Intersexuality

The term intersexuality refers to a series of conditions in which sexual characteristics (genital, chromosomal, genetic) can be defined as ambiguous. Individuals with such characteristics do not conform to cultural standards relating to the typical definition of “male” and “female.”

Recent scientific literature claims that about 2 in 1,000 children are born with anatomical characteristics that are considered “ambiguous;” that is, they have genitals that are difficult to define because of variations in their chromosomes or hormones. Most of these undergo surgery that alters their “natural” condition, to conform to the sexual anatomical “standards” of compulsory gender reassignment surgery. Intersexuality is particularly interesting for studies of social deviance as proof of how the construction of normality (in this case medical and surgical) is entrusted to professionals (i.e., doctors) who play a role in defining standards. The existence of groups of intersex activists (Intersex Society of North America) and their experiences show not only that gender, sex, and sexuality are not aligned with each other but also how medical labels can be a means of control as they reinforce the male or female dichotomy and, more generally, reduce or remove any variation in gender that might challenge the social order. Surgically imposed adaptation reflects the shared social norms determining what constitutes the normal sexual anatomy of an individual and its appearance.

The first medical treatments for intersex individuals date back to 1930 and were mainly practiced in the United States. The scientific community assumed that the intersex individual did not functionally develop as a fetus. It was only starting in 1950 that the first intersex individuals underwent surgery to remove any physical differences: starting with the dominant physical features, physical appearance was thus corrected. Doctors were concerned with setting standards and deciding what defined a male and a female, and which sexual characteristics could be defined as aberrant and which conventional.

In the medical–surgical field, in fact, there seems to be a clear cultural correspondence between gender and genitals, and thus between the penis and masculinity and the vagina and femininity. These medical–surgical and endocrinological principles date back to the 1950s and specifically to the work of John Money, whose model of therapy and treatment recommended treating intersex newborns and babies surgically and with hormone operations to make them conform to cultural standards and social norms. One of the most controversial principles consisted in limiting the information given to intersex individuals and their parents to avoid any psychological trauma. Parents even received minimal information on a newborn's general condition, so that they could be led to the decisions that the doctors considered most appropriate for that specific case. Even today, the American Academy of Pediatrics (AAP) policy is that a birth with ambiguous genitalia constitutes a social [Page 384]emergency. It provides suggestions and recommendations on treatment of cases of intersexuality and on communicating them to the parents: The publication claims that a diagnosis should be given, and surgical treatment carried out, as soon as possible, to minimize the risks of medical, psychological, and social complications. These assumptions came under fire, especially due to the intervention of intersexual adults and activists. These activists denounced the physical and psychological suffering caused by surgeries. They claim that surgical reconstruction is almost never perfect and can result in partial and poor reconstruction of genitals, which makes it impossible to feel orgasms and can leave individuals unable to reproduce. It should be emphasized, moreover, that the medical and surgical practices used to humiliate intersex individuals are a reaction to the cultural imperative of a capacity for sexual performance, constructing an individual whose main characteristic is a facility to conduct sexual relations, independent of the person's ability to experience pleasure or reproduce. The contemporary debate has focused on delicate aspects relating to informed consent and the deficiency of standards of care for individuals with ambiguous genitalia. Activists and a new generation of scholars have pondered the necessity and responsibility to inform not just parents but also patients themselves of the risks of an operation, its effectiveness, and the alternatives. Providing such information is based on the right of the individual to self-determination. The debate on surgical treatment of intersex newborns and babies is ongoing and still provokes considerations that are useful in understanding processes of anatomical and cultural normalization. The traditional (dominant) medical protocol imposing surgical reconstruction of the sex of newborns coexists with models that are more patient oriented. Such models assess the apparent gender of the intersex newborn, provide gender education and socialization, offer support to the parents, and encourage postponement of surgery until the individual is fully aware of it and can decide whether it is the right course of action. Due to the work of activists, the practice of surgical alterations to individuals has been called into question, given that it can jeopardize psychic balance and physical integrity. The idea that the parents who are well informed of the risks of all the protocols will be able to make the decisions in the best interests of their child, based on real informed consent, has also gained ground.

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