What's Changed in the Care of Children with Atypical Sex?

Every year seems to bring another request by another bioethics textbook publisher to reprint my 1998 Hastings Center Report article on the medical (mis)treatment of people with atypical sex, “‘Ambiguous Sex’ or Ambivalent Medicine? Ethical Problems in the Treatment of Intersexuality.” That article represented the first sustained ethical critique in that field, and although it still holds up pretty well, this year in response to another reprint request I finally penned an update to be published along with it. Since I’ve retained rights to the update, I thought I’d put it up here.

Why not just create a new article? Three reasons: (1) today the medical care system for atypical sex is so in flux that it would be difficult to accurately capture the current variety of practices without that representation potentially becoming quickly out of date; (2) the ethical critiques I put forth in 1998 are still worth reviewing, even though some practices have changed; (3) the 1998 article when taken in conjunction with this 2011 epilogue may provide the reader with a sense that medical practice can change for the better through the efforts of patient advocates (including clinicians) who are attuned to evidence and ethics.

Wanting Privacy versus Being Ashamed

A recent event at Northwestern University that I won't bother to describe in detail (but if you've been following it, you might want to see Bailey's apology here) raised an issue I've been meaning to write about. Said event involved public "demonstration" of a live sex act in a classroom in the context of a course on human sexuality. Since the "demonstration" apparently resulted in orgasm, I'm not sure how the "demonstration" is different from a regular ol' live sex act, but let's leave that issue aside for now.

In discussions of the event, various commentators claimed that the problem here wasn't the sex act but the "sex negative" attitudes of people who felt uncomfortable about the "demonstration." Some of these commentators have gone further, to imply that people who were troubled by what happened are downright ashamed of sex.

I think this attitude reflects a naive assumption that I used to share, namely that anything which you want to keep private is necessarily something of which you are ashamed. I used to think this with regard to people's attitude towards atypical genitalia: if parents felt the need to consistently hide their child's atypical genitalia, then the parents were ashamed of those genitals, and that shame would be transmitted to the child.

But this assumption is indeed naive.

Do Gay Men Have More Sexual Interest in Children than Straight Men Do?

I thought about holding off on this post until the next time somebody in the news declares that gay men are to blame for the sexual abuse of children. I’d probably only have to wait a couple of weeks at most. But I’ve decided to go ahead and put this research notice out there, so that hopefully the next time this issue comes up, the rational folks talking about it have the data they need to back up their hunches.

So, at the outset, let me give away the answer to my headline question: Do gay men have more sexual interest in children than straight men do? No. And we have lab studies to prove it.

In fact, the British Journal of Psychiatry published a major study backing up the “no” answer almost 40 years ago. The distinguished sex researcher Kurt Freund and his colleagues used a laboratory method (described below) that demonstrated that the sexual responses of gay men to boys were similar to the responses of straight men to girls. (Both responses are relatively low.) This past June in Canada, at the major international research conference on sexual orientation science, sex researcher Ray Blanchard (who was trained under Freund) presented substantial new data confirming and expanding on Freund’s findings.

Blanchard has published this work online, making the work freely available to all comers. Click here to see the full paper. But, because this work is so important (the scientists assembled in Canada were stunned into near silence when they saw the impressive datasets and theoretical work Blanchard put before us), I asked Blanchard to explain the work somewhat more plainly for those who are not scientists. He’s been kind enough to do so for us here.

The Tale of Tea with Jim the Third

It was one of those messages I get occasionally, this time from a man who had suddenly realized we were just a few blocks away from each other. The writer's father was at a nearby Northwestern hospital, suffering from a terminal cancer.

"While trying to pass some time I went to ISNA's Web site only to discover that it was no more. [The Intersex Society of North America] basically saved my life. Wonderful people such as yourself, Cheryl Chase, Anne Fausto-Sterling, etc., have no idea how much of a difference [you made] and how many lives you have deeply affected. THANK YOU! It would be an honor meet you and shake your hand."

I offered to meet the next morning at the local tea place. And then I started wondering, as I often do with these out-of-the-blue communiqués, if this message was a fake. Was I being set up?

Straight Life with Rainbow Flag

Although two days ago my mate had completely cleared our driveway of the fourteen inches of fresh powder, yesterday at dawn the snowplow came and barricaded us in. By that point, my husband had come down with a bad cold, so it was up to me to spend an hour with one of our heavy metal gardening shovels, breaking the icy barricade into movable chunks and chucking those chunks into what will be, in six months time, a wild profusion of black-eyed susans blooming under our rainbow flag.

As I toiled away, I could not help but notice that none of my neighbors had been plowed in. And so I could not help but wonder, as I often do at such moments, was it because of our rainbow flag? Did the driver of that truck see our rainbow flag, assume we are gay, and punish us accordingly?

Sex Researchers Discover the Clitoris

As an historian of sex, I surely must open this post with the following delightful quotation from Tom Laqueur’s book Making Sex: Body and Gender from the Greeks to Freud:

"In 1559 [...] Columbus—not Christopher but Renaldus—claims to have discovered the clitoris. He tells his 'most gentle reader' that this is 'preeminently the seat of woman’s delight.' Like a penis, 'if you touch it, you will find it rendered a little harder and oblong to such a degree that it shows itself as a sort of male member.' Conquistador of an unknown land, Columbus stakes his claim: 'Since no one has discerned these projections and their workings, if it is permissible to give names to things discovered by me, it should be called the love or sweetness of Venus.' Like Adam, he felt himself entitled to name what he found in nature: a female penis."

I am happy to report that finally—four hundred and fifty years later—sex researchers have rediscovered the clitoris. What am I talking about?

For years now, we’ve been hearing that men on average are sexually target-specific, while women on average are not. In other words, if you show men various kinds of pornography while having a little measuring device strapped to their penises, those penises don’t get hard to every type of pornography; instead, they seem to evince a distinct preference for either men or for women as sexual “targets.” By contrast, if you insert a blood-flow measuring device into women’s vaginas and show them various kinds of porn, well, they appear to become aroused to just about everything sexual—men, women, monkeys, you name it.

Fetish or Orientation? The Case of Men Wearing Female Masks

This week in his ever-pleasurable Savage Love iPhone app, the internationally-syndicated sex advice columnist Dan Savage reprinted a question from a woman whose boyfriend "enjoys wearing women's clothing and acting like a submissive woman when we have sex." The woman told Dan, "Nothing gets him off more. We have only just started exploring his fetish in the past year because he has been ashamed of it all his life. I have encouraged him so far and now we have a couple hundred dollars' worth of sexy women's clothing that fits him. Last night he asked me if he could wear a latex mask of a woman's face during sex."

As one can see, Dan’s reader termed her boyfriend’s proclivities “his fetish,” but as Dan implied in his response, the boyfriend’s interests may be more like a sexual orientation. What’s the difference? In sex research and in clinical psychology, “fetish” usually refers to an object (like a particular article of clothing) or substance (like latex) that an individual finds particularly sexually arousing. By contrast, a sexual orientation is more about how we are wired to interact (or not) sexually with others.

Out of curiosity, I asked Ray Blanchard, a sex researcher, clinical psychologist, and Professor of Psychiatry at the University of Toronto, his thoughts on this reader’s boyfriend. Ray and I actually met over the sexual orientation possibly at issue here, namely autogynephilia, when I wrote a history of a controversy over autogynephilia.