Suzanne J. Kessler
Lessons from the Intersexed
(New Brunswick, NJ: Rutgers University Press, 1998) 193 pages
(ISBN: 0-8135-2529-2; hardcover)
(ISBN: 0-8135-2530-6; paperback)
(Library of Congress call number: RC883.K47 1998)
Intersex people were physically ambiguous at birth with respect to their sex:
They were born neither clearly male nor clearly female.
And since it became possible in the 20th century,
they were usually given medical treatments
to make them more definitely one sex or the other.
But the author of this book takes a different stand:
Kessler believes that doctors should not interfere with what nature has created.
She believes that 'gender' is a social construct.
Her consistent use of the word "gender" to refer to the sex of an individual
--whether that person is a male or a female--
continues the confusion so common in our everyday thinking about sex and gender.
When we discuss the gender-personality of an individual person,
whether that person has 'masculine' or 'feminine' character traits,
we are clearly dealing with learned emotional responses.
Likewise, when we refer to the sex-role of an individual,
we a discussing external behavior expected in any society
because the individual is either a male or a female.
Both gender-personalities and sex-roles are fluid and flexible.
These are cultural constructs--the results of experiences since birth.
But the biological sex of any animal organism is not a social construct.
Most animals are clearly male or female.
Only a few have any ambiguity with respect to their biological sex.
These are the intersex individuals.
For a comprehensive discussion of such confusions,
see the present reviewer's book:
Variations of Sex & Gender:
Six Phenomena Frequently Confused.
(Search the Internet for this title: "Variations of Sex and Gender".)
As this reviewer sees it, Lessons from the Intersexed makes more sense
if we readers substitute the word "sex" whenever the author uses the word "gender".
The author's use of the word "gender" is part of her over-all political purpose
of claiming that one's sex is as flexible as one's gender-personality or one's sex-roles.
This book is written from the perspective of the organized groups of intersexuals.
Most babies born with some sexual ambiguity
are now diagnosed and treated from birth
so that they can be as close as possible to whichever sex they most resemble.
The parents of these intersex babies make a decision based on science.
And their children are raised as either boys or girls.
They grow up wanting to be as 'normal' as possible.
Because they want to fade into the general population as regular men or women,
they have no use for the political movement of intersexuals.
Such individuals do not figure in this book.
Before medical treatments for sexual birth defects was possible
or when the facts were not recognized early enough,
some people grew into adulthood as intersex individuals.
Each found his or her own way to cope with his or her body as given.
And sometimes they joined social and political groups
with others who have some variation of biological sex.
Some of the interviews for this book took place in 1985.
So they reflect the experiences of the interviewees some years before that time.
Kessler describes a rather rudimentary method for treating intersex babies:
Sex was assigned on the basis of the external genitals alone:
If it is large enough and can be enlarged, it is called a penis.
And the baby is a boy.
If it is small and can be reduced, it is called a clitoris.
And the baby is a girl.
The family doctor of decades ago had no way to discover
whether the baby was XX (female) or XY (male),
or some other patterns of genes that created an intersex baby.
But modern science has much better tools now:
instead of depending on the appearance of the external genitals alone,
we can now decide the sex of the baby on the basis of sex-chromosomes.
A simple blood-test can disclose the exact chromosomal make-up of the new child.
Once the biological sex of the child is determined and announced,
the socialization processes begin.
All the relatives treat the new baby as either a boy or a girl.
If there was some ambiguity of biological sex present from birth,
the doctor might have given a simple, one-sentence explanation.
But when individuals born intersex become teen-agers,
they usually want more explanation of their differences from their peers.
They might consult the scientific literature about their birth defects.
But if they join groups for intersexuals,
they will usually have developed their own mythologies,
which explain what they are and how they should live.
In some state laws in the United States that deal with sex-change operations,
the sex of an individual is defined by reproductive capacity:
When a born-male is changed into a female,
he must lose the capacity to father children.
Likewise, when a born-female is changed into a male,
she must lose the capacity the bear children.
Intersex individuals who have grown into adulthood
with little or no physical modifications
might also adopt the same convention:
Their male/female self-designation might depend on their reproductive capacities.
Are they closer to normal biological males or normal biological females?
When unusual imprinted sexual fantasies and homosexual variations are added,
the situation becomes even more complex.
See Variations of Sex & Gender: Six Phenomena Frequently Confused.
Kessler is concerned about changing the size and appearance of the external genitals.
She takes the position that doctors should do nothing.
Herein she goes against most modern medical advice.
She has talked mainly with intersex individuals who had problems later
because of decisions that were made when they were babies.
So she concludes that these individuals
would have been better off if the doctors had done nothing.
If her research had included people who were very satisfied
with their sex as assigned (and perhaps surgically corrected)
when they were still infants,
she would not be so completely against operations to correct birth defects.
If she interviewed only intersex individuals
who believe they were damaged or mutilated as infants or children,
how could she come to any other conclusions than
that operating on intersex babies should be banned?
However, we do have lots of experience with the 'do nothing' option:
Thru-out most of human history (and pre-history),
it was simply not possible to do anything about birth defects.
People just learned to live with whatever abnormalities they had from birth.
In other words, the 'default' decision for most of the human race was do nothing.
Until the middle 20th century, there was no way to investigate
the causes and prognosis of any abnormality.
But now doctors can carefully compare each variation
with what is known about that variation in other individuals.
A good scientific research project would be a follow-up survey
of all children who received some medical treatment
because of various sexual birth-defects.
What percentage had each identified kind of defect?
What percentage of each class was pleased with the results as adults?
What percentage of each class was displeased with the results
--and in what specific ways were they dissatisfied?
There are now probably thousands of adults in the US
who were treated for birth-defects related to sex.
Adults have a right to make their own decisions about sex.
But parents must decide for their infant children.
And they will usually depend on medical advice.
So far, there are few medical experts who support the do-nothing option.
But will further research find cases in which it would be best to do nothing?
Readers of this book will notice a strong author-bias against doctors.
She worries that doctors will not be concerned enough
about the sexual enjoyment of people who have had genital surgery,
which would be especially relevant when 'reducing' a clitoris.
The author seems to want to blame doctors
for everything bad reported by intersexuals.
She has read the medical literature,
but she basically uses it to discredit doctors.
The author mostly ignores the underlying
genetic and hormonal causes of the birth abnormalities.
About 70 different variations from normal biological males or females
have now been identified.
These are really mistakes of nature,
not distortions caused by doctors.
Doctors seek to correct these mistakes of nature,
not force all people to be conventional men or women.
Is the author worried that medical science
might once again be turned toward 'curing' homosexuality?
The people interviewed for Lessons from the Intersexed
mostly see themselves as victims and part of the sex-and-gender minority.
But most intersex babies were 'corrected' soon after birth.
And they went on to live unremarkable lives as men or women.
Some do not even know they were abnormal in any way.
And most have learned to live with whatever physical differences they have.
After all, exact genital appearance is not a matter of public concern.
Scientific follow-up for such individuals would not be easy.
How would a researcher find them?
Those who know about their birth-defects
usually do not think of themselves as socially or sexually different.
And they might not want to be reminded of their birth-defects.
Nevertheless this book was needed.
It does validly point out many problems in handling intersex individuals.
This reviewer agrees that some of the surgeries were not needed.
They were done mainly because of lack of tolerance of sexual ambiguity.
In some cases, surgery was done because it could be done.
Since most children do not see many genitals when they are young,
they do not have a lot of data for making comparisons.
Their own variations from some norm might not be important.
But it is psychologically and socially important
for each child to know which sex he or she is.
This might be different in a hypothetical culture that ignores sexual differences,
but in most cultures, everyone must be known as either male or female.
Some surgeries can be delayed
until the child is old enough to participate in the decisions.
For example, why construct a vagina that will never be used?
Kessler points out that some female-to-male transsexuals
do not need a penis for sex.
They want to continue having sex with women
while believing that they are men.
Surgeons are content with good-looking results.
But the parents and the patients have to cope with lots of other problems
created when the child is not normally a male or a female.
This book does not deal with the reproductive capacities of intersex individuals.
This seems a serious omission since having children
is one of the most important meanings-of-life for some people.
Some intersex persons are surely more concerned about parenthood
than about the external appearance of their genitals.
This is a book of advocacy rather than science.
Parents looking for help in deciding what to do with defective newborns
will have to look elsewhere.
When they have a full picture of the exact biological situation
and when they have considered the whole future of the child
with each of the possible courses of action,
then they should be able to make wise decisions.
A more complete (and accurate) title for this book might have been:
Lessons from Intersexed Individuals Who Disagree
with the Treatment Decisions Taken for Them When They Were Children.
If you would like to read other books on being intersexual,
search the Internet for the following bibliography:
James Leonard Park, author of
Imprinted Sexual Fantasies: A New Key for Sexology.