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to accurately capture the current variety of practices without that representation potentially becoming quickly out of date; (2) the ethical critiques I put forth in 1998 are still worth reviewing, even though some practices have changed; (3) the 1998 article when taken in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.

Does Monogamy Really Drive Us to Drink?

A recent article by Mara Squicciarini and Jo Swinnen in the journal of the American Association of Wine Economists (and no, I'm not making that up) suggested the answer to that question might be "yes." Wrote the authors: "Historically, we find a correlation between the shift from polygyny to monogamy and the growth of alcohol consumption. Cross-culturally we also find that monogamous societies consume more alcohol than polygynous societies in the pre-industrial world."

Naturally, lots of bloggers picked up the story, delighted (as bloggers almost always are) to be told what they already believed to be true: monogamy is so frustrating it drives us to drink. Implicitly they were suggesting a beer in the hand is not worth two in the bush.

I was curious to know whether this article might actually support the idea that monogamy drives us to drink, so I asked my colleague Raymond Hames, Chair of Anthropology at the University of Nebraska in Lincoln, to give it a look-see. Ray seemed the perfect person to ask, since his work is cited in this article, he's studied some of the populations considered, and he's engaged (with a former student) in a major study of polyandry.

Pink Boys with Puppy Dog Tails

What to do with a "pink boy"?

In my e-mail in-box a few weeks ago, I received a polite message from a woman named Sarah Hoffman who was writing to ask why I was being such a gender conservative. Sarah didn't quite put it that way, but that was the gist of her message, and given that I'm usually accused of being a gender radical, I sat up and listened. And as I read the whole of Sarah's message, I realized she was absolutely right.

Sarah identifies herself as a mother of a "pink boy" - a boy whose manner of play and dress has often tended toward what's common in girls. Sarah was writing to me specifically in response to a piece I'd written for the Hastings Center Report called "Gender Identity Disorder in Childhood: Inconclusive Advice to Parents." There I had outlined the two basic clinical approaches taken to children labeled as having "gender identity disorder," and had mentioned my sympathies for and reservations about each.

Meet the Hebephiles, the Missing Link between Pedophiles and the Rest of Us

Consider the little-known group falling between pedophiles and the rest of us. But first, their sponsors....

Like the dinner party guest who manages to put more feet in his mouth than he even has, on Tuesday, the Vatican equated pedophiles and those who seek the ordination of women, at least in terms of their place in Church doctrine. Yes, apparently priests who use their office to repeatedly sexually assault children are now officially akin to those who might dare to suggest women are capable of serving the Lord in the same manner as men. The mind reels.

This whacked worldview is at least sort of cohesive. To do the Vatican Hustle, you just pair up any non-normative gender behavior with the devil (or his alleged earthly representatives), and dance! Damn to hell any women who might actively seek power, and tell the world that the root problem of the sexual abuse of young boys is gay men, not pedophilia

For those of you who haven't been following the Vatican edition of "Dancing with the Stars (around Your Head)", the issue of the ordination of women has arisen in this context because some have suggested that introducing women into the priesthood might help stem the problem of sexual abuse. And indeed, if the guys at the Vatican knew any sexology, they'd know there's something to this idea.

Hot Cosmo Piece Screws Nasty Men!

Why do some women pay to let scummy men get into their pants?

I've been bemoaning the death of the free press a lot lately. With Internet competition, newspapers just don't have the resources to support good investigative journalism much anymore. So imagine my surprise when, on the check-out line of my grocery store yesterday, I discovered that the free press is alive and well in the form of . . . Cosmo?

"VAGINAS UNDER ATTACK," screams the cover of the July issue: "Don't Let Greedy Gyno Talk You Into This Horrible Mistake." So I'm going to forgive Cosmo the mistake of capitalizing a preposition in a title. Because Molly Triffin's on-the-ground reporting for Cosmo has the potential to save scores of young women from unnecessary pain, scarring, and loss of sexual function.

Inside the magazine, Triffin's story gets the title "WARNING: These Doctors May Be Dangerous to Your Vagina." Again, I'm going to forgive Cosmo, this time for using the word "vagina" to talk mostly about vulvas. Why? Because Triffin kicks ass. She bothered to go for herself to the International Society of Cosmetogynecology's Global Symposium on Cosmetic Vaginal Surgery.

And what did she see there?

Notes Home

What if we admitted to children that sex is primarily about pleasure?

A couple of months ago, the sex education notice came home in my nine-year-old son's backpack. I didn't realize that, in our district, sex ed starts in the fourth grade. Another sign of the state having more access to my baby than I sometimes wish.

When I handed the note to my mate at the dinner table, our son said with something of a proud smile, "I told Mrs. Reverby we've already talked about it at home."

The mate and I looked at each other and obviously had the same thought. Two weeks before, the class had been learning about electricity. The teacher had gotten stuck on some questions about batteries, so she had turned to our son, who was able to explain to the class exactly how batteries charge, recharge, and discharge. He's learned a lot about electricity at home.

And quite a lot about sex.

To Have Is to Hold

What's wrong with trying to engineer your child's sexual orientation?

Or more specifically, what's wrong with taking a steroid, while you're pregnant, to try to increase the odds that your female fetus will someday grow up to be a straight woman who gives you grandchildren, and not a lesbian daughter more interested in puppies?

I have a funny feeling I'm about to get hit by various versions of that question, since Ellen Feder of American University, Anne Tamar-Mattis of Advocates for Informed Choice, and I just submitted a new post to Bioethics Forum revealing what we think is the first organized medical "paradigm" for attempting to prevent homosexuality in the womb.

Let me give five answers to that question. Maybe six.

Can You Hear Us Now?

Why is a Cornell doctor vibrating little girls' clitorises . . . and is this really medicine?

In a brief article entitled "Bad Vibrations" just posted at the Hastings Center's Bioethics Forum, my colleague Ellen Feder and I express our shock over the follow-up techniques being used by pediatric urologist Dix Poppas at Weill Medical College of Cornell University on girls whose clitorises Poppas has cut down in size.

There's no point in my repeating here what we say at Bioethics Forum. Instead, I want to use this space to answer some questions I'm already getting from people about this scene.

Sugar, Boys, and Sugar Boys

Ok, here goes: I'm going to see how many people I can offend by suggesting that maybe many little gay boys, like many little girls, are made up of sugar and spice and everything nice.

In North America, I suffer from a terrible disease. When the disease flares up, I am virtually incapacitated by the symptoms. But if I go to many other parts of the world-for example, most of Asia, I am miraculously cured. There's something in the North American environment that makes me sick, and that thing is largely absent in Asia. What is it?

Milk. It took me a long time to figure out that my body can't tolerate lactose, the sugar in milk, long enough that I also managed to develop an allergy to the milk protein casein. If I lived in a part of the world where milk was not part of the adult diet, I'd be fine. In fact, that's most of the world; scientists estimate that eighty percent of the world's adult human population is lactose intolerant. Thus, most of the world's cuisines skip milk. Frankly, from an evolutionary perspective, it's rather freaky to keep eating milk past the age of weaning. Y'all are freaks. I'm normal.

Except in North America, that is, where I live in constant fear of accidentally ingesting milk. I've learned the hard way that Americans sometimes hide milk in margarine, Cool Whip, baba ganoush, "vegan" muffins, Tums (Tums!), French fries, and, increasingly--tragically--beer.

Now, as my good friend Paul Vasey, the super sharp Canadian sex researcher, packs to head off for his annual research trip to Samoa, I have been thinking about how my milk problem is analogous to what Paul has been tracing in his work with regard to male androphilia. "Androphilia" refers to being sexually attracted to males. Paul uses the term "male androphilia" where other researchers talk about "male homosexuality" because Paul studies a special population of people in Samoa, the fa'afafine.

Of Kinks, Crimes, and Kinds: The Paraphilias Proposal for the DSM-5

When is a kinky interest really sick?

That’s the central question the Paraphilias Sub-Work Group of the American Psychiatric Association has had to face as they’ve developed proposed revisions for the DSM-5. Pity those given the task of trying to figure out how, when, and why to medicalize or de-medicalize everything from asexuality to zoophilia (the latter being the sexual interest known to less progressive types as bestiality).

Looming over the whole task is the ugly history of the pathologizing of homosexuality. As I teach my students every year, it took until 1973 for the American Psychiatric Association to stop officially categorizing all forms of homosexuality as mental disorders. And that official demedicalization happened not because a happy and spontaneous consensus emerged that the science supported the change, but because gay psychiatrists understandably had had enough.

Nowadays, you can find self-appointed representatives of every sexual interest who will try to align their history with homosexuality, because, like the gay psychiatrists of the early 1970s, they want out of the DSM. The bondage folks, the zoophiles – even the pedophiles want out. At least the vocal ones do. They’ll tell you that, like gay men and lesbians, they never should have been in the book in the first place.

I would have been watching the progress of the Paraphilias Sub-Work Group regardless; as an historian of sexuality, I’m professionally fascinated to see where it will all go. But as it turns out, I’ve had something of a ringside seat, because my friend Ray Blanchard has been serving as the chair of the sub-work group.

Intersex and Sports: Back to the Same Old Game

More craziness around sex divisions in sports.

If you’re trying to make sense of the “decisions” just made in Miami about sex-typing in sports, and you’re struggling, join the club.

The International Olympic Committee (IOC) presumably tasked the group of expert physicians who just met in Miami with the job of coming up with a fair way to decide who should be allowed to compete as a woman in cases of sex ambiguity. Instead, the group “did not address fairness” according to Dr. Joe Leigh Simpson of Florida International University.

What the group did apparently conclude is this: anomalous sex is always primarily a medical condition, athletes must submit to “treatment” if they want to compete, and expert doctors will play by an “I know it when I see it” approach as these doctors personally decide, on a case-by-case basis, who will and won’t compete.

Sex at the Office: The Other Problems

David Letterman’s admission of fooling around with his employees has got me thinking about sex at the academic office, and particularly about sexual relations between professors and their graduate students, or between senior and junior faculty. Especially since sex researchers appear to be famous for engaging in this behavior.

I don’t happen to be one of those feminists who thinks that sex between someone in a superior role and someone in an inferior role can never really be consensual. I think men and women can actually be grown up enough to manage sexual advances at the office in a way that is respectful and fair.

How and Why to Take "Gender Identity Disorder" Out of the DSM

As a wizened gender rights advocate, I know better than to assume the activists making the most noise are actually representative of “the community” they insist they represent. So, while American transgender activists have lately been fairly unified and very vocal about the need to remove “Gender Identity Disorder” (GID) from the Diagnostic and Statistical Manual of Mental Disorders (DSM), I know that not all trans people agree.

Womb Gay

Reading an excerpt from the new book Sex and War has got me thinking about the Mormons and California’s Prop 8. Sex and War features a meditation on how biology might help to explain why and how humans kill each other. The battle between the Mormons and the LBGT civil rights movement, now being waged over the Mormon’s support of California’s anti-gay Proposition 8, has not (yet) turned bloody. But I can’t help but think about the interesting biological background to all this.

Discussions and debates over the origins of homosexuality have tended to focus on two possibilities: you’re either gay because you’ve got a “gay gene,” or you’re gay because of some aspect of your upbringing. (The latter option is usually imagined to involve something nasty, like a pedophilic priest.)

These two options—gene-gay and turned-gay—fit neatly in the (yawn) nature-nurture debate, and that probably explains why almost everyone seems to keep ignoring a third option, one for which there is astoundingly robust data: womb-gay.