Pathological (hetero)sexism and the medicalisation of sex in children

Intersex – The sex that dare not speak its name

by Curtis E. Hinkle

It is hardly a newsflash that we live in a sexist society. However, just when we think we might be making progress in our struggle for equality and dignity, we are sometimes surprised at the backlash and the political power behind it. We have seen evidence of this powerful (hetero)sexist machinery in the United States just recently with the announcement by ISNA, the Intersex Society of North American, concerning its embrace of the term “disorder of sex development”. This term is supposedly better for children than the term “intersex”, according to this US group.

I read an article just the other day by Vincent Guillot, an intersex activist in Europe, entitled “C’est à nous de sortir du discours medical” (“It is up to us to distance ourselves from medical discourse”). I agree. It is also up to those of us who are intersex adults to speak out against pathological (hetero)sexism and its devastating effects on intersex children. We were once children. The doctors and experts who speak for us often do not have our best interest at heart. They are part of the sexist machinery which has so damaged many of us as children, who have not listened to us and who continue to control our lives.

The fact that many intersex adults may in fact feel that they suffer from a medical condition in no way should silence those of us who disagree with this view of our sex. The term intersex was quite capable of being used as both a medical term referring to a condition of atypical sex differentiation and those wishing medical help were able to get help with all the current pathological diagnoses which are associated with those of us who have bodies which are not standard male or female. No one was dictating to the intersex adults who viewed their bodies from a pathological perspective about how to seek help, nor was anyone saying they did not have a right to view their intersex condition as a pathology. The situation has changed drastically however with the term DSD or “disorder of sex development”. This disenfranchises a large segment of the intersex community because it is purely pathological, sexist and humiliating to many of us. We also have a right to protect children from such damaging, sexist, pathological politics which are entrenched in our medical, legal and social institutions.

Let’s look closely at this term. It may help us understand the mentality of those who would choose to use this in speaking about a defenceless child. First of all, they are saying the child is disordered. Merck is the publisher of one of the most popular medical reference books in the United States. This is the definition of “disorder” from their website: “a derangement or abnormality of function; a morbid physical or mental state.” (1) From the day of birth and often even before birth, the intersexed child is now going to be labelled as deranged or abnormal because there is a perceived malfunction or morbid physical state. This deranged or abnormal malfunction is based on centuries of defining people by sexual reporductive function. To define a child based on their future sexual and reproductive function is clearly sexist and something most children would not understand since most have no concept what it means to be sexually functioning adults. It sexualizes infants and sends the message that their real purpose in life is to have biological parts which would work heterosexually for reproductive purposes even if no treatment devised will probably permit many of them to reproduce. The proposed treatments often simply allow the intersexed infant to simulate heterosexual activity later in life, something the child may have no interest in as they mature and come to terms with their sexuality or lack of sexual interest. It is incorrect to assume that all children will want to simulate heterosexual copulation as adults. This often makes them even more ashamed because they are being treated for a deranged state (that of not being born with what is deemed proper for future reproductive, and therefore heterosexual, functioning). Their body becomes a destabilizing element to such sexist, political institutions and the young child is propelled into an array of sexist discourse about who they are and what their body should look like in order to have any hope of fitting into the system. But what I would like to ask is this: Is this really helping the child? Is the child really deranged or abnormal? Does this really require medical intervention? What is really sick about the body of the intersexed child? Why does the child need to be ordered? I think that the answer to everyone of these questions is based on profoundly sexist and heterosexist political discourse which controls our societies and has little to do with the interest of the child. It is all about the health of the heterosexist political institutions in our societies. The disorder or derangement is not in the body of the child in my opinion; it is in the society which the child is going to have to live in which is going to use a whole panoply of biomedical technology to enforce an unnatural order which has been accepted as self-evident and therefore requiring all possible measures to impose this unnatural order on all bodies which do not conform to the sexist division of all people into female and male. To blur the arbitrary division between these two categories of people is threatening to (hetero)sexist dictatorships which thrive on male/female dichotomies and the resulting power they receive within the system. The inequality of power among members within this system is not viewed as the real threat. No, it is the body of a defenceless child which is the battleground and s/he will pay a big price for having a body which questions the arbitrary, sexist categories required to make the heterosexist system work.

Sex is the next word in the new term “DSD” used to replace intersex, the sex that dare not speak its name. The following is a rather good definition of what most people are talking about when they use this word:

"A biological construct premised upon biological characteristics enabling sexual reproduction" (from Krieger N. A Glossary for Social Epidemiology, J Epidemiol Community Health 2001; 55:693-700.)

We see the inherent heterosexism in this definition. From a biological perspective, sex in humans is basically dimorphic. But even from a biological perspective, sex cannot be defined as dimorphic. However, biology is just one area of science dealing with the human body and sex. From a genetic perspective, sex in humans becomes much more complex and less dimorphic. Genetic variations within individuals which would make them not standard male or female are numerous, with very few people being totally male or totally female. Even using the terms “male” and “female” when referring to genetic markers poses serious problems because what one is calling a “male” marker does not inevitably lead to “maleness”, etc. The sexism of the arbitrary, binary construct becomes even more obvious when trying to talk about genetic components of sex.

The message that many intersexed children will hear is that their sex itself is a disorder, a disability and a deranged physical state. This does nothing to relieve the shame and stigma associated with being intersex. I feel it only increases the shame and stigma because we are once again making intersex the sex that dare not speak its name. Just as being a hermaphrodite was so humiliating, the more accurate term “intersex” now is deemed too “political” to use when speaking about an infant. (See article by ISNA about why they feel intersex is too political.) (2) What is really wrong with not being clearly male or female? Can we not love a child that does not meet these unnatural norms? Red hair is not typical but it is natural for infants to be born with red hair and it is just as natural for children to be born intersex and it usually requires no more medical treatment than being born with red hair. Both children, the one with red hair and the intersexed child need love and acceptance from parents. Denying who you are and pretending you are not intersexed is not a loving, nurturing act in my opinion. It further damages the child.

We have two officially legal sexes. This legal system is necessary for a heterosexist patriarchy. However, it is not natural. It is politically and socially imposed and the intersexed child risks paying an extremely high price for revealing the obvious – there are not just two sexes. The child was unfortunate enough to be born of a sex that dare not speak its name – intersex.

Next, we have the word “development” as part of the new medical diagnosis for the young child. I have personally felt that the word "differentiation" is more accurate because what the medical experts are viewing as disordered is that the foetus did not differentiate “properly” into a male or a female. The word “differentiate” seems more accurate because we are actually talking about maintaining strict “differences” between male and female. Choosing the word “development” appears obfuscating to me – as if the DSD activists are trying to say that the problem is just that certain reproductive parts did not develop properly when the problem really is that the child is defying the strict and very arbitrary divisions between what we classify as male or female. This is clear if we were to consider how a child born with a big penis is treated. Most likely the child would not be viewed as having a disorder of sex development, even though the genitalia would be “overdeveloped” in relation to most other infants born. No, having a big penis would not blur the sexist legal categories of male and female. There would be no treatments for this child most likely. The problem is not clearly being differentiated as male or female and has nothing to do with development, underdevelopment or overdevelopment.

I read an interesting commentary by a very articulate intersex activist who mentioned the connotations of the word “development” and his reasoning made a lot of sense to me. By using this term, the child is being told they might be undeveloped. This is certainly not a very enabling way of talking about children.

What it seems to boil down to in my opinion is that those of us who did not develop into the full malehood are now simply underdeveloped people and children. This keeps the category “male” even safer and harder to attain, even though many of us identify as male or live as male.

I think that those of us in the intersex community who disagree with this sexist politicization of intersex infants and their bodies have a right to speak out. Others have the right to speak for children also, not just a select few.

In my opinion, being deranged, deformed, of the wrong sex, and undeveloped does not help infants and children. Dare to speak up for them. Dare to speak the sex that dare not speak its name – INTERSEX.

(1) Mercks definition of disorder is found at

http://www.mercksource.com/pp/us/cns/cns_hl_dorlands.jspzQzpgzEzzSzppdocszSzuszSzcommonzSzdorlandszSzdorlandzSzdmd_d_24zPzhtm

(2) "Parents and doctors are not going to want to give a child a label with a politicized meaning." From ISNA's article on why they are using the term DSD (Disorder of Sex Developtment) found at

http://www.isna.org/node/1066