...______________sexpolice

Sex police | page 1, 2, 3

Since the 1960s, most doctors confronted with a baby like Patrick would likely excise his penis and testicle shortly after birth and call him a girl. If he had a Y chromosome, they might keep the penis but rebuild the urethra to reach the organ's tip. If he had two XX chromosomes like most girls, but an extra-large clitoris that could be mistaken for a penis, they'd trim it back. Or if he had the right chromosomes but a very small penis, off it would go. The surgeons were certain that life without the appropriate genitals would be impossible, and as recently as last year, an article in Pediatric Nursing suggested that doctors ought to consider it child abuse if the parents refused genital remodeling.

Katherine Rossiter, the pediatric nurse practitioner who wrote the article in the January-February 1998 nursing journal, argues that intersex activists represent only a minority, albeit a vocal one, and that allowing a baby with a tiny penis and no testicles to grow up as a boy, rather than surgically reassigning him as a girl, might harm him beyond repair. But she admits that "listening to what real people say and their arguments" has broken down some of her conviction. "I've become muddy mishmash in my thinking," she says.

The medical literature and the opinions of specialists are increasingly divided. "In some cases it's led to a human tragedy -- it might have been better not to reassign the sex of this particular child. But there are cases where it's clearly right to reassign," says Raymond Hintz, an endocrinologist and professor of pediatrics at Stanford University. "It's sometimes justified, but it's not something you do lightly."

William Cromie, a Chicago pediatric urologist who serves as secretary and treasurer of the Society for Pediatric Urology, stresses that proper treatment relies on the carefully considered opinions of parents along with ethicists, endocrinologists, pediatricians and other specialists. As many as 30 conditions may lead to a child being considered intersexed. "It's not an arbitrary, capricious decision by one person," he says. "You try to make the very best decision -- it's usually ground over by a lot of people who are very thoughtful. This is an area that's immensely complex. And lay people just plain and simple don't understand it."

However well-meaning, though, doctors who perform intersex surgery employ a very finite tool in making their decision. The first measure of manhood is a ruler: If a penis is less than one inch (2.5 centimeters) at birth, it doesn't count. And if it's more than three-eighths of an inch (0.9 centimeters) long, it can't qualify as a clitoris either. Any appendage that falls in the middle must be fixed. Then there's the question of the urethral opening, which must be in the right place -- men don't pee sitting down. A curving penis must also be corrected.

For a boy to be a boy, he ought to have two testicles just below a straight penis, and only one opening down there. If the genitals fall short, a pediatric urologist will almost always assign the infant a female gender, remove anything protruding too far and prescribe estrogen at puberty. A talented surgeon can construct a vagina using a piece of the bowel, although the woman who owns it will never experience any sensation inside.

Hale Hawbecker narrowly escaped such a prognosis. When he was born in 1960, his doctors, aghast at his small, perfectly formed penis and internal testicles, wanted to reassign him female. His parents refused, not comprehending the doctors' distress. "It's kind of a strict club in this country to be a man, with very rigid rules to qualify," says Hawbecker, now a Washington attorney who is developing a legal challenge to infant intersex surgeries in his spare time. "It doesn't matter if you're XY. If your penis is too small, you lose it."

Hawbecker says his penis size and absent testicles, removed in childhood, don’t hurt his ability to love and make love to his wife. "I very happily engage in sex whenever I can. You have to be creative, and not so focused on genitals," he says. As for his own pleasure, "My penis does everything you'd expect a penis to do -- it's just small."

Hawbecker says he thinks like a man; with his clothes on, he looks typically male too. And yet, he says, "I guess I've never really felt like I fell neatly into the camp of guys. I love to cook. I love to take care of things around the house. I hate the Three Stooges and I don't like football." Often, he thinks about the female he might have become; where she'd be right now. "I think she'd be OK. I could've done 'girl' too. I could be happy that way, too. That's what's mind-boggling."

Medical literature says that about one in 2,000 babies is born like Hawbecker or Harmon-Smith, with uncommon variations of genitals and gonads, or sex-conditioning hormones that don't match sexual organs. About one in 1,000 women has three X chromosomes instead of the usual two; some people have had as many as four X chromosomes -- plus two Ys. Some women have facial hair, some men don't. Breast size, voice timbre and body structure, all generally accepted cues, also can contradict chromosomal identity.

"The basic story is, it isn't simple," says Alison Jolly, a Princeton evolutionary biologist who studies ringtail lemurs in Madagascar. "It's all just more complicated than people will admit." In the first few weeks of life, every human embryo develops the equipment for both sexes, the foundations for both ovaries and testes. At about eight weeks, a chemical chain of events stimulates one set to disintegrate. One week later, the external genitalia begin to form -- and usually, to match what's left inside.

All this seems to be triggered by a spot on the Y chromosome called SRY, for "sex-determining region, Y chromosome," that scientists have dubbed the "master switch." Throw it, they say, and a chain of events run mostly by genes on the X chromosome leads to the development of testes and the production of male hormones. Without SRY, females continue along what molecular biologists have dubbed the "default" pathway. In February, however, researchers reported the first evidence that an active signal stimulates female development, too.

Of course, there's a lot more going on as well -- much of it still not even vaguely understood. A wash of hormones primes the brain for one sex or another, though not always the same as the one indicated by genitalia at birth. Jolly suggests looking at sex as statistical -- a compendium of characteristics that, when plotted on a graph, looks like a couple of camel humps. One set of features tends to be viewed as male and the other female. The section in between is as normal as the outlying regions in the land of "super-macho" and "super-fem."

From classical antiquity through the Renaissance, anatomists thought there was just one sex, and it was male. Female bodies simply mirrored the male reproductive organs -- with the vagina an inverted penis; the ovaries, interior testicles. During the 18th century, the idea of two separate sexes took hold. Then in 1993, Anne Fausto-Sterling, a well-regarded biologist and feminist studies theorist at Brown University, raised a ruckus when she proposed that male and female were not enough. In a tongue-in-cheek proposal, she recommended five categories in all.

Some people seized upon the idea as a revelation finally explaining their own bodies. Others felt the thesis went too far. Fausto-Sterling says her readers were taking her too literally. She has abandoned the proposal -- which at root simply challenged people to think differently about sex -- and now wants to eliminate the term from our vocabulary. "There is no sex; there's gender," Fausto-Sterling says.

Fausto-Sterling argues that scientific discoveries about the ways our bodies work employ cultural understandings and, as in the male "master switch" and female "default pathway," the language of existing social models. Whenever faced with a lack of clarity, surgeons get out the ruler and make a choice. "There's a set of decisions by which we're going to socially agree what is a penis. How we organize the continuous variability that nature offers us is what gender is about," Fausto-Sterling says. "What we call the truth of the body is also a cultural view of the body through a scientific lens."

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