Some interesting debate has been going on in the circumcision post about genital surgery on children. Therefore, I felt it was time to bring up one of the most important and overlooked issues about children and genital surgery.
The intersex.
An intersex person was born with anatomy that doesn’t match the ordinary definitions of female or male: for instance, an intersex person might have some cells with XY and some with XX chromosomes, or female-type anatomy on the outside and male-type on the inside, or female genitalia without a vagina. Somewhere between 1 in 1500 and 1 in 2000 babies have anatomical differences so severe that a specialist in sex differentiation is called in; others may discover their intersex condition at puberty, when trying to reproduce, or when autopsied at death.
Traditionally, intersex conditions have been treated using a strategy called the “Hopkins model” or the “optimum gender of rearing” system. Gender was believed to be 100% a social construct; if you took a child who was born female and made her body look like a boy’s and made her and her parents believe her gender assignment, then she would essentially become a boy.
In support of a child acquiring a “normal gender,” doctors would often lie to their patients about their intersex condition, often hiding their medical records. Even worse, doctors would perform “normalizing” surgery on the genitalia of children. For instance, the American Academy of Pediatrics recommends that “infants raised as girls will usually require clitoral reduction,” although it reassures the reader that “current techniques will result not only in a normal-looking vulva but preservation of a functional clitoris.”
Oh good. I’m so glad that not only is the genital surgery you’re performing on children will lead to them not only looking normal, which is clearly the important bit, but a clitoris that’s functional and everything. It’s not like cutting off part of a person’s clitoris and/or penis could possibly interfere with their future sex life!
There is no medical evidence which suggests that performing cosmetic surgery on children’s genitalia to make them more conventional-looking makes the child have better life outcomes. The development of “normal” genitals is not necessary for someone to identify as male or female. It is one of the key insights of trans activism that gender is not based on genitalia, but on identity. If a person with a penis identifies as female, then she is a woman; if a person with a vagina identifies as male, then he is a man. If a child with ambiguous genitalia identifies (or, practically, is identified based on hormonal, genetic and radiological tests, subject to the child’s own self-identification later in life) as one gender, then that child is that gender.
Without those concerns, many of the reasons for the surgery on children’s genitalia are for the parents: they might be distressed at the sight of their child with an intersex condition; the parents might have to explain it to family members and babysitters. In addition, the child may be bullied for his or her genitalia. It seems to me the solution here is not genital surgery– which may be dangerous or reduce sexual pleasure later in life, not to mention being a major violation of bodily autonomy– but counselling for both parent and child, peer support from other intersex people and a shame-free, open environment with complete disclosure.
Of course an intersex person may choose surgery later in life. However, it is a violation of human rights for a parent to choose for his or her child what their genitalia “should” look like. Intersexuality is a problem of trauma and stigma, not a problem of gender.
For more information about intersex conditions, I recommend the Intersex Society of North America.
Sure, if you want to trade emails, though I prefer IM. My IM is the same as my email, schala_zeal22 at yahoo dot ca
Not really asking you to identify as “transsexual cisgender X”, that’s just a term, as I’ve explained, that’s developed some use in certain circles (particularly trans male circles) to differentiate between people who see themselves as “men with a particular medical condition” and those that identify as “trans” (or some variation on that). I’m not an anomoly in using the phrase as plenty of trans people do believe “I was born with a female body (sex) and that is precisely the problem!”. Though, this may be a trans guy thing, seeing as “a vagina is just as male as a… Read more »
I have a high level of dysphoria alright, but I don’t consider sex to be solely about primary or secondary sex characteristics. Hence, to me it was a female but misassigned-as-male-by-doctor (just by declaring me male at birth legally, not because of any surgery) body, rather than a male body I change into a female one. Until puberty, at 16, my voice was juvenile, until 19-20, I had no facial hair at all – the effects I had over 8 years (until 24) are milder than what effects you’d expect on a trans man (given my voice is not deep… Read more »
@Schala – Then presumably you’d have a different identity (or way of describing it) from someone who has a high level of physical dysphoria and does not consider their body to be the correct sex from birth and therefore would consider a physical change a change in sex (for the better/less dysphoric end of the scale).
Ami :
Specific hypothetical. I wanted to explore the idea that perceived sex isn’t totally relative.
@Clarence I’m talking about someone who, in my hypothetical always has identified as male and suddenly due to a trauma identifies as female.
I’m confused.. o_O are you talking about trans ppl in general and why you believe they’re trans… or a specific hypothetical where it’s objectively known (b/c it’s a hypothetical) that the trauma caused the identity? xD
“So, in some circles, “transsexual cisgender male” has arisen as a term for someone who chaned their sex from female to male but feels their gender is simply male, has always been male, and is no different from the male identity of a cis male (the difference is in the body, nothing else). ”
My sex has not changed, my gender has not changed, my sex identity has not changed, all female, always has been since birth. With a penis. And if I get SRS/GRS whatever they call it nowadays, I still won’t have changed sex, except legally.
As I use the term, someone who is transsexual is changing his or her sex but this comment much, actually, on his/her gender identity. There’s some FtM (and presumeably MtF but I have less experience there) who say that “trans” or “FtM” is their gender identity, not male. So, in some circles, “transsexual cisgender male” has arisen as a term for someone who chaned their sex from female to male but feels their gender is simply male, has always been male, and is no different from the male identity of a cis male (the difference is in the body, nothing… Read more »
It’s harder to say cisgender transsexual (I’d say passable or “with temporary cis privilege” transsexual), but it’s possible to be cissexual and not cisgender.
For example, it’s possible to be a butch woman who gets crap for what her gender expression is, and identifies as female.
So a cisgender transsexual would be like a male, who became female, and identifies as a woman, or a female that became male and identifies as a man?
[[Aside: Neither cis- term makes sense to me, but that’s a personal failing based on “cis” not being a word or prefix in my head, it’s an abbreviation. Right… so it’s based off of a Latin prefix that’s used in chemistry… That explains it! I neither completed Chemistry, nor speak Latin. Maybe it’ll start making more sense if I keep beating it into my head.]]
Transsexual is opposite cissexual, transgender is opposite cisgender. The latter is harder to maintain as a distinction, the former is easier.
@OrangeYouGlad – could you explain what you mean by “cisgender transsexuals”? I’ve never heard that term before. I always thought those two terms were antonyms.
(This isn’t an attack on your comment – you sound like you really know what you’re talking about; I’d just like to learn more.)
@Clarence How do you know that you have a mental marker and not the other? Maybe you “identified as male” because everyone told you that’s what you were, regardless of your position on the matter, and not wanting to appear crazy, lose reputation, or get disowned, you remain silent on what you think is the truth, and simply hope to get reborn as female in a future life instead… Then circumstances change, and your position might change. My position changed once I learned it was even possible, so I transitioned quite early on the average, but some do so late,… Read more »
TomeWyrm:
I’m ok. I think you all are partly missing what I am saying anyway. I’m sort of talking about having a delusion that one is of the female sex even though one has every biochemical, physical, and mental marker of the male sex known and thus is not intersex. I’m not talking a preference for “female” gender expressions (such as a cross dresser), I’m talking about someone who, in my hypothetical always has identified as male and suddenly due to a trauma identifies as female. At that extreme, I would say yes, we have a mental illness.
“That is, according to the DSM, someone with an intersex condition cannot be transsexual. It is a physical condition that immediately disqualifies one from the disorder. ”
That’s mainly part of the protocol of doctors who treat intersex patients (including giving them lifelong hormones and monitoring etc) – into preventing their changing sex assigned.
Ergo, it makes it harder for someone with XXY syndrome assigned male to transition to female than an undiagnosed-as-intersex person, because no one will block your taking estrogen and your intersex doc will probably NEVER mention it even is a possibility.
“homosexuality than transexuality – my spell check knows the first word, but not the second, for example” Might be because you spelled it wrong, it’s “transsexuality”. Two “s”s, since the word is a combo of “trans” and “sexuality”. : P Anyhow, it hardly matters if it is a “mental illness” or not since really, at this point, no one knows whether there is a “mental” cause (that’s incredibly vague in itself considering “mental cause” could cover any number of things) or has a physiological origin (though, if that physiological origin is in the brain then is it a mental or… Read more »
@ Schala: I was going to talk about the distinction between “gender expression” and “gender identity” in that post, but it was getting so long I thought I should just cut it. But I agree with you. I didn’t transition just for the sake of wearing men’s clothes and doing “macho” stuff (whatever that is) or because I was afraid to come out as lesbian (in fact, I tend to like men more). And yes, it’s one of those comments that makes you want to laugh so you don’t cry (I’m not saying being gay is generally easier – many… Read more »
Thank you for that amazing post James. It is so gratifying to have someone explain something with such depth and eloquence. Also, sorry if I went off on you Clarence… the knee-jerk reaction of “They are crazy” is almost as intolerable to me as “let’s sue”. Both have good uses, but seem to be viewed as some kind of magic handwave to mold the world into your image a little at a time. Psychiatric help has plenty of legitimate uses, as do counseling and therapy. But equating “different” with “insane” is just not something someone should do with a clean… Read more »
“The difference between sex and gender is usually seen as this: “sex” refers to biological characteristics – choromossomes, genitals, reproductive organs, secondary sexual characteristics. “Gender” refers to the social construct around people who have those biological characteristics (like people with penises assumed to be “men” and “strong” and “masculine” and “brave”). Gender changes across times and cultures – 100 years ago pink was a male colour in the West. 1000 years ago Viking men kept their hair long because only slaves had short hair). Gender identity is our core sense of self. I don’t need to have a certain type… Read more »
On another subject, great post! (If I was going to be picky I would push for a more specific definition of intersex, like some people have already made on comments, but I don’t think that’s necessary. You got your point across very well). I think genital surgeries in babies are only ok if there is a REAL reason for it (for example, the baby would not be able to pee otherwise, or there was dead tissue due to infection, these sort of things). If it’s because the parents/doctors are uncomfortable with the situation and don’t know how to deal with… Read more »
@ Clarence: Not all trans people are intersex, indeed. And not all intersex are trans. There is some overlapping of the two, but they are not the same thing. Intersex is someone born with chromossomes, reproductive organs and/or external genitalia that is somewhere in-between what is “traditionally” considered male or female. There are many ways this can happen, and some cases are more visible than others. Some people never find out, while some, like it was said in the article, may have undergone genital surgeries as little babies because their condition was obvious. If a child that has had genital… Read more »
You see, there’s a cause and effect there. Head injury makes SENSE that it might cause mental problems. The problem arises when THOSE PEOPLE are “forced” into treatment. If they don’t like being male, or female, or gendered AT ALL, who are you, or I, or ANYONE to tell them, nope, you’re sick, we’re fixing you? With no cause we can point to that they suffered a sudden mental shift that has a rational cause? Why not start curing gays? Gender may not be entirely social or “all in your head”, but that doesn’t give us the right to tinker… Read more »
@Clarence Be careful, because you’re going beyond sexual function, and the argument that “male and female means sperms and eggs, duh”, and into “maleness is a special thingy that requires to be assigned male at birth, and have a penis, to exist”. Which borders on religious (both the right-wing and the radfem argument hinge on this). And given that we (as a society) generally DO say penis = boy/man = maleness. For sure, to debunk this notion, you must completely ignore it. As to “feeling perfectly feminine”, you’ll have to tell me what this entails Clarence, because there’s way more… Read more »
DMB: If I was to go out of my house and a large rock fell on my head, and I woke up and felt perfectly feminine, then yes, I am indeed saying so, and you can take all the offense you want. At the extremes “gender dissociation” may very well be a form of mental illness provided that the person who has these desires has in every way known a single “binary” sex profile. Obviously people with mixed genitalia, different than norm chromosomal counts, etc, should be given the benefit of the doubt. In short, I’m saying that not all… Read more »
Ozymandias: That may be so to traditional doctors. But the “important” ones to me are those that are likely to impair sexual and reproductive functionality, like say, an extremely curved penis or a partially closed vagina. Mere cosmetics mean nothing and can be changed by the child later if they so choose. I would also disagree with people who say there is no “supposed”. There is a “supposed” in that something has to be FUNCTIONAL and if surgery is needed to make it so, then I would have no issue with getting my kid surgery as early as it was… Read more »