CONTEXT:
This excerpt was taken from Volume 31, Issue 6 of "Current Problems in Pediatrics," and is a surgeon's perspective on medical intervention regarding intersex babies. Aptly titled "The investigation and management of the infant with ambiguous genitalia: A surgeon's perspective," this piece explores various medical and ethical issues that surround "managing" intersex children. This article was published in July of 2001.
Course Reading:
Today, despite the general consensus that intersexual children must be corrected immediately, medical practice in these cases varies enormously. No national or international standards govern the types of intervention that may be used. Many medical schools teach the specific procedures discussed in this book, but individual surgeons make decisions based on their own beliefs and what was current practice when they were in training—which may or may not concur with the approaches published in cutting-edge medical journals. Whatever treatment they choose, however, physicians who decide how to manage intersexuality act out of, and perpetuate, deeply held beliefs about male and female sexuality, gender roles, and the (im)proper place of homosexuality in normal development (Fausto-Sterling, Sexing the Body: Gender Politics and the Construction of Sexuality, 48).
Analysis:
Fausto-Sterling suggests in her book that surgeons who “decide how to manage intersexuality act out of, and perpetuate, deeply held beliefs about male and female sexuality.” Even though this surgeon’s perspective brings to light other factors that lead to genital reconstructive surgery, such as parental concerns, this excerpt overall supports and enforces the male/female binary. The author first mentions the suggestion that intersex children should be brought up in a gender-neutral space and allowed to “declare their own gender identity.” However, the remainder of the paragraph and the one following refute this proposal due to a variety of psychological and social reasons, indicating that the author believes that a sex, and furthermore a gender, should be assigned and constructed at birth to prevent future “psychologic problems.” Likewise, the language used in the article serves to erase the voices of intersex people: nowhere are intersex individuals mentioned or brought into the argument, which ultimately affects only their bodies. Instead, the author focuses on the parents and the doctors involved: “urologists and endocrinologists” whose expert opinion is that parents are the deciding factor in their child’s surgery, as well as “the psychiatrist who is left to pick up the pieces when things go wrong.” This last statement is particularly striking because it reduces intersex children to “things [going] wrong,” when the real culprit is the doctor who decided to perform surgery to choose a sex for the child before they could choose for themselves, leading to the cited psychological problems. These ideas, while seemingly more self-aware than the surgeons Fausto-Sterling writes about, still serve to reinforce the male/female dichotomy, leaving no room for intersex people to live between this binary. Ultimately, the author reasons that intersex children should be appropriately managed in order to reduce (but not eliminate) their problems later in life. Both the doctors and the parents are informed by their “deeply held beliefs” on how boys and girls should look, how they should act, and how the treatment of those who are neither a boy nor a girl should proceed. These beliefs leave a space that restricts the existence of intersex people and makes their bodies hidden or erased starting from the day they were born.