GenitalCuttingand

Sisterhood
Transnational
DisputingU.S.Polemtcs

E DITE D B Y S TA NL I E M. J A ME S

A ND CLA IRE C. RO B E RT S O N

Univcrsityof lllinois Press

IJ III' NA N I) ( ]}I I C AG O
 Contents

l)rologuc:PositionPaperon ClitoritlcctortryrtrttlI rI Ii II rr|.rt i rr

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5. "Cultural Practice"or "Reconstructive
Surgery"?U.S.GenitalCutting,the Intersex
Movement,and MedicalDouble Standards
CHE RY L CHA S E
ONEoF rHE FoRMSof powerthatmaintainsgenderboundariesinthedit-
ed Statesis the surgical"correction" of infantswhosegenitalsaredeemed
by medicalprofessionals to be sociallyunacceptable. Media and scholarly
discourses on "femalegenitalmutilation," however,havenot engagedthese
surgeries,insteadservingup only representations ofAfrican women.These
discoursescontinue a long tradition of making Africansinto the "other,"
suggesting that ethnocentrismis a key factor in the sometimespurposeful
maintenanceofignoranceaboutcontemporaryU.S.genitalsurgeries. This
essaywill describehowAmericansparticipatein the productionof norma-
tively sexedbodiesfrom thoseborn intersexed,the consequences of such
genitalsurgeriesfor thosesubjectedto them,the effortsof intersexpeople
to organizeto eliminatepediatric genitalsurgeriesand how thoseefforts
havebeentreatedby manyfeminists,andthe doublestandardregardingrep-
resentationsof genitalcutting, dependingupon who is cutting and where
in the world the cutting is done.
, "NewLawBansGenitalCuttingin UnitedStates"readthe headlineon the
front pageof the New YorkTimes.tThe law seemsclearenough:"Whoever
knowingly circumcises, excises,or infibulatesthe whole or any part of the
labiamajora or labiaminora or clitoris of anotherpersonwho hasnot at-
tainedthe ageof eighteenyearsshallbe finedunder this title or imprisoned
not more than five years,or both."'?Yetthis law wasnot intendedand has
not beeninterpretedto protectthe approximatelyfivechildrenper dayin the
UnitedStateswho aresubjectedto excisionof part or all oftheir clitorisand
inner labiasimplybecausedoctorsbelievetheir clitoris is too big.l
Sexualanatomies, genitalsin particular, conrein manysizesandshapes.
TheIntersexMoyementand Mediml DoubleStandards t2 7
U.S.doctorsIabelchildrenwhosesexualanatomiesdiffer significantlyliorrr
the cultural ideal "intersexuals"or "hermaphrodites"(a misleadingtclrrr
becausethesechildren are born with intermediategenitals,not two scls).
Medicalpracticetoday holds that possession of a largeclitoris, or a snrirll
penis,or a penisthat hasthe urethra placedother than at its tip is a "psy.
chosocialemergency."a Thechildwouldnot be accepted by themother,wortltl
be teasedby peers, and would not be ableto developinto an ernotionally
healthyadult.Themedicalsolutionto thispsychosocial problemis sLrrllcly-'
beforethe child reachesthreemonths of ageor evenbeforethe newburn is
dischargedfrom hospital.Although parentalemotionaldistress nd rcjce.
tion of the child and peerharassmentarecitedasthe primary justificllions
for cosmeticgenitalsurgerytherehasneverbeenan investigationof non-
surgicalmeans-suchasprofessional counselingor peersupport-kr ttdrlt'ttss
theseissues.
The federalLawto BanFemaleGenitalMutilation notwithstandinll,girls
born with largeclitorisesaretodayroutinely"normalized"by excisingpnrts
ofthe clitorisandburyingtheremainderdeepwithin thegenitalrcgion.IArttl
boyswith smallpenises? Current medicalpracticeholds that intclscx chil-
dren "can be raisedsuccessfully asmembersof eithersexif tlre proccssbc-
gins beforezY.years."5Becausesurgeonscannot createa largcpcnis frrrr
a smallone,the policyis to removetestesand raisethesechildrcnrs girls,
This is accomplished by "carvIing] a largephallusdown into rr clilori$,
creatIing]a vaginausinga pieceof Ithechild's]colon,"nrarvclcdu seicrtcc
writer who spokeonly to physicians and parents,not to anyol'thc inlu
sexpeoplesubjectedto this miracletechnology.T Effortsto creatcor cxlurtl
a penileurethrain boyswhoseurethraexitsother than at thc lip ol lhc
penis-a conditioncalledhypospadias-frequently leadto rrrulliplcsrrr'
geries, eachcompoundingtheharm.3Heart-rending storicsol physical rrnd
emotionalcarnage arerelatedbyvictimsofthesesurgerics in "(irowirtgLrp
in the SurgicalMaelstrom"and, with blackhumor, in "'l'akcOhulgcrA
Guide to Home Catheterization."n
"Reconstructive" surgeriesfor intersexinfant genitals6rstclnrc into wirlc.
spreadpracticein the195os. Because wastreatedasshunrclirlirrrrl
intersexuality
physiciansactivelydiscouragedopen discussionby their paticnts-irrdcctl,
recommended lying to parentsandto adult intersexpatients-urltil rccrnlly
mostvictimsoftheseinterventions suffered
aloneiu shantcanclsilcncc.r"
By1993 theaccomplishments ofa progressionofsocialjusticc rnovcnlcnls
civil rights,feminism,gayandlesbian,bisexualancltransgcncicr-hclpcdrrrukc
it possible for interscxpeopleto speakout.I nitially,physiciansscollirluI llrcir'
assertior'rsthatintcrscxuality wasnol shrnrclirlrntl thatnrcdicirlly rrrrrrcces
128 CHERYL C H A S E
sarygenitalsurgeriesweremutilating and shouldbe halted.Onesurgeonfrom
JohnsHopkins,the institutionprimarily responsible for developingthe cur-
rent medicalmodel,dismissedintersexpatient-adyocates as"zealots."ttOth-
erscitedthe technologicalimperative.Doctors "don't reallyhavea choice"
aboutwhetheror not to performsurgeryinsistsGeorgeSzasz.r'?
By 1992theintersexmovementhadgatheredenoughstrengthto visit Con-
gressand askthat the Law to Ban FemaleGenitalMutilation be enforcedto
protectchildrennot only againstpracticesimportedfrom otherculturesbut
alsoagainstthis uniquelyAmericanmedicalizedform of mutilation.Their
work won coveragen the NewYorkTimesand.on Dateline NBC, and by the
following yearthe UrologyTimeswasreporting a smallbut growing"new tidal
waveof opinion" ftom physiciansand sexresearchers supportingthe actrv-
ists.13Sadto report,the struggleof intersexactivistsagainstArnericanmed-
icalizedgenitalmutilation hasyet to attractsignificantsupportor evenno-
tice ftom feminists and joumaliss who expressoutrageoverAfrican genital
cutting.
Hermaphrodites:Medical Authority
and Cultural Invisibility
Many peoplefamiliarwith the ideasthat genderis a phenomenonnot ade-
quatelydescribedby male/female dimorphismandthat the interpretationof
physicalsexdifferencesis culturally constructedremainsurprisedto learnhow
variablesexualanatomyis.raAlthoughthe male/femalebinary is construct-
ed asnaturaland thereforepresumablyimmutable,the phenomenonof in-
tersexualityoffers clearevidencethat physicalsexis not binary. Intersexuali-
ty thereforefurnishesan opportunityto deploy"the natural"strategically as
a meansfor disruptingheteronormative systems The
ofp€x/gender/sexuality.
conceptofbodilysex,in popularusage,refersto rriultiplecharacteristics, in-
cludingkaryotype(organizationof sexchromosomes); gonadaldifferentia-
tion (e.g.,ovarianor testicular);genitalmorphology;configurationofinter-
nal reproductiveorgans;andpubertalsexcharacteristics suchasbreastsand
facialhair.Thesecharacteristics areassumedand expectedto be concordant
in eachindividual-either all-maleor all-female.
Becausemedicineintervenesquickly in intersexbirths to changethe in-
fant's body,the phenomenonof intersexualityhasbeen,until recently,largely
unknownoutsidespecialized medicalpractices.Generalpublicawareness of
intersexbodiesslowlyvanishedin modern WesternEuropeansociettesas
medicinegraduallyappropriated to itselfthe authorityto interpret-and
eventually manage-themucholdercategoryof "lrcrnraphroditism." Vic-
TheIntersexMovementand Medical DoubleStandads
torian medicaltaxonomybeganto effacehermaphroditismasa lcgilirrlrt
statusby settlingon gonadalhistologyasthe arbiterof "true sex."r,'l'hc V
torian taxonomy(still in useby medicalspecialists)requiredboth ovrlri
andtesticulartissuetypes,microscopically confirmed,to bepreseDtin rl "tr
hermaphrodite-" Conveniendy, giventhe limitationsofVictoriansur6cryu
anesthesia, suchconfirmationwasimpossiblein a living patient,All otl,
anomalieswerereclassified as"pseudo-hermaphroditisms" rrraskingrr"lr.
sex"determinedby the gonads.16
With advancesin anesthesia, surgery,embryology,and cndocrirrolo
however,twentieth-century medicinemovedfiom merelylabclingirrtcrsc
bodiesto the far more invasivepracticeof "fixing" them-altcring thr
physicalappearance to conform with a diagnosedtrue sex.'l'hctcchniqr
andprotocolsfor physicallytransformingintersexed bodieswcrcrlcvclop
primarily at fohns Hopkins Universityin Baltimoreduring thc rgronlr
r93osunderthe guidanceof urologistHugh HamptonYoung."Only drrri
the lastfewyears,"Youngenthusedin the prefaceto his pionccringtcxtb(x
GenitalAbnormalifles, havewe begun"to get somewhcrencilr lltc cxpLln
tion ofthe rnarvelsof anatomicabnormalitythat maybc portraycdby tlrc
amazingindividuals.But the surgeryof the hermaphroditchasrcrnliltcd
terra incognito."The "sadstateofthese unfortunates"prontptcdYrrrrrr
devise"a greatvariety of surgicalprocedures"by which hc rltcnrptctl
normalizethe their bodily appearances to the greatestextcnl possiblc.r/
Quite a few ofYoung's patients resistedhis efforts.Enrr:ra'l'.,l "'snrrpp
young negrowomanwith a good figure" and a largeclitoris,hatl nrrrrric
man but found her passiononly with women.Emmarefuscdstrrgcrylo "l
madeinto a man" because removalofher vaginawould nrcanthc lossol lt
"mealticket"(i.e.,her husband).'3 By the 195os, theprinciplcol lrrpidpos
nataldetectionand interventionfor intersexinfantslradbcclrrlcvckrncd
JohnsHopkins,with the statedgoalof completingsr.rrgcry cirrlycnorrghr
the child would haveno memoryof it.reOnewonderswhelhcr(ltc insistcl
on earlyinterventionwasnot at leastpartly motivatedlty tlrc rcsislirnce o
feredby adultintersexpeopleto "normalization"throughsrrrgcry.|rightclrt
parentsof ambiguouslysexedinfantsweremuch more opcn k) sugllcstir
of normalizingsurgerythan wereintersexadults,and thc irrfarrlstlrclrsclv
could,of course,offer no resistance whatsoever.
Mostofthe theoretical foundationsjustifringtheseintcrvcnlionsilrc ltlil
utableto psychologist )ohn Money,a sexresearcher invitccito lohnsI lopkir
by LawsonWilkins,founderof pediatricendocrinology.r" Wilkils's nrlrrt
ousstudents subseqr.rcnlly
carricdthcscprotocols [r<lrnI lopkinsto lrospit
throughoutthcUnitcclSl lcsi rd irllftrd,rrIrrr99llSrrzarrnc Kcsslcr lrotcrltlr
 13o CHERY L C H A S E
Money'sideasenjoyeda "consensus of approvalrarelyencounteredin sci-
ence.""But therevelationin zooothatMoneyhadgrosslymisrepresented and
mishandledthe famous"John/Joan"case(in which an infant wascastrated
and raisedasa girl after his peniswasdestroyedin a circumcision accident)
sentMoney'sstockinto a steepdecline.2r
In keepingwith the Hopkinsmodel,the birth of an intersexinfant rs to-
day deemeda "psychosocialemergency"that prope.lsa multi-disciplinary
teamofintersexspecialists into action.Significantly,they aresurgeonsand
endocrinologistsrather than psychologists, bioethicists,intersexpeer sup_
port organizations, or parentsof intersexchildren.The teamexaminesthe
infant and chooseseithermaleor femaleasa "sexof assignment,', then in_
formstheparentsthat this is the child'struesex.Medicaltechnology, includ-
ing surgeryand hormones,is then usedto makethe child'sbody conform
ascloselyaspossibleto the assignedsex.
the phallustrimmed to an acceptable size.The only exceptionto this sort_
ing rule is thatevena hypotheticalpossibilityof femaleferiiliry mustbepre-
servedby assigningthe infant asfemale,disregarding masculinegenitalsand
a phalluslongerthan one inch.ra
The sort of deviationfrom sexnorms exhibitedby intersexpeopiers so
higl y stigmatizedthat emotionalharm dueto likelyparentalrejectionand
community stigmatizationofthe intersexchild providesphysicianswith their
most compellingargurnentto justify medicallyunnecessary surgicalinter-
ventions.Intersexstatusis consideredto be soincompatiblewith emotional
healththat misrepresentation, concealment of fac\and outrightlying (both
to parentsand later to the inters€xperson)are unabashedlyadvocatedin
professionalmedicalliterature.rs
The Impact of "Reconstructive"Surgeries
The insistenceon two clearlydistinguishedsexeshascalamitouspersonal
consequences for the manyindividualswho arrivein the world with sexual
anatomythat failsto be easilydistinguishedasmaleor female,who are la-
beled'intersexuals"or "hermaphrodites"by modern medicaldiscourse.16
About one in onehundredbirths exhibitssomeanomalyin sexdifferentia_
tion, and aboutonein two thousandis differentenoughto renderproorem-
TheIntersexMovementand MedicalDoubleStqndards r,tI
atic_thequestion,Is it a boy or a girl?,7Sincethe earlyt96os,nearly cvery
medium-sizedor largercity in the UnitedStateshashad at leastonc hosr)i_
tal with a standingteamof medicalexpertswho intervenein thesecuscsro
'assign"-through drasticsurgicalmeans-a maleor female
statuslo intcr-
sexinfants.The factthat this systemfor enforcingthe boundariesof thc cut_
egories"male" and "female"existedfor so long without drawingcriticisll
or scrutinyfrorn anyquarteris an indicationof tle extremedisconrforrtnirl
sexpeoplehavebegunto politicizeintersexsubiectivity,th s tr.lnsli)nnilll{
intenselypersonalexperiences ofviolationinto collective
opposilionto lhc
medicalregulationofbodiesthat queersthe foundation,,rf'h.1"r,,,,.,r,,,u,
tive genderidentificationsand sexualorientations.
ment ripple out everafterward.The emotionalimpact of this trc tlrcnt ls
sodevastatingthatuntil the middleofthe r99ospeoile whosclivcshavcbccn
original).'z8
The tragic irony in all this is that while intersexualanakrnryoccnsiorrirlly
indicatesan underlyingmedicalproblemsuchasadrenaldisordcr, ultrbigrr-
ousgenitals are,in andofthemselves, neitherpainfulnor harnrfirlto hclltlt.
Theoftendebilitatingpediatricgenitalsurgeries areentirclycosnrcticin lurrc.
tion.Surgery is essentially a destructive process.It crDrentovctissUC itrr(tlo il
limitedextentrelocate it, but it cannotcreatenewstructtrrcs.,l.lris tcchrrieal
limitation,takentogetherwith theframingof the feminincasa corrditiorrol.
lack,leads physicians to assign 9opercentof irnatomically anrbiguous irrtitrrts
asfemaleby excising genitaltissue. Surgeons justi$,fenralcassigrrrrrcrrt he
cause"you canmakea hole,but you can'tlruild a pole."].,Hcroiccllirts slrolc
up a tenuousmasculine statusfor theone-tcnthassigncd trlillc,wllo ilt.csut,.
jectedto multipleoperatiolls-twenty-lwoir.tonc clsc-with thc
*oll ol
straighterringtht'pcrris irrrdconst r.r.rclir
tg rtrclhra l()ct)itblc
stlrrrlin6 rrlilral,y
132 CHERYL C H A S E
posture.ro For some,the surgeries endonlywhenthe child growsold enough
to resist.rr
Childrenassigned femalearesubjectedto surgerythat removesthe trou-
bling hypertrophic (i.e.,large)
ditoris.Thisis thesametissuethat wouldhave
beena troubling micropenis (i.e.,smallpenis)had the child beenassigned
male.Through the r96os,feminizingpediatricgenitalsurgerywasopenly
labeled"clitoridectomy"and wascomparedfavorablyto the Afiican prac-
ticesthat havenow becometJrefocusof such intensescrutiny.As three Har-
vard surgeonsnoted,"Evidencethat the clitoris is not essentialfor normal
coitusmay be gainedfrom certainsociologicaldata.For instance,it is the
customofa numberofAfrican tribesto excisethe clitorisandotherpartsof
the externalgenitals.Yet normal sexualfunction is observedin thesefe-
males."r':Authors Robert E. Gross,JudsonRandolph,and John F. Crigler
apparentlyunderstandnormal femalesexualfunction only aspassivepene-
tration and fertiiity.A modifiedoperationthat removesmost ofthe clitoris
andrelocatesa bit ofits tip is variously(andeuphemistically) calledclitoro-
plasty,clitoralreduction,or clitoralrecession anddescribedasa simplecos-
meticprocedurein order to differentiateit from the now-infamousclitori-
dectomy.The operation,however,is far from benign.
)ohnsHopkins surgeonsJosephE.Oesterling,IohnP.Gearhart,and Robert
D. )effshavedescribedtheir technique.r3 They makean incisionaroundthe
clitoris, at the corona,then dissectthe skin awayfiom its underside.Next they
dissectthe skin awayfrom the upper sideand removeasmuch of the clito-
ral shaftasnecessaryto createan "appropriatesizeclitoris."Thentheyplace
stitchesfrom the pubic areaalongboth sidesof the entire length of what
remahs ofthe clitoriq whentheytightenthesestitches,the tissuefolds,like
pleatsin a skirt, and recesses into a concealedposition behind the pubic
mound. If they think the resultstill "too large,''tlreyfurther reducethe tip
of the clitoris by cutting awaya pie-shapedwedge.
For manyintersexpeople, this sort ofarcane,dehi:manizedmedicalliter-
ature,illustratedwith close-upsof genitalsurgeryabd nakedchildrenwith
blacked-outeyes,is the only availableversionof Our Bodies,Ourselves. Thts,
evenasfierceargumentsover genderidentity, gender role development,and
socialconstructionof genderragein psychology, feminism,and queerthe-
ory we haveliterally delegatedto medicinethe authority to police the bound-
ariesof maleand female,leaving intersexpeopleto recoverasbesttheycan,
aloneand silent,from violent normalization.
My own case,asit turns out, wasnot unusual.I wasborn with ambigu-
ous genitals.A doctor specializingin intersexualitydeliberatedfor three
davs-and sedatedmv mothereachtime sheaskedwhatwaswrongwith her
TheIntersexMoyementand MedicalDoubleStandqrds I l.i
baby-before concludingthat I wasmale,with micropenis,complclc hy-
pospadias, undescended testes,and a strangeextraopeningbehind thc urc-
thra.A malebirth certificatewascompletedfor me, and my parentslrcgarr
raisingme asa boy.When I wasa yearand a half old, my parentsconsullc(l
a differentset of intersexexperts,who admittedme to a hospital for "scx
determination.""Determine"is a remarkablyaptword in thiscontext,nrcrn-
ingbothto ascertainby investigationand to c44seto cometo a resolution,lt
perfectlydescribes the two-levelprocesswherebyscienceproducesthrouglr
a seriesof maskedoperationswhat it claimsmerelyto observe.I)ockrrstokl
my parentsthat a thorough medicalinvestigation,including cxplolrtlrtry
surgery,would be necessary to determine(that is, ascertain)what nty "l tuc
sex"was.They judged my genitalappendage to be inadequateasa pcrri$:too
short to effectivelymark masculinestatusor to penetratefemalcs.As n lc-
male,howevel I would be penetrableand potentiallyfertile. My anulonty
havingnow beenre-labeledasvagina,urethra,labia,and outsizcdclitoris,
my sexwasnext determined(in the secondsense)by amputatingIny gcni-
tal appendage-clitoridectomy.Followingdoctors'orders,my prrcnls lhcn
changedmy name;cornbedtheir houseto eliminateall tracesof my cxislcncc
asa boy (photographs,birthday cards,etc.);engageda lawyerto changcrny
birth certificate;movedto a differenttown; instructedextendedfanrilynrcnr.
bersto no longerreferto me asa boy; and nevertold anyoneelsc-includ.
ing me-just what hadhappened.My intersexualityand changc'ol scxwcrc
the family'sdirty little secrets.
At ageeight, I wasreturned to the hospitalfor abdominalsurgcrythirl
trimmed awayth€ testicularportion of my gonads,eachof which wrrsprrrt-
Iy ovarianand partly testicularin character. No explanationwasgivcnlo ntc
then for the long hospitalstayor the abdominalsurgery,nor f<rrthc rcguku
hospitalvisitsafterwardin which doctorsphotographed rny gcnitalsarrd
insertedfingersandinstrumentsinto my vaginaandanus.Thescvisi(sccitsctl
assoonasI beganto menstruate. At thetime ofthe sexchange, tloctorshatl
assuredmy parentsthat their once-son/now-daughter would grow into ir
womanwho couldhavea normalsexlifeandbabies. With theconlirrrrirtiorr
ofmenstruation, myparentsapparently concluded thatthatprctlictiorrh rl
borne out and their ordealwasbehind them.For me, the wor$t p rt ol tllc
nightmarewasjust beginning.
As an adolescent, I becameawarethat I hadno clitorisor inncrllbia arrtl
wasunableto experience orgasm.Bythe endof my tcens,I beganto rcsclrclt
in medicallibraries,trying to discoverwhat might havehappcncdto nrc.
When I finallydeternrined to obtainmy personalrrcclicalrccorrls,il took
thr€eyearsto overcomc thcobstructionol thccloctors whonrI askc<l
lirr hclp.
t
134 CHERYL CHASE
When I did obtain a scantthreepagesfiorn my medicalfiles,I learnedfor
the first time that I wasa "true hermaphrodite"who had beenmy parents'
sonfor a yearanda half,with a namethat wasunfamiliarto me.The records
alsodocumentedmy clitoridectomy.This wasthe middle r97os,whenI was
in my earlytwenties.I had cometo identifr myselfaslesbianat a time when
lesbianismand a biologically basedgenderessentialismwerevirtually syn-
on1'rnous.Men wererapistswho causedwar and environmentaldestruction;
womenwereloving beingswho would healthe earth;lesbianswerea supe-
rior form ofbeing uncontaminatedby "men'senergy."In sucha world, how
couldI tell anyonethat I hadactuallypossessed the dreaded"phallus"?I was
an impostor,not reallya womanbut rathera monstrousandmythicalcrea-
ture.And because my hermaphroditismandlong-buriedboyhoodwerethe
history that underlay the clitoridectomy, I could never speakopenly about
that either,or about my consequentinability to orgasm.I wassotraumatized
by discovering the circumstances that producedmy embodimentthatI could
not speakofthese matterswith anyone.
Nearlyfifteenyearslater,in my middle thirties,I sufferedan emotional
meltdown.In the eyesof the world I wasa highly successful businesswom-
an,a principal in an international high-techcornpany.To mysel( I wasa fteak,
incapableof loving or being loved,filled witi shameabout my statusasa
hermaphrodite,about the imaginedappearance of my genitalsbeforesur-
gery (I thought "true hermaphrodite"meantthat I had beenborn with a
penis),and about my sexualdysfunction.Unableto makepeacewith these
factsaboutmyself,I finally soughthelp from a professionaltherapist,only
to find my experiencedenied.Shereactedto eachrevelationaboul my his-
tory and predicamentwith someversionof "no it's not" or "so what?"I'd
say,"I'm not reallya woman." Shewould say,"Of courseyou are.Youlook
female." I'd say,"My completewithdrawal fiom sexuality hasdestroyedev-
ery relationshipI've everentered."Shewould say,"E.er-itody hastheir ups
and downs."I tried anothertherapistand met with a similarresponse. In-
creasinglydesperate,Iconfidedmy storyto severalfriendswho shrankaway
in embarrassed silence.I wasin emotionalagonyand found myselfutterly
alone,with no possibleway out. I decidedto kili myself.
Confronting suicide asa real possibility proved to be my personalepiph-
any.In contemplating my own death,I fantasizedkilling myself quite mess-
ily anddramaticallyin the officeofthe surgeonwho had slicedout my clito-
ris,forciblyconfrontinghim with the horror he hadimposedon mylife. But
in acknowledgingthat desireto put my pain to someuse,not to wastemy
life completely, I turned a crucialcorner,finding a wayto directmy ragepro-
ductivelyout into the world rather than aim it destructivelyat myselflMy
TheIntersexMoyementand MedicalDoubleStandards r-j5
breakdownbecamemy breakthough,and I vowedthat, whateverit ttxrk, I
would healmyself.Still, I had no conceptualframework for developinga ntor.c
positiveself-consciousness. I klew only that I felt mutilated,not fully wonr-
an,Iessthan fully human even,but I wasdeterminedto heal.I struggledlirr
weeksin emotionalchaos,unableto eator sleepor work. I could not acccpl
my imageofa hermaphroditicbodyanyrnorethan I couldacceptthe [.rutch-
eredoneleft me by the surgeons. Thoughtsof myselfasa Frankenstein prtch-
work alternatedwith longingsfor escape by death,only to be followcdby out-
rage,anger,and determinationto survive.I couldnot acceptthat it w s iust
or right or goodto treatanypersonasI had beentreated-my sexchlngcrl,
my genitalscut up, my experiencesilencedand renderedinvisible.I borc u
privatehell within me,wretchedlyalonein my condition without cvcn rrry
tormentorsfor company.Finally,I beganto envisionmyselfstandingin rl
driving rain storm but with clearskiesand a rainbowvisiblein thc'distrrncc,
I wasstill in agony,still alone,but I wasbeginningto seethe painful proccss
in which I wascaughtup in termsof revitalizationand rebirth,a nrcirnsol'
investingrny life with a new senseof authenticitypossessing vastpotcntiuls
for further transformation.Sincethen I haveseenthis experienccdcscribcrl
by other intersexand transsexual activists.ra
I slowlydevelopeda newly politicizedand critically awarefornr ol scll-
understanding.I had beenthe kind oflesbian who at timeshad a girlfricntl
but who had neverreallyparticipatedin the life of a lesbianconrntLrnity.I
felt almostcompletelyisolatedfrom gaypolitics,feminism,and quco. rltl(l
gendertheory.I did possess the rudimentaryknowledgethat thc grrycivil
rights movementhad gatheredmomentum only when it could cffcctivcly
denythat homosexualitywassickor inferior and assertto thc contritry lllill
"gayis good."As impossibleasit then seemed,I pledgedsimilarlyto aflirrtr
that'intersexis good"and that the body I wasborn with wasnol sickor
shameful,only different.I vowedto embracethe senseof being" rrota worrr-
an" that I had initially beenso terrified to discover.
I begana searchfor communitythatbroughtnreto SanFrancisco irr thc
fall of rygzon the theorythat peopleliving in the "queerMccca"worrkl
havethemostconceptually sophisticated, socially rolerant, al d politicl lly
astuteanalysisof sexedand genderedembodiment.I fourrclwhirt I was
lookingfor, in part because my arrivalin the BayAreacorrespondccl witlr
the rathersuddenemergence ofan energetic trat)sgcnder polilicitlnrovc.
ment.At the sametime,a vigorousnew waveof gcudcrscholarshiphrttl
emergedin theacadenty. ln thiscontext,MorgiurHolrlescouldanalyzchcr
own clitoridectontyfor hcr master'sthcsisantl hlvc hcr sttr<lyllkcrr scli-
ouslyasacadc'nric work.'"()pcnlytrarrsscxrral scholrrs,irrclu<lirrgSrrsurr
136 CHERYL CHASE
Strykerand SandyStone,werevisiblein responsibleacademicpositionsat
major universities.36
Into this headyatmosphere, I brought my own experience. I startedtell-
ing my story to everyoneI met. Beforelong I learnedof six other intersex
people-including two who had beenfortunateenoughto escapemedical
attention.Realizingthat intersexuality,rather than beingextremelyrare,must
be relativelycommon,I decidedto createa supportnetlvork.SoonI wasre-
ceiving severalletters per weekftom intersexpeoplethroughout the United
Statesand Canadaand a few ftom further afield.Although detailsvaried,the
lettersgavea remarkablycoherentpictureof the emotionalconsequences of
medicalintervention:
All thethingsmy bodymighthavegrowato do,allthepossibilities,
wentdown
thehallwith my amputatedclitodsto thepathologydepartment. Therestof
mewentto therecovery room-I'm stillrecoverhg.
-Morgan Holmes
I amhorrifiedby whathasbe€ndoneto meandby theconspiracy of silence
andlies.I am filledwith griefandrage,but alsorelieffinallyto believethat
maybeI amnot theonlyone.
-Angela Moreno
As soon asI sawthe tiie Hermaphroditeswith Attitude 1 Clied aloud for sheer
joy. . , . Iinally I cansay,'I'm hermaphrodite,I'm intersex,I'm transgender,I'm
queerand damn proud,' astearsof joy and belongingstreamdown my face.
_Lee
Doctorsneverconsultedme. . . . [T]he idea of askingfor my opinion about
having my penis surgically alteredapparendynever occurred to them. . . . Far
too many peopleallow socialstigmato cloud thet judgment.It's OK to be
different,
TowardSocialJustice
The peersupport network that I formed grewinto the IntersexSocietyof
North America(ISNA).ISNA'slong-termandfundamentalgoalis to change
the way intersexinfants are treated.We advocatethat surgerynot be per-
formed on childrenborn with ambiguousgenitalsunlessthereis a medical
TheIntersexMovementandMedicalDoubleStandarcls 87
reason(to preventphysicalpain or illness)and that Parentsbe given the
conceptualtools and emotionalsupport to accepttheir children'sphysical
differences. We alsoadvocatethat childrenbe raisedeitherasboysor girls,
accordingto which designationseemslilely to offer the child the greatest
future senseof comfort. Advocatinggenderassignmentwithout resorting to
normalizing surgeryis a radicalposition giventhat it requiresthe willful
disruption of the assumedconcordancebetweenbody shapeand gender
category.However,this is the only position that Preventsirreversiblephysi-
caldamageto the intersexperson'sbody,that preserves the intersexperson's
agencyregardingtheir own flesh,and that recognizes genitalsensationand
erotic functioning to be at leastasimportant asreproductive capacity.If an
intersexchild or adult decidesto changegenderor to underSosurgicalor
hormonal alterationof his/herbody,that decisionshould alsobe fully re-
spectedand facilitated.The keypoint is that intersexsubjectsshouldnot be
violatedfor the comfort and convenience of others.
One part of reachingISNA'slong-terrngoal hasbeento docurnentthe
emotionaland physicalcarnageresultingftom medicalinterventions.As a
rapidly growingliterature (seethe bibliographyon our Web-site,<http://
www.isna.org>) makesabundantly clear,the rnedicalmanagementof inter-
sexualityhaschangedshockinglylittle in the more than forty yearssincemy
fust surgery-doctors still cut up children's genitalsand still perpetuatein-
visibility and silencearound intersexlives.Kesslerexpresses surprisethat "in
spite of the thousands of genitaloperations performed every year,thereare
no meta-analyses ftom within the medicalcommunity on levelsof success."37
Surgeonsadmit to not knowing whether their former patientsare "silent and
happyor silentandunhappy."38 Thereis no researcheffort to improYeerot-
peoplewhosegenitalshavebeencut, nor are
ic functioning for adult intersex
there psychotherapistswho specializein working with adult intersexclients
trying to heal frorn the trauma of medical intervention. To provide a coun-
terpoint to the mountainsofprofessionalmedicalliteraturethat neglectin-
tersexexperienceand to begin cornpilingan ethnographicaccountof that
experience,ISNA hasworked to rnakepublic the livesof intersexpeople
through our own publications (includ tng our ideo, HermaphroditesSpeak!)
and by working with scholarsand the popular media.3'g
ISNAs presencehasbegunto be effective.It hashelpedpoliticize the grow-
ing number of intersexorganizationsaswell asintersexidentities themselves.
When I firstbeganorganizingISNA,I met leadersofthe Turner'sS1'ndrome
Society,the oldestknown supportgroup focusingon atypicalsexualdiffer-
entiationfoundedin 1987.(Turner'sSyndromeis definedby an XO genetic
karyot)?e that resultsin a femalebody morphologywith nonfunctioning
l
-16
( ;tl ll.l tYt. (i
^stl
ovarics, cxtrcrrelyshortstaturc,nd,variably, r valictyofothervisiblephys-
ical differencesstill describedin the ureclicalliteraturcwith suchstigmatiz-
ing labelsas"web-necked"and "fish-mouthed.")Eachof thesewomentold
me what a profound,life-changingexperienceit had beensimply to meet
anotherpersonlike herself.Iwasinspiredby their accomplishments (theyare
a nationalorganizationservingthousandsof members)but wantedISNA to
havea different focus-less willing to think of intersexuality asa pathology
or disability,moreinterestedin challengingthe medicalizationof sexualdif-
ferenceentirelSand more interestedin politicizinga pan-intersexual revolt
acrossthe divisionsofparticularetiologiesin orderto destabilize the hetero-
normativeassumptions that underliethe violencedirectedat our bodres.
Public Discourseon PediatricGenital Surgeries
Becausethe politicizedintersexcommunity is still quite young,and most
intersexpeopleremaintoo burdenedby the crippling emotionalconsequences
of what hasbeendoneto them to comeout publidp ISNA hasdeliberately
cultivateda networkof non-intersexed advocates who commanda measure
of sociallegitimacyand can speakin contextswhereuninterpretedintersex
voiceswill not be heard.Because thereis a strongimpulseto discountwhat
intersexpeoplehaveto sayaboutthemselves (asif we aretoo closeto the is-
suesto offerobjectiveopinions),this sort of sympatheticrepresentation has
beenwelcome-especiallyin helpingintersexpeoplereftameintersexuality
in nonmedicalterms.ao Somegendertheoryscholars,feministcriticsof sci-
ence,medicalhistorians,andanthropologists havebeenquickto understand
andsupportintersexactivism.Feministbiologistandsciencestudiesscholar
Anne Fausto-Sterling-whowrote,yearsbeforeISNA cameinto existence,
aboutintersexualitf in relation to intellectuallysuspectscientificpracticesthat
perpetuatemasculinistconstructsof gender-becamean earlyISNA ally.ar
Likewise,socialpsychologistSuzanneKesslerwrote a brilliant ethnography
of surgeonswho specialize in treatfngintersex.After speakingwith a num-
ber ofthe normalized"products"of thesemedicalprograms,she,too,became
a strongsupporterof intersexactivism.{'Historianof scienceAJiceDrege6
whosework focusesnot only on hermaphroditismbut alsoon other forms
of atlpical embodimentthat becomesubiectto destructivelynormalizing
medicalinterventions(asin her discussionofconjoined twins in "Limits of
Individuality"), hasbeenespecially supportive.4r Fausto-Sterling,Kessler,and
Dregerhaveeachwritten booksthat analyzethe medicaltreatmentof inter-
sexualityasbeingculturallymotivatedand criticizeit asoftenharmful to its
ostensiblepatients.*
TheIntersexMovementandMedicalDoubleStandards r.l9
Allieswho help contestthe medicalizationof intersexualityhavebecncs-
peciallyimportant,becauseISNA initially found direct,nonconfrontationrrl
interactionswith medicalspecialists who determinepolicy on the treatntcnl
of intersexinfants and actuallycarry out the surgeriesto be both difficu lt l nd
ineffective.loycelyn Elders,the Clinton administration'sfirst surgeongcncr-
al,is a pediatricendocrinologistwith manyyearsofexperiencein mannging
intersexinfants.In spiteof a generallyfeministapproachto healthc rc rln(l
frequentoverturesfrom ISNA,sherejectedthe concernsof interscxpcoplc
themselves.a5
SurgeonRichardSchlussel,at a pediatric plasticsurgerysymposiunr(wh ich
had reiectedISNA'sofferto providea patients'panel)at Mount SirrniMcdi.
calCenterin NewYorkCity in 1990proclaimed,"The parentsofchildrcn wilh
ambiguousgenitalsaremore gratefulto tle surgeonthan any-morc gnltc-
firl eventhan parentswhosechildren'sliveshavebeensavedthrouglr opcn
heartsurgery."a6
Anotherpediatricianremarkedin an Internetdiscussionon intcrscxrrul.
ity, "I think this whole issueis preposterous.. . . To suggestthat Inrcdicll
decisionsabout the treatmentof intersex]aresomehowcruelor arbitrrrryis
insulting,ignorant and rnisguided.. . . To spreadthe claimsthat I ISNAI it
makingis just plain wrong,and I hope that this [on-line group of dockrrsI
will not blindlyacceptthem."Yetanotherphysicianparticipatingin th tsrlntc
chat,in a marvelousexampleofthe degreeto which practitioncrsof scicncc
canbe blind to their complicityin constructingtheobiectstheystu(ly,rskc(l
what wasfor him obviouslya rhetoricalquestion:"Who is thc cncrrry?I lc-
ally don't think it's the medicalestablishment. Sincewhen did wc cstablish
the male/femalehegemony?" lohns HopkinssurgeonGearhart,<luotcdirr rr
New YorkTimesarticleon ISNA,summarilydismissedus as "zcalots,"but
professionalmeetingsin the fieldsofpediatrics,urology,genit lltllsticsur-
gery and endocrinologyare abuzzwith anxiousand defensivccliscussions
of intersexactivism.aT In response to a r996protestby Hermaphroditcswith
Attitude at the AmericanAcademyof Pediatricsannualnrceting,tlrirt()rgrl-
nizationfelt compelledto hold a pressconference andissuea statcntcnt:"'l'hc
Academyis deeplyconcernedaboutthe emotional,cognitive,anrl lrodyinr-
agedevelopmentof intersexuals, and believesthat successful carly gcnittl
surgerymhimizestheseissues." The academyrefused,howcvcr,to spclk with
intersexpeoplepicketingits meeting.
Therootsofresistance in themedicalestablishnrerlt k) thc truth-cLlinls ol
intersex people run deep.Not onlydocsISNA'scxistcncc inrplyI crititlrrcol'
the normativistic biases couchcdwithin mostscicntilicLrrrcticc btrt it irlso
advocates protocollirr inlcrscxirrlitnlsthrrtdisruptsconvcntiorr-
a treatrncrrt

140 CHERY L C H A S B
al understandings ofthe relationshipbetweenbodiesandgenders. On a level
more personallythreateningto medicalpractitioners,ISNA'sposition implies
that theyhave-unwittingly at bestandthrough willfirl denialat worst-spent
their careersinflicting a profound harm from which their patientswill never
fully recover.ISNA'spositionthreatensto destroythe foundationalassump-
tionsmotivatingan entiremedicalsubspecialty, thusjeopardizingtheir con-
tinued ability to perform what surgeonsfind to be technicallyfascinating
work. Science writer MelissaHendricksnotesthat Gearhartis known to col-
leagues asan "artist" who can"carvealargephallusdowninto a clitoris"with
consummateskill.a8Given thesedeep and mutually reinforcing reasonsfor
opposingISNA'sposition,it is hardly surprisingthat medicalintersexspe-
cialistshave,for the mostpart, turned at deafeartowardus.ae
Thus,the mostimportant aspectofour currentactivitiesis the struggleto
changepublic perceptions.By usingthe massmedia,the Internet,and our
growing network of alliesand sympathizersto makethe generalpublic aware
of the frequencyof intersexuality and of the intensesuffering that medical
treatmenthascaused, we seekto createan environmentin which manypar-
entswill havealreadyheard about the intersexmovementwhen their inter-
sexchild is born. Suchinformed parentshaveprovedbetter ableto resist
medicalpressure for unnecessary genitalsurgeryandsecrecyandto find their
wayto a peer-supportgroupandcounselingratherthan to a surgicaltheater.
The Double Standard:First-World Feminism,
African Clitoridectomy and IntersexGenital Mutilation,
and the Media
African practicesthat removethe clitorisand other partsof femalegenitals
havelatelybeena targetof intensemediacoverage and feministactivismin
the UnitedStatesand otherindustrializedWesternsocieties, andthe euphe-
mismfemalecircumcisionhasbeenlargelysupplantedby the politicized term
femalegeninl mutilation(FGM). Analogousmedical(ratherthan folk) op-
erationsperformedon intersexpeople in the UnitedStateshavenotbeenthe
focusof similar attention-indeed, attemptsto link the two forms of geni-
tal cutting havemet with multiform resistance.Examining the waythat first-
world feministsandmainstreammediatreatAftican practicesand compar-
ing that treatmentwith their respanseto intersexgenitalmutilation (lGM)
in North Americaexposes someofthe complexinteractionsbetweenideol-
ogiesof race,gender,colonialism,and sciencethat effectivelysilenceand
renderinvisibleintersexexperience in first-worldcontexts.Cutting intersex
\
TheIntersexMovementandMedicalDoubleStandqrAg l .l I
genitalsbecomesyet anotherhidden rnechanismfor imposing norn\(clt
upon unruly flesh,a meansofcontairing thepotentialanarchyofdesircsarrd
identificationswithin oppressive heteronormativestructures.
In ry94theNewEnglandloumal of Metlicinepairedan artrcleon thc phys-
ical harm resultingfiom African genitalcutting with an editorialdenounc-
ing clitoridectomyasa violation of human rights but declinedto run ir rc"
ply draftedby Universityof Californiaat Berkeleymedicalanthropologirit
LawrenceCohenandtwo ISNAmembersdetailingthe harm causedlry nrctl-
icalizedAmericanclitoridectomies.soIn responseto growingmediaattcntion,
Congresspassedthe FederalProhibition of FernaleGenitalMutil tiot) Acl
in Octoberr996.s'That actspecificallyexemptedfrom prohibitiou nrc<licnl-
izedclitoridectomiesofthe sort perform€dto "correct"intersexbodics.'l'hc
bill's principal author, feminist CongresswomanPat Schroedcr,ignorcd
multiple lettersfrom ISNA membersand Brown University professorol'
medicalscienceAnne Fausto-Sterling
askingher to recastthe[rill'slrrngulgc.
"New Law BansGenitalCutting," the New YorkTimesproclained aud rclincd
to addressdocurnentationfiom ISNAandMichiganStateUniversityprolcs-
sor Alice Dregerpointing out that genitalcutting continuesto be st ndflrd
medicalpracticein the United States.s'?
The BostonGlobe'ss1-ndicated columnistEllenGoodmanhaslrccnonc ol'
the fewjournalistscoveringAfticangenitalcutting to makeany responsclo
ISNA overtures."I must admit I wasnot awareof this situation,"shewrolc
to me in 1994."I admireyour courage."Shecontinued,howevcr,to tliscr.rss
Africangenitalcuttingin her columnwithout mentioningsimilarAnrcricrrn
practices. Ironically,Goodmanis basedin Boston,a Meccaofsortsaftcr lohrrs
Hopkinsfor the surgicalrnanagement of intersexchildren,witlr prorrrinclrl
specialists operatingat Harvard,Massachusetts GeneralHospit l, and ltos-
ton Children'sHospital.AnOctober1995Goodmancolumnon gcnitalcrrt-
ting waspromisinglyentided"We Don't Want to BelieveIt HappelrsI lcrc"
but discussedonly practicesimported to the United Statesby inrnrigrrrrrts
from third-world countries.
While anti-excisionAfrican immigrant womenwithin the Unitcd St tcs
havebeenreceptiveto the claimsmadeby intersexopponentsto nrcrlicrrl-
ized clitoridectomies,first-world feministsand organizationsworking on
African genitalcutting havetotally ignoredus. Only two of thc r arryarrti-
genital-cuttingactivistgroupscontactedhavebotheredto respondkr rcpcrrt-
ed overturesfrom intersexactivists.Fran Hosken,who sincctgtiz lraslcgtr.
larly publisheda catalogof statisticson femalegenitalcuttingworklwirlc,
wroteme a tersenotesayingthat"wc arcnot conccrncd with biologicllcx-
ceotions."sr
 142 CHERYL
cHAsE ThelntersexMoyementand MerliculI)ortltlt Stturlrnls r4 |
ForwardInternational,a London-based, anti-female-genital-cuttingorga- photojournalistsin searchof sensational clitoridcctomyphotos(lo Iol I('lr
nization, replied to Germanintersexactivist Heike Spreitzerthat her letter of resenta yeritabletourism boom for a country thc sizcof WcslVir'11irrirr,
inquiry was "most interesting" but they could not help becausetheir work Theserepresentations manifesta profound act of "otlrcrin11"Aliicurr eli
focusesonly on genitalcutting "that is performed asa harmfirl cultural or tra- toridectomythat contributesto the silencesurrounding sinrililr nlc(liculizc(l
ditional practiceon younggirls." practices in the "modern,"industrialized West."Their" gcnitrl cllltirll is
As ForwardInternational'sreply to Spreitzerdemonstrates, many first- barbaricritual;"ours" is scientific. Theirsdisfigures; ours nornrnlizcs lhc
world, antiFGM activistsseerningly considerAfticans to have,.harmfirlcul- deviant.The colonialistimplicationsof these representatiorrsof gcrt
ilrtl cut-
tural or traditional practices,"whereaswe in the modern industrializedWest ting areeyenmoreglaringlyobviouswhencontemporaneous inragcsol in-
presumablyhavesomethingbetter.We havescience,and scienceis linked to tersexsurgeriesare juxtaposedwith imagesof African practiccs.Mcdicrtl
the meta-narratives of enlightenment, progress, andtruth. Genitalcuttingis books describinghow to perform clitoral surgeryon interscxchiklrcn rtrc
condonedto the extentthat it supportstheseculturalself-conceptions. almostalwaysillustratedwith extremegenitalclose-ups,disconncctin$thc
RobinMorganandGloriaSteinemsetthe tonefor much ofthe first-world genitalsnot only ftom the individual intersexedpersonbut also lrotn llrc
feminist analysisofAfrican genital cutting with their pathbreakingarticle in body itself.Full body shotsalwayshavethe subject'seyesblackcdout. Why
the March r98o issueof Ms. magazine,"The International Crime of Genital is it considerednecessary-orat leastpolite-to blackout thc cycsol Antcr-
Mutilation." A disclaimeratop the first pagewarns,"Thesewordsareparn- ican girls but not tle eyesof the African girls usedto illustr tc Stcinc|ll'!r
ful to read.They describefactsof life asfar awayasour mostfearfulimagi- "InternationalCrime" or Life'smore recent"Ritual Agony"?| suspcclrtnc
nation-and ascloseasany denialof women'ssexualfreedom.,,5a For Ms. reasonis that a Westernreaderis likely to identifowith an Anrcricut bul rtot
readers,whorn the editorsapparentlyimaginearemore likelyto experience an African girl. Blackingout the Americangirl's eyesallowsthc rcrttlcrtrt
the pain of genitalmutilation betweenthe coversof their masazinethan rernainsafelyon this sideof the camera.
betweentJreirown thighs, clitoridectomy is presentedasa fact oiforeign life First-worldfeministdiscourselocatesclitoridectomynot only clscwhctc
whoseprincipal relevanceto their readershipis that it exemplifiesa loss of in Afiica but also"elsewhen."An Atlantic Monthly articleon Alrican clikr-
"freedorn,"that mostcherishedpossession ofliberal Westernsubjects.One- ridectomy,for example,asserted that the "Americanmcclicalproltssion
half of the article'sfirst pageis filled with a photographof an African girl stopped performing clitoridectomies decades ago,"and thc nl glzinc (lc'
seatedon the ground,her legsheldopenby the arm ofan unseenwomanto clinedto publisha letterfrom ISNAcontradictingthat clairrr.tT Acrtdctttie
her right. To her left is the disembodiedhand of the midwife,holding the publications areasproneto thisattitudeasthepopularprcss.Fcnrinist Mrtt-
razorbladewith which shehasjust performeda ritual clitoridectomy.The thaNussbaum, in a discussion ofjudgingothercultures,acknowlctlgcs, " ll'
girl's faceis a rnaskofpain, her mouth open,her eyesbulging. two abusesaremorallythe sameandwe havebetterlocalinfirrnralirtttitlrottl
In sometwenty yearsof coverage, WesternimagesofA_fricanpracticeshave oneandarebetterplacedpoliticallyto do something aboutit, lhatrtncsccttts
changedlittle althoughthey havefound their way into more mainstream to be a sensible choiceto focuson in our actionshercartdnow."llul thctt
publications."Americansmadea horrifring discoverythis year,,'the Janu- shecounter-factually locates U.S.genitalsurgeries solelyin thc plst: "A$ rc-
ary 997 issteof Lifesoberlyinformedreaders.ss The two-pagephoto spread centlyasthe r94os,[genitalsurgeries] were performed by U.S.and llritish
showsa Kenyangirl held ftorn behind, a hand clampedover her mouth, her doctorsto treatfemale'problems'suchasmasturbation artdlcsbirtnisnt."'l
facecontorted in pain asunseenhandscut her genitals.Interestingly,the girl By collaborating in the silenceaboutintersexgenitalsurgcrics, Nussbittttt
in this photo is adolescent, her breastsare shown,coveredwith rivuletsof excuses first-worldfeministsfrom anyobligationto challengcthcir own ctrl
sweat,and thereis a definiteair of sensualityin the presentation. The 1996 tural practicesasrigorouslyasthey do that of others.s'
Pulitzerprize for featurephotographywent to yet anotherportrayal of a Ken- In the influentialD eviantBodiesanthology, visuallrtist SusirnIilho(lrr'r
1an clitoridectomy.56And, in the wake of FauziyaKassindja'ssuccessfulbid "Theatresof Madness" .juxtaposesnineteenth- and twentielh-ccntury nlu
for asylumin the UnitedStatesafterfleeingclitoridectomyin Togo,the num- terialdepicting" theconceptual intcrdependence of scxuality,rcprotlucliott,
ber of relatedimagesfrom her countryskyrocketed. Onewondersif Wesrern familylife,and'fernaledisordcrs."'Ii)rcprcsenttwcnticth-ccnlur
r 144 CHERYL CH A S E
clitoridectomypractices,Jahodaquotesa r98o letter to the editor of Ms.
magazineprompt€dbytheSteinemandMorganarticle.Thewriter,a nurse's
aid in a geriatrichome,saysshehad beenpuzzledby the strangescarsshe
sawon the genitalsof fiveofthe forty womenin her care:"Then I readyour
article.. . . My God!Why?Who decidedto denythem orgasm?Who made
them go through sucha procedure?I want to know.Wasit fashionable? Or
wasit to correct'a condition?'I'd like to know what this so-calledcivilized
country usedasits criteriafor sucha procedure.And how widespreadis it
here in the United States?"o
While Jahoda'sselectionof this letter doesraisethe issueof medicalized
American clitoridectomies, it again safelylocat€sthe cutting in the past,as
somethingexperienced a long time agoby womennow in their later stages
oflife. Significantly,
fahodaliterallypasses overan excellentopportunity to
commenton the continuingpracticeof clitoridectomyin thecontemporary
UnitedStates. Twomonthsearlier,in theApril r98oissueof Ms.,notedfem-
inist biologistsPatriciaFarnes(a medicaldoctor) and Ruth Hubbard also
repliedto Morgan and Steinem:
Wer^,antto drawthe attentionof your readersto tie practiceof clitoddecto-
my not only in th€Third World . . . but righr herein theUnitedStates,
where
it is usedaspart of a procedureto 'repair" by 'plastic surgery''so-ca.lled gen-
ital ambiguities.Fewpeoplerealizethatthis procedurehasroutinelyinvolved
removalof theentireclitorisandits nervesupply-in otherwords,total clito-
ridectomy. . . . In alengthyarticle,[JohnsHopkinsintersexexpert]ohnl Money
andtwocolleagues write,"Therehasbeenno evidence of a deleterious
effect
ofclitoridectomy. Noneof thewomenexperienced in genitalpractices.report-
edalossoforgasmafterclitoridectomy." Thearticlealsoadvises that"athree-
yearold girl aboutto beclitoridectomized . . , shouldbewellinformedtlat tlle
doctots will makeherlooklikeallothergirhandwomen" (ouremphasis), which
is not unlikewhatNorthAfticangirlsareoft€ntold abouttheirclitoridecto-
mies.. . . But to date,neitier Moneynor hiscriticshav€investigated tJIeeffect
of clitoridectomies on thegirls'development. Yetonewouldsurelyexpectthis
to affecttheirpsychosexual development andtheirfeelingsofidentity asyoung
women.ol
AlthoughFarnesand Hubbard'sprescientfeministexpos6of medicalized
clitoridectomiesin the contemporaryUnited Statessankwithout a trace,
therehasbeena veritableexplosionof work like Nussbaurn'sand Jahoda's
that keeps"domestic"clitoridectomyat a safedistance.Suchconceptualiza-
tions of clitoridectomy's cultural remoteness-both geographicallyancltem-
porally-allow feminist outrageto be divertedinto potentiallycolonialist
I'
TheIntersexMovementand Medical Double Standards I 45
meddlingin the socialaffairsof otherswhile hamPeringwork for socialjus-
tice at home,62
Conclusion
Feminismrepresents itselfasbeinginterestedin unmaskingthe silencethrtt
surrounds violence against womenandin providingtoolsto understandthc
personalas political.Most rnedicalintersexmanagementis a form of vio-
lencebasedon a sexistdevaluingof femalepain and femalesexuality:l)oc-
tors considerthe prospectof growing up malewith a small penisto be a worsc
altemativethan living asa femalewithout a clitoris,ovaries,orsexualgr0ti6-
cation.Medicalinterventionliterally transformstransgressive bodiesinto
onesthat can safelybe labeledfemaleand subjectedto the many forms of
socialcontrol with which womenmust contend.Why then bavemost lbnr-
inistsfailedto engagethe issueof medicalabuseof intersexpeople?
I suggestthat intersexpeoplehavehad suchdifficulty generatingmllin-
streamfeministsupportnot only because ofthe racistandcolonialistfrornc'
worksthat situateclitoridectomyasapracticeforeignto propersubjectswith'
in the first world but alsobecauseintersexualityunderminesthe stabilityof
the category"woman" that undergirdsmuch first-worldfeministdiscoursc.
We call into questionthe assumedrelationbetweengendersand bodics0nd
demonstrate how somebodiesdo not fiteasilyintomale/female dichotomics.
Weembodyviscerally thetruth ofJudith Butler'sdictum that "sex,"thc con-
ceptthat accomplishes the materializationand naturalizationof culturnlly
constructedgenderdifferences, hasreallybeen"genderall along."'rlly rcfits'
ing to remainsilenced, wequeerthefoundationsupon whichdependnot only
the medicalmanagement of bodiesbut alsowidelysharedfeministassurrrp'
tions of properlyembodiedfemalesubjectivity.
In r99oSuzanneKesslernoted,"IT]he possibilitiesfor realsocietaltrans-
formationswould be unlimited [if physiciansand scientistsspecializingin
the managementofgendercould recognizethatl finally,and always,pcoplc
constructgenderaswell asthe socialsystemsthat are groulrdedin gender-
basedconcepts.. . . Acceptinggenitalambiguityasa naturaloption woukl
requirethat physiciansalsoacknowledge that genitalambiguityis 'corrcct-
ed' not because it is threatening to the infant's life but because it is threatclr-
ing to the infant'sculture."6n
To the extentthat we arenot normativelyfemaleor nornlativelywolrlcll,
we arenot the propersubjects of feministconcern,Westernfenrirrism hts
represented African genital cutting as primitive, harnrfitl,
irratiorral, itlttl
 146 cHBnvl.cHAtt
tlcscrving nl lion.'l'hcWcslcrntrrcrlierrl
ol contlcnr colrrrrrtrnily
h.tsrcprcscnt_
editsgenitalcuttiugasnroclern, scicnlilic,
hcnlirrg,
irntlah,,u.,.prno.h.W},"n
will Westernfeministsrealizethat their lhilurckr cxanrineeitherof these
claims"others" African womenand allowsthe violerrtnredicaloppression
of intersexpeopleto continueunimpeded?
Notes
My appreciation
goesto Susan
Strykerfor herextensive
contributionto thedevelopment
of this essay.An earlier version appeared as ,,Hermaphrodites with Attitudq Mapping the
Emergenceof In tersexPolitical Activism," Gl e: A lournal of Gayand LesbianStircs
4 no.
2 (1998):r8F2rr. @1998.All rights reserved.Us€d by permission of Duke University prcss.
r. CeliaDuggen"New Law BansGeniralCutting in the United States,,,NewyorkTimes,
O.t. 12,7996,r.
2. Departm€nt of DefenseAppropriations Act, public Law to4_20E,Sept.30,1996,
3. Alice Domurat Dreger, "'Ambiguous Sex,----orAmbivalent Medicine? Ethical Issues
intheMedicalTreatmentoflntersexuality,,'HastingsCefitetReport2S,rro-3O99a\24_
35,available from <http://www.isna.org/articles/dregerart.htrnl>.
4. American Academy of Pediatrics Section on Endocrinology and Section on Urclo_
gy Committee on Genetics,"E]"luation ofthe Newbom with DevelopmentalAaomalies
of the External Genitalia," Pediatricsto6, no. 1 (2oooj: 138-42,availableftom <httpr//
wwwaap.orglpolic/le9gsE.html>; Clttthia H. Meyers-seiferand NancyJ.Charest,,.Di_
agnosisand ManagementofPatients with Ambiguous Genitalia,,,Seminars in perinatol_
ogy 6,rto. 5 (tggz): yz-39; American Academy of pediatrics Section on Urology, .Timing
of Elective Surgery on the Genitalia ofMale ChilcLen with particular Referenceto the Risls.
Benefits, and Psychological Effects of Surgery and Anesthesia,. pedia trics g\,no.
4 \1996)l
59o,availablefrom <http://www.aap.orglpolicy/0l306.htnl>; LeslieA. parker,,,Anbis_
uous Genitalia: Etiology, Treatmenr,and Nursirg Implications,,'
lournal of Obstetric,
Gynecologicand Neonatal Nursing 27, rro. | (\ggE)t rS-22.
5. JosephE, Oesterling,John P Gearhart,and Robert D.leffs,,,A UnifiedApproach to
Early Reconstructive Surgery of the Child with tunbiguous cenital ia,,,joum)i of Wolo_
&r'r3E,no. 4 pt. 2 (1987):ro79 84.The following video trains surgeonsin the procedure:
fuchard Hurwitz, H. Applebaum, and S. Mu enchow,Surgical ReconstructionofAmbigu_
ous Genitolia in FemaleChildren, CinC-Med Inc,, r99o (the video can be ordered from
CinC-Med at MACROBUTTON HtmlResAnchor <htrp://www.cine-med,com>as vid_
eo number ACS-16r3).
6. American Academy of pediatric$Section on Urology, "Timing ofEleaive Surgery"
59o.
z. Melisa Hendricks,'Is it a Boy or a Girl?,'ro hnsHopkins Magazine 45,no. 5 (1993):ro.
8. John F. Stecker,Charles E. Horton, Charles J. Devine, and John B. McCraq .Hypo_
spadias Cripples," Urohgic Clinics of North Americo: Symposiurn on HypoEadios 8, no,3
\r98r)t $9 44.
9. Howard Devore, "Growing up in the Surgical Maelstrom,,, and SvenNicholson,
"Take Charge: A Guide to Home Catheteriz atiorr,', both jn Inte$er in the Age
of Ethics,
ed.Alice Domurat Dleger (Hagentown: University publishing Group, 1999),
78_8r.
The InterscttMovcmfit ffit lfrttlael lrou,tc standofit rQ7
r{}.,AnilrNllulrjnrr,"N4etlirlllllhlt r ,ttlrl'll rtllr'li'lllrll lrl tltct irr'col All(ll('8cllllli(ll
sitivitvSvr)(fronrc,"()u hu Mtrlh Astrtrinlh httttttd t14,tto4 (1996):561t Trt,rlvrrll
ablefrorrr <lrttp://www.cnl0.c$/ctul)/vol 154/{15('ltc.llltll 'i l)tcgcr',cd,lt,/t'trtxi'l ll''lfr'
oI Ethics.
u. NatalieAngicr,"lntcrscxurlllcrtling:Att Attotttllylintls I ( iroup,"Ncw Yrrrl'lirrtrt'
Feb,4,1996,Er4.
rz. Ian Mulgrew, "Controversyover Intcrscxl'reatment," ydrc0tlvcrSkr, AFril 7' 1997,
u Edna Durbach and GeorgeSzasz,"Spare thc Knife, Spoil thc Child"' Gklrc aul Mtll'
Feb.27, 1996,76.
r3. Natalie Angier, "New Debateover Surgeryon Genitals," Nsla
york ?inrcs' Moy t1'
1997,87:"Getdet Limbo," Dateline NBC,lune l7' 1997;
Anne Scheck,
" lntcr$cxu0lityl\kcr
a ConservativeTurn," lJrologyTimes26,no.r (1998):l'32-ll.
r+. Iudith Butler, Gender'llrouble:Feminismand the Subwrsionof ldettritl (Ncw Y(rrkl
Routledge, r99o); Tho masLaquLeu4Making Sex:Body and Gender[ron the Orutksk' I]ftu
(Cambridge: Harvald University Press,r99o).
15."Histology" lefers to the structure ofthe tissueof the sexglandswhon 0 $0nlPlclil
surgicallyremoved,stained,and observedunder a microscope.
16.Alice Domurat Dre ger,Hermaphroditesand the Medical lnventio o/.S.'x ((hnl"
bridge Harvard University Press,r99E).
17.Hugh Hampton Yotng,Genital Abnormalities,Heftndphroditism,/,,rrlRchtl l Al-
rcflal Diseases(Baltimore:Williams and Wilkins' 1937),xxxix-xl.
rE.Young,"Genital Abnormalities," 139-42.
19.Howard W Jones,Jr, andWilliam WallaceScott,HermoPhrcditit,rt,Gc,tilil A,ttxtt-
aliesand RelatedEndocrineDisorders(Baltimore:williams and wilkin$' 1958)'269'
20. John Money,)oan G. HamPson,and John L. HamPson,"An Exonrinltion ofsrxnc
BasicSexualConcepts:The Evidenceof Human Hermaphroditism," llullclitt ol tlt( h'lntr
Hopkins Hospital gT, + (1955):3or-r9; John Money, loan G Hanlpson, 0nd ,t)hn l,'
^o. ConcerningAssignmcnt()f Sex,(:hfl 18(
Hampson,"Hermaphroditism:Recommendations
of Sex,and PsychologicManagement,"Brlletitl of lohns HopkinsHospilalgT' tto, 4 \t911ll
2E4-3oo; John Money, VenusesPenuses:Sexology,Sexosophy,and Exigc,lcy'l'htoty lllttll\t-
lo: PrometheusPublishers,1986).
zr. Robert M. Blizzard,'Iawson Wilkins," in Wllkins the Diagnosisa l'lltrtl tt'ttl ol
EndocrineDkorders in Chitdhoodand Adolescerce, +th ed.,ed. Michael S. Knppy' ltobcrl
M. Blizzard,and Claudef. Migeon (Springfield:Charles C Thomas' t994), xiii
22. Suzanne Kessler, "The Medical Construction ofGender: CaseManlScmcnt ol lll-
tersexual lnfants," s:
Sigt, Joumal ofWomen in C hure afid Society16,no l (1991')iJ-26'
quotation on 7.
23.Johr Colapinto,As NqtureMade Him: TheBoy Who WasRaisedasa (iiri ( Ncw Yrrlk:
Harpercollins, 2ooo).
zq. American Academyof PediatricsS€ctionon Endocrinology and Sccti(nroll IJr(rl
ogy Committee on Genetics,"Evalution of the Newborn"; Gerardo lzquicrdo nrl(l Kcn
neth I. Glassberg,"Gender Assignmentand Genderldentityin Patientswith AnrltiSurrtlr
ltont thr' ltrt,.rtr'nI
Genitalia," Urology 42,no,3 G9y): z3z-42;SuzanneKe sslet Lessons
(New Brunswick:RutgersUniversityPress,r9p8);BarbaraC McGillivray,"'l'hc Ncwlrolrr
1 4u CHERYL CHA S E
with Ambiguous Genitaha," Semifiafi in Perinatolog)/16,no. 6 (1992):365-68;Meyers-
Seifer,"Diagnosisand Management."
25,The best sourceto view the dgramics ofthe medicalrelianceon prevaricationis B.
Diane Kemp, Sherri A. Groveman,Anonymous, H. Deni Tako,and Karl M. Irwin, "Sex,
Lies and Androgen lnsensitivity S),ndrome,"CanadianMedicalAssociaion]ournal84,
no. u (1996): r8z9-33, available from MACROBUTTON HrmlResAnchor <http://
www.cma.calcmaj/vol-154/1829e.htm>. For evidencethat the practiceofwithholding the
diagnosis from intersex patients is still common, seeRobert Marion, "The Cr_rrse of
the Garcias," Discover zt, no. r (zooo): 4z-44, available from MACROBUTTON
HtmlResAnchor<http://www.findarticles.com/cf0/m I51l/t 2 211671852941pl1
article.jhtmb. Representative older work recornmendingwithholding the diagnosisin-
clude Tom Mazur, "Ambiguous Genitalia:Deiection and Counseling," PediatricNutsing
9,no.6 (D83):4\7-22. 43r;l. Dewhurst and D. B. Gnnt, "lntersex P toblems,"Archittesof
DiseaseinChildhood 59,no. D (r9E4)iu9r-r94; Froukje M, E. Slijper,StenvertL. S.Drop,
fan C. Molenaar,and R.I. Scholtmeijer,"Neonateswith Abnormal Genital Development
Assignedthe FemaleSe* ParentCounseling,"lournal of SexEducaion and Therary 20,
no. r (r994l:9-17.
26. Claudel. Migeon, GaryD. Berkovitz,and Terry R. Brown, "SexualDifferentiation
and Ambiguity," in Mrftins the Diagnosis andTreahnent of Endocrine Disorders in Aild-
hoorlanil Ailolescence,4thed., ed. Michael S. Kappy, Roberr M. Blizzard,and Claude J.
Migeon (Springfield:CharlesC Thomas,1994),573 7r5.
27. Lalitha Raman-WiLns,Alice Lin-in Tseng,SuzanneWighardt, Thomas R. Einarson,
and Gideon Koren, "Fetal Genital Effects of First-Trimester Sex Hormone Exposure: A
Meta-Analysis,"Obstericsand Gynecology85.no. I (1995):141-48;J. Fichtner,D. Filipas,
A. M. Mottrie, G. E. Voges,and R. Hohenfelher "Analysis of Meatal Location in Five
Hundred Men: Wide Variation QuestionsNeed for MeatalAdvancementin All Pediatric
Anterior H)?ospadiasCases,"Jo nal ofUrology r54,no.2 (r9g5):A3;-14;Melanie B|ack-
less,Anthony Charuvastra,Amanda Detryck, Anne Fausto-Sterling,Karl Lauzanne,and
Ellen Lee,"How SexuallyDimorphic Are We?Reviewand Synthesis,"AmericanJounal
of Human Biologytz,no.2 (20oo):151-66;AnneFausto-sterling,SeringtheBody: Gendet
Politicsand the Consttuctionof Humafl Sealtallry(New York BasicBooks,zooo).
28. Milton T. Edgerton,"Discussion:Clitoroplasryfor Clitoromegalydue to Adreno-
genital S;.ndromewithout Lossof Sensitivity,"Plasic and Reconsttu.til,eSurgerygr,rlo.
s s56.
'9ca\
29. Hendricks, "ls It a Boy or a Girl?" Quotation on 15.
3o. Stecker,"HlryospadiasCripples."
3r. Devore,"SurgicalMaelstrom."
32.Robert E. Gross,JudsonRandolph, and lohn F. Crigler, "Clitorectomy for Sexual
Abnormalities:Indications and Technique,"Surgery59,r'o.2 (1966):3oo-30E,quotation
on 3o7.
33.Oesterling,"Uni6ed Approach."
34. Kiira Triea, "The Awaketing," Hermaphroditesv,ith Attitude (Winter 1994-95):r,
availableftom <hftp://www.isna.org/hwa/winter94-95/winrer94-95.html>; SusanStryk-
et "MyWords to Victot FrankensteinabovetheVillage of Chamounix," GLQ: A Joumal
ofGay and LesbianStltdies1no.3 j994):47 54.
ThelntersexMot ementand Medic&lDoubleStandards r4g
35.Morgan Holmes,"Medical Politicsand Cultural Imperatives:Intersexualitybeyond
Pathologyand Erasure,"master'sthesis,YorkUniversiry,1994.
36. Sandy Stone, "The Empire Strikes Back A PosttranssexualManifesto," i|r lror'l/
Guards:The Cubutal Politicsof GenderAmbiguitl,, ed. Julia Epstein and Kristina Strnuh
(New York: Routledge,rggr).
37. Kessler,Lessonsfrom the Interse\ted, 53.
38. Ellen Barry, "United StatesofAmbiguity," BostonPhoenia,No't.22,1996,stylc scc-
tion, 6-8.
39. Cheryl Chase,Hsrnxaphrodites SPeak!thirty-minute videotape(SanFrancisco:In-
tersexSocietyof North America, r99Z),availableftom <httP://www.isna org>; Kcsslcr,
Lessons from the Intersexed; Dreger, ed..,Intersex ik the Age of Ethics; Angiet " l n tcrscx tril I
Healin1"; Is It a Boy or a Gii? d:ie.tedby Phyllis Ward, DiscoveryChannel, March 26,
zooo,availablefrom <http://www.isna.org>;Ruth G. Davis,"Was I Meant to Bc a Milr?"
Cosffi opolitan zz9.no. 4 (2ooo):2oo-zoj.
40. Similarly,some Westernfeminist opponents ofAfiican genital cutting hlvc llkcn
it upon themselvesto speakfor thoseaffected,under the assumptionthat they.rrc cilhcr
too ignomnt or too vestedin the practicesto make any valid contributions ((ilxitc (l
Robertson,"Getting beyond the Ew! Factor: Rethinking U.S.Approachesto Africitn lc-
male Genital Cutting," chapte.2 in this volume).
4r. Anne Fausto-sterling,"The Five Sexes:why Male and FemaleAre Not lix)tr8h,"
me Sciences33,no. 2 (1993):20-25; Anne Fausto-SterliDg,M/ffis ol Gendct: Ilidolii
meoties about women and Men, zd ed-(New Yorlc BasicBooks,1985),t34-4t
42. Kessler"Medical Construction ofGender."
43.Alice Domurat Dreger,'The Limits ofIndividuality: Ritualand Sacrificcirt thc Livr'n
and Medical TreatmenrofConioined Twins," Studiesin History atld Philosoqhynl llidn-
gy and BiomedicalScience29, no. a (rgg8\ r-29; Alice Domurat Dreger,"l)oul)tltll Scxi
The Fateof the Hermaphrodite inVictorian Medicire," Victorian Sturriss3{i,rlo. I ( |995)l
(l(trl ds," in
336-70;Alice Domurat Dreg€r,"H€rmaphrodites in Love:The Truth of thc
Scienceahd Hofiosexual;fiet ed.Veinon A. Rosario(NewYork: Routledge,1997),46-66;
Alice Domurat Dreget "Doctors Containing Hermaphrodites:The Victorirrl l,c8ir(y,'
Chrysalis:The lournal ofTrahsgressh/e GenderIdentities2, no. 5 \rgg7). 15-2.2..
44. Fausto-Sterling,Sexingthe Body; Kessler,Lessons from the I tcrstxc.l;l)rcgcr, c(1.,
Intersexin theAge of Ethics;Dreger,Hermaphroditesand the Medical Invurtiut ol Stx
45. ]oycelynEldersand David Chanoff,From ShareuoPPer's Daughtcr to St,rgro (;[
enl of the united Statesof America (NewYork: William Morrow, 1996),t5o-54i "l )r. lll-
ders' Medical History," The New Yorker,Sept.26, rgg4,45 46.
46. Mt. Sinai SchoolofMedicine, Conferenceon PediatricPlasticand Roconstrlrclivc
Surgery,New York City, May 16,1996.
47. Angier, "lntersexual Healing."
4E.Hendricks,"ls It a Boy or a Girl?" More than one ISNA membcr hasdiscov(rr(l thrtl
the surgeonswho operatedon them did so at no charge,A 1994wirc scrviccncwstlrtielc
(Tom Majeski, "Surgery ChangesRussianChild's Sex,"Sa JoscMtr.ury Ntwllrtly )5,
r994,Au) relates how a Moscowfamily,clrivcnto thouShtsof murdcr-suiciclc by tht'ironc
year-oldsonMisha'sanatonry, sc;rrchcd high ancllow ttntil thcyconrrcctc(l wilh nn Anlcr
icanpcdiatricLlrologisl.l hc Llrologisl (lon lc(l ils sefvi(('s,
thc hrtsl)itirl
o|crirtctllirr'lr-ec,
 l5o c t |I RYL ( j l t ^ s t l
and an airline footed the expcnsesfor a round trip to Sr. Paultirr thc cntirc lhnrily. Doc-
tors removed Misha's penis, testis,and ovary and irrstructedtlrc family to rcname him
and to move,The family plans neverto revealanypart ofthe story to relativesor to their
now-daughter Masha.The medical establishment'sfascinationwith its power to change
sex and its drive to rescueparents from intersex children are so strong that intervention
can be delivered acrossnational borders and without regard to the commercial model that
ordinarily governsU.S.medical services,
49. The first exception was ulologist Justine Schober,who, after watching a videotape
made at the 1996 ISNA retreat and receiving other input fiom various intersex groups,
suggestedin a new textbook on pediatric surgery that altho ugh technology has advanced
to thepointthat "our needs[assurgeons]and the needsofparents to havea plesentable
child can be satisfied," il is time to acknowledge that there are problems that "we as sur-
geons,despite the most technically perfect surg€ries,cannot address." She then called for
a thorough reevaluationoftheprotocols surrounding medical managehent of intercex-
uality: "Surgery makesparents and doctors comfortable, but counselingmakespeople
comfortable too, and is not irreversible." Justine M. Schober, "Ferninizing Genitoplasty
for Intersex," in Pediatric Surgery and Urclogy: Long'lerm O tcotnes,ed. M. D Stringer
et al. (London: W. B. Sar:nders,r99E),j49-58. By eally 2oo1,there was finally growing
acknowledgment within the medical community that a.llis not well. Surgeon lan Aaron-
son, in forming a "North American Task Force on Intersex' in zooo, acknowledged that
"long-term outcome data lon intersexgenitalsurgeries]is r.erysparseand selective,and
this puts surgeonson tenuous ethical grouflds." The july zooo issueof the Amerrcan
Academy of Pediatric s' journal Pediatrics carried an article that called for a moratorium
on pediatric geoital surgeries: Chanika Phornphutkul, Anne Fausto-Sterling, and Philip
A. Gruppuso, "Gender Self-Reassignment in an XY Adolescentlemale Born with Am-
biguous Genitalia," Pediatricsro6,no. | (zooo): 135-37.Unfortunately,it also carried an
arnouncement of a newly adopted poliry of the academy calling for continued pediatric
genital surgeries as standard practice (Arnerican Academy of Pediatrics Section on En-
docrinology and Section on Urology Committee on Genetics,"Evaluation.ofthe New-
born"),
5o. Patricia Schroeder, "Female Genital Mutil aion," New England loumal of Medicine
94 no. t (1994): 79-4o; Nahid Toubia, 'Female Circumcision asa Public Health Issue,"
New England Journal d Med icine 33t, no. \ (1994)t 7 12-16.
5r, IsabelleR. Gunning, "FemaleGenital Surgeries:EradicationMeasuresat the West-
ern Local Lwel-A C,autionary Tale" (chapter 4 in this volume).
5r. Dugger,"New Law Bans Genital Cutting."
53. Fran P, Hosken, ?}e Hoskeh Report: Genital afid Sexual Mutilation of Ferndles,4th
iev. ed. (Lexingtonr Women's International Network News, 1994).
54. Robin Morgan and Gloria Steinem,"The International Crime ofGenital Mutila-
tion," Mr 8, no.9 (r98o): 65-67,98,quotation on 65.
55. Mariella Furrer, "Rit:ual Agony," Life zo, rlo. 1 (1992):38-39.
56. Robertson, "Getting beyond the Ew! Factor"; seealso Pulitzer PrizeBoard, Featute
Photography: Stephanie Wehh (t996), available from MACROBUTTON Hrn ResAnchor
<hft p://www.pulitzerorg/1.ear/I 996/feature-photography/>.
tttttlMttlitnll)othlr Stnnltnls
'l'fuI lrsu Movt','|trtl rtl
(:{tlrl('slo All(.ri(i|," n I lNJttitMonthly t7t',
57.Lin<firllttrstyrr,"Icnrnlo(liJcllnlcisioll
no.4 (r995):28-35,quol.r(ronon 3l
58.Martha C. Nussba:urn,Sexa d soci l lusllu' (Ncw Yrrk: Oxfor(l Ljlivcrsity l)rcilil,
rggg), r22-2j,
59.One wishesthat first-worldcriticsofAfrican Benitalcutting would do lhcir ht'lllc'
work. lt is easy(and ftee) to perform an Internct search of the Nationnl Librnry ol Mc(l-
icine's database of medical Searching for "clitoris" and "surgcry" iln(l th(ll
Publications.
eliminating referencesto cancer,transsexuals,animals,and bladder cxstrophy Pto(ltlccd
196citations in April 2ooo.Of these,3l relat€to folk genital cutting prilcliccs,wlrilc l1i
relateto genital surgery for transforming intersex genitalsinto nornriltivc fcnrlllc onc{'
Many ofth€ titlesshould draw immediatefeminist suspicion:"The SurSicalM n0g0tllcnl
ofthe EnlargedClitoris," "surgical Techniquefor Clitoral Reduction," "A Ncw tntlSlttl'
plified Method for Concealingthe HyPertrophied Clitoris," "Clitori(lcclonry or l'lrrll(
Reduction of the Clitoris in the AdrenogenitalSyndrome," "Opera(ivc llcdtlctioll tll thc
EnlargedClitoris," "TechniqueofVaginoplastyand clitoridectomy in I hc A(lrcnol|ctlltnl
Syndrome," "A Simple Technic for Shortening the clitoris without AnlPul$ti(|n"' nlld
"Clitorectomy for SexualAbnormalities:Indications and Techniquc."NcIrly lll thc lrtl'
cleson folk genital cutting use condemnatory language'while thosc on in(cricx l{cllll0l
surgeriesall representit astheraPeutic.
60. Susanlahoda, "Theatresof Madness," in Detianl Bodies:Criliul l\nlla(livat o
Dffirence in Scienceand Popular Cuhure, ed. JenniferTerry and lacquclinc Urlo (llhtrt'
mington: Indiana UniversityPress,t995),273;Letter to the Editor, Mi lt, no,lo (lgtlr)): l2'
6r. Patricia.Farnesand Ruth Hubbard, Letter to the Edibr, MJ, lt, no. lo(l9lt(')i9 l(''
(;ct lt," M'l9 l'1'rl
62 Crmpare SebleDawit and SalemMekuria, "TheWest,ust Docsn't
Times, Dec. 7, 1993,Az7.
g. Blutler, Gender Tlouble, 8.
64. Kessler,"Medical Construction ofGender," 25.