Remember how Dr. Ruth told us that size doesn't matter? As it turns out, the kindly doctor was wrong, and all those nervous adolescents she reassured have good reason to clutch their genitalia in fear.
According to a new book called Lessons From the Intersexed (Rutgers University Press, August, 1999) by Suzanne Kessler, Professor of Psychology at Purchase College in New York, babies' genitals are measured with a ruler and snipped if they don't fit into supposedly normal size ranges. If you're born with a penis that's deemed too small, or a clitoris that pokes its head out too far, most doctors will order "corrective" genital surgery before you're old enough to say "no."
At birth, a medically acceptable clitoris measures .02 to .09 cm. A medically acceptable penis is 2.5 to 4.5 cm. That makes the 1.0 to 2.4 range a veritable pubic Twilight Zone, the land of ambiguous genitalia. Estimates vary, but as many as 1 in 2,000 babies are born with ambiguous genitals -- one of several conditions referred to as "intersex" conditions. These may occur for reasons that range from chromosomal and hormonal syndromes to simple biological variation. Over the past 40 years, doctors have done hundreds of clitoridectomies on girls with what medical literature calls "offensively large" clitorises, and numerous nonconsensual sex changes have been performed on boys born with "micropenises" (below the golden 2.5 cm).
"I didn't have surgery; it was done on me," says intersexual activist Cheryl Chase. "Doctors decided I would be better off without my clitoris because it was ugly." Chase is now the director of the San Francisco-based Intersex Society of North America, or ISNA, a group she founded in 1993 to raise awareness about intersexuals and the often bizarre, unnecessary surgeries they're subjected to.
Chase's fellow activist Kira Triea says she was raised as a boy until she turned 13 and began to menstruate. Her frightened parents took her to Johns Hopkins. Under extreme duress, she was given a clitoridectomy and what she calls "a crude vaginoplasty, an artificial vagina made from a piece of skin on my arm. Basically it's a bunch of scar tissue and a hole." Triea was asexual until she reached 32, when she fell in love with a woman.
Although Chase notes that many intersexuals are gay, lesbian, or bisexual, she also emphasizes that this shouldn't be the point. She comments sardonically, "The only attention we've gotten so far from the medical community is, 'Oh goody, God made these experiments of nature just for us to examine so we can find out why people turn out queer or whatever.' We're sick of that kind of attention."
For both Chase and Triea, intersexual activism isn't about in-your-face gender ambiguity, either. Remarks Triea, "Transsexual activists say to me, 'You're so plain.' Well, that's sexism, that we have to look like exotic intergendered people. I don't need to make statements like that. I just want to stop nonconsensual surgery."
Ironically, surgeries like those Chase and Triea experienced take place every day in the U.S., a country where feminists are blind with rage over African clitoridectomies. And yet when Chase tried to place intersexuality on the feminist agenda, she was rebuffed. "Alice Walker won't talk to us, and [Nation columnist] Katha Pollitt actually told me that to compare the clitoridectomy done on me to those done on Africans was to belittle the significance of clitoridectomies."
Perhaps some clitoridectomies are better than others? Says Chase dryly, "Feminists care about the African clitoridectomy because it's an icon for the 'bad man/abused woman' idea." Intersexuals' experiences don't always fit into that nifty little '70s feminist paradigm.
Yet 90 percent of intersexuals are assigned a female gender. Boys born with a micropenis (or, sometimes, a damaged penis) are given what amounts to transsexual surgery -- often before they reach puberty, and virtually always without informed consent. Apparently, the medical establishment believes that it would be so terrible to grow up with a small penis that it's better to perform radical surgery. So doctors typically cut off the child's penis and remove his gonads. Later, they will perform a vaginoplasty and still later, as a soon-to-be-even-more-traumatized teen, the intersexual will be given hormones to stimulate breast growth. "Doctors don't value female sexuality, and they say that if your sex life is going to be difficult then we'll just make you a girl so you won't mind," scoffs Chase. "Of course one doctor simply said, 'It's easier to dig a hole than build a pole'."
The Surgical SWAT Team
But why do they need to build all these holes and poles in the first place? Kessler comments, "I think we've turned to medicine to make people more normal in every way -- growth, teeth, age, etc. You want nothing to make you look distinctive. Genitals are supposed to be the perfect, unambiguous marker of gender, which is also supposed to be unambiguous."
In other words, allowing kids to grow up with ambiguous genitals could make gender roles a bit too fuzzy for comfort. Adds Kessler, "If parents get crazed about a girl wearing jeans, then no wonder they're crazed about a big clitoris."
Medical debates around these issues heated up in the early 1960s when Johns Hopkins medical researcher John Money asserted that gender was purely a matter of socialization and had nothing to do with biology. To prove his point, he operated on a number of children with ambiguous genitals -- including Triea. She calls Money and "his surgical SWAT team" the "biggest SOB's I've ever met." After chopping up these kids' genitals, Money ordered their families to treat them like the gender he'd chosen for them. Presto chango -- with knives and proper nurturing, a boy becomes a girl!
Some of Money's human guinea pigs later switched genders, and most others recall Money's treatment -- including enforced surgery and creepy interrogations about their sex lives -- as far more emotionally damaging than having unusual genitals ever could have been. This phenomenon is not unique to Money's patients. In fact, ISNA's newsletter, Hermaphrodites With Attitude, has published numerous testimonials from intersexuals who harbor bitter anger over having been, by their own assertion, mutilated and invaded as young children.
What Do Intersexuals Want?
As a post-millennial Freud might ask, what do intersexuals want? Activists like Chase and Triea are asking that parents and doctors forego genital surgery unless it's specifically requested by intersexed people or necessary to save the life of the child. Anatomy professor Milton Diamond, after consulting with ISNA, has issued guidelines recommending how babies with genital ambiguity can be assigned a provisional gender, with the caveat that their parents be given counseling about how to help their children through a possible future gender reassignment or just some plain, old fashioned sexual confusion.
We need to fight against what social critic Leslie Fiedler has called "the tyranny of the normal." Kessler muses, "When you eliminate surgery, you talk about allowing a wide range of behaviors. There are a number of masculine girls and feminine boys, and I think if we expand what's allowable for girls and boys and don't get anxious about deviations from the 'norm,' people won't have to change their gender [with surgery]."
Annalee Newitz is a freelance writer who occasionally uses her Ph.D. to stand at the front of classrooms and talk about pop culture. She writes brainsploitation for Salon, SF Gate, The Chronicle of Higher Education, New York Press, and other publications.