Stories of Gay Teen Suicide

Suicide is a tough topic to talk about. That's why many people don't talk about it.

One of the myths about suicide is: if you ask someone about their suicidal intentions, you will only encourage them to kill themselves. Actually, the opposite is true. Asking someone directly about their suicidal intentions will often lower their anxiety level and act as a deterrent to suicidal behavior by encouraging the ventilation of pent-up emotions through a frank discussion of his problems.

There are 2 types of suicide stories on this site:

  1. Left Behind. Stories and letters from parents, relatives, and close friends of those gay teens who committed suicide.
  2. A Price Too High. News articles, obituaries and other accounts of gay teenagers who committed suicide.

 



next: A Suicide Note From Bruce David Ciniello
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~ all articles on gender

APA Reference
Staff, H. (2007, August 10). Stories of Gay Teen Suicide, HealthyPlace. Retrieved on 2024, December 20 from https://www.healthyplace.com/gender/gay-is-ok/stories-of-gay-teen-suicide

Last Updated: March 14, 2016

Coming Out and Staying Out

A Guide For Gay and Bisexual Men

This guide has been written for gay and bisexual men of all ages who are thinking of coming out. We know that making the decision to come out can be scary and stressful. It is for these reasons and because of our work as gay men's health workers that we put together this guide. We believe that useful information and other people's experiences of coming out can help to prepare you for some of the consequences that coming out to family and friends may bring.

Coming Out Gay or BisexualComing out is different for every person. We have tried to answer some of the questions that we are regularly asked, although in reality, this guide is likely to prompt more questions than it answers, but we hope it will help you during this time.

Remember - there is always someone you can talk to. There are many organisations that can help with your questions and concerns about being gay or coming out and we have listed some of them on the information page of this guide.

This guide has been written with the United Kingdom in mind, please remember if you live outside the UK that some of the information will not apply to where you live. For example, in some countries being homosexual is still illegal, or attitudes towards being gay or bisexual can be so severe that coming out is not safe. Use the web to look for more information about how things are where you live.

Good Luck!

Douglas Newberry and Mark Rendell

What Does Being Gay Mean

In simple terms, being gay means that you are sexually attracted to members of your own sex and that you identify with other gay people or the larger gay community. Sexuality is a term used to describe a whole range of feelings, desires and actions relating to sex.

Why Am I Gay?

Nobody knows for sure why some of us are gay and some of us are not. Lots of theories have been put forward ranging from genetic differences to overbearing parents. The evidence so far suggests that random genetic factors play a part in determining our sexuality in the same way they play a part in determining, for example, lefthandedness.

One thing we do know is that no-one chooses their sexuality. Some gay people knew they were different, if not gay, from as young as five or six. It is said that, for most of us, our sexuality is determined by the age of 12 or 13 and probably 16 at the latest. By and large, society tends to assume that everyone is, or wants to be, heterosexual. This is known as heterosexism. Some people continue to believe that it is a choice and that we can be persuaded into heterosexuality. By assuming heterosexuality, society gives rise to the dilemma, for those of us who know we are gay, of whether to hide our sexuality or to come out - with all that this entails.

There have been small but perceptible changes in the way British society views homosexuality, but there is a long way to go before it will accept us in the same way as it does people who are, say, lefthanded. This has more to do with society's hang-ups around sex and sexuality than individual gay people. Often, once people know someone who is gay, their prejudices and fears about homosexuality disappear all together.

Growing Up Gay

For many young gay or bisexual people, adolescence can be a time of particular anxiety and fear. Many lesbians and gay men look back on this part of their lives with sadness and regret. There are very few positive gay role models and a lot of hostility towards openly gay people. Gay teenagers often become painfully aware that they are not like other people and many become withdrawn and lonely, convinced that only they are feeling this way. They learn to hide their true feelings or act as others want them to, for fear of being ostracised, ridiculed or rejected by loved ones and friends.

Above all, there can be a sense that we are somehow different, that we are abnormal and that we are going to disappoint people.

Some people believe that if they get married their gay feelings will disappear. It is unusual for this to happen. Most store up a great deal of stress and anxiety for their later years. Coming out as a gay parent has particular challenges. Breaking out of a clearly defined role, or even attempting to shift the definition of it, involves tremendous courage and strength. The conflict between their relationship with their spouse and family and their need to be themselves can be enormous.

Coming Out

There are several stages in the process of coming out. It's your life so take your time - do things for you and only when you are ready.

Coming Out To Yourself

Acknowledging that you are gay can take many years. Some of us probably hoped these feelings were "just a phase". In time, we realise that these feelings are not just a phase and we have to find a way of accepting them and dealing with the fact that we are sexually attracted to members of our own sex.




accepting your sexuality, being gay, can put you on an emotional rollercoasterThis realisation is the first stage of coming out. There is no hard and fast rule when this point is reached. For some it happens in their teens, for others it may happen much later in life.

Some people describe this time of accepting their sexuality as though they were riding an emotional rollercoaster. One day they felt happy and confident and ready to tell everyone; the next they felt confused, scared and relieved that they hadn't. You may want to talk to someone who understands what this is like. We have included details of a number of organisations in the United Kingdom that can help on the GMHP Directory.

So You Still Want To Come Out

This is a nerve racking time - the fear of rejection is likely to be immense. Bear in mind that there are many ways to tell someone that you are gay.

It may be helpful to ask yourself some of the questions that come up later in this guide, as it is more than likely that others will ask you them at some point. Don't rehearse your answers but think of your reasons - it will make you and your discussions stronger and more assured.

Coming Out To Others

The next stage involves going public in some way, of "coming out of the closet". Who you tell next is really up to you. You may decide to tell your best friend or a member of your family.

Remember, once you have told someone about your sexuality it can become known to others within a short period. This is human nature and there is very little you can do to prevent this. If you are resolved to deal with any negativity that this disclosure may bring, you will be sufficiently prepared for it.

Why Do I Want To Come Out

This is the most important question to ask yourself. If you answer something like: "Because I'm proud of who I am" or "It is impossible to become a fully happy human being if my sexuality remains suppressed" or "I want to meet other gay people" then these are good reasons. Think very carefully if your reasoning is to hurt or shock people. Often the person who gets hurt will be you.

Who Should I Tell

If you are going to come out gay or bisexual, tell someone you trust and who is supportiveMany gay people describe how important it is to first tell someone outside the family. Make sure it's someone you trust and who you believe to be open minded and supportive. Be careful if you decide to confide in a teacher at school - they may be obliged to tell someone else what you have told them. Find out the school policy on confidentiality before you go ahead.

If you have decided to tell your family it may be easier to talk to one parent before the other. You could then ask them for help to approach the other. Sometimes brothers and sisters are a good starting point as they are likely to understand more about homosexuality or bisexuality. Make sure you understand why you are going to tell them. One of the best reasons to come out to your family is to become closer to them.

There are a number of typical responses that parents, particularly, are known to say: "How can you be sure?", "I went through a phase like this at your age", "You'll grow out of it", "You haven't tried hard enough with the opposite sex" and "How can you know at your age?"

We have listed them here because they may help you to think of your answers to them. You might find it helpful to discuss these questions first with a trusted friend or a lesbian and gay helpline or switchboard. See the GMHP Directory for details.

Support For Your Family

This can be a traumatic time for some members of your family. You may feel unable to answer all their questions or to deal with all of the issues that come up for them. They, in turn, may not feel comfortable talking about homosexuality or bisexuality with you. There are several organisations that offer support to parents who are coming to terms with their sons' and daughters' sexuality. Acceptance produces booklets written for parents - you can request copies from the address given on the GMHP Directory national organisations page.

This can be a difficult time if your happiness is dependent to some degree on your family's reaction. If this is the case for you, we would advise that you talk it over with someone who has been through it already - perhaps your local gay switchboard or helpline.

How Should I Tell Them

There is no rule that says you have to sit down and talk to others about this, there are other ways.




Writing a letter may be a good way to come out gay or bisexualYou might like to write to them first and give them time to react in their own way. This is probably a better approach if, for example, you live a long way from your family or friends. Remember that you have probably taken a long time to get used to the idea yourself and others might need the same amount of time. Writing a letter allows you to take your time and to compose your thoughts carefully and clearly. It can also give the person you are writing to space to react and consider the news before discussing it with you. This could be a useful approach if you are expecting a very hostile or negative reaction.

If you decide to talk face to face, remember not to rush it or to do it when one of you is in a hurry or distracted. It probably won't help to memorise a script either - you can guarantee that some people do not respond in a predictable manner. If you are worried about their reaction, tell them of your fears and that you don't want to hurt them but need to be honest with them. Remember to listen to what they have to say - it should be along the lines of a chat, not a speech!

When Should I Tell Them

When it comes to coming out, timing is an important consideration. Choose the moment carefully - do it when you (and they) have lots of time - not last thing at night when you are likely to be more tired and emotional.

Think about the way you are feeling, allowing for nerves, which are perfectly natural under the circumstances, don't do it if you are feeling angry or emotionally sensitive - this will affect what you say and how you say it. For obvious reasons, don't do it when you are drunk (even if you think you need a drink to steady your nerves).

And remember - only when you are good and ready. A friend once said that he knew he was ready to tell his family only when he realised that, if he had to, he could live without their support. Fortunately for him (and his family), this didn't happen.

Consequences and Reactions

So you've told someone. You are either balancing on the edge of an erupting volcano or dancing with joy on the moon (or both!). Some people describe a huge weight being lifted from their shoulders, of feeling euphoric and giggly and childlike again.

Don't feel guilty about it - go on and enjoy yourself, you deserve it. The thrill of revealing something long kept hidden can give a tremendous sense of relief.

Use this new found energy wisely and remember that close friends and family may be worried that you have changed out of all recognition. Reassure them that you have changed - and for the better and that you are simply exploring a new, more complete you.

Most people will experience many positive reactions. For example, "We're so pleased you could tell us" or "Well we had already guessed and were just waiting for you to say something". Some gay people have also met with the response, "So am I".

"My parents refused to talk about it. They dismissed it and said they didn't want the subject brought up again. I decided that I was going to continue to live my life as a gay man. I stopped going home as often as I used to and attending family occasions. It is only now, three years later, that they have begun to broach the subject with me."

If it hasn't gone too well - don't lose heart. Time is a great healer and things will get better. If you are experiencing rejection from some close friends, ask yourself if they were really so close that they couldn't support you through this. If your family is reacting badly, this is in all probability, normal. They may be experiencing a whole range of emotions including shock, grief, guilt, blame, disappointment and lots of pain.

"My family say that they accept that I am gay but they don't want to see me being affectionate with another man. They say that they won't be able to cope with it."

Remember how long it took for you to come to terms with being gay. Many parents will feel a loss in some way - perhaps of future grandchildren or weddings and other family gatherings. This can blur their happiness and their love for you.

"I was at a wedding recently and everyone was there with their partners. I was upset that I couldn't bring mine. Everyone asked the usual embarrassing questions about girlfriends and I just had to smile and make excuses. I didn't want to row with my family about it but it's just not fair."

At the end of the day, your parents are still your parents and, in time, few reject their children because they are gay.

"My dad said, "You're still my son and I'm proud of you." He'd been very homophobic up to then."

If they go quiet on you, give them time to react and the opportunity to think about what you have told them. If they ask lots of questions, it's a good sign. It may help to think of it as though it is in your interests to respond to them - they are likely to be the same ones that you have asked yourself many times along the way.

If things are so bad that you feel like giving up with the whole process of coming out, it's important to talk to someone about your fears and concerns. Again your local switchboard, helpline or Gay Men's Health Project can offer you support and guidance.




coming out gay or bisexual, telling others you are gay or bisexualIt's probably better to persevere and keep going, after all, you have come this far and in many ways it would be difficult or impossible to go back now. The next person you talk to will probably give you a huge hug and say that they were relieved that you had found the courage to tell them and that they had suspected that something may have been on your mind for a long time.

Coming Out At Work

There are some circumstances where coming out could seriously affect your job security and promotion prospects. In some circumstances, being openly gay could be in contravention of the rules of the employer, for example the Armed Forces, probation services, some non-metropolitan police forces and prisons.

The Armed Forces

Because of changes in the law, this section of the coming out guide is not currently up to date ... we have therefore decided to remove it until a new version is written. However, if you work for the Armed Forces and you wish to seek the latest information, or need to talk to someone about your sexuality, contact a confidential service such as a local gay switchboard or talk to experienced counsellors at Rank Outsiders or At Ease (phone numbers on the GMHP Directory national information page).

Prisons

In some prisons where the prison culture is particularly homophobic, gay prisoners, including those on remand, risk harassment, abuse and violence. An address for Gay Rights in Prison appears on the GMHP Directory national organisations page.

Telling Your Doctor

It is worth mentioning, too, that if you disclose your sexuality to your general practitioner (doctor), they may record these details in your medical records. These medical records can be accessed by a range of organisations for many different purposes.

Meeting Other Gay People

There comes a time to stop talking and to get on with living your (new) life exactly how you want to. It's time to meet other gay and bisexual people and to explore your sexuality safely and confidently.

A common reaction to this statement, especially in rural areas is, "Fine - but where do I start?" Remember that being gay is about expressing yourself in the way YOU want to. Despite the stereotypes, there is no single way of being gay. We are all as different as any other group of people.

gay social groups, gay men's health projectsGoing out with friends and meeting new ones at clubs or parties can be great. But the scene isn't for everybody and it's not everything there is to being gay. Most towns and cities have gay social groups and gay men's health projects. These can be excellent places to meet new people and to find out what there is to do locally and most will arrange to meet first time visitors beforehand.

As with any group of people, there will be some you get on with and some you won't. If you feel that you have little in common with the gay people you have met so far, you could try different ways of contacting more gay men, for example as pen pals, or through the many special interest gay groups (like gay men's choirs or gay football supporters networks) - look them up in Gay Times (available from some local newsagents or by subscription see the GMHP Directory).

Healthy Lives and ...

There's no doubt that having a positive attitude towards yourself goes a long way to keeping healthy. It's also important, in whatever you do, that you look after yourself and consider your actions in relation to others.

This is particularly useful advice when it comes to sex. Whether it's a relationship or a one night stand, sex with another man can feel great and should make us feel good about who we are. Sex with other men can be whatever you want it to be and it's important to be clear about what you do want to do and what you don't. As with anything, people have their likes and dislikes and it's important that you talk them over with your sexual partner.

...Safer Sex

In the United Kingdom, HIV (the virus that is believed to be the cause of AIDS) affects more gay men than any other group and this can make us anxious about sex. But once we know how we can protect ourselves and our partners, we can relax and enjoy ourselves. HIV cannot be passed on through wanking (masturbating), kissing, touching or hugging. The risk of transmitting HIV through oral sex (cock sucking) is believed to be very low but if either of you have cuts or sores in the mouth, you should use condoms (flavoured ones taste much better).

safe gay sexAnal sex (fucking), is the riskiest activity as far as transmitting HIV is concerned but by using suitable condoms and lubricant every time you fuck you can substantially reduce the risk. Suitable condoms for fucking are: Mates Superstrong, Durex UltraStrong, H.T. Special, GaySafe and Boy's Own. Of course, there is still a risk if the condom breaks, leaks or comes off. Lubricant is essential as it makes it safer and easier, so always use plenty of water based lube such as KY or Liquid Silk. Don't use oils, creams or lotions such as Vaseline or baby oil as they weaken the rubber in condoms in seconds.

You can obtain suitable condoms free of charge from Gay Men's Health Projects, some gay bars and clubs, Family Planning Clinics, some Youth Advisory Services and local GUM (Clap/VD/STD) clinics. Check the Yellow Pages for the clinic addresses if you are unsure where the nearest ones to you are.

While on the subject of sexually transmited diseases, it is worth mentioning that Hepatitis B is far more prevalent than HIV among gay men and it is much easier to become infected with it. The good news is that there is a vaccine against Hepatitis B and you can get vaccinated free of charge at your local GUM clinic.

For a confidential chat or for more information on any aspect of HIV, AIDS, safer sex or Hepatitis B, contact your local gay men's health project.

© 1994 - 2000 Salisbury Gay Men's Health Project Mid Hampshire Gay Men's Health Project.



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APA Reference
Staff, H. (2007, August 10). Coming Out and Staying Out, HealthyPlace. Retrieved on 2024, December 20 from https://www.healthyplace.com/gender/gay-is-ok/coming-out-and-staying-out

Last Updated: March 14, 2016

Frequently Asked Questions from Non-Intersexed People

Do intersexed people really exist?

Yes... intersexed people, real hermaphrodites, really do exist! The trouble is that most people are only familiar with the two types of mythological hermaphrodite. Hermaphroditus, the merger of Hermes and Aphrodite into one body is a myth and only a myth. Hermaphroditus gives rise to a myth herself about intersexed people - what I call the Two in One myth. Intersexed people are not "both sexes in one" but are a biological uniqueness of their own form.

The second type of mythological hermaphrodite can be seen in some types of pornography. These people are NOT intersexed people. They are women with carefully done prostheses who are making pornography. Some people also seem to be identifying themselves as "intersexed" when perhaps what they mean is "intergendered". Intersex refers to the physical manifestation of genital/genetic/endocrinological differentiation which is different from the cultural norm (refer to the ISNA FAQ for a detailed discussion of biological specifics).

Where are intersexed people?

People who know that intersexed people really do exist may wonder, "If there may be as many as one out of two thousand people affected by some form of intersex condition... where are they all? Why don't we hear of them or see books about their stories?"

The answer is that most intersexed people have a very, very hard time with the personal issues which surround being born intersexed. There is a relatively small group of "out" intersexuals in the world, a number that is steadily growing, but the vast majority of us live with the silence, shame and fear that we learned as children and teens. Other misunderstood minorities have made great strides in being recognized. There are thousands of books written by Gay men and women and even dozens on the subject of transexuality, which is thought to be quite rare in actuality.

The reason may be that most intersexed people have been subjected to very, very powerful family, medical and societal proscriptions about talking about their bodies or medical status. This begins from the very moment of birth for most of us because that is usually when the question is first asked, "Is IT a boy or a girl?" Intersexuals who are subjected to neonatal surgery undergo that early physical trauma and resulting lifelong trauma on many levels. Intersexuals who miss early surgery often grow up alone and confused... and often abused, because of their "in between" status. Surgery as young teens and adults to "correct" their bodies is also traumatic and may not have a satisfactory outcome. It all adds up to one thing: a very strong desire to keep quiet and not tell anyone about being intersexed.

Another factor may be abuse. Some intersexed chidren are abused by peers and family due to their intersexuality. But there is also a sort of institutionalized abuse which takes its toll. The constant dehumanizing exams, case studies, etc. are painful, humiliating and upsetting for a child or young teenager. The result is a desire to never have to talk or deal with the subject ever again.

What term do intersexed people prefer for themselves?

It varies from person to person. You will certainly never offend anyone with the terms intersexed and intersexual. Unfortunately those terms seem to be becoming more prevalent amongst people who are not intersexed, so there is the possibility of confusion. Some people are using what I used to call the "H" word. I never used the term because it symbolized my oppression as a research subject utilized for medical experimentation. I also objected to its mythological origins. We are not creatures from myth or Ovid. Other intersexed people are comfortable calling themselves hermaphrodites. Perhaps the use of the word will help de-mythologize it.

Street terms like "morph" and "morphodite" will not be well received.

What is the difference between "true" and "pseudo" hermaphrodites?

People known in the medical literature as true hermaphrodites have a mixed gonadal structure, ovo-testis, or sometimes one ovary and one testis. Pseudo- hermaphrodites constitute everyone else. As far as intersexuality itself goes... the separation is arbitrary and of academic interest only. Gonadal cellular structure is but one aspect of human biology which affects sex and sexual identity. Early medical writers could have chosen some other form of intersex and labeled it as "true hermaphroditism", such as Androgen Insensitivity Syndrome, but they didn't. The origin of this division is probably more properly in the realm of the social sciences as applied to the medical culture of the time.

What are herms, merms and ferms?

These terms were used by Anne Fausto-Sterling in her 1993 article in _The Sciences_ "The Five Sexes: Why Male and Female are not enough". Herm refers to "true hermaphrodite"; a merm would be a person born intersexed whose karyotype was XY and a ferm is an XX intersexed person. These delineations serve to educate people that sex is not a bipolar dichotomy, but they do not really classify intersexed people themselves in any meaningful way.




What are the other forms of intersexuality?

  • Progestin-induced androgenization

    Caused by prenatal exposure to exogenous androgens, most commonly progestin. Progestin is a drug which was administered to prevent miscarriage in the 50's and 60's and it is converted to an androgen (virilizing hormone) by the prenatal XX persons metabolism. If the timing is right, the genital anlagen is virilized with effects ranging from enlarged clitoris to the development of a complete phallus and the fusing of the labia. The virilization only occurs prenatally and the endocrinological functionality is unchanged, ie. feminizing puberty occurs due to normally functioning ovaries.

    In other words, XX people affected in-utero by virilizing hormones can be born into a continuum of sex phenotype which ranges from "normal female with large clitoris" to "normal male with no testes". It is noteworthy that the use of progestin is not effective in the prevention of miscarriage.

  • Congenital Adrenal Hyperplasia

    Caused when an anomaly of adrenal function (21-hydroxylase or 11-hydroxylase deficiency) causes the synthesis and excretion an androgen precursor, initiating virilization of a XX person in-utero. Because the virilization originates metabolically, masculinizing effects continue after birth. As in PIA, sex phenotype varies along the same continuum, with the possible added complication of metabolic problems which upset serum sodium balance. The metabolic effects of CAH can be counteracted with cortisone. The scenario for medical intervention for intersex is similar... but CAH people have an increased likelihood of early detection due to metabolic imbalances (Salt Losing Form).

  • Androgen Insensitivity/Partial Insensitivity Syndrome

    In AIS/PAIS the cellular metabolism of an XY person is such that the cells do not respond to the effects of androgens. Endocrinological function is normal... but the cells ability to bind androgens, due to compromised receptor site metabolism, causes a partial or complete lack of response to virilization. PAIS produces effects similar to CAH or PIA in a neonate... genital ambiguity. With complete AIS a neonate shows no indication that they are intersexed as the external genitalia are completely phenotypically female. Internal female structures do not develop however because Mullerian Inhibiting Hormone is present and prevents the formation of a female genital tract (oviducts, cervix, uterus, part of the vagina).

    Another form of AIS is present in individuals with 5-alpha reductase deficieny. During the formation of the male genital tract from the Wolffian duct portion of the genital anlagen, the target tissues are not repondent to testosterone, another form, hydrotestosterone is required at this stage. The required enzyme, 5-alpha reductase, is missing so these people may be assigned and reared as girls. However, since pubertal genital tissue is sensitive to the effects of testosterone... such a child could experience masculinizing puberty and genital growth - assuming that their gonads have not been removed.

  • Turner's Syndrome

    Turner's Syndrome children are born with an XO karyotype and, in the absence of gonads, develop without any endocrinological influenceing sexual phenotype. What this means however, is that they are phenotypically female and raised as such.

It is significant that these events... the discovery and "management" of our medical conditions occur as neonates, children or teenagers ie. during puberty. Our say in which physical "sex" we are intended to be ranges from very little to none.

Additional FAQS include:



next: Sexual Development - Glossary of Terms
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APA Reference
Staff, H. (2007, August 9). Frequently Asked Questions from Non-Intersexed People, HealthyPlace. Retrieved on 2024, December 20 from https://www.healthyplace.com/gender/inside-intersexuality/frequently-asked-questions-from-non-intersexed-people

Last Updated: March 14, 2016

Intersexuality Frequently Asked Questions Table of Contents

© 2000 Intersex Society of North America
This document is reprinted from the original at
http://www.isna.org/FAQ.html
You may wish to visit this original site if you have further interest in this topic.

Additional FAQS include:


What is intersexuality (hermaphroditism)?

Our culture conceives sex anatomy as a dichotomy: humans come in two sexes, conceived of as so different as to be nearly different species. However, developmental embryology, as well as the existence of intersexuals, proves this to be a cultural construction. Anatomic sex differentiation occurs on a male/female continuum, and there are several dimensions.

Genetic sex, or the organization of the "sex chromosomes," is commonly thought to be isomorphic to some idea of "true sex." However, something like 1/500 of the population have a karyotype other than XX or XY. Since genetic testing was instituted for women in the Olympic Games, a number of women have been disqualified as "not women," after winning. However, none of the disqualified women is a man; all have atypical karyotypes, and one gave birth to a healthy child after having been disqualified.

The sex chromosomes determine the differentiation of the gonads into ovaries, testes, ovo-testes, or nonfunctioning streaks. The hormones produced by the fetal gonads determine the differentiation of the external genitalia into male, female, or intermediate (intersexual) morphology. Genitals develop from a common precursor, and therefore intermediate morphology is common, but the popular idea of "two sets" of genitals (male and female) is not possible. Intersexual genitals may look nearly female, with a large clitoris, or with some degree of posterior labial fusion. They may look nearly male, with a small penis, or with hypospadias. They may be truly "right in the middle," with a phallus that can be considered either a large clitoris or a small penis, with a structure that might be a split, empty scrotum, or outer labia, and with a small vagina that opens into the urethra rather than into the perineum.


What is androgen insensitivity syndrome?

Androgen Insensitivity Syndrome, or AIS, is a genetic condition, inherited (except for occasional spontaneous mutations), occurring in approximately 1 in 20,000 individuals. In an individual with complete AIS, the body's cells are unable to respond to androgen, or "male" hormones. ("Male" hormones is an unfortunate term, since these hormones are ordinarily present and active in both males and females.) Some individuals have partial androgen insensitivity.

In an individual with complete AIS and karyotype 46 XY, testes develop during gestation. The fetal testes produce mullerian inhibiting hormone (MIH) and testosterone. As in typical male fetuses, the MIH causes the fetal mullerian ducts to regress, so the fetus lacks uterus, fallopian tubes, and cervix plus upper part of vagina. However, because cells fail to respond to testosterone, the genitals differentiate in the female, rather than the male pattern, and Wolffian structures (epididymis, vas deferens, and seminal vessicles) are absent.

The newborn AIS infant has genitals of normal female appearance, undescended or partially descended testes, and usually a short vagina with no cervix. Occasionally the vagina is nearly absent. AIS individuals are clearly women. At puberty, the estrogen produced by the testes produces breast growth, though it may be late. She does not menstruate, and is not fertile. Most AIS women have no pubic or underarm hair, but some have sparse hair.

When an AIS girl is diagnosed during infancy, physicians often perform surgery to remove her undescended testes. Although removal of testes is advisable, because of the risk of cancer, ISNA advocates that surgery be offered later, when the girl can choose for herself. Testicular cancer is rare before puberty.

Vaginoplasty surgery is frequently performed on AIS infants or girls to increase the size of the vagina, so that she can engage in penetrative intercourse with a partner with an average size penis. Vaginoplasty surgery is problematic, with many failures. ISNA advocates against vaginal surgery on infants. Such surgery should be offered to, not imposed on, the pubertal girl, and she should have an opportunity to speak with adult AIS women about their sexual experience and about surgery in order to make a fully informed decision. Not all AIS women will choose surgery.

Some women have successfully increased the depth of their vagina with a program of regular pressure dilation, using aids designed for that purpose. Contact the AIS Support Network.

Physicians and parents have been most reluctant to be honest with AIS girls and women about their condition, and this secrecy and stigma has unnecessarily increased the emotional burden of being different.

Because AIS is a genetic defect located on the X chromosome, it runs in families. Except for spontaneous mutations, the mother of an AIS individual is a carrier, and her XY children have a 1/2 chance of having AIS. Her XX children have a 1/2 chance of carrying the AIS gene. Most AIS women should be able to locate other AIS women among siblings or maternal relatives.




Is there a test for androgen insensitivity syndrome?

The answer depends upon exactly what you are looking for--diagnostic information, or carrier status. If were born with female genitals and testes, and have very sparse or absent pubic hair, you most likely have complete AIS. If you were born with ambiguous genitals and testes, there are a number of possible etiologies, including partial AIS.

Testing for partial AIS is more problematic than the complete form. Hormonal tests in a newborn with 46 XY karyotype and ambiguous genitals will show normal to elevated testosterone and LH, and a normal ratio of testosterone to DHT. A family history of ambiguous genitals in maternal relatives suggests partial androgen insensitivity.

If you are wondering if you are a carrier, or if you know that you are a carrier and are wondering about the status of your fetus, genetic testing is possible. AIS has been diagnosed as early as 9-12 weeks gestation by chorionic villus sampling (sampling tissue from the fetal side of the placenta). By the 16th week it can be detected by ultrasound and amniocentesis. However, prenatal diagnosis is not indicated unless there is a family history of AIS.

See the following for details of testing.

Hodgins M. B., Duke E. M., Ring D.: Carrier detection in the testicular feminization syndrome: deficient 5 alpha-dihydrotestosterone binding in cultured skin fibroblasts from the mothers of patients with complete androgen insensitivity. J. Med. Genet. Jun 1984, 21, (3), p178-81.

Batch J. A., Davies H. R., Evans B. A. J., Hughes I. A., Patterson M. N.: Phenotypic variation and detection of carrier status in the partial androgen insensitivity syndrome. Arch. Dis. Childh. 1993; 68: 453-457.


What is partial androgen insensitivity syndrome?

The extent of androgen insensitivity in 46 XY individuals is quite variable, even in a single family. Partial androgen insensitivity typically results in "ambiguous genitalia." The clitoris is large or, alternatively, the penis is small and hypospadic (these are two ways of labeling the same anatomical structure). Partial androgen insensitivity may be quite common, and has been suggested as the cause of infertility in many men whose genitals are of typically male appearance.

Individuals with ambiguous genitals have typically been subjected to "corrective" surgery during infancy. Based on our own painful experiences, ISNA believes that such cosmetic surgery of the genitals is harmful and unethical. Surgery is justified only when it is necessary for the health and well-being of the child. Surgery which is intended to make the genitals appear more male or more female should be offered, but not imposed, only when the child is old enough to make an informed decision for her/himself.


What is Progestin Induced Virilization?

Caused by prenatal exposure to exogenous androgens, most commonly progestin. Progestin is a drug which was administered to prevent miscarriage in the 50's and 60's and it is converted to an androgen (virilizing hormone) by the prenatal XX persons metabolism. If the timing is right, the genitals are virilized with effects ranging from enlarged clitoris to the development of a complete phallus and the fusing of the labia. In all cases ovaries and uterus or uterine tract are present, though in extreme cases of virilization there is no vagina or cervix, the uterine tract being connected to the upper portion of the urethra internally. The virilization only occurs prenatally and the endocrinological functionality is unchanged, ie. feminizing puberty occurs due to normally functioning ovaries.

In other words, XX people affected in-utero by virilizing hormones can be born into a continuum of sex phenotype which ranges from "female with larger clitoris" to "male with no testes". It is noteworthy that the use of progestin is not effective in the prevention of miscarriage.

Progestin androgenized children are subjected to the same surgically enforced standards of cosmetic genital normalcy as other intersexed children... meaning that clitoridectomy and possibly more extensive procedures are often performed early in life, most often with the effect of loss of erotic sensation and ensueing psychological trauma. ISNA believes that this surgery is unneccessary, cosmetic and primarily "cultural" in its significance. It is of no benefit to the child, who suffers even more from the stigma and shame of having been surgically altered than she would have had her non-standard genitals been allowed to remain intact.

Occasionally a female neonate will be so genitally virilized that she is given a male identity at birth and raised as a boy. It is important not to hide the circumstances of her biology from such a child, in order to the avoid shame, stigma and confusion which results from secrecy. After the onset of puberty the child may want to explore the option, hopefully with the aid of loving parents and peer counseling, of having surgery to allow expression of either female or male sexuality. This is not a choice that should be forced prematurely, it is a personal choice to be made by a teenager about his/her body and about her/his choice of sexual identity and sexuality.




What is Adrenal Hyperplasia?

Adrenal Hyperplasia is the most prevalent cause of intersexuality amongst XX people with a frequency of about 1 in 20000 births. It is caused when an anomoly of adrenal function (usually 21-hydroxylase or 11-hydroxylase deficiency) causes the synthesis and excretion an androgen precursor, initiating virilization of a XX person in-utero. Because the virilization originates metabolically, masculinizing effects continue after birth.

As in progestin induced virilization, sex phenotype varies along the same continuum, with the possible added complication of metabolic problems which upset serum sodium balance. The metabolic effects of CAH can be counteracted with cortisone. The scenario for medical intervention for intersex is similar... but CAH people have an increased likelihood of early detection due to metabolic imbalances (Salt Losing Form). The long term use of cortisone itself produces significant dependance and other side effects, all of which need to be explained honestly and openly.


What is Klinefelter syndrome?

Most men inherit a single X chromosome from their mother, and a single Y chromosome from their father. Men with klinefelter syndrome inherit an extra X chromosomes from either father or mother; their karyotype is 47 XXY. Klinefelter is quite common, occuring in 1/500 to 1/1,000 male births.

The effects of klinefelter are quite variable, and many men with klinefelter are never diagnosed. The only characteristic that seems certain to be present is small, very firm testes, and an absence of sperm in the ejaculate, causing infertility. Except for small testes, men with klinefelter are born with normal male genitals. But their testes often produce lower than average quantities of testosterone, so they don't virilize (develop facial and body hair, muscles, deep voice, larger penis and testes) as strongly as other boys at puberty. Many also experience some gynecomastia (breast growth) at puberty.

Physicians recommend that boys with klinefelter be given testosterone at puberty, so that they will virilize in the same way as their peers, and that men with klinefelter continue to take testosterone thoughout their lives, in order to maintain a more masculine appearance and high libido. Many ISNA members, however, report that they do not like the effects of testosterone, and prefer to reduce their dosage, or not to take it at all.

Many ISNA members with klinefelter syndrome are homosexual, a few are transsexual, and nearly all experience their gender as quite different from other men. In contrast, medical literature tends to discount any connection between klinefelter syndrome and homosexuality or gender issues. We suspect that medical reassurances that "your son will not be gay" are based more on homophobia than on an accurate assessment of probabilities. Gay children deserve honesty and parental love and support!


What is hypospadias?

Hypospadias refers to a urethral meatus ("pee-hole") which is located along the underside, rather than at the tip of the penis. In minor, or distal hypospadias, the meatus may be located on the underside of the penis, in the glans. In more pronounced hypospadias, the urethra may be open from mid-shaft out to the glans, or the urethra may even be entirely absent, with the urine exiting the bladder behind the penis.

See Hypospadias: A parent's guide to surgery for a discussion of causes and treatment.


Is there a risk of gonadal tumors?

Dysgenetic testicular tissue (testicular tissue that has developed in an unusual way) is at risk of developing tumors, and not merely because it is undescended. That is, the risk persists even after successful orchiopexy (surgically bringing undescended testes down into scrotal sac).

Ovarian tissue in intersexuals is not generally the cause of intersexuality, is not dysgenetic, and does not appear to be at elevated risk of developing tumors.

Undescended testes in women with AIS are at risk of developing tumors.

There are certain gonadal and adrenal tumors which produce hormones and therefore intersexual expression. However, in this case the tumor causes the intersexuality; the intersexuality does not cause the tumor.

In general, the likelihood of gonadal tumors is small (~5%) before mid-twenties, and increases thereafter, with lifetime probabilities of 30% for partial or complete gonadal dysgenesis, and 10% for 46XY true hermaphroditism.

Gonadal tumors are less likely in cases of sex-reversal (46XX male, 46XX true hermaphrodite).

Testosterone replacement in men with dysgenetic testes may increase the probability of gonadal tumors developing.

To summarize,

Tumors are not likely in the absence of a Y chromosome (or Y genes involved in testicular determination, which may be present on the X chromosome in sex-reversal)

When there is a Y chromosome or Y genes are surmised to be present, the gonads are at elevated risk, and should be carefully monitored. Monitoring is easier to do if the gonads are brought down into the scrotum.

Because the risk is slight before early adulthood, gonadectomy should not be imposed on infants. It should be delayed until the patient can weigh the options and choose for her/himself. Functioning gonads, even partially functioning gonads, are a big advantage over hormone replacement therapy. The patient must be allowed to weigh the risks, talk with other patients about their experiences, and choose what is best for her/himself. Note, though, that it is critical to remove partially functioning testes before puberty from an intersexual who identifies as female and wishes her body not to virilize.

Much of this material (except the paragraph above!) comes from "Wilkins The Diagnosis and Treatment of Endocrine Disorders in Childhood and Adolescence 4th edition," ed Kappy, Blizzard and Migeon, Baltimore: Charles C. Thomas, 1994.




Hormone replacement therapy and osteoporosis

Sex hormones (principally testosterone or estrogen) are necessary to maintain healthy adult bones. Persons born without functioning gonads, or whose gonads have been removed, should be under an endocrinologist's care and should maintain hormone replacement therapy for life.

Many intersexuals, having developed a distrust or aversion for medical people, avoid medical care and drop hormone replacement therapy which was prescribed during puberty. This can result in extreme osteoporosis (brittle bones). Osteoporosis worsens silently, but at advanced stages it can destroy your quality of life. Persons with advanced osteoporosis are vulnerable to frequent bone fractures, especially of the spine, hip, and wrist. These fractures can be caused by a small amount of force, and are extremely painful and debilitating. Each spine fracture may put you flat on your back for one to two months.

If you have been without gonads or hormone replacement therapy for years, it is vital to get a bone density scan performed, to evaluate the condition of your bones (a simple, non-invasive procedure using a specialized x-ray machine), and to seek the advice of an endocrinologist in order to establish a regimen of hormone replacement therapy that works for you. If you have had bad experience in the past with hormones, we encourage you to find an endocrinologist who will work with you to adjust the mix and schedule of hormones until you find what works. If your bone density is low, your endocrinologist will probably recommend calcium supplements and weight-bearing exercise (not swimming!) to maintain density.

If your bone density scan is performed on a DEXA machine, make certain to do any follow-up scans on the same machine, and with the same reader.

A number of drugs currently in the biomedical news may prove useful for rebuilding lost bone density. If your bone density is low, check in with a qualified specialist regularly for the latest information.

The danger of osteoporosis is considerably worse for intersexuals than for post-menopausal women, because the intersexual will be without hormones for many decades. Do not disregard this danger!


Where can I read some of the earliest first person writings of intersexuals?

Personal narratives of intersex people are available in ISNA's newsletter, Hermaphrodites with Attitude, in a special issue of the magazine Chrysalis, and in the video Hermaphrodites Speak!.

Alvarado, Donna. "Intersex," West Magazine section of Sunday San Jose Mercury News, Jul 10, 1994.

Describes the life stories of Cheryl Chase and Morgan Holmes, based on personal interviews. Photos of Holmes. Opinions of intersex specialists Grumbach of UCSF and Gearhart of Hopkins (surgery is necessary to prevent parents from treating child as an outcast) are contrasted with personal experience of Chase and Holmes (surgery experienced as mutilation, causing sexual dysfunction). Anne Fausto-Sterling criticizes intersex specialists as unwilling to follow up patients to determine the outcome of their interventions.

"Once a dark secret," BMJ 1994; 308:542 (19 February).

A woman with XY karyotype and "testicular feminization" (androgen insensitivity syndrome) briefly relates how damaging she has found the secrecy surrounding her condition. "Mine was a dark secret kept from all outside the medical profession (family included) but this is not an option because it both increases the feelings of freakishness and reinforces the sense of isolation. It also neglects the need for the counselling of siblings."

"Gender identity in testicular feminization," BMJ 1994; 308:1041 (16 April).

This letter responds to "Once a dark secret" in the 19 Feb issue. The author discusses the issue of gender identity, criticizes the secrecy and the labeling of women with complete androgen insensitivity as "male" or "hermaphrodite."

"Be open and honest with sufferers," BMJ 1994 308:1042 (16 April).

The author of this letter has also been subjected to secrecy surrounding her androgen insensitivity. This secrecy produced a "lifetime of unnecessary secrecy, shame, delayed action, and great damage to my personal and sexual identity and self esteem."

Holmes, Morgan. See entries under "Where can I read deconstructions of the medical viewpoint?"

Horowitz, Sarah. "Both and Neither," SF Weekly, February 1, 1995.

For generations, doctors have been "fixing" babies born with ambiguous genitals. Now adult "intersexuals" wonder if their true identities have been surgically mutilated. The article doesn't take sides, and plays the "expert" doctors' opinions against our opinions. Needless to say, the doctors insist that no one can be allowed to remain intersexual, and we (Cheryl, Morgan, and David) assert that we are intersexual, and that we have been harmed by medicalization. Anne Fausto-Sterling takes our side, and Suzanne Kessler is "sympathetic" with ISNA's goals, but cautions that what doctors are doing is enforcing a cultural mandate, and that doctors are not likely to participate in a revolution.


Where can I read some of the earliest deconstructions of the medical viewpoint?

Alice Dreger, Harvard University Press. Hermaphrodites and the Medical Invention of Sex available from Amazon.com.

Alice Dreger, Assistant Professor of Science and Technology Studies at Michigan State University and adjunct faculty at the Center for Ethics and Humanities in the Life Sciences, brings us this study of how and why medical and scientific men have construed sex, gender, and sexuality as they have. A 36 page long epilogue contains narratives of intersexuals treated according to the still-standard medical protocols developed in the 1950s and calls for change: "Surely, ...it will be familiarity rather than knowlege that finally takes away [intersexuals'] supposed 'strangeness.'"

Fausto-Sterling, Anne. "The Five Sexes: Why Male and Female are Not Enough," The Sciences, March/April 1993:20-24. Reprinted on New York Times Op-ed page, March 12, 1993. See also the Letters from Readers in the July/August 1993 issue.

Fausto-Sterling questions the medical dogma that, without medical intervention, hermaphrodites are doomed to a life of misery. What would be the psychological consequences of raising children as unabashed intersexuals? Imagine a society in which sexuality is celebrated for its subtleties and not feared or ridiculed. The author's acceptance of the Victorian classification of intersexuals as male, female, and true pseudo-hermaphrodites is unfortunate, as is her naivite about the success of surgical intervention.

Holmes, Morgan. "Re-membering a queer body," Undercurrents, May 1994: 11-13. Published by Faculty of Environmental Studies, York University, 4700 Keele St, North York, Ontario Canada M3J 1P3.

Ms Holmes, who was subjected during childhood to "clitoral recession" surgery which removed most of her clitoris, analyzes the cultural imperative to surgically alter intersexual children's genitals. "The medical definition of what female bodies do not have and must not have: a penis. Any body which does possess a penis must either be designated 'male' or surgically altered. ... In the minds of doctors, bodies are for procreation and heterosexual penetrative sex. ... I would have liked to have grown up in the body I was born with, to perhaps run rampant with a little physical gender terrorism instead of being restricted to this realm of paper and theory. Someone else made the decision of what and who I would always be before I even knew who and what I was."

Holmes, Morgan. "Medical Politics and Cultural Imperatives: Intersexuality Beyond Pathology and Erasure," Master's Thesis, Interdisciplinary Studies, York University, September 1994.

Kessler, Suzanne. "The Medical Construction of Gender: Case Management of Intersexed Infants." Signs: Journal of Women in Culture and Society, 16(1) (1990):3-26.

Ms Kessler interviewed six medical specialists in pediatric intersexuality to produce an account of the medical decision making process. She describes the processes by which cultural assumptions about sexuality in effect supersede objective criteria for gender assignment. Kessler concludes that the key factor in making a decision is whether or not the infant has a "viable" penis.

Lee, Ellen Hyun-Ju. "Producing Sex: An Interdisciplinary Perspective on Sex Assignment Decisions for Intersexuals," Senior Thesis, Human Biology: Race and Gender, Brown University, April 1994.

Ms Lee ananalyzes medical literature for clinical recommendations concerning the diagnosis and treatment of intersexed infants, while invoking deconstructive feminist theory to critique the medical "management" of ambiguous genitalia. Her interdisciplinary approach places intersexuality within a broader discourse of sex and gender, disputing the binary male/female opposition as a social construction. Especially valuable is her transcription of an interview with "Dr Y," an intersex specialist/clinician who acceded to be interviewed about gender assignment only under the condition that his identity be disguised.

more: Frequently Asked Questions from Non-Intersexed People



next: Parents of Intersexed Children FAQ
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APA Reference
Staff, H. (2007, August 9). Intersexuality Frequently Asked Questions Table of Contents, HealthyPlace. Retrieved on 2024, December 20 from https://www.healthyplace.com/gender/inside-intersexuality/intersexuality-frequently-asked-questions

Last Updated: March 14, 2016

Hermaphrodite Porn is Faked

Hermaphrodite porn on the web is faked. Those depicted are mostly normal women posing with false penial prosthetics or are pre-operation transsexuals. (The sexualizing pornographers make these fakes.)

In today's world, most hermaphrodites are altered into women by surgery under AMA Standards of Care or appear totally male. Although many have very small genitalia and many choose gay or lesbian lifestyles, some do marry.

The idea of a dual sexuality, as pictured in current adult popular culture, is mostly untrue (the reality is it's not an enviable position to be in.) Yet the idea of the hermaphrodite as an object of love and sexual desire has fascinated artists throughout history. Some more artistic renderings are pictured below.

If you have comments or knowledge of the source, or description of these images, please email me. I also welcome non-copyrighted images or art of hermaphrodites.

Satyr and hermaphrodite

SATYR AND HERMAPHRODITE

Presented by Jamie Ledbetter, Kent School class of 2000

This Greek statue is a Hellenistic work of art, created around 150 B.C. Later on however, a Roman copy was made of this statue. This statue is clearly hellenistic because of its stunning realsim and lifelike activity. Although it may have looked better when it was first created, one can still appreciate the amazing artistic aspects which give the piece beauty as well as meaning. This statue, as well as most other Hellenistic statues tell a story of an important event, myth, or perhaps a legend in the famous age of the Greeks.

This work of art was created in the Hellenistic era, which expains the nature of this statue. In this statue, and battle goes on between Satyr and a Hermaphrodite. Like most Hellenistic works of art, this piece expresses great emotion and determination. Clearly there is emotion in the faces of both people, especially the struggle and look of frustation in the face of Satyr. In addition, what can also be noted is that neither of the bodies are perfect beautiful bodies which were considered ideal by Greek standards. This is one way in which Hellenistic art differed from classical art. Instead in striving to achieve the perfection of the body, Hellenistic art was mainly the portrayal of bodies as they were, and sometimes the bodies were grotesque. The hermaphrodite is grotesque and in no way considered the ideal body to have, and the Satyr's body is not perfect as well. Hellenistic art takes a natural, rational, and humanistic approach to life. The Satyr's body is not a large, powerful muscle-bound body. Rather, it is a normal body for a middle-aged man. The focus of this piece is a fight between two people, which is common for a Hellenistic piece.

Bibliography:
Stewart, Andrew. Greek Sculpture: An exploration. New Haven: Yale University Press, copyright 1990.

Title Unknown #2
Hermaphrodite statues

Title Unknown #3
Hermaphrodite statue



next: Sexpolice
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APA Reference
Staff, H. (2007, August 9). Hermaphrodite Porn is Faked, HealthyPlace. Retrieved on 2024, December 20 from https://www.healthyplace.com/gender/inside-intersexuality/hermaphrodite-porn-is-faked

Last Updated: March 14, 2016

Berdache Tradition

Zuni Berdache

We'wha (1849-96), a Zuni berdache, lived in New Mexico. He is shown holding a ritual vessel, dressed in women's clothing.

In some Native American cultures, male children who display feminine characteristics at an early age are valued by the tribe as a sacred trust. It is believed that the Great Spirit has sent this child to them as a go-between for males and females, a bridge between the sexes who understands both sides of the human condition.

Such a child is apprenticed to a shaman, or holy man of the tribe. In his training, he learns the traditional work of both sexes, dresses as a woman, and usually performs the functions of healer and arbiter for his people.

The European word for this person is "berdache". Among the Zuni, for example, it is "lhamana".

The ideal of male and female sharing one body has long been fertile soil in my psychic garden. These images explore the fusion of male and female which the berdache represents, and are part of a larger series.

The subject is a young Native American from New Mexico who has recently discovered and is exploring this aspect of his culture.

See A Native American Perspective on the Theory of Gender Continuum by DRK

 



next: Multi-Dimensionality of Gender
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APA Reference
Staff, H. (2007, August 9). Berdache Tradition, HealthyPlace. Retrieved on 2024, December 20 from https://www.healthyplace.com/gender/inside-intersexuality/berdache-tradition

Last Updated: March 15, 2016

Articles Table of Contents

A Brief Life Story

 

Articles

Information, Points of View on Gender, Intersexuality and Hermaphrodites
Brief History of a Hermaphrodite
  • Hermaphrodite Porn is Faked
    Hermaphrodite porn on the web is faked. Those depicted are mostly normal women posing with false penial prosthetics or are pre-operation transsexuals.

  • Sex Police
    The biology of sex is being hotly debated, as parents, doctors and researchers reevaluate what it means to be male and female.

  • John/Joan
    In 1967, an anonymous baby boy was turned into a girl by doctors at Johns Hopkins Hospital. For 25 years, the case of John/Joan was called a medical triumph — proof that a child's gender identity could be changed — and thousands of "sex reassignments" were performed based on this example. But the case was a failure, the truth never reported. Now the man who grew up as a girl tells the story of his life, and a medical controversy erupts.

  • Intersex Survivors of Domestic Violence
    A significant number of intersex individuals identify themselves as survivors of domestic violence, but many are afraid to come forward and ask for help. Why?

  • A Native American Perspective on the Theory of Gender Continuum
    Many of the world's cultures recognize more than two genders. The notion that there are those of us who do not fit precisely into either a male or female role has historically been accepted by many groups.

  • Multi-Dimensionality of Gender
    Probably more upsetting to our conventional view of gender than this fuzziness of gender roles is that we can be a MIX of male and female identities within the same individual.

  • Marriage Between Close Relations Increases Risk
    Marriage within close relations or within the same community may increase the risk of hermaphroditism.

  • Intersexuality - A Plea for Honesty and Emotional Support
    Intersexual children need early access to a peer support group where they can find role models and discuss medical and lifestyle options.
  • Syndromes of Abnormal Sex Differentiation
    From the Johns Hopkins Children's Center, this booklet is designed to help parents and patients understand intersexuality and the challenges that accompany syndromes of "abnormal" sex differentiation.

  • A Single Word: Stop!
    Deborah E. Brown, Director of the Intersex Support Group International, advises parents of intersexed newborns not to jump into gender assignment surgery.

  • American Academy of Pediatrics Report
    Medical staff and parents should refrain from immediately assigning a gender to newborns with genital abnormalities until the child's condition can be thoroughly reviewed and given careful consideration.

  • The Medical Management of Intersexed Children
    How psychologically traumatic is it for intersexed children who have to receive repeated medical exams and procedures?

  • Management Of Intersexuality
    Guidelines for dealing with individuals with ambiguous genitalia. Directed towards doctors but good for parents of intersexed children to know.

  • Sexual Scientists Question Medical Treatment of Hermaphroditism
    The fate of persons born with ambiguous genitals (also called hermaphrodites, or intersexuals) was the focus of debate when sexual scientists from around the world met.

  • Genital Surgery on Intersexed Children
    This letter was sent from Cheryl Chase, Exec. Dir., Intersex Society of North America to a judge in Columbia, South America. It explains why the court should allow the child to make any decisions about surgery herself, when she is old enough to evaluate risks and benefits.


next:   Hermaphrodite Porn is Faked
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APA Reference
Staff, H. (2007, August 9). Articles Table of Contents, HealthyPlace. Retrieved on 2024, December 20 from https://www.healthyplace.com/gender/inside-intersexuality/articles-on-intersexuality-and-hermaphrodites

Last Updated: October 23, 2015

Sex Police

sex police The biology of sex is being hotly debated, as parents, doctors and researchers reevaluate what it means to be male and female.

By Sally Lehrman, 1999

Patrick took a long time in coming -- two weeks in the birth canal -- but the moment he arrived, nurses bundled him up and rushed him out of the delivery room. The Jacksonville, Fla., hospital cloistered the eight-pound, 20 1/2-inch baby in a back section of the intensive care unit and drew the curtains. One doctor after another went to visit. The infant had a well-defined penis, but with an opening at the base, not the tip. There was just one testicle, though it was producing plenty of testosterone. In most of his cells, the baby had no Y chromosome, the one that contains the genetic instructions for the body to develop as a male. The doctors assured the adoptive mother, Helena Harmon-Smith, that Patrick was a girl. They would remove the offending appendages right away.

But Harmon-Smith had seen Patrick have an erection. Actually, several. "You're not cutting off anything that's working," she protested. The authorities checked the infant's internal organs and still insisted this baby would be better off as a girl. His mother refused. More tests. After 11 days, 20 doctors filed into a hospital conference room and solemnly announced that they would allow the family to raise Patrick as a boy. "We put him in a little tux and took him home," Harmon-Smith says.

Two and a half months later, Patrick's doctor warned his mother that the boy's testicle, really an ovotestis that also contained some ovarian tissue, was probably malignant. It should be removed -- like the one already taken from his abdomen. His mother finally agreed to a biopsy, just in case. When the surgeon returned from the operating room, he said the gonad was diseased. He had cut it off.

Harmon-Smith pestered the doctor for the pathology report for more than a month. Once she got it, "the first thing I read was 'normal, healthy testicle.' My heart stopped. I just cried," she says. Five years old March 24 and in the first grade, Patrick will never be able to produce semen.

"My son is now a non-functioning eunuch. Before, he was a functioning male," Harmon-Smith says. "I don't think the doctor cared. His reasoning was that this was a hermaphrodite, so everything should be removed."

Quietly and in near secrecy, pediatric urologists and other specialists decide what are the minimum qualifications for manhood, correcting any babies with ambiguous genitalia -- known as "intersexed" -- before their births are announced to the world. Under the urgent conditions of a medical emergency, they decide whether a smallish appendage is a proto-penis or a maxi-clitoris, and perform the surgery to make it so -- sometimes without even telling the parents the truth about their child, and rarely revealing anything to the patient as he or she grows up. Guiding the doctors' work is a commonly accepted theory, pioneered in 1955 by Johns Hopkins University sexologist John Money, that infants are psychosexually neutral at birth. If a surgeon sculpts a baby's undersized, oversized or otherwise confusing genitals to match a sex label within a few months of birth, normal psychosexual development will follow.

But evidence is building that sexual identity is not so easy to manage or mold. New studies in human development are demonstrating that the biological division between male and female isn't clear-cut or even stable. The simple presence of a Y chromosome -- considered by many people to be as male-identifying as a six-pack of Bud and a 4-by-4 Dodge Ram -- isn't necessarily enough to make a man. And frilly dresses adorning a body shaped to be female can't always contain the guy hidden inside.

The questions aren't limited to hospital birthing rooms. From sports arenas to geneticists' labs, experts are struggling to find new ways to define and describe the biology of sex. And some members of the medical establishment are beginning to question whether intersex surgeries make sense in infancy, before the child has a chance to reach puberty, develop his or her own sense of identity and give consent. Later this month, academic surgeons and pediatric urologists meet in Dallas to thrash out the psychological, hormonal, surgical and practical issues of intersex treatment. Their debates are likely to get hot.

Since the 1960s, most doctors confronted with a baby like Patrick would likely excise his penis and testicle shortly after birth and call him a girl. If he had a Y chromosome, they might keep the penis but rebuild the urethra to reach the organ's tip. If he had two XX chromosomes like most girls, but an extra-large clitoris that could be mistaken for a penis, they'd trim it back. Or if he had the right chromosomes but a very small penis, off it would go. The surgeons were certain that life without the appropriate genitals would be impossible, and as recently as last year, an article in Pediatric Nursing suggested that doctors ought to consider it child abuse if the parents refused genital remodeling.

Katherine Rossiter, the pediatric nurse practitioner who wrote the article in the January-February 1998 nursing journal, argues that intersex activists represent only a minority, albeit a vocal one, and that allowing a baby with a tiny penis and no testicles to grow up as a boy, rather than surgically reassigning him as a girl, might harm him beyond repair. But she admits that "listening to what real people say and their arguments" has broken down some of her conviction. "I've become muddy mishmash in my thinking," she says.

The medical literature and the opinions of specialists are increasingly divided. "In some cases it's led to a human tragedy -- it might have been better not to reassign the sex of this particular child. But there are cases where it's clearly right to reassign," says Raymond Hintz, an endocrinologist and professor of pediatrics at Stanford University. "It's sometimes justified, but it's not something you do lightly."

William Cromie, a Chicago pediatric urologist who serves as secretary and treasurer of the Society for Pediatric Urology, stresses that proper treatment relies on the carefully considered opinions of parents along with ethicists, endocrinologists, pediatricians and other specialists. As many as 30 conditions may lead to a child being considered intersexed. "It's not an arbitrary, capricious decision by one person," he says. "You try to make the very best decision -- it's usually ground over by a lot of people who are very thoughtful. This is an area that's immensely complex. And lay people just plain and simple don't understand it."

However well-meaning, though, doctors who perform intersex surgery employ a very finite tool in making their decision. The first measure of manhood is a ruler: If a penis is less than one inch (2.5 centimeters) at birth, it doesn't count. And if it's more than three-eighths of an inch (0.9 centimeters) long, it can't qualify as a clitoris either. Any appendage that falls in the middle must be fixed. Then there's the question of the urethral opening, which must be in the right place -- men don't pee sitting down. A curving penis must also be corrected.

For a boy to be a boy, he ought to have two testicles just below a straight penis, and only one opening down there. If the genitals fall short, a pediatric urologist will almost always assign the infant a female gender, remove anything protruding too far and prescribe estrogen at puberty. A talented surgeon can construct a vagina using a piece of the bowel, although the woman who owns it will never experience any sensation inside.

Hale Hawbecker narrowly escaped such a prognosis. When he was born in 1960, his doctors, aghast at his small, perfectly formed penis and internal testicles, wanted to reassign him female. His parents refused, not comprehending the doctors' distress. "It's kind of a strict club in this country to be a man, with very rigid rules to qualify," says Hawbecker, now a Washington attorney who is developing a legal challenge to infant intersex surgeries in his spare time. "It doesn't matter if you're XY. If your penis is too small, you lose it."




Hawbecker says his penis size and absent testicles, removed in childhood, don't hurt his ability to love and make love to his wife. "I very happily engage in sex whenever I can. You have to be creative, and not so focused on genitals," he says. As for his own pleasure, "My penis does everything you'd expect a penis to do -- it's just small."

Hawbecker says he thinks like a man; with his clothes on, he looks typically male too. And yet, he says, "I guess I've never really felt like I fell neatly into the camp of guys. I love to cook. I love to take care of things around the house. I hate the Three Stooges and I don't like football." Often, he thinks about the female he might have become; where she'd be right now. "I think she'd be OK. I could've done 'girl' too. I could be happy that way, too. That's what's mind-boggling."

Medical literature says that about one in 2,000 babies is born like Hawbecker or Harmon-Smith, with uncommon variations of genitals and gonads, or sex-conditioning hormones that don't match sexual organs. About one in 1,000 women has three X chromosomes instead of the usual two; some people have had as many as four X chromosomes -- plus two Ys. Some women have facial hair, some men don't. Breast size, voice timbre and body structure, all generally accepted cues, also can contradict chromosomal identity.

"The basic story is, it isn't simple," says Alison Jolly, a Princeton evolutionary biologist who studies ringtail lemurs in Madagascar. "It's all just more complicated than people will admit." In the first few weeks of life, every human embryo develops the equipment for both sexes, the foundations for both ovaries and testes. At about eight weeks, a chemical chain of events stimulates one set to disintegrate. One week later, the external genitalia begin to form -- and usually, to match what's left inside.

All this seems to be triggered by a spot on the Y chromosome called SRY, for "sex-determining region, Y chromosome," that scientists have dubbed the "master switch." Throw it, they say, and a chain of events run mostly by genes on the X chromosome leads to the development of testes and the production of male hormones. Without SRY, females continue along what molecular biologists have dubbed the "default" pathway. In February, however, researchers reported the first evidence that an active signal stimulates female development, too.

Of course, there's a lot more going on as well -- much of it still not even vaguely understood. A wash of hormones primes the brain for one sex or another, though not always the same as the one indicated by genitalia at birth. Jolly suggests looking at sex as statistical -- a compendium of characteristics that, when plotted on a graph, looks like a couple of camel humps. One set of features tends to be viewed as male and the other female. The section in between is as normal as the outlying regions in the land of "super-macho" and "super-fem."

From classical antiquity through the Renaissance, anatomists thought there was just one sex, and it was male. Female bodies simply mirrored the male reproductive organs -- with the vagina an inverted penis; the ovaries, interior testicles. During the 18th century, the idea of two separate sexes took hold. Then in 1993, Anne Fausto-Sterling, a well-regarded biologist and feminist studies theorist at Brown University, raised a ruckus when she proposed that male and female were not enough. In a tongue-in-cheek proposal, she recommended five categories in all.

Some people seized upon the idea as a revelation finally explaining their own bodies. Others felt the thesis went too far. Fausto-Sterling says her readers were taking her too literally. She has abandoned the proposal -- which at root simply challenged people to think differently about sex -- and now wants to eliminate the term from our vocabulary. "There is no sex; there's gender," Fausto-Sterling says.

Fausto-Sterling argues that scientific discoveries about the ways our bodies work employ cultural understandings and, as in the male "master switch" and female "default pathway," the language of existing social models. Whenever faced with a lack of clarity, surgeons get out the ruler and make a choice. "There's a set of decisions by which we're going to socially agree what is a penis. How we organize the continuous variability that nature offers us is what gender is about," Fausto-Sterling says. "What we call the truth of the body is also a cultural view of the body through a scientific lens."

Both the scientific and social interpretations are increasingly complicated and controversial. The International Olympic Committee has found itself at the center of the uncertainty. The first shock came when Hermann Ratjen, who ran as Dora Ratjen for Germany in the 1930s, confessed in 1957 that he had disguised himself at the request of the Nazi Youth Movement. So in 1966, as the opportunities for women to compete expanded rapidly, a panel of judges began checking female athletes for vaginal openings, overlarge clitorises, a penis or testicles. By 1968, chromosome testing replaced these "nude parades," and in 1992, a more sophisticated instrument to hunt for the SRY gene was adopted. But as the technology advanced, so did the confusion.

Five women out of 2,406 tested "male" in the 1992 Barcelona Olympics. Eight women in the 1996 Atlanta games didn't pass as females. In February, the Athletes' Commission of the International Olympics Committee urged its parent organization to do away with sex analysis entirely and rely instead on observed urination during drug testing to pinpoint any likely imposters.

Anatomy, gonads, hormones, genes, rearing, identity and even the presumptions of others all play into a person's sex. "To select only one, the genetic sex, out of a large number of sex-determining factors and analyze for that one is scientifically incorrect," says Arne Ljungqvist, head of the International Amateur Athletics Federation doping commission.

Both women and men in sports have begun to accept a broader definition of what a "woman" is, accepting those with chromosomal variations and sometimes even testes. Intersex activists hope pediatric specialists also will quit worrying about what those jock straps contain -- and indeed, some already have.

William Reiner, who started out as a urologic surgeon, went back to school after witnessing the misery of children living with the results of sex-correction surgery. Now a child psychiatrist at Johns Hopkins University, he says the most important sex organ is the brain. Reiner doesn't buy any theories about a range in biological sex; in fact he thinks it's quite binary. All the more reason to step back from aggressive enforcement, he says. Sure, go ahead and assign sex at birth, he suggests, but in the final analysis boys will be boys, girls will be girls, and they know what they are better than any parent or doctor.

Some surgeries are medically necessary, and many seem to turn out just fine. Reiner hopes to sort out some of the mysteries by following the lives of 700 children born with atypical genitals, 40 of whom had their sex reassigned at birth. "The kids are going to tell us the answers," he says. Cheryl Chase thinks she knows some already. She founded the network that grew into the Intersex Society of North America, a clan of 1,400 whose anatomy doesn't fit the binary ideal. Born with both ovarian and testicular tissue, Cheryl started out life as Charlie. But doctors decided later that since she was potentially fertile and had a short penis, she'd be better off as a girl. Her parents changed her name, threw away photographs and birthday cards and had her clitoris removed when she was 18 months old. Her ovotestis came out at age 8. She was in her 20s and living as a lesbian in the 1970s when she dug up the truth about her birth and life as a boy -- making her feel like an imposter in her own community. And for her, like many others who had surgery on their genitals, the missing parts and scarring made sex more likely to bring pain than pleasure.

The Intersex Society doesn't oppose assigning gender at birth. Instead it -- and now some medical specialists -- urges parents and doctors to refrain from surgery and be open to a change in sex identity later.

But Chase, for one, isn't waiting for culture to come to terms with biology. "I'm focused on practical changes that come quickly, not pie in the sky," Chase says. "I would much rather keep my clitoris and have orgasms than have a box to check off."

Helena Harmon-Smith, Patrick's mother, says she wants children like her son to be allowed their own decisions -- and more than anything, to be recognized as real. "My son was one of the lucky few -- because he is technically both. He can be boy or girl," she says. She will never forgive Patrick's doctor for making the choice for him.



next: The True Story of John / Joan
~ all inside intersexuality articles

APA Reference
Staff, H. (2007, August 9). Sex Police, HealthyPlace. Retrieved on 2024, December 20 from https://www.healthyplace.com/gender/inside-intersexuality/sex-police

Last Updated: March 14, 2016

A Native American Perspective on the Theory of Gender Continuum by DRK

Many of the world's cultures recognize more than two genders. The notion that there are those of us who do not fit precisely into either a male or female role has historically been accepted by many groups.

Among Native Americans, the role of third, fourth, or even fifth genders has been widely documented. Children, who were born physically male or female and yet showed a proclivity for the opposite gender, were encouraged to live out their lives in the gender role, which fit them best. The term used by Europeans to describe this phenomenon is Berdache. "Indians have options not in terms of either/or, opposite categories, but in terms of various degrees along a continuum between masculine and feminine (Williams 80)."

A berdache was one who was defined by spirituality, androgyny, women's work and male/male homosexual relationships (127). The berdache could adopt the clothing of women, associate and be involved with women, do the work normally associated with women, marry a man and take part in many spiritual ceremonies of the tribe. Female versions of the role also occurred, but are less well documented and will not be discussed in this paper. Generosity and spirituality more than homosexuality and gender characterized berdachism.

In the traditional tribal sense, these roles have often been ones associated with great respect and spiritual power. Rather than being viewed as an aberration, the role was seen as one, which bridged the gap between the temporal and spirit worlds. The spiritual aspect of the berdache role was emphasized far more than the homosexual or gender variant aspect. Because of this, berdaches were highly valued by the people of the tribe.

Given the choice between discarding or honoring a person, who did not fit neatly into rigid gender compartments, many Native American groups chose to find a productive and venerated place for the berdache. A Crow traditionalist says, "We don't waste people the way white society does. Every person has their gift ( 57)." According to the Mohave creation story, "Ever since the world began, there have been transvestites, and from the beginning of the world, it was meant that there should be homosexuals. (Roscoe, ed. 39)."

With the arrival of European settlers and pressure from Christian and governmental sources, the tradition of the berdache changed in dramatic ways. The homosexual aspect of the role was all that was seen by the whites. The white powers attempted to remove all traces of berdachism.

As Native Americans began to convert to Christianity, internal pressure developed to disown the berdache tradition within the Indian Nations. Although pockets of traditional berdache practice survived, these were seen primarily among the old. As these people began to die off, the tradition, which had gone underground for the most part, was lost to upcoming generations.

In the last three decades, interest has been rekindled in the tradition. Disenfranchised Native American gays and lesbians searching for a means to access their spiritual heritage looked to the traditions and found much in the berdache role. As groups became reacquainted with the role, questions arose about its definition and application. Still in the formative stage, the reexamination of berdachism has provided many with a foothold by which they are able to step back into becoming meaningful members of society.

Lee Staples, founder of American Indian Gays and Lesbians, said "... I thought all there was to our lives as gays was the bar scene and sex, but to explain our lives as Indian gays and lesbians is to look at our spiritual journeys. It has much more depth on a spiritual level (Roscoe, Changing 108)."

Some Native Americans object to the very word used to describe the special role of berdache. Some sources say the term has its origins in an Arab word for male prostitute or "kept" boy and was coined not by the Indians, but by Europeans. Will Roscoe, author of several books on the topic states the problems involved with choosing a term "creates as many problems as they solve, beginning with the mischaracterization of the history and meaning of the word berdache. As a Persian term, its origins are Eastern, not Western. Nor is it a derogatory term, except to the extent that all terms for nonmarital sexuality in European societies carried a measure of condemnation. It was rarely used with the force of faggot, but more often as a euphemism with a sense of lover or boyfriend. (17)."

Those who object to the term feel the implications are derogatory and insulting. In addition and perhaps more importantly, it is felt the term berdache does not speak to the many facets of the role. This is of course very true as the role has many variations and aspects.

All tribes that recognized the role, had their own terms for it. Using these terms would be ideal, but as Roscoe also points out, " ...in order to speak of traditional statuses generally, to compare roles of different tribes and those for males to those of females, it is necessary to have an umbrella term to refer to the subject. (19)".

Out of respect for the Native American culture, much deliberation took place about whether to use the term berdache or to substitute some other term for it in the remainder of this paper. Although the term Two Spirit has come into vogue among Native Americans, I have chosen to follow Mr. Roscoe's decision to use the term berdache.

Much of the anger and frustration expressed about the use of the term stemmed from Native people's experience of being studied and often misinterpreted by white anthropologists and is therefore certainly acknowledged. Considering Will Roscoe's well-respected position within the area of study and his obvious good intentions and love for the people, I feel confident in following his lead. The following is a very limited glimpse into the amazingly complex world and history of the berdache.

The consideration of alternative genders does not come easy to most Americans, but many traditional Native American tribes had no trouble accepting berdache into their midst. The concept of a gender continuum, completely separate from biological sex types is something widely accepted by Native cultures. Many native religions explain the concept of the berdache.

The Arapaho of the plains believe the role existed due to supernatural gifts from birds or animals (Williams 22). The Creation story of the Colorado Mohave "speaks of a time when people were not sexually differentiated". In the Omaha language, the term for berdache meant, "instructed by the Moon" (29). Many myths warned not to try to interfere with the fulfillment of the role. Consequences could be dire and sometimes resulted in death (23).




In a similar vein, the belief was strong that no one should not resist spiritual guidance when lead to follow the berdache path (30). This, combined with a level of respect sometimes bordering on fear, lead to acceptance with blind faith that the berdache was indeed a gift to the tribe; someone to be honored and cherished.

Many tribes believed that the person was lead by a spiritual experience into the role. A boy was never forced into the role but rather was allowed to explore his natural inclination (24). They often went through some sort of ceremony to determine their path. Because berdaches were believed to have great spiritual vision, they were often viewed as prophets (42).

The following sentence seems to sum up the overall feeling of the Native American about differences among their people. " By the Indian view, someone who is different offers advantages to society precisely because he or she is freed from the restrictions of the usual. It is a different window from which to view the world."

In 1971, a Sioux shaman interviewed a winkte (berdache). "He told me that if nature puts a burden on a man by making him different, it also gives him a power" (42). The Zapotec Indians around the Oaxaca area in Mexico, staunchly defend their berdache's right to adopt different gender and sex roles because "God made them that way."(49). The emphasis in defining the role is placed on the person's character and spirit and not on the sexual aspects.

Nearly all tribes honoring the berdache status had different names for the roles. Most sources used suggest using the specific name associated with the tribe and this was done whenever possible

The Lakota call their berdache Winktes. The Mohave call theirs alyha. Lhamana is the Zuni word for berdache as is nadleeh among the Navajo. There are literally dozens of others; most being variations on a general root word that is used in a certain geographic area (Roscoe, Changing 213-222). The berdache role also exists among peoples of the Southern American continent and various other places in the world as well. In Mexico, Zapotec people call their berdache ira' muxe (Williams 49)..

Some Definitions

There are many definitions of being berdache. Some of the many found are listed below.

1) "Berdache has been employed to refer to special gender roles in Native American cultures that anthropologists have interpreted as ceremonial transvestitism, institutionalized homosexuality and gender variance/multiple genders." (Jacobs, Thomas and Lang 4).

2) ".....a berdache can be defined as a morphological male who does not fill a standard society's man's role, who has a nonmasculine character (Williams 2)."

3) In 1975, in their book, The Female of the Species, Martin and Voorhies wrote, "sex differences need not necessarily be perceived as bipolar. It seems possible that reproductive bisexuality establishes a minimal number of socially recognized physical sexes, but these need not be limited to two (Roscoe, Changing 123)."

4) In The Zuni Man/Woman , author, Will Roscoe describes the famous We'Wha as "a man who combined the work and social roles of men and women, an artist and a priest who dressed, at least in part, in women's clothes (Roscoe, Zuni 2)."

Anthropologist, Evelyn Blackwood felt "The berdache gender is not a deviant role; nor a mixture of the two genders, nor less a jumping from one gender to its opposite, nor is it an alternative role behavior for nontraditional individuals who are still considered men and women. Rather it comprises a separate gender within a multiple gender system (Roscoe, Changing 123)."

Suffice it to say the subject is complex and often seems to defy description. There are common attributes, however. These vary from group to group, but a core set of four traits is shared.

Specialized work roles- Male and female berdaches are typically described in terms of their preference and achievements in the work of the "opposite" sex and/or unique activities specific to their identities.

Gender difference - In addition to work preferences, berdaches are distinguished from men and women in terms of temperament, dress, lifestyle and social roles.

Spiritual sanction - Berdache identity is widely believed to be the result of supernatural intervention in the form of visions or dreams, and/or it is sanctioned by tribal mythology.

Same-sex relations - Berdaches most often form sexual and emotional relationships with non berdache members of their own sex" (Roscoe, Changing 8).

The role of berdache was determined during childhood. Parents would watch a child who seemed to have a tendency toward living as berdache and would assist him in pursuing it rather than discouraging him. At some point, usually around puberty, a ceremony would be performed which would formalize a boy's adoption of the role. One ceremony commonly practiced involved placing a man's bow and arrow and a woman's baskets in a brush enclosure. The boy went inside the enclosure that was then set on fire. What he took with him as he ran to escape the flames was believed to be indicative of his spiritual guidance to follow or not to follow the berdache path (Williams 24).

It is important to remember that Indians do not consider this role one that is a matter of personal choice. They generally believe that one who follows the path is following his own spiritual guidance. The important feature here is living a life true to one's spiritual path. In most cases, a person assumes berdache status for life, but in the case of a nineteenth-century Klamath berdache named Lele'ks, the role was abandoned. He began wearing men's clothing, acting like a man and married a woman. His reason for doing so was because he had been instructed to do so by the Spirits.




Following spiritual direction is the key issue in assumption or abandonment of the role (25). "Of those who became berdaches, the other Indians would say that since he had been 'claimed by a Holy Woman, ' nothing could be done about it. Such persons might be pitied because of the spiritual responsibilities they held, but they were treated as mysterious and holy, and were respected as benevolent people who assisted others in time of starvation (30)."

Berdaches excel in weaving, beadwork, and pottery; arts associated almost solely with the women of the tribe. We'Wha, a famous Zuni berdache was an accomplished weaver and potter as well as a sash and blanket maker. Her pottery was sold for twice that of other potters in the village (Roscoe, Zuni 50-52). Berdache men are also involved with cooking, tanning, saddle-making, farming, gardening, raising children, basket-making (Williams 58-59).

One notable attribute of the berdache is that the work of these people is greatly prized both within and without the tribe. "To tell a woman that her craft-work is as a good as a berdache's is not sexist, but rather the highest compliment" (59) Because of their superior quality, work done by the berdache is highly valued by collectors and tribal members as well. There is a belief that some of the spiritual power of the maker has been transferred to the craft itself. Some believe that the exquisite art is itself a manifestation of that power (60).

In addition to craftwork, berdaches are known to be strong family and community members. They were traditionally considered assets to the tribe and were sources of great pride. A man raised with his berdache cousin said, "The boy lived as though he had some higher understanding of life (52)."

Many berdaches adopt children and are known to be excellent parents and teachers. Native Americans as a whole readily accept adoption of children and traditionally share in child rearing among their kin (55). They excel at cooking, cleaning and all other domestic duties. Many, such as We'Wha, took great pride in being able to provide their families with the ultimate in comfort, nourishment and nurturing.

Throughout the literature there are references to the berdache finding no greater purpose than that of serving his fellow tribesmen. Hastiin Klah, a famous Navajo shaman and berdache was written about with much love and respect by the wealthy Bostonian, Mary Cabot Wheelwright. " I grew to respect and love him for his real goodness, generosity -and holiness, for there is no other word for it.... When I knew him he never kept anything for himself. It was hard to see him almost in rags at his ceremonies, but what was given to him he seldom kept, passing it on to someone who needed it... Everything was the outward form of the spirit world that was very real to him (Roscoe, ed. Living 63)."

In terms of child rearing and education, the berdache fulfil an important role. They not only adopt children of their own; they are often involved with the care of other's children. One of the best examples of this is within the Zuni culture. All adult members consider themselves responsible for the behavior of all the children within the tribe. An adult passing the misbehaving child of another will correct the child. We'Wha was reported to have benefited from this as a child herself and became noted for her excellent way with children as she matured and became a berdache (Roscoe, Changing 36).

Today, the practice of berdaches being involved in child rearing persists and seems to be gaining importance in tribes where abuse and alcoholism abound. "Terry Calling Eagle, a Lakota berdache, states, 'I love children, and I used to worry that I would be alone without children. The Spirit said he would provide some. Later, some kids of drunks who did not care for them were brought to me by neighbors. The kids began spending more and more time here, so finally the parents asked me to adopt them.'

After those children were raised, Terry was asked to adopt others. In all, he has raised seven orphan children, one of whom was living with him when I was there. This boy, a typical masculine seventeen-year-old, interacts comfortably with his winkte parent. After having been physically abused as a young child by alcoholic parents, he feels grateful for the stable, supportive atmosphere in his adoptive home. (Williams 56)."

The berdache role is most often characterized by a tendency to a pacific temperament, but they were known to go to war or on hunts on a regular basis. Some cultures took the berdache along to do the cooking, washing, caring for the camp and tending to the wounded.

Their presence among the warriors was valued because of their special spiritual powers. Occasionally, a berdache would participate directly in warfare. This dispels the argument among early anthropologists that the role was adopted as a means of avoiding warfare. The Crow berdache Osh-Tisch, which means Finds Them and Kills Them got his name by turning warrior for one day in 1876. He took part in an attack on the Lakota and was distinguished for his bravery (68-69).

Because of their unique position as neither male nor female, berdache would act as counselors for marital conflict. Among the Omaha tribe, they were even paid for this service. Berdache also performed the role of matchmaker. When a young man wanted to send gifts and get the attention of a young woman, the berdache would often act as ago between with the girl's family (70-71).

One of the most notable aspects of the berdache is their association with wealth and prosperity. Because they were subject to menstruation, pregnancy or tied down to nursing infants, they were able to work during times when women could not. In addition, their greater musculature made them strong and able to endure long days of hard labor. They were known to do almost twice the work of a woman. "...the berdache is ever ready for service, and is expected to perform the hardest labors of the female department (58-59). " When a man wished to marry a berdache often her ability and inclination to work hard was a large part of the attraction.

Although there is much fluidity in alternate gender behavior, a berdache reaches some absolutes when it comes to adopting biological female roles. This limitation has not eliminated attempts at mimicking such female biological processes such as menstruation and pregnancy. The Mohave alyha were known to have gone to great lengths to simulate mock pregnancies. They would self induce constipation and then "deliver" a stillborn fecal fetus. Appropriate mourning rites and burial were performed with the involvement of the alyha's husband.

Alyha also simulated menstruation through scratching their legs until they bled. They would then require their husbands to observe all the taboos associated with menstruation. They had never been observed attempting to nurse infants, however (Roscoe, Changing 141). Sometimes an alyha would fake a pregnancy to stop her husband from trying to leave or divorce her on the grounds of infertility (Roscoe, ed. 38).

Certainly one of the most entertaining stories associated with the berdache adoption of female dress and attitude comes from We'Wha. In 1886, she went to Washington DC to meet President Grover Cleveland accompanied by anthropologist and debutante, Matilda Coxe Stevenson. Because she passed easily as a woman, she was allowed into the ladies rooms and boudoirs of the elite. She delighted in telling the Zuni upon arriving home that "the white women were mostly frauds, taking out their false teeth and 'rats' from their hair." One woman gossiped, "To hear Mrs. Stevenson give Waywah's description of the way a society lady in Washington 'makes herself young again' was exceedingly amusing (Roscoe, Zuni 71)."




The traditional berdache was known for living within a strong moral code. Their ethics were above reproach and they were valued as peacemakers and settlers of disputes (Williams 41). They accepted the duties of the role and tried to exceed the expectations of others in how well they performed. Not only were they adept at settling disagreements among tribe members, but they also could act as intercessors between the physical and the spiritual world (41).

The tribes held them in great esteem and were quite respectful and often frightened of their connection with the spirit world. This seems to be one reason traditional berdaches were not harassed or bothered. Most tribes believed it very dangerous to attempt to interact with the spiritual realm and felt fortunate to have a berdache in their midst to perform that task.

Although berdache often fulfilled the role of caring for the sick and wounded, they were not usually shaman, but rather ones to whom the shaman would turn for guidance. As a Lakota stated, "Winktes can be medicine men, but are usually not because they already have the power (36)."

Berdaches were closely associated with dreams and visions. In some cultures dreams were believed simply to guide the person and, as such were considered a benevolent force. In others, such as the Maricopa, adoption of the berdache role was associated with "too much" dreaming (Roscoe, Changing 145-146).

Among the Plains tribes, it was the berdache who was assigned to bless the sacred pole for the Sun Dance ceremony, the most important religious rite of the culture. Their association with anything on a spiritual plane brought luck to the ritual or the person involved. Berdaches are often in charge of preparing the dead for burial. Among the Yokuts, tongochim were so esteemed, they were allowed to keep any of the deceased's belongings they chose (Williams 60).

In the Potawatomi tribe if a berdache groomed the hair of a man going on a hunt, it was thought to provide "special spiritual advantage and protection for the hunter (36-37)." Although they could be among the most gentle and loving members of a group, if crossed, they could become vindictive and formidable foes, a characteristic, which underscores the mystery and power of the role (103).

In relation to the spiritual nature of the role, people approached their relationships with the berdache, as they would have with a deity, with awe, respect and a sense of acceptance without needing to fully understand.

As opposed to European views of sexuality, Native Americans experience sex as more than a means of reproduction. It is also an activity to be enjoyed and appreciated. Sexual pleasure is considered a gift from the spirit world. As a result, most traditional tribes felt no inhibition in regard to sexual relations. Children were exposed to the sight of adults having sex and some ceremonies involved sex on an orgy level (88). Additionally, sexual contact was not necessarily limited to one's spouse or to the opposite sex; thus same sex activity was not the exclusive realm of the berdache (90-91).

There are some characteristics of the sexual practices of berdache, which differ from those of other same sex relationships. Berdaches almost always observe an incest taboo which involves the avoidance of sex with another berdache. One explanation for this is that sexual partner of the berdache must, by nature, be masculine (93). This belief is consistent with the emphasis on the gender aspects of the role rather than the sexual aspects. It also dovetails with the information on berdache marriages to masculine men. In these unions, the berdache is considered a wife and is valued by the husband not only for the domestic duties the berdache performs, but also for the socially acceptable homosexual relationship.

In a sense, Native American cultures have institutionalized and socially sanctioned homosexual relations by utilizing the berdache role as the preferred same sex partner. When men want to have male/male sex, they are encouraged to do so with a berdache (95).

The usual sexual behavior of the berdache is to take the passive role in anal intercourse. At times they may indulge in oral sex or take the active role in anal intercourse, but this is not widely talked about. If a berdache wishes to take an active role, it is usually done only in secret and with a partner who can be trusted not to talk. This is also true of the feelings of the man involved with a berdache. If he wishes to assume the passive role, he will try to keep the activity secret.

Another distinctive aspect of berdache sex is that during foreplay and actual intercourse they generally do not like to have their genitals touched. ".... Intercourse with an alyha is surrounded by an etiquette to which the partner had better conform; or else the man could get in all sorts of trouble. Kuwal, a Mohave man who had several alyha as wives, said "they insisted on having their penis referred to as cunnus (clitoris) (97)." ".... I never dared touch the penis in erection except during intercourse. You'd court death otherwise, because they would get violent if you play with their erect penis too much (98)."

Berdaches frequently are available for sex with both unmarried adolescent boys and married men who occasionally seek out same sex partners. Because of this, female prostitution is not needed. Traditional berdaches were also available as sexual partners during hunts and in war parties (102). This was yet another reason why they were welcomed on these excursions.

During research on the Internet, I came across the website of Berdache Jordan, an "Other". His site is listed under "Hermaphrodite-The Other Gender" and he states he is a true genetic hermaphrodite, having the rare DNA karyotype XXXY (mosaic). He has both male and female characteristics. From a scientific standpoint one theory that explains his genetic makeup is that his mother produced two ova and the eggs were fertilized separately as fraternal twins. Sometime during the gestation, the two eggs merged. If one egg was destined to be male and the other female, the ambiguous gender of hermaphrodite could occur. There is a chance this could have been caused by incest, which is a distinct possibility in this case according to his writing. Another possible cause could have been fertility drugs, but these were not available at the time.

At the time of his birth, he was assigned as an "open birth" meaning the medical staff could not determine his sex. In a subsequent e-mail to me, he described himself as an "abandoned, premature miscarriage." Later he was given two birth certificates and finally was legally recorded as a male. He was given an ambiguous gender nickname along with both a girl's and a boy's name by his foster parents. During his years as a child growing up, several members of his family abused him in every way imaginable. At age sixteen, he was able to put a stop to the most invasive sexual abuse by taking massive doses of testosterone to maximize his secondary male sex characteristics. He was abused by both sexes and stated that there seemed to be a need for these people to live out their sexual fantasies with him as the victim.

Berdache Jordan alludes to having been in several all male environments such as the military, jails and prisons and passing as a macho male during that time. He states he did not succumb to homosexual relations during this time, even though they were common in prison, especially. He was too inhibited and traumatized by his abuse history.

"Actually, the only way I could even have a homosexual relationship would be to have sex with someone like myself (not likely)." He married and divorced two "normal" women and raised three children as a single parent. He writes eloquently about the pain and healing that have been the substance of his life. He is writing a book titled Masquerade which is close to publication.

In one of his e-mails, he wrote, "As to your 'I began to wonder how present day transgender people were feeling', I can't answer this as I am not now 'transforming to some other gender, nor am I transforming my biological sex (as in transsexual). I am intersexual, of both sexes." He goes on to explain his attempts to pass as masculine through hormone supplements and concludes with, "I contributed to society as a male, better perhaps than some who were born of the single male sex.

Were circumstances different I could have contributed and performed as a female too. How well we will never know, as I have the legal identity as a male, assigned by our western culture, which denies my existence except as a single sexed person. Every social application form has a limited answer to the blank Male----- Female-----. Choose one or we will. It is the path of least resistance... and the law. If your question above was addressed to me... how intersexuals are feeling, I would have to answer, denied, disenfranchised, occasionally happy, productive at times, sad and human X two."

After "meeting" this man via the Internet, the far-reaching possibilities of the berdache role began to shift and deepen for me. I was struck with the realization that although Berdache Jordan does not fit the precise definition of the word, there is a sense that this is the perfect title for him. It seemed perhaps to speak to some of psychological healing he seems to have done. It seems to imply a return to a healthy way of perceiving his existence on this planet. His journey must be a very difficult one and I like to think that having the ability to assume an identity that seems to suit him even if it is not totally accurate according to the literature seems right somehow.

There must be others like him and perhaps rekindling the traditional can help the healing process. In a world where differences are sought out and exaggerated, is this a traditional role that perhaps can embrace and empower those who would otherwise be without definition? Does the spiritual basis of the role give a sense of purpose and of belonging to the universal human family?

In the cold and sterile medical world, does the berdache role offer nurturing and being seen and appreciated for being different? In a society that must have people categorized, does the role provide a delicious array of variations? I like to think so.

 

References

Jacobs, Sue-Ellen, Wesley Thomas, and Sabine Long. Two-Spirit People. Urbana and Chicago: University of Illinois Press, 1997.

Jordan, Berdache. A Berdache's Odyssey. 1997. Online. Internet. 4 April 1999. Available

Jordan,Berdache. "Re: Just Touching Base." E-mail to the author. 01 April 1999.

Roscoe,Will. Changing Ones: Third and Fourth Genders in Native North America.New York: St. Martin's Press, 1998.

Roscoe, Will, ed. Living the Spirit: A Gay American Indian Anthology. Complied by Gay American Indians. New York: St. Martin's Press, 1988.

---.The Zuni Man-Woman.Albuquerque: University of New Mexico Press, 1991.

Williams, Walter L.The Spirit and the Flesh, Sexual Diversity in the American Indian Culture.Boston: Beacon Press, 1986.



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APA Reference
Staff, H. (2007, August 9). A Native American Perspective on the Theory of Gender Continuum by DRK, HealthyPlace. Retrieved on 2024, December 20 from https://www.healthyplace.com/gender/inside-intersexuality/a-native-american-perspective-on-the-theory-of-gender-continuum-by-drk

Last Updated: March 15, 2016

The Medical Management of Intersexed Children: An Analogue for Childhood Sexual Abuse

Introduction

Medical procedures have often been used as analogues for childhood sexual abuse (CSA) and have been seen as opportunities to observe children's memories of these experiences in a naturalistic context (Money, 1987; Goodman, 1990; Shopper, 1995; Peterson Bell, in press). Medical traumas share many of the critical elements of childhood abuse, such as fear, pain, punishment, and loss of control, and often result in similar psychological sequelae (Nir, 1985; Kutz, 1988; Shalev, 1993; Shopper, 1995). It has been difficult, however, to find a naturally occurring trauma which incorporates aspects thought to be critical to the phenomenon of forgotten/recovered memories: namely, secrecy, misinformation, betrayal by a caregiver, and dissociative processes. There has been the added difficulty of finding medical events that directly involve genital contact and which accurately reflect the family dynamic in which abuse occurs.

The study which has come closest to identifying the factors likely to be involved in children's recall of CSA is a study by Goodman et al. (1990) involving children who experienced a Voiding Cystourethrogram (VCUG) test to identify bladder dysfunction. Goodman's study was unique in its inclusion of direct, painful, and embarrassing genital contact, involving the child's being genitally penetrated and voiding in the presence of the medical staff. Goodman found that several factors led to greater forgetting of the event: embarrassment, lack of discussion of the procedure with parents, and PTSD symptoms. These are precisely the dynamics likely to operate in a familial abuse situation.

The medical management of intersexuality (a term encompassing a broad range of conditions including ambiguous genitalia and sexual karyotypes) has not been explored as a proxy for CSA, but may provide additional insights into the issues which surround childhood memory encoding, processing, and retrieval for sexual trauma. Like victims of CSA, children with intersex conditions are subjected to repeated genital traumas which are kept secret both within the family and in the culture surrounding it (Money, 1986, 1987; Kessler, 1990). They are frightened, shamed, misinformed, and injured. These children experience their treatment as a form of sexual abuse (Triea, 1994; David, 1995-6; Batz, 1996; Fraker, 1996; Beck, 1997), and view their parents as having betrayed them by colluding with the medical professionals who injured them (Angier, 1996; Batz, 1996; Beck, 1997). As in CSA, the psychological sequelae of these treatments include depression (Hurtig, 1983; Sandberg, 1989; Triea, 1994; Walcutt, 1995-6; Reiner, 1996), suicidal attempts (Hurtig, 1983; Beck, 1997), failure to form intimate bonds (Hurtig, 1983; Sandberg, 1989; Holmes, 1994; Reiner, 1996), sexual dysfunction (Money, 1987; Kessler, 1990; Slipjer, 1992; Holmes, 1994), body image disturbance (Hurtig, 1983; Sandberg, 1989) and dissociative patterns (Batz, 1996; Fraker, 1996; Beck, 1997). Although many physicians and researchers recommend counseling for their intersexed patients (Money, 1987, 1989; Kessler, 1990; Slipjer, 1994; Sandberg, 1989, 1995-6), patients rarely receive psychological intervention and are usually reported as being "lost to follow-up." Fausto-Sterling (1995-6) notes that "in truth our medical system is not set up to deliver counseling in any consistent, long-term fashion" (p. 3). As a result, the intersexed child is often entirely alone in dealing with the trauma of extended medical treatment.

In cases where the intersexed child is identifiable at birth, s/he is subjected to extensive testing physically, genetically, and surgically, to determine the sex most appropriate for rearing. Kessler (1990) notes that "physicians... imply that it is not the gender of the child that is ambiguous, but the genitals... the message in these examples is that the trouble lies in the doctor's ability to determine the gender, not in the gender per se. The real gender will presumably be determined/proven by testing and the "bad" genitals (which are confusing the situation for everyone) will be "repaired"." (p. 16). Although the child is repeatedly examined through puberty, there is often no explanation given for these frequent medical visits (Money, 1987, 1989; Triea, 1994; Sandberg, 1995-6; Walcutt, 1995-6; Angier, 1996; Beck, 1997). Because both parents and physicians view these treatments as necessary and beneficial to the child, the child's trauma in experiencing these procedures is often ignored. The underlying assumption is that children who do not remember their experiences are not negatively affected. However, medical procedures "may be experienced by a child or adolescent as a trauma, with the medical personnel considered as perpetrators in collusion with the parents... the long-range effects of these events may have serious and adverse effects on future development and psychopathology" (Shopper, 1995, p. 191).

Shame and Embarrassment

Goodman (1994) notes that sexuality is characterized in children's minds primarily in terms of embarrassment and fear. Children may thus respond to all situations that carry sexual connotation with embarrassment and shame. She suggests that " children come to react to situations that carry sexual connotation by becoming embarrassed-- a shame that they are taught to feel, without necessarily understanding the reasons why. Perhaps one of the first things children are taught to be embarrassed about concerning sexuality is the exposure of their own bodies to others" (p. 253-254). Children who had experienced more that one VCUG were more likely to have expressed fear and embarrassment about the most recent test and to have cried about it since it occurred. A few even denied that they had had the VCUG.

Children experiencing other types of genital medical procedures also experience their medical procedures as shameful, embarrassing, and frightening. Medical photography of the genitals (Money, 1987), genital examination in cases of precocious puberty and intersex conditions (Money, 1987), colposcopy and examination in a girl exposed to DES (Shopper, 1995), cystoscopy and catheterization (Shopper, 1995) and hypospadias repair (ISNA, 1994) may lead to symptoms highly correlated with CSA: dissociation (Young, 1992; Freyd, 1996), negative body-image (Goodwin, 1985; Young, 1992), and PTSD symptomology (Goodwin, 1985). One of Money's patients reported "I would be laying there with just a sheet over me and in would come about 10 doctors, and the sheet would come off, and they would be feeling around and discussing how much I had progressed... I was very, very petrified. Then the sheet would go back to over me and in would come some other doctors and they would do the same thing... That was scary. I was petrified. I've had nightmares about this..." (Money, p. 717)




Similar scenarios have been reported by other intersexuals (Holmes, 1994; Sandberg, 1995-6; Batz, 1996; Beck, 1997). Like CSA, repeated medical examinations follow a pattern which Lenore Terr calls Type II traumas: those that follow long-standing and repeated events. "The first such event, of course, creates surprise. But the subsequent unfolding of horrors creates a sense of anticipation. Massive attempts to protect the psyche and to preserve the self are put into gear... Children who have been victims of extended periods of terror come to learn that the stressful events will be repeated." (cited in Freyd, 1996, p. 15-16). Freyd (1996) proposes that "psychological torment caused by emotionally sadistic and invasive treatment or gross emotional neglect may be as destructive as other forms of abuse" (p. 133). Schooler (in press) noted that his subjects experienced their abuse as shameful, and suggests that shame may be a key factor in forgetting sexual abuse. "The possible role of shame in causing disturbing memories to be reduced in accessibility... might well resemble those sometimes proposed to be involved in repression" (p. 284). David, an adult intersexual, states "We are sexually traumatized in dramatically painful and terrifying ways and kept silent about it by the shame and fear of our families and society" (David, 1995-6). Most intersexuals are prevented by shame and stigma from discussing their condition with anyone, even members of their own family (ISNA, 1995). This enforced silence is likely to be a factor in how their memories of these events are understood and encoded.

Secrecy and Silence

Several theorists have postulated that secrecy and silence lead to the child's inability to encode the abuse events. Freyd (1996) suggests that memory for never-discussed events may be qualitatively different from memory for those that are, and Fivush (in press) notes that "When there is no narrative framework... this may well change children's understanding and organization of the experience, and ultimately their ability to provide a detailed and coherent account" (p. 54). Silence may not impede the formation of the initial memory, but lack of discussion may lead to decay of the memory or failure to incorporate the information into the individual's autobiographical knowledge of self (Nelson, 1993, cited in Freyd, 1996).

When a child suffers a trauma, many parents attempt to prevent the child from focusing on it in hopes that this will minimize the impact of the event. Some children are actively told to forget the trauma; others are simply not given room to voice their experiences. This dynamic operates especially forcefully in the case of intersexed children (Malin, 1995-6). "Never mind, just don't think about it" was the advice of the few people to whom I spoke of it, including two female therapists," states Cheryl Chase. Her parents' only communication with her regarding her intersex status was to tell her that her clitoris had been enlarged, and so it had to be removed. "Now everything is fine. But don't ever tell this to anyone else," they said (Chase, 1997). Linda Hunt Anton (1995) notes that parents "cope by not talking about "it", hoping to lessen the trauma for [the child]. Just the opposite happens. The girl may conclude from the adults' silence that the subject is taboo, too terrible to talk about, and so she refrains from sharing her feelings and concerns" (p. 2). Both Malmquist (1986) and Shopper have put similar views forth (1995), noting that a child may view the adults' silence as an explicit demand for his or her own silence. Slipjer (1994) noted that parents were reluctant to bring their intersexed children to outpatient check-ups because the hospital served as a reminder of the syndrome they were trying to forget (p. 15).

Money (1986) reports cases in which "the hermaphroditic child was treated differently than a sexually normal child, in such a way as to signify that she was special, different, or freakish -- for example, by keeping the child at home and forbidding her to play with neighborhood children, placing a veto on communications about the hermaphroditic condition, and telling children in the family to lie or be evasive about the reasons for travelling long-distance for clinic visits" (p. 168). The Intersex Society of North America (ISNA), a peer support and advocacy group for intersexuals, notes that "This "conspiracy of silence" ... in fact exacerbates the predicament of the intersexual adolescent or young adult who knows that s/he is different, whose genitals have often been mutilated by "reconstructive" surgery, whose sexual functioning has been severely impaired, and whose treatment history has made clear that acknowledgement or discussion of [his or her] intersexuality violates a cultural and a family taboo" (ISNA, 1995).

Benedek (1985) notes that even therapists may fail to ask about traumatic events. The victim of trauma may view this as a statement by the therapist that these issues are not safe topics for discussion or that the therapist does not want to hear about them. She suggests that retelling and replaying stories is one way for the victim to gain mastery over the experience and to incorporate it (p. 11). Given the infrequency of such discussions, it is not surprising that both CSA victims and intersexuals often experience negative psychological sequelae as a consequence of their experiences.

Misinformation

Alternatively, the abuser's reframing of reality ("this is just a game", "you really want this to happen", "I'm doing this to help you") may lead to the child's lack of comprehension and storage of the memory of the abuse. Like CSA victims, intersexual children are routinely misinformed about their experiences (Kessler, 1990; David, 1994, 1995-6; Holmes, 1994, 1996; Rye, 1996; Stuart, 1996). Parents may be encouraged to keep the child's condition from him or her, with the justification that "informing the child of the condition prior to puberty has an undermining effect on its self-esteem" (Slipjer, 1992, p. 15). Parents are often misinformed themselves regarding the procedures being enacted on their children as well as the possible outcomes for their child. One medical professional (Hill, 1977) recommends "Tell parents emphatically that their child will not grow up with abnormal sexual desires, for the layman gets hermaphroditism and homosexuality hopelessly confused" (p. 813). In contrast, ISNA's statistics suggest that "a large minority of intersexuals develop into gay, lesbian, or bisexual adults or choose to change sex -- regardless of whether or not early surgical repair or reassignment was performed" (ISNA, 1995).




Angela Moreno was told at 12 that she had to have her ovaries removed for health reasons, although her parents had been given the information about her true condition. Angela has Androgen Insensitivity Syndrome (AIS), a condition in which an XY fetus fails to respond to androgens in utero and is born with normal appearing external female genitalia. At puberty, the undescended testes began to produce testosterone, resulting in the enlargement of her clitoris. "It was never addressed to me that they were going to amputate my clitoris. I woke up in a haze of Demerol and felt the gauze, the dried blood. I just couldn't believe they would do this to me without telling me" (Batz, 1996).

Max Beck was carted to New York every year for medical treatment. "As I reached puberty, it was explained to me that I was a woman, but I was not yet finished... We'd head home again [after a treatment] and not talk about it for a year until we went again.... I knew this didn't happen to my friends" (Fraker, 1996, p.16). This lack of comprehension and explanation for the events happening to the child may result in their inability to make sense of their experiences and to encode them in a meaningful way. Parental and physician emphasis on the benefit of the medical procedures may also result in emotional dissonance which impedes the child's ability to process the experience; the child feels hurt, while being told that he or she is being helped.

Dissociation and Body Estrangement

Examining intersexed children's memories for their medical treatments may shed some light on the processes by which a child comes to understand traumatic events involving his/her body, and offers a unique opportunity to document what happens over time to the memory of these events. Because the child lacks the ability to comprehend the crossing of this body boundary as anything but destructive, regardless of the intents of parents and the medical community, genital procedures in childhood may have the same affective valence as CSA. As Leslie Young (1992) notes, the symptoms of sexual trauma are rooted in the issue of living comfortably (or not) in the body.

[T]he boundary between "inside me" and "outside me" is not simply physically crossed against a person's will and best interests but "disappeared" ... - not simply ignored but "made-never-to-have-existed." To physically challenge or compromise my boundaries threatens me, as a living organism, with annihilation; what is "outside me" has now, seemingly, entered me, occupied me, reshaped and redefined me, made me foreign to myself by conflating and confusing inside me with outside me. Of necessity this assault is experienced by me as hateful, malevolent, and entirely personal, regardless of the intentions of any human agents involved. (p. 91)

This confusion may be especially acute in intersexed children, whose bodies are quite literally reshaped and redefined through genital surgery and repeated medical treatments.

Among criteria listed as triggers for dissociative episodes during trauma, Kluft (1984) included "(a) the child fears for his or her own life... (c) the child's physical intactness and/or clarity of consciousness is breached or impaired, (d) the child is isolated with these fears, and (e) the child is systematically misinformed, or "brainwashed" about his or her situation." (cited in Goodwin, 1985, p. 160). Undoubtedly all of these factors come into play during the intersexed child's medical treatment; the child, having been told little or nothing regarding the rationale for the surgery and examinations, is fearful for his/her life, the child's genitals are surgically removed and/or altered, representing a clear breach of physical intactness, the child is isolated with fears and questions about what has happened to his or her body (and what will happen in the future), and the child is given information which does not reflect the true nature of the treatment or the details of the procedures.

Both Angela Moreno and Max Beck report extensive dissociative episodes. "I was a walking head for most of my adolescence" recalls Max (Fraker, 1996, p. 16). Moreno reports that "After years of therapy, she finally feels like she's in her body, filling out her skin and not just floating" (Batz, 1996). These statements are similar to those of CSA victims who report separating themselves emotionally from their bodies in order to withstand a physical violation. The woman subjected to repeated colposcopies reports that she "survived the vaginal examinations by completely dissociating herself from the lower half of her body -- that is, becoming "numb" below the waist, without sensations or feelings" (Shopper, 1995, p. 201). Freyd (1996) calls dissociation "a reasonable response to an unreasonable situation" (p. 88). Layton (1995) notes that fragmentation is a likely outcome of experiences such as these: "... if the mirror of the world does not reflect your smile back to you, but rather shatters at the sight of you, you, too, will shatter" (p. 121). Dissociative response appears to operate as a defense and consequence in both CSA and medical procedures.

Betrayal Trauma

Jennifer Freyd (1996) has proposed that forgetting of the experience is more likely to occur when the child relies on and must maintain a close relationship with the perpetrator. Betrayal trauma posits that there are seven factors predicting amnesia:
1. abuse by caregiver
2. explicit threats demanding silence 3. alternative realities in environment (abuse context different from nonabuse context)
4. isolation during abuse
5. young at age of abuse
6. alternative reality-defining statements by caregiver
7. lack of discussion of abuse. (Freyd, p. 140)
Certainly these factors operate in the medical management of intersexed children. Shopper (1995) suggests that medical procedures are "similar to those of child sexual abuse in the sense that within the family there is often a manifest denial of the child's traumatic reality. From the child's perspective, the family is seen as being in tacit collusion with the perpetrators (medical staff) of the traumatic procedures. This perception may lead to strong rage reactions against the parents, as well as affecting the sense of trust in the parents' ability to protect and buffer" (p. 203). Conversely, the child may stifle the recognition of this betrayal in order to keep the relationship with his or her parents intact. Freyd (1996) notes that "registration of external reality can be deeply affected by the need to preserve the love of others, especially if the others are parents or trusted caregivers" (p. 26). She also notes that the degree to which the child is dependent on the perpetrator, and the more power the caregiver has over the child, the more likely the trauma is to be a form of betrayal. "This betrayal by a trusted caregiver is the core factor in determining amnesia for a trauma" (p. 63).




In either case, the child's relationship with parents may be damaged. This may occur at the time of the trauma if the child holds the parent responsible for failing to protect him or her from the painful experiences, or later when the child recovers or reinterprets these early experiences. Freyd (1996) suggests that some people realize the full impact of the event when they realize the betrayal, either by forming a new understanding of the event or in recovering the event of the betrayal (p. 5). The way in which events are internally evaluated and labeled may be a key component of such recovery experiences (p. 47). Joy Diane Schaffer (1995-6) suggests that parents of intersexed children should be given full informed consent, including the fact that "there is no evidence whatsoever that intersexed children benefit from genital surgery.... Parents should also be routinely informed that many intersexed adults who received childhood genital surgery consider themselves to have been harmed by the procedure, and are frequently estranged from their parents as a result" (p. 2).

Directions for Future Research

Children treated for intersex conditions within the medical establishment experience many of the same types of trauma as children who are sexually abused. A study of intersexed children's experiences of their treatment and their memory for these events is likely to more closely approximate the experience of childhood sexual abuse than studies done to date for several reasons. The medical management of intersex conditions involves direct contact with the child's genitals by a person in power over the child, and with the cooperation of his/her parents. The procedures are painful, confusing, and repeated. The family dynamics of the child's situation also parallel those in familial abuse: children are routinely silenced or misinformed about what is happening to them and parents are held responsible for the harm that is done. Finally, the outcomes of these experiences result in remarkably similar negative psychological sequelae, including depression, body image disruption, dissociative patterns, sexual dysfunction, intimacy issues, suicide attempts, and PTSD.

Research design in a study of intersexual children's experiences of medical treatment would afford distinct advantages for the memory researcher over those done to date. A fundamental criticism of past studies has been the difficulty in establishing "objective truth" regarding episodes of CAS. Because abuse is usually hidden, unless the child comes to the attention of the authorities, no documentation exists to show what events occurred. Critics of retrospective studies point out that it is therefore virtually impossible to compare the adult account with actual childhood events (the major exception to this rule being studies done by Williams, 1994a,b). In the case of intersex treatment, the researcher would have access to extensive medical documentation regarding the procedures and the child's responses while in the clinic or hospital. Intersex children could be interviewed at the time of procedures and followed longitudinally to see what happens to their memories of these events as they grow into adulthood. This would allow a more process-oriented approach to the problem of childhood memory of these traumatic experiences (How do children understand and encode trauma in the absence of external support or in the presence of misinformation? What is the effect of mood on memory processing? What is the role of parental interaction?) as well as adult recollection (How does the meaning of the trauma change over time? What is the long-term effect on the child's social and emotional development? What happens to the family dynamic when adults research their medical conditions and discover that they have been misinformed?). An observation of these children's emotional and cognitive strategies for dealing with their medical treatment may shed some light on how these processes operate for victims of child sexual abuse.


Editor's note: Tamara Alexander has been wedded in spirit to ISNA member Max Beck for almost four years. The couple make their home in Atlanta, Ga. When she is not writing papers and working on planning for a baby, Tamara is busy raising their four cats, a dog, and the consciousness of emory psychology undergraduates. Partners of intersexuals are welcome to contact her for mutual support.

© 1977 Copyright Tamara Alexander

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© 1977 Copyright Tamara Alexander



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APA Reference
Staff, H. (2007, August 9). The Medical Management of Intersexed Children: An Analogue for Childhood Sexual Abuse, HealthyPlace. Retrieved on 2024, December 20 from https://www.healthyplace.com/gender/inside-intersexuality/the-medical-management-of-intersexed-children-an-analogue-for-childhood-sexual-abuse

Last Updated: March 15, 2016