ok I don't usually put up my essays even though I usually plan on doing so. Here is one of the two that I am handing in for tomorrow. I have bitched and moaned on my blog about the way western society deals with intersex over the past year and now finally I have writen something on it. I hope you enjoy . . .

We tend to assume that the normal existed before we encounter the abnormal,
but it is really only when we are faced with something that we think is
‘abnormal’ that we find ourselves struggling with what normal is.
~ Alice Dreger
Hermaphrodites and the Medical Invention of Sex, pg. 6

Introduction

Before this year, my experience of intersexuality was limited. I had a friend who came out as intersex and transitioned from female to male, and had a few friends whose main partners were intersex. I had also seen a short film at the Inside Out film festival in Toronto where an intersex women did a performance where, in the process of talking about her body, she took off her clothes, putting not just a face to intersexuality, but also a body. I had taken a class on Sex and Gender in the Renaissance that used a one-sex model in describing hermaphrodites. I believe we might have touched on intersex in a few other classes but they were talked about in reference to Fausto-Sterling, who is not intersex herself, and as I found out afterwards, did not talk to any intersex people themselves before she wrote her infamous book The Five Sexes. I must confess that what first attracted me to research intersexuality was my queer theory background, an interest in the social construction of sex and gender, and the possibility of reaching a more fluid reality of sex, gender and sexuality. The more I read up on intersexuality, the more I realized that a few of my other backgrounds were itching with excitement. It was my activist side that saw a huge social injustice; for example, the hypocritical demonization of female genital mutilation versus the social acceptance via silence of intersex genital mutilation. It was also my background in anti-oppression education that saw the possibility of changing social attitudes through education on intersexuality by having intersexuals tell their stories and by having allies speaking with intersex people and not speaking for them as experts. I was very conscious of not being intersex myself while writing this paper. What I want to do is demonstrate the injustices being done to children everyday in western countries while exploring the hegemonic heteropatriarchal system that underpins the medical model in dealing with these infants. I will look at the possibility of political and social change through conscious-raising and education. By placing intersex voices as central, I believe critical thinking will develop and that sense of power will lead to creating social change.


Intersex — what are we talking about?
I want to look initially who gets constituted as intersex and then what is happening to these children. Then I will look at the underlying structures that allow such practises to occur. To start off with, what has been coined “true hermaphrodites,” where the infant has both ovaries and testes, occurs in less then 5% of the cases of ‘ambiguous’ genitalia. (Kessler, intro) Generally there are female pseudo hermaphrodites (having ovaries, XX chromosomes, external genitalia that look ‘masculinised’); male pseudo hermaphrodites (testes, XY); and those who have XXY chromosomes, yet these children are not always diagnosed as ambiguous or intersex. There are several types of female pseudo hermaphrodites; the two rarest accounts are when a tumour on the mother’s suprarenal gland produces excessive amounts of androgens, and when a woman is administered androgen hormones to prevent miscarriage or from environmental toxins. The most common way this occurs is natural and not from accidents or disease, CAH, where there are high amounts of androgen created by the adrenal glands in the fetus. Male pseudo hermaphrodites most commonly occur in two ways: AIS, where bodies lack a key androgen receptor, keeping the body from acknowledging the androgen in the body. The results of this at puberty are full breasts, round hips, little body hair, tall with long arms and legs — generally what our western society has constructed as the feminine goal. The second type is called 5-AR deficiency which was popularized in the award winning novel Middlesex. What happens here is that at puberty, the developing genitals can’t read the testosterone due to 5-AF deficiency, so ‘masculinising’ puberty occurs, meaning that the body becomes taller, stronger, with more body and facial hair, breasts do not develop, testes often drop and the penis/clitoris grows and acts like a penis. (Dreger 38-39) It is not because one has CAH, AIS or 5-AR that the medical community feels the need to cut the flesh of these children. It is because the clitoris is too long, which is seen as socially unacceptable; the penis is too short which challenges masculinity; or the urethra is in the ‘wrong’ location, preventing a boy from urinating in the socially allocated manner.

Cheryl Chase, founder of the Intersex Society of North America (ISNA) says that one in two thousand births has an abnormality that is problematic enough to question whether the child is a boy or a girl. Surgery is the response to this otherwise theoretical question. The violence done to these infants in the western world can be understood in several ways: first of all, it is comparable to female genital mutilation, and secondly it can be understood as maintaining the hegemonic heteronormative patriarchy system. In the United States during the Clinton administration, there was a law passed that was put in place to protect children from female genital mutilation. It read as follows: “whoever knowingly circumcises, excises, or infibulates the whole or any part of the labia majora or labia minora or clitoris of another person who has not attained the age of 18 years shall be fined under this title or imprisoned not more then 5 years or both . . .a surgical operation is not a violation of this section if the operation is necessary to the person’s health and is performed by a person licensed as a medical practitioner in that state.” (Kessler 81) Intersex genital mutilation should fall under this law, except for the fact that the “experts” in every major hospital to deal with this situation say that that these surgeries are socially and psychologically necessary and to “advocate medical nonintervention is irresponsible.” (Kessler 121) This attitude refers to a social responsibility to maintain a two sex/two gender model. There are cases where surgery is required, for example, treatment of CAH may save a child’s life and fertility; treatment is required because CAH is a metabolic disease, but the ‘ambiguous’ genitalia are not.

Child and sexual abuse and the connection of female genital mutilation
The mutilation of intersex people’s bodies that resulted from the research of John Money is said to be psychosocially necessary, yet there is little proof of these. A speaker at the first gathering of intersex people by the ISNA said that her body was left alone and that she had had a positive experience with her body. Another speaker at the same gathering had her “enlarged” clitoris removed after it started to grow at 12; she had loved it and had problems only after it was taken without telling her. Claude Migeon, one of the head doctors advocating these surgeries did some research on people with AIS, some of whom were assigned male and others female. Despite policy that states that it would be a disaster if someone with AIS was assigned male, some were. He was shocked by his own results and at the end of the day confessed he no longer knew which gender assignment was the right choice. In his study, those who were assigned male were doing well and those who had surgery and were assigned female were not doing so well. (Chase 130)

A study done by the Intersex Initiative in Portland on the psychological effects of these surgeries on intersex people found that adults’ psychological suffering was similar to adults who suffered child sexual abuse and that early surgical treatment on genitals often results in psychological and sexual problems rather then better social adjustment. (Koyama 3) There are a few dimensions that constitute abuse of intersex people. First of all, there is the physical violation of their bodies where parts of there flesh is removed for no medical reason and as a result of this mutilation their possibility of erotic pleasure and sensation is reduced, if not removed. The second dimension of abuse is that these children are lied to, surgeries are done under false pretense, records are erased, and their histories are generally silenced. The third dimension of abuse is the way that intersex children are treated like monsters, anomalies on display for the medical community. Several intersex people have told stories remembering how there were left naked on tables, in rooms that were being observed by classes of students, that doctors, experts, surgeons would come in poke at them look at them and laugh. This is a common memory of intersex people. The final dimension of abuse toward the children in the method of creating a vagina that requires a continuous stretching process. An intersex adult said that she personally felt that any excess genital exams are a form of abuse. (Kessler 59) And Kessler questions the difference between ‘appropriate medical procedure’ and sexual abuse from the perception of the child who is experiencing a painful, humiliating procedure. (Kessler 63)

What is interesting is how similar female genital mutilation and intersex genital mutilation are, both in practice and in theory. Many women in modern African countries have parts or all of there genitalia removed in order for them to be socially acceptable for marriage to a man. We cannot see these as barbaric practices and western practices as scientific when the underlining theory of why intersex surgeries take places is very similar. There does seem to be the same criterion for why intersex genital mutilation occurs; it is so heterosexual intercourse can function (in physical and socially acceptable ways) in marriage. I will further explore this in the next section. What I also would like to note is the change in language to attempt to dissociate intersex genital mutilation from female genital mutilation. “Up until the early 1970s Western doctors always called it ‘clitorectomy’. Now they call it ‘clitoral reduction’ or ‘clitoral recession’ or ‘clitoroplasty’ because the word ‘clitorectomy’ has come to be equated with barbarism, child abuse and mutilation.” Chase further explores this distinction between African ‘clitorectomy’ and Western ‘clitoroplasty’ as purely political.” (Chase 124) This is a clear case of othering and blindness to one’s own social problems. It is not only institutions that have this double standard blind spot; it is clear that through the lack of work being done in intersex issues by feminist groups, feminists in the western world also have a double standard towards these two types of genital mutilations.


Maintaining heterosexuality and the dichotomy of femininity and masculinity
Dreger asks, “why is intersexuality managed in the way that it is? Why does the ‘solution’ for variant genitals lie in knives and not in words?” (Dreger 105) The medical community says it is for the social well-being of the child. Chase, Dreger, Kessler and ISNA all say that children who have these surgeries suffer hardship and pain, and are silenced by bad science. Chase further questions the authority of the surgery stating that “in spite of the thousands of operations…there are no meta-analyses from within the medical community on levels of success.” (Chase 37) The answer Dreger gives for her question lies in the criterion for heterosexuality and the history of cosmetic surgery. The problem along side these issues is the modernist criteria of science, “that medicine gradually appropriated to itself the authority to interpret—and eventually manage—the category which had previously been widely known as ‘hermaphroditism’.” (C 32) This appropriation is maintained through “a mythology” that “encases the technology to make it necessary and acceptable. Once it becomes technically possible, it becomes inevitable” (Dreger 186) Dreger goes further to say that if all you have is a hammer everything looks like a nail. This medical model approach to intersex bodies does not allow for the voices of intersex people to become part of the dialogue of how to deal with this difference. Chase questions “whether the insistence on early intervention was not at least partly motivated by the resistance offered by adult intersexuals to normalisation through surgery” since “for some, the surgeries end only when the child grows old enough to resist.” (C 33)

It is not unreasonable to assume that it is the criterion for heterosexuality that results in the violent mutilation of intersex bodies. In the Missing Vagina Monologue, Esther Morris recounts her experience of having surgery to construct a vagina. She clearly spells out the underlining reasons for her surgery and other surgeries by remembering that her doctors talked to her parents about vaginal reconstruction so she could have a normal sex life with her husband. This is not an uncommon criterion of the vagina. The surgery, vaginaloplasy, that is done to construct a vagina is said to be done shortly before women wants to have sexual intercourse. (Kessler 106) Sexual activities are reduced to heterosexual intercourse and vaginas are not required for any other reason then this activity. Many vaginoplasty follow-up studies for intersex females include “marriage” as part of the proof of surgical success. The goal of this vaginal construction is specifically for the assumption of heterosexuality. Vaginas are built or lengthened if necessary in order to make them big enough to house an average-sized penis. (Dreger 183) There is no criterion for a functioning vagina to act in a way that many vaginas work, such as self lubricating, changing shape when stimulated, orgasmic ability or even sensation. As long as non painful intercourse with an average sized penis is possible, the constructed vagina is a success.

Since 9 out of 10 intersex babies are assigned female, this brings up an interesting dimension of sexism in the practice; of course you have the dimension where there is a history of only male doctors becoming the experts in determining gender. And then you have the dimension of the socially accepted penis size and the construction of masculinity. Below is a chart modified from Kessler’s book Lessons from the Intersexed. This chart shows the arbitrary nature of what constitutes acceptable genitals. What I feel it also does is shows the fascination with penis size and how it defines masculinity starting from birth. There is a disagreement among doctors what is the best method to deal with children assigned as males. Some doctors encourage hormones, which is the most common method, saying that “as a result the boy has greater self confidence in the locker room or in normal childhood heterosexual rehearsal play”. (Kessler 68) The surgeons who advocate surgery also emphasise self confidence, since their argument is that in cases where hormones don’t provide enough penile growth, these boys may commit suicide. And since it seems to be easier to make a “functioning” vagina then a penis that is an “appropriate” size most babies, like I said, are made into females. The importance for women’s genitals is to accommodate a reductionist view of heterosexual sexual activists concentrating on the male’s pleasure, while the importance for men’s genitals is to reconfirm his masculinity with the size of his penis.

0 1 2 3 4 5
|……....|……...|…….. |………|…….. |

Medically accepted clit
Phallic netherland
Medically accepted penis

Voices that refuse to be silenced
A major issue resulting from these surgeries in the silence and shame that builds around intersex people. The medical community facilitates this shame with lies and silence, encouraging further deception from parents and encouraging uprooting from communities. Many stories of intersex people will express a sense of feeling that they were the only one and different emotions of identity, community and so on when they meet other people with similar histories. Kessler writes about the intersex identity, which explores an ironic nature of the identification; doctors name it to erase it and by doing so an identity develops among people who are able to fight the medical community through their shared experiences.
Chase, the founder of ISNA, refused to be silent. Like many other intersex people, ze lived a life without knowing anyone else who had had a similar experience. After uncovering the lies of hir doctors, ze started tell hir story to everyone ze met. After a while, ze started to meet other people like hir. Through this telling of stories, the ISNA developed and started to challenge the way the medical community dealt with intersex bodies. They took a then radical approach, advocating against surgery and for allowing the children to determine their own sex. They do not advocate non assignment though; they still feel that the binary gender system is too hegemonic and agree with the medical community that living as a third sex would be socially and psychologically detrimental to the children. Although that is the standpoint of the group, others do choose to live their lives as another gender and claim an intersex identity.
Chase is one voice that has spoken out, but there are so many more. It was through all these voices sharing similar stories that the activism started to develop. When a doctor at the Johns Hopkins Medical Centre was asked what he thought about activists and intersex people joining groups like ISNA he said that “intersexual activists are a self-selected group brought together through their negative experiences”. He really should have listened to what he was saying, since doctors like him actually selected these people and their negative experiences are often as a result of the process that they are mobilising against. The medical community refuses to listen to intersex people as experts on their own experiences. Dreger acknowledges this issue in her book Hermaphrodites and the medical invention of sex, where she says that although she would like to centralise the voices of intersex people and use them as experts, “the social history of medicine is usually recorded by its practitioners, by social workers, or researchers. Not much of it is chronicled by its victims or the recipients of treatment.” (Dreger 167) This is a reason why it is so essential that the voices of intersex people are heard and recorded. Groups like IIP and ISNA have been publishing essays that are recording their own history. There are groups like Body Like Ours that are working toward days of action and awareness for intersex people. And there are the Missing Vagina Monologues that have started to be added to the regular Vagina Monologue performances. These are just a few of the voices that are refusing to be silenced. Now that people are talking about intersexuality, it is important to look at how they are taking about it and who is doing the talking.

How is intersex being taught?
There have been two types of imperialism happening simultaneously towards intersex people. The first is by the medical community, to erase bodies and stories to have children fit into the hegemonic heteronormative binary sex and gender model. The second type of imperialism has been done by academics that have reduced intersexuality to use as a argument for social construction theory. Emi Koyama has said that “people’s bodies were used to support abstract theories, rather than social theories being used to support people.” (Teaching Intersex Issues 1) Koyama and Lisa Weasel conducted a survey of lectures that had brought intersexuality into their classrooms; the results were disappointing and seemed to support Koyama’s above claim. The problems found included using non intersex scholars, not giving voice to intersex people, using intersex to deconstruct the notion of binary sex, confusing or conflating intersex and transsexual/transgender issues, not addressing the medical ethics, and referring to authors that don’t deal with intersex issues specifically as resources. I agree with the authors that including intersex in the curriculum is a positive step towards removing the silence surrounding these issues. Yet if it is taught in a voyeuristic way, or by treating intersex people as the other, awareness is occurring without challenging the silences that are there. The authors talked about the privileging of non-intersexual people in the classroom by addressing questions that were not too challenging and with the assumption that none of the students were intersex themselves or were close to anyone that was. This type of pedagogy is oppressive. It is in gender and queer studies classes where this topic has been taken up; both of these theories have come from an understanding of silenced communities, and from challenging the otherness that had been prescribed to them through the medical communities and other institutions. This just shows that in one way we can be oppressed and in another way we can be the oppressor.

Koyama and Weasel go on to provide guidelines for teaching intersex issues. These, as one might expect, include providing first person narratives and academic writing by intersexuals. To use theories to support people in line with this sentiment, they point out that there needs to be a realization that intersex people are not responsible to live as a third gender. They ask the lectures to assume intersex people are everywhere, to recognize the intersex movement has priorities and strategies beyond those of the LGBTQ community. They make connections to other movements that intersexuals have connections to such as dis/ability, health activism, feminist anti-violence, reproductive, children and youth rights. And finally, they expect lectures to engage in activist work; this is something I will explore in more depth later on in the paper. With the assumption that intersex people are everywhere also comes the understanding that intersex students may not want to “come out” in the classroom as intersex and that in order to get first person narratives you would have to show videos, have guest speakers, or read accounts. This should be all done in a respectful way and not done in a voyeuristic manner, this can only be ensured in the manner that the material is introduced and the questions that are brought up for discussion.

Developing pedagogy of intersex people
Paulo Freire, the author of Pedagogy of the Oppressed, challenges the mainstream education model as a banking system and suggests a problem posing model for the possibility of freedom. He has suggested a method of education for liberation based on a breakdown of the hierarchies between student and teacher, knowing that each can learn from each other. He feels the role of the educator is to create a space that would allow discussion to take place and have the dialogue of personal experience placed within a wider theoretical framework. He felt that through these processes, one could develop a level of critical consciousness that would allow them to be active though praxis. The direction into which intersexuality has been introduced in academia is through women’s studies and gender and queer theory. The ideas of Freire are not alien to these fields, since women’s studies, for example, was formed through activist means and got its foundation through consciousness raising feminist groups in the seventies. Feminists such as bell hooks, who are interested in how Friere’s philosophies can be adapted to teaching within feminist and race studies, acknowledge the root of women’s studies classes and feel that it is essential for feminist scholars to contribute something back to the movement they study, rather then merely using it as an object of academic inquiry. This perpective is fundamentially what the Intersex Initiative Portland is presenting with their proposed syllabus for intergrating intersexualiy into women’s and queer studies classes. Lisa Weasel says it is time to “turn the analytical gaze away from intersex bodies or genders and towards doctors, scientists and academics who theorize about intersexuality.” (Koyama 32) She also reiterates the points of other feminists who are interested in liberation education, that with all feminist pedagogy the classes should be engaging with activist strategies.

Conclusion
For intersex people it is not their bodies that are the issue but rather the way that their bodies are understood by those who study them and have control over them. The real issues here are issues of silencing and abuse. They are issues of sanctioned and approved violence and the theft of one’s own eroticisms. It is the erasure of their existence by lies, surgery and isolation. It is how the medical model has silenced their voices, how the surgeons have cut off their existence and how the academia has analysed and used intersex people as a means to the ends of proving the social construction of sex and gender. The academia has the possibility to end one form of imperialism of intersex people by centralising their voices and stories while it is being discussed, and through this, adopt a form of pedagogy that would work towards ending the other form of imperialism on intersex bodies. It is essential to be working towards developing critically conscious minds through pedagogy and making connections between the experiences of intersex people and the underlying theories of oppression. It is through this type of engagement that people see themselves in connection to the world and as actors of change. Right now, everyday, babies in the western world are suffering under the knife of sexism, homo-, gender- and sex-phobia. They are suffering violence due to the separation of third world barbaric practice and first world scientific theories. They are suffering, but many of them are refusing to be silenced; they are providing voices and dialogues for political and social change. It is the responsibility of everyone who is teaching and being taught about intersexuality to provide these voices and dialogues and work with intersex activists to end the imperialism of their bodies.










Bibliography
Chase, Cheryl, (2003) “Hermaphrodites with Attitude: Mapping the Emergence of Intersex Political Activism”, in R. Corber and S. Valocchi (eds) Queer studies: An Interdisciplinary Reader. Oxford, Blackwell Publishing.

Cheryl, Chase, “Intersex Activism, Feminism and Psychology: Opening a Dialogue on Theory, Research and Clinical Practice” in Feminism & Psychology, 2000, 10, 1, Feb, 117-132

Dreger, Alice. (1998) Hermaphrodites and the Medical Invention of Sex. Cambridge: Harvard University Press.

Freire, Paulo. (1970) Pedagogy of the Oppressed. Penguin Books.

Kessler, Suzanne. (1998) Lessons from the Intersexed, Rutgers University Press.

Koyama, Emi. (2003) Introduction to Intersex Activism: a guide for alias, 2nd edition. Intersex Initiative Portland.

Koyama, Emi. (2003) Teaching Intersex Issues. Intersex Initiative Portland.

Hooks, Bell. (1994) Teaching to Transgress: Education as the Practice for freedom. Routledge

Morris, Esther. 2001. The Missing Vagina Monologue. Sojourner, March.

Rye, BJ. 2000. “Teaching about intersexuality: A review of Hermaphrodites Speak! and a critique of introductory human sexuality books” in Journal of Sex Research 37 (3):295-298.

www.bodieslikeours.org
www.isna.org
www.ipdx.org