Accepting genital ambiguity as a natural option would require that physicians also acknowledge that genital ambiguity is corrected not because it is threatening to the infant's life but because it is threatening to the infant's culture. [Kessler, 1990, 25]
For expediency's sake I want to focus attention on the typical manner in which intersexuality is diagnosed and treated. The 'need for speed' in diagnosis and treatment is reflected in this paraphrasing of Dr. Y., interviewed by Ellen Hyun-Ju Lee:
[Drs.] make it a social emergency and assemble a team to handle the case. The goal is to determine gender assignment within 24 hours of birth. 'We send the child out as a sex;' in other words, a newborn cannot leave the hospital until the label 'male' or 'female' is assigned. [1994, 30]Why is this the standard mode of teatment? In Bodies That Matter, Judith Butler states:
...the initiatory performative, "It's a girl!" anticipates the... arrival of the sanction, "I pronounce you man and wife." Hence... the peculiar pleasure of the cartoon strip in which the infant is first interpellated into discourse with "It's a lesbian!" ...the queer appropriation of the performative mimes and exposes both the binding power of the heterosexualizing law and its expropriability." [232]Butler's statement is one that I am quite fond of and I think of it often... wondering what the potential could be for the proclamation "It's an Intersexual!" However, this is an example of how the expropriation of citational laws is much more difficult than simply overturning an utterance. I recognize that Butler is partly engaged in 'wishful thinking' and not prescribing an easy subversion of norms, but I think a reminder that some bodies are more violently manipulated to force pronouncement "It's a girl!" or, "It's a Boy!" [1], is in order.
All intersexual children with an 'xx' karyotype and all those who are considered to have an 'inadequate' phallus are assigned female[2]--only those who are believed to possess a phallus that matches an 'xy' Karyotype and a minimum size standard for heterosexual penetration are assigned male. The "heterosexual imperative [which] is inextricably linked to the treatment of intersexuality."[Hyun-Ju Lee, 35] is an imperative that operates as much to heterosexualize males as females.
In Johns Hopkins Magazine (Nov. 1993), Melissa Hendricks' article on the artistic genius of those who affix sex to bodies with scalpels makes it clear that more often than not, the intersexed infant will leave as female[3]. This is because it is easier to realize the medical view of heterosexuality by making a receptacle for the phallus. In the article Dr. John Gearheart states: "A child who has a micropenis... that's not going to be of use to him for sexual satisfaction, urination, ejaculation..."[Hendricks,10] What Gearheart fails to make explicit is that the amputated phallus, and constructed vagina that will replace the male genitalia are not going to provide sexual satisfaction for the child who will grow up as a woman -- they will only provide sexual satisfaction for her, presupposed, male lover. The surgery, like the declaration/command "It's a girl!", presumes and commands a heterosexual future[4] and cares little about pleasure.
Decisions about the future of intersexed children's sexualities are made based on an assumption that children are property and that parents have the right to try to ensure their children's heterosexuality. In addition to the obvious violence of the surgery(ies) the very objective of treatment, which seeks to impose silence and sexual restrictions, is emotionally violent.
The imperative to silence intersexed children can be seen in medical texts which repeatedly advise against fully disclosing a patient's history to him/her once s/he has reached maturity. The medical establishment assumes, from the outset, that a patient will not be able to tolerate the 'truth' about his/her intersex status[5]. Thus a patient whose testicles are removed and whose clitoris is amputated because s/he has Androgen Insensitivity[6] will be informed that s/he is sterile because her ovaries didn't function well, not that s/he is sterile because s/he has no uterus and never had ovaries in the first place.
One of the more powerful tools available to medical 'experts' who perform genital revisions is the promise made to parents that their children will become adults with "normal sexual function" [M. Holmes, Med. File, January 23, 1984]. This promise is repeatedly alluded to in the medical files and literature dealing with intersexuality and it implies that if the child does not have reconstructive surgery then his/her adult sexual function will be abnormal.
I am arguing that concern for the intersexed child's well-being is a ruse which obfuscates scientific and cultural investments in maintaining clear distinctions between normalcy/health and deviance/pathology. Intersexed bodies blur distinctions between the two recognized sexes and call into question the oppositional categories of sex as they are constructed in Western, heterosexist culture. Only by limiting the possibilities to two distinct sexes can a predominantly homophobic culture posit that heterosexuality is "normal/natural" and not a constructed imperative.
In the 19th century practitioners of the growing discipline of statistics developed the idea of the normal [distinguished from the natural], as that which occurs with greater frequency. From this viewpoint, males and females are normal while intersexuals, natural as they may be are not. Medical practitioners fused the notion of the abnormal with that of the pathological--something harmful, to be controlled. ...The knowledge developed by the medical disciplines empowers doctors to maintain the normal by changing the hermaphroditic body to fit as best we can make it into one or the other cubby hole [sex](my emphasis)[Fausto-Sterling, forthcoming, 63].At what price is this promise of normalcy fulfilled and is it indeed fulfilled?
Of all ISNA's members, to this point only one has reported being reliably responsive at the physical level of sexual activity and it is significant that her surgeries were performed after the onset of puberty. From these accounts it seems clear that, in fact, 'normal sexual function' is not accomplished -- the medical treatments are only capable of augmenting the trauma of difference while in the pursuit of "... the best cosmetic effect"[(my emphasis)M. Holmes, Med. file, October 25, 1974 ].
When I tell my story and the stories of other intersexuals, people are often thankful not to be faced with the limited choice available within a medical framework. Sympathy for parents who have to make tough decisions is more prevalently expressed than sympthy for the mutilated intersexuals. But denying any personal interest in social norms which prohibit sexual difference places all responsibility for the mutilating treatment on the shoulders of surgeons who specialize in the reconstruction of intersexed genitals. Anne Fausto-Sterling argues that the surgeons do not operate in a vacuum but within a larger social climate which adamantly refuses to recognize homosexuality as legitimate:
>BLOCKQUOTE>But why should we care if a "woman," defined as one who has breasts, a vagina, uterus and ovaries and who menstruates, also has a clitoris large enough to penetrate the vagina of another woman? Why should we care if there are people whose biological equipment enables them to have sex "naturally" with both men and women? ...Society mandates the control of intersexual bodies because they blur and bridge the great divide [Fausto-Sterling,1993a, 24]. In the desire to produce a sexually 'normal' child, is the desire to ensure heterosexuality. A desire to be fulfilled, as I have pointed out, at any cost to the intersexed child. I urge people to stop feeling sorry for parents who have to decide the future of their children's sexual lives because the point is that no one except the child should be deciding if s/he will be hetero/lesbian/gay/bi or just "queer" by any estimation.
Parents of intersexed infants deserve some sympathy for being misled by the medical 'experts' but I want to point out that in this case the old adage, "If you aren't part of the solution, you're part of the problem," holds true. Societally sanctioned homophobia predicates and reciprocates the invasive, violent and damaging treatment of intersexuality. When parents sign consent forms, allowing doctors to remove the erotogenic tissue of their children, they are willingly following a heterosexist requirement that humans live as either male or female. The cost is paid in terms of physical function and sensation, in terms of self-image and self-esteem and it is paid by intersexuals -- not their parents .
With the intersexed child it is all too easy to look at his-her body as a 'sick' one -- one that is diseased and in need of 'repair' or 'curative' measures. However, what I am positing in this paper is that the treatment to which intersexed children are subjected is indeed a form of violence that cannot be justified by diagnosing these bodies 'diseased'. Indeed, or rather, it is the culture/society around the child which is dis-eased by the child's intersex characteristics.
Is it ethical to permanently damage the sexual organs of some people just so that those who (don't?) care for them can be made more comfortable? Who decided that it would be morally acceptable to erase the 'dismay' of parents, aunties and babysitters who might otherwise exclaim "My God!"[forthcoming, 104-105].