The Unkindest Cut

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Female genital mutilation--usually cast as a brutal procedure practiced in Third World countries--has received a spate of news coverage in the West recently. What's been overlooked is the fact that in developed countries radical surgery is performed routinely on infants born with ambiguous genitals: a particularly large clitoris, an uncommonly small penis, and all the variations in between. The condition to be 'corrected' is called intersexuality, or hermaphroditism.

Prior to the 1950s hermaphroditism was not treated as a medical emergency. But in American hospitals today, Sarah Horowitz reports in SF Weekly (Feb. 1, 1995), the birth of an ambiguously sexed baby brings a team of specialists--including doctors, psychologists, and social workers--to counsel parents on their options. Doctors claim that surgery, the most common solution, is no longer as destructive as it was years ago, when surgeons routinely removed 'clitoro-penises'--a procedure that often left severe scarring and sexual dysfunction. Instead, doctors now typically recess the clitoris and remove some of the erectile tissue, which they claim prevents painful erections.

'To compare genital mutilation of young girls in tribal Africa to reconstructive surgery of a young baby is a giant, giant leap of misrepresentation,' says Dr. John Gearhart, a pediatric urologist at Johns Hopkins medical school, which has pioneered intersexuality treatment. Still, critics point out that the operation does radically alter a healthy child's body (often with multiple surgeries and hormone treatment).

Though doctors say the goal is to produce well-adjusted kids, social psychologist Suzanne Kessler and other critics argue that the real purpose is to satisfy doctors and parents and to conform to a society that remains uncomfortable with sexuality in general, and particularly with its more complicated permutations. 'Genital ambiguity is corrected not because it is threatening to the infant's life,' Kessler has said, 'but because it is threatening to the infant's culture.'

After all, intersexuality is anything but a biological aberration, as Anne Fausto-Sterling noted in The Sciences (March/April 1993). For the first five weeks or so of fetal development, all humans have unisex genitalia. Then about half develop ovaries and female genitals, while the other half develop testes that produce hormones that cause the clitoris to enlarge into a penis. Some (about one in 2,000 births) develop something in between--a uterus and a penis, one ovary and one testis, or a set of organs that defy categorization. Their shape may or may not correspond with the chromosomal gender markers, which in turn come in a variety of combinations beyond the 'standard' XX and XY. Fausto-Sterling claims that there are at least five sexes, including three types of intersexuals with varying degrees of 'male' or 'female' characteristics. Indeed, she calls gender 'a vast, infinitely malleable continuum that defies the constraints of even five categories.'



All this is more than an academic debate. Most observers agree that the common surgical procedures have no direct physical health benefits (with the exception of cases in which tissue that could grow into cancers or become infected is removed). Where they disagree, writes Natalie Angier in the New York Times (Feb. 4, 1996), is on the question of who needs changing--intersexuals, or the world around them. In a recent paper presented to the Queer Frontiers conference (http://www.usc.edu/Library/QF/papers/holmes.short.html), Morgan Holmes, an intersexual doctoral candidate at Concordia University in Montreal, claims the surgery is evidence of homophobia and 'patriarchal misogyny.' Yet, she argues, prominent feminists soundly condemn clitoridectomies among Third World people and immigrants, but at the same time embrace or ignore mutilating 'genital revision' surgery in the West.

Cynics could argue that at a time when scientists are investigating the gender-bending effect of certain pollutants (Florida alligators grew hermaphrodite organs after exposure to chlorinated compounds, for example), society better get used to gender fluidity. Optimists like Holmes hold out the promise of a world in which 'sexuality is something to be celebrated for its subtleties, and not something to be feared or ridiculed.' If you're a newborn hermaphrodite, on the other hand--unless your parents and doctors are extraordinarily courageous--you're likely to have no choice at all.



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