible to the physically “normal”. Similarly, the only reason why intersexed bodies are perceived as “different” is because of imposed “norms” of what a “good” body should look like. The association of disability with sin also adds to the figuring of people with disabilities as “other”, and impairment as something to be feared (which leads to it being demonised), rather than as a common occurrence in many ordinary lives. Part of the “eschatological” nature of envisaging a just world must surely be the tension of the visionary “foretaste”, the behaving as if this just world already exists: otherwise the false barriers to freedom erected by the bogus powers will seem too insurmountable.

There are massive implications here for Christian worship, especially in terms of inclusive symbolism and liturgy, as well as for the dismantling of actual physical barriers for people with disabilities. Nancy Eiesland comments that often the level of “inclusivism” allowed by churches is only to the extent that they will not have to significantly change how things are already done. A person in a wheelchair might be brought the bread and wine to their pew rather than having to negotiate an awkward path to the altar rail, but everyone else will continue to go forward to receive – so the disabled person is still excluded from participation/communality with everyone else. Thus, argues Eiesland, new symbols or rituals or worship must “alter the regular practices, ideas, and images of the able-bodied” (Eiesland 1994:91). For example, perhaps we need a new imagery of “wholeness”, not necessarily based on “perfect” Adonis-like bodies. Perhaps we need new figurings of sex and gender, acknowledging they do not tell the full story of creaturehood. Eiesland suggests that resymbolization, new metaphors, are crucial not only to include people with disabilities but also to unsettle those in unchallenged “power”.

“Imperfections” need no longer be barriers: Christ himself has a wounded body even after his resurrection. God inhabits unexpected, non-dominant bodies. This image of God is far less “top-down” than the metaphor of a king or judge suggests. It is the suffering servant, the friend, the child, the poor woman, the paraplegic, the rent boy. Jesus’ wounds are not to be pitied, for they are simply marks of life experience. This makes disabled bodies far less “other”; Eiesland emphasizes the significance of the risen Jesus inviting people to touch his wounds, for this speaks of helping people to overcome their fear of coming into contact with “distorted” bodies lest they should somehow “catch” the impairment, or be tainted by association with someone who lacks conventional status.

Transcending the limitations of individual bodies must be inextricably bound-up with an understanding of the uniqueness and perfect imperfection of every body. Societal ideals are just that, and must not be allowed to decide “worth”. Some suffering can never be eradicated; but much can, particularly that which comes from alienation and fear. This is as true for bodies with ambiguous or unusual genitalia as for those with impairments.

Organisation Intersex International

"In Christ there is no male and female:

The challenge of intersex conditions for theology"