The Politics of Sex

Anne Fausto-Sterling

Anne Fausto-Sterling

At the time that Bruce Jenner became Caitlyn Jenner, I was reading a set of articles by Anne Fausto-Sterling: “The Five Sexes: Why Male and Female Are Not Enough” (1993) and “The Five Sexes, Revisited” (2000). It was a wonderful coincidence, because I think they relate, but I will get to that in a moment. The articles covered the concept of intersex individuals. I will first explain my title.

What Do I Mean by “Politics?”

Politics usually conjures a picture of concrete governments. Think presidents, congresspersons, judges, etc. I mean something much broader. When you see “political” or “the politics” of something in this post, I mean how people generally conceptualize and negotiate their group and people outside their group according to their own interests. This can intersect with politics as typically defined, but my use of it is not exhausted by that use. In my usage, how parents settle fights between their children, how parents navigate conflict in front of their children, how a female employee chooses to respond in a sexist work environment, how friends negotiate a mutual love interest: all of these situations and more include the political. Politics involves the negotiation of some scarce resource (e.g., land, prestige, the definition of marriage, medical insurance, employment, leadership positions, the choice to have children, leisure, etc.) between at least two parties. Something is at stake.

Russell McCutcheon

Russell McCutcheon

This understanding extends to how people use language. Definitions do not mean something in themselves; they are the artifact of someone delimiting a phenomenon, concept, etc. Follow me for a moment. What is a “vegetable?” Does it really matter if a tomato is a fruit or a vegetable? What is at stake if a tomato is a fruit or a vegetable? Russell McCutcheon uses these questions to demonstrate the stakes involved in something as trivial as what we call a tomato: it made it to the Supreme Court. Nix v. Hedden (1893) involved a tax on imported vegetables but not on fruit. Scientifically, tomatoes are fruit, but a port authority (Hedden) had exacted the tax from the Nixes, calling the tomatoes vegetables. I won’t get into the case, but suffice it to say that the classification of tomatoes becomes significant when money (or other scarce resources) is at stake. Now that I have discussed the stakes of definitions, let us move on to the concept of intersex.

The Definition of Intersex

Biological sex as a category (not act) is most often broken down into primary and secondary characteristics. Primary sex characteristics are gonads (ovaries and testicles), sex organs (vaginas, cervixes, uteri, penises, and scrotums), and chromosomes (XX, XY). Secondary sex characteristics (generally the visible ones) are those primarily used in social interaction to categorize people: breasts, body shape, facial/body hair, vocal pitch, and hormones. So far, nothing is yet “political.”

In intersex persons, there is some overlap in what is normally male or female. When Fausto-Sterling discussed intersex persons in her first article, note the very terms she uses to develop her essay: “true hermaphrodites,” “male pseudohermaphrodites,” and “female pseudohermaphrodites.” While I will get to what she means, note the scarce resource of dignity caught up in the prefix “pseudo-.“ If anyone called you a “pseudo-parent” or a “pseudo-human,” or a “pseudo-nice-person,” or a “pseudo-wife,” etc., do you think the name-caller and the other person are going to be bosom chums? Fausto-Sterling in her later article admitted she was being provocative; today I would just term it inflammatory. But I digress. She noted that the then Intersex Society of North America (ISNA) had advocated for in further classifying intersex persons: Type I, Type II, etc.

What did Fausto-Sterling mean by these terms and how did they relate to intersex? Intersex covers the three subgroups she termed. “True hermaphrodites” have at least one working ovary and teste; “female pseudohermaphrodites” have at least one ovary and some shared primary sex characteristics (e.g., an enlarged clitoris, fused perineum, facial hair, etc.) but no testes; “male pseudohermaphrodites” have at least one teste and some shared sex characteristics (e.g., a vagina, breasts, etc.) but no ovaries. For a list of technical terms, see the FAQ page on ISNA’s site for the various permutations (

Why Talk about Something So Intimate and Personal (i.e., politics)?

I have asked myself this question since reading Michel Foucault’s book The History of Sexuality, Volume 1. He argued that discourse about sex had increased since the seventeenth century and had along the way morphed into what is called “power-knowledge” (similar to how I defined politics: s/he who defines the terms determines where the debate/discussion goes). The literal religious phenomenon of confession socially transformed into “confessing” to doctors, teachers, parents, and psychiatrists. Confession developed into a way for authorities/experts to extract confessions from children, patents, etc. This intellectual nugget challenges me to think about why I study things and the possible effects of that study. It will at least result in publication on this blog, and potentially in academic publishing in the future. But what is at stake in talking about people I don’t even know?

I think my intentions lie in aiding peoples’ full inclusion in society, people who don’t normally fit societal expectations. This probably comes from experiences in my childhood where I was bullied, didn’t often fit in, and not accepting the dogma that “life isn’t fair.” Life isn’t fair, but that doesn’t mean I sit back and leave life to its own devices. To do so forfeits agency and the potential for change.

Intersex persons are living, breathing examples of persons who lie outside sex/gender norms of heteronormativity. In that sense, they are abnormal. It is easy to stop when we hear the word abnormal and then move on with life by ignoring those who are abnormal according to a definition or castigating them until they fit normalcy. That is the politics of words. If people aren’t normal or are deviant, then I don’t have to hear their concerns.

But norms are norms only insofar as they are agreed upon. What is at stake in including or excluding intersex persons from normalcy?

By virtue of being born, the very bodies of intersex persons question the foundations of what it means to be a sexual being. Constructs of heterosexuality, homosexuality, and bisexuality are built upon a two-sex model: people are born either male or female. From this postulate, persons have sex with the “opposite” sex or the “same” sex or “both.”

The problem is intersex persons do not have an “opposite” sex to make heteronormativity work. They can literally have sex with men and with women and not be heterosexual, homosexual, or bisexual; each of these terms assumes a strict two-sex model: the “opposite,” “same,” or “both” sexes.

What is at stake then? What is the politics of sex? Let’s say Obergefell v. Hodges hadn’t happened. Let’s go all the way back to the early 1990s when same-sex marriage hadn’t even entered litigation. The definitions of sex, gender, marriage, ethics, medicine, psychology, and more is at stake. Normalcy (as conceived in the West) itself is at stake. The All-American Boy and Disney Princess are at stake.

Can the All-American Boy, the Disney Princess, and the intersex child coexist?

Where is the model the intersex gets to model his life after?

PRONOUNS! What language can the intersex come up with that doesn’t exclude them but also doesn’t target them for abuse?

Do we try to get them to either “play house” or “cops and robbers,” or both or introduce a new space of activities? What about sex/gender-neutral activities?

Exclusivity helps define an identity but where does exclusivity become a detriment to society and to persons? Is there a point where inclusivity goes too far? Why?

Past Attitudes and Procedures Concerning People Who Are Intersex

I include the questions above because of how intersex persons have been treated in the past. Two physicians in the late 1960s, Christopher J. Dewhurst and Ronald R. Gordon, asserted that parents of intersex persons and the intersex persons themselves would be doomed to a life of misery. This attitude fueled procedures to alter the organs and hormones of these persons. This is where the politics of sex relates transgender persons and intersex persons: “sex changes” or sex-reassignment surgery. What some decry in transgender persons—the taking of hormones and the manipulation of genitals* to alter birth sex—was and is prescribed by doctors so that intersex persons fit a two-sex model of humanity. Literally, they sometimes have parts of their identities cut off at the root.

Up to 1:58 people are born intersex according to Fausto-Sterling’s research. This number is slightly higher than the rate for autism, which is 1:68 (CDC 2014). To put that in perspective then, of the 159,498 people living in Springfield, Missouri, 2,749 were born intersex. Why don’t we hear about them? Why don’t they have public services like those in Springfield can have (e.g., Development Center of the Ozarks, ARC of the Ozarks, Abilities First, etc.)?

While genital and hormonal manipulation was probably done out of humanitarian concern, it nonetheless took choice away from parents, and definitely from the child. It was forced sex-reassignment surgery according to “what nature intended” (the words of John Money from Johns Hopkins University in the 1950s).

To get a picture of Dewhurst and Gordon’s (mentioned above) sensitivity, consider the following quote from their work, The Intersexual Disorders:

“One can only attempt to imagine the anguish of the parents. That a newborn should have a deformity … [affecting] so fundamental an issue as the very sex of the child … is a tragic event which immediately conjures up visions of a hopeless psychological misfit doomed to live always as a sexual freak in loneliness and frustration.” (quoted in “The Five Sexes: Why Male and Female Are Not Enough”)

In a limited sense, Dewhurst and Gordon are empathizing with parents who wished for “normal” children. On my read, they dropped the ball (threw it into the stands?) on doing no harm. These doctors who were meant to heal were the first people these children met after exiting their mothers. The crying babes didn’t hear the words “It’s a boy” or “It’s a girl” but “It’s a hopeless psychological misfit” or “It’s a sexual freak.”

To lay all the blame at the feet of doctors, though, would be unfair. We also don’t hear much about intersex persons, because most people don’t run about with exposed genitals. It’s pretty customary to wear clothes in public. So even if a family and their doctor chose not to go the route of genital and hormonal manipulation, there is still a lot of things people don’t have to know about you if you don’t want them to. Many choose not to participate in the wonderful locker room comparative ritual involved with penis and breast sizes. And that’s ok.

I wrote this post to provoke how we deal with the sometimes heavy burden of normalcy. Hopefully it is food for thought. Normalcy can be a blanket that warms you if you lie beneath its fabric or a means of suffocation for those not completely covered by it.

*Below is a surgical video (clitoroplasty), so if you are opposed to seeing it yourself, or do not wish your child(ren) to see it, do not click on it; I will describe it. Urologists at the University of Belgrade, Serbia perform a clitoroplasty on a 20 year old intersex person. The person’s genitalia include an enlarged clitoris (after its hidden anatomy had been uncovered, it appeared around the size of a fully mature penis, approximately 4-5 inches), a vagina, and testicles (only one is visible to the left of the clitoris, though both are there). The patient transitions fully to female. The urologists removed all erectile tissue that had been present beneath the clitoris in what I could only assume was very painful (when erect, the tissue was S-shaped).

I am happy for the patient because her parents and pediatricians gave her the option to choose this herself. Surgeries that are so intimate and invasive deserve different ethical consideration than they have received in the past. This is not an ear piercing of an infant. While its morality is also up for debate, it involves more than male circumcision. This affects the sex of a person; that decision should be left up to the person whose manipulation it affects, not another, including the parents.

Clitoroplasty in intersex repair using disassembly technique

This previous Wednesday I did not want to cover the recent news with Planned Parenthood, because I hadn’t read much on it. Frankly, I hadn’t thought much about Planned Parenthood or abortion in general because I hadn’t ever considered getting pregnant. It’s interesting what will make you sit down and think about something. Next Wednesday’s post will cover my emerging thoughts on abortion.

Link Wednesday #2: Is Caitlyn Jenner Mentally Ill?

(~1350 words: analyzing Paul McHugh’s dealing with transgender issues)

Caitlyn Jenner’s last interview as Bruce Jenner occurred a little over a month ago. Then on June 1, 2015, she announced herself to the world with her new name and a cover shot. This prompted comments ranging from support to denigration.

So this link Wednesday has to do with one psychiatrist in particular who holds a lot of clout with conservatives who oppose to transgender persons (or what transgender people do, not their persons, according to the rhetoric).

1. “Surgical Sex” by Paul McHugh

Paul McHugh

Paul McHugh

Paul McHugh was the longtime chief psychiatrist, professor of psychiatry, and department head at Johns Hopkins University and Johns Hopkins Hospital. He has gained much publicity for his position against SRS. In this article published on First Things (see their About page here), he discusses why he opposes it. He primarily found the desire for SRS solely in men who could not deal with their own homosexual attraction and sexual experience. He wished to test his unease with these men by testing 1) if an operation resolved other “psychosocial issues” (“relationships, work, and emotions”) in them and 2) if operations performed on boys with abnormal genitals combined with raising the them as girls allowed them to be gender-adjusted in adult life as women.

Concerning his first inquiry, McHugh followed Jon Meyer’s research. Meyer had spoken with SRS patients years after their surgeries, finding that they were largely satisfied with their choice. McHugh inferred, though, that the surgery did not resolve other psychological issues present in them.

Concerning his second inquiry, he followed the research of William G. Reiner. First, Reiner used comparative anatomy to conclude that even if boys were surgically altered postpartum, they had still been exposed to testosterone in utero. These young children, though raised as girls, preferred “boy” play: “enjoying rough-and-tumble games but not dolls and ‘playing house.’” Reiner’s case study on 16 “genetic males with cloacal exstrophy” found that once the youths had learned about their birth sex:

  • 8 boys declared themselves male
  • 5 continued to live as females
  • 1 lived in sexual ambiguity
  • (2 had parents who had elected not to have the surgery performed on their children)

McHugh then concluded that gender identity flows not from socialization, but from genetics and intrauterine encounters with testosterone. I have two issues with McHugh’s inferences from the data and studies. The first has to do with the propriety of his first inquiry: is it appropriate to ask if SRS solves other psychological problems in a person? I’ll propose something and let you think about it: does gall bladder surgery have benefits for asthma sufferers? McHugh admitted that men who underwent SRS were satisfied with the results in the majority of cases. His contention is that it did not solve attendant psychological issues. Should that be expected? If I suffer from bipolar disorder, schizophrenia, and obsessive-compulsive personality disorder, will treatment for one diagnosis work for the other two? Some medications help multiple things. For example, Depakote can be used as a treatment for seizures, migraines, or the manic phase of bipolar disorder. But this isn’t always the case, and to expect one treatment to affect multiple issues doesn’t seem reasonable to me.

My second issue has to do with McHugh’s use of Reiner: “sexual identity is mostly built into our constitution by the genes we inherit and the embryogenesis we undergo. Male hormones sexualize the brain and the mind.” If effects in the uterus are primarily what account for sexual identity, why did nearly 43% of the boys operated on live as females—i.e., according to socialization—or ambiguously? Wouldn’t his claim call for a much higher ratio of “boyness” trying to overcome female socialization? Can a claim for naturalness/normalcy hold if it only accounts for roughly 57% of the sample?

2. “Transgender Surgery Isn’t the Solution”

(Google the title; if you click on this link, you have to subscribe in order to read the full article)

I came across this article when another article referenced it. That article had the catchy snippets in its title: “Johns Hopkins Psychiatrist: Transgender is ‘Mental Disorder;’ [sic] Sex Change ‘Biologically Impossible.’” (check out what the DSM-V says about it being a mental disorder; thanks to Brynn Tannehill; In the upcoming weeks, when I discuss the “institution” aspect of religion, I will discuss the politics of classification) While I read that article, I wanted to read the original. It is imperative in research to see what writers/speakers do with their sources in order to see if there are unstated motivations beneath their stated intentions.

I want to draw attention to one statistic provided by McHugh:

When children who reported transgender feelings were tracked without medical or surgical treatment at both Vanderbilt University and London’s Portman Clinic, 70%-80% of them spontaneously lost those feelings. Some 25% did have persisting feelings; what differentiates those individuals remains to be discerned.(Monte’s emphasis)

He also refers again to his reason for stopping sex surgery at Johns Hopkins: “surgically treated patients” were satisfied with the surgery, but didn’t experience relief from other “psychosocial” issues which he doesn’t detail here.

In this article, he produces a much more relevant study to his aims. The Karolinska Institute in Sweden conducted a 30+ year longitudinal study on over 300 people who had undergone SRS. He highlights two things. One, 10 years following the surgery brought about mental health issues, and two, the patients had a 20-fold suicide mortality rate when compared with the general population.

Concerning the Vanderbilt/Portman study, McHugh admits that no one knows for sure why gender dysphoria continues in 25% of individuals who experience it as children. With him, I don’t know what to do with this. It could have genetic or social contributors, or a combination of the two. We just don’t know. However, he’s the psychiatrist, and he doesn’t offer any alternatives to SRS (besides “devoted parenting” for children and adolescents) or help. If you’re a public intellectual offering your two cents, provide some solutions.

The second study concerns me. That suicide statistic is astounding. An article by Mari Brighe (about The Transadvocate here) critiquing McHugh’s op-ed detailed many of his misuses of data, including the following quote from the Karolinska study:

It is therefore important to note that the current study is only informative with respect to transsexuals persons health after sex reassignment; no inferences can be drawn as to the effectiveness of sex reassignment as a treatment for transsexualism. In other words, the results should not be interpreted such as sex reassignment per se increases morbidity and mortality. Things might have been even worse without sex reassignment. As an analogy, similar studies have found increased somatic morbidity, suicide rate, and overall mortality for patients treated for bipolar disorder and schizophrenia. This is important information, but it does not follow that mood stabilizing treatment or antipsychotic treatment is the culprit. (Monte’s emphasis)

Further links in the article cite differences in androgen receptors between transgender and cisgender men and a difference in brain anatomy between transgender women who haven’t yet undergone hormonal treatment (the article calls them “male-to-female (MTF) transsexuals”) and cisgender men.

What I take from this is that transgender persons need more access to mental health resources, but that a ban on SRS in itself would not “fix” them. With high suicide rates, abuse from families of origin, mistreatment by police and hospitals, and homelessness, exclusionary tactics like negative labels are not helpful. Labels more often than not serve to categorize a group as “Not us,” that can then serve as a shield of indifference to real complaints, issues, and needs.

So is Caitlyn Jenner mentally ill on account of being transgender? The DSM says no. I think the question might be missing an issue, though. My question is, do Jenner and people like her have access to mental health, relational, financial, occupational, housing, and other resources that I enjoy because no one is obstructing my access according to my appearance? I guess a person could say, “Stop trying to be something you’re not. Make your appearance more normal and you won’t have these problems.” To me that’s like saying, “Stop practicing Christianity, because it’s against your nature. You won’t have relational problems associated with being resisted because of your religious observance.”