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to accurately capture the current variety of practices without that representation potentially becoming quickly out of date; (2) the ethical critiques I put forth in 1998 are still worth reviewing, even though some practices have changed; (3) the 1998 article when taken in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

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?

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.

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.

Footnote to a Footnote: On Roving Medicine

Why language and little groups of radicals matter.

“Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.” This insight from Margaret Mead functioned as the guiding inspiration for those of us who worked for years as the Intersex Society of North America. A footnote to a recent Hastings Center Report article made clear Mead was right. And, because Mead was right, the history of social change (including in medicine) is actually significantly more interesting than it at first appears.

Is a Small Penis in the Hand Worth Three in the Bush?

OK, that title may be too cheeky. But it got your attention. Here’s what I’m thinking about….

The internationally-syndicated sex-advice columnist Dan Savage recently asked me to help out with a reader who thought he had a small penis and was considering “enhancement” surgery or pills. As a consequence, I’ve gotten a bunch of mail from guys with penis size questions or comments. A man I’ll call Bob wrote to say this:

“I am one of the people with extreme small [penis] size but am proof it doesn’t cause problems if you learn to work with it. I have 3 grown children now and am happily married. We are all given many differences in life and how we deal with them is what makes the difference. Keep sending the messages…your work is important.”

When I wrote Bob to thank him for his mail and to ask him if I could quote him, he followed-up:

The Federal Marriage Amendment and the New 'One Drop of Blood' Rule

Intersex messes with the opponents of gay marriage.

As anti-miscegenation laws took hold in an effort to stop blacks and whites from marrying, by necessity courts had to start deciding who counted as white or black. The standard that ultimately emerged – namely the “one drop of blood” rule of blackness – dictated that any trace of black heritage, no matter how remote or invisible, made you black.

Although a legal necessity, the rule amounted to a biological and social absurdity, one that thrust upon many people an identity that made no sense in terms of their bodily appearances and their lives. For example, Susie Phipps grew up, lived, and married twice as a white woman, but was informed in 1983 by the Louisiana courts (in response to a passport application dispute) that she was really “colored” because she had had one black ancestor six generations back.

As conservatives continue to push the Federal Marriage Amendment and similar state-level same-sex marriage prohibitions, there are signs that a new one drop of blood rule is about to emerge – but this time it will be about sex instead of race. Soon, the way this sort of legislation is going, against their will some men will legally become women, and vice versa. It’s already happening in Texas.

Let me back up a bit.