Gretchen Herb

Dr. Billharz
WGST 302
12/5/13
Sex & Gender Dilemmas
Its controversial in the United States for people to be born intersex or to
cross gender barriers that have been already been put into place by our societys
norms. Unlike some cultures the United States isnt fully comfortable with
ambiguity. When a person doesnt identify with a specific category we tend to
ostracize them because their life doesnt follow the criteria we consider normal. For
instance when a baby is born with both male and female genitalia its viewed as an
unnatural horror, that must be fixed by professionals. Its believed that if a young
babys genitalia doesnt fit this so called norm that the medical field has made up
then these babies will not be able to grow up and live a healthy happy life. For
children that are diagnosed with PAIS (Partial Androgen Insensitivity Syndrome)
this dilemma is all too real. The struggle with raising a child like this, can also relate
to a young male with strong cross-gender identification tendencies. Our society
accepts cross-identification when its used for a performance, but when the
performance is transferred to real life circumstances people dont know how to
respond. Parents with children that have these kinds of issues will be faced with a
lot of internal and external dilemmas with themselves and their children.
What is a parent supposed to do when their child is born with PAIS? If the
child is a genetically born a girl with XX chromosomes then it really isnt a problem
since the condition doesnt affect womens genitalia. The issue arises when a child is
genetically born a boy with XY chromosome, but his external genitalia arent fully
masculinized as well as his secondary sexual characteristics. The partial
unresponsiveness of the cells to the presence of androgenic hormones hinders the
masculinization of the male genitalia. There are many dilemmas that arise for
parents if their young boy is born with ambiguous genitalia like this. Medical experts
usually advise a sex to the parents for their baby. When the sex is picked surgeons
will then do an operation that surgically corrects the baby to fit their assigned sex.
Sometimes the surgeons goal is to assign a babys sex in the first 24 hours of birth
so that they can send the baby out with one pair of genitalia. Much of the surgical
part of the reassignment of sex is sometimes based off of our cultural description of
what a female and male genitalia look like. Medically this description of the female
and male genitalia has been based off of actual measurements of the clitoris and
phallus. In order to prove a point the Intersexual Rights Movement campaigned by
using a system defined as Phall-O-Metrics. This system exploited medical
professionals opinion of the so called normal clitoris and penis. For a female a
medically acceptable clitoris measures anywhere between 0.2 and 0.85 cm. For a
male a medically acceptable penis measures anywhere from 2.5 to 4.5 cm at birth. In
past cases where male babies with PAIS have been reassigned to be females because
they are born with a penis that measures smaller than the normal penis. Why is it
that the Euro-American culture values the size of a males penis so much so that they
would reassign a childs sex to be a female just so that the young boy would avoid
ridicule for his tiny penis? Unfortunately in our culture its assumed that bigger is
better.

Corrective surgery like I mention before is an option for these children. A
very common saying that has been incorporated into the medical field is that is
easier to make a whole than a pole. Some parents may go with this logic especially if
the doctors express why this may benefits the childs life in the future. Back in the
1970s doctors would perform Clitorectomys if the parents decided that they
wanted their child to be a female. The procedure removed most of the clitoris. This
included erectile tissue, glans and nerves. Most intersex people who got this surgery
as a baby later complained about their inability to achieve orgasm and the loss of
most of the sensation in their clitoris. This procedure was soon abandoned because
of its unsatisfactory results. One of the more common ones used today is a
Clitoroplasty. The Clitoroplasty is the reconstruction of the clitoris. Clitoral
reduction and Clitoral recession are both procedures that have been used in
Clitorplasty. Yet, even though this procedure was shown to be more human than the
Clitorectomy there were still major complications like loss of sensation, inadequate
appearance, and the reduction of enjoyment during sexual intercourse. There is also
a Vaginoplasty, which is one of the more complicated procedures where the doctors
reconstruct the entire vagina. The goal usual is to connect the outer vaginal opening
to the cervix. When a child has PAIS their vagina can have different degrees of depth.
Sometimes the vagina can be dilated an acceptable depth or surgery can be done to
extend the vagina.
Yet, there is always the chance the parents will go in the opposite direction
and want their child to be a boy. In these kind of situation the baby may go under
surgery like Orchiopexy. This surgery focused on repairing the undescended to
testes to make it look like a normal male genitalia. There can be complications if
the blood supply isnt maintained. Just like for the female vagina there is
Phalloplasty surgery for the male penis. Its basically the reconstruction of the penis.
Though, this can be challenging especially with the erectile tissue. Issues with this
procedure can be major scaring, lack or no erection when aroused, or erections can
become painful.
After the surgery is performed usually children will have to go
through some sort of hormone replacement therapy (HRT) before puberty in order
to ensure a smooth transition to the sex they are assigned at birth. The hormones
are used mainly so that the childs secondary sex characteristics eventually match
their genitalia. There are therapy and support groups offered for young children
who have gone through this surgery. More often then not children with PAIS who
got surgery at a young age end up with Gender Identity disorder also know as
gender dysphoria. There are groups of people that were assigned the wrong gender
at birth and then grow up not know why they feel uncomfortable in their own body.
Their genitalia do fit the gender they feel that they truly are in their head. Watching
YouTube videos on some adults that were made aware of the PAIS as a child seemed
to be embarrassed of their genitalia. Not only because it didnt fit them but also
because it was so mutilated from the surgery they didnt feel like they deserved to
have sexual relations with a significant other.
It seems as if assigned gender right after birth creates this binary that our
society cannot seem to get over. The surgical viewpoint is that if these children
physically follow their assigned gender then they will grow up having a normal life.
And for some reason our culture really values the ideals of science and medicine. So
its very difficult to break this mind set that we have to assign sex right at birth. On a
personally level though, if I gave birth to a child with PAIS I wouldnt get corrective
surgery for my child right away. Why should it be the parents or doctors choice
what sex the child is assigned, especially if the procedure is just done so the child
can fit the norm. Its that childs body and they should be able to make the decision if
and when they are old enough to know and understand what they want. As a parent
I would probably try my best to not force any gender norms on my child. Especially
when buying clothing or toys. To be honest I think the surgery seems completely
superficial. Its just to put these children into boxes that make sense to us. The
assumption is that the public cant handle a different gender than what is already
put in place. Intersex is this third gender that we are afraid of because most of the
public isnt as educated on the topic. Because people are not as educated on this
matter there can be a very negative reaction to bringing up a child with ambiguous
genitalia.
One can be viewed as an unfit parent if they do not comply with the doctors
orders and assign a sex to their baby right after birth. If others find out about the
childs ambiguous genitalia, the child could be alienated and become an outcast of
society. This threat becomes very real when the child begins any kind of schooling.
There they will face different sex bathrooms and locker rooms. School is hard
enough for kids even without having ambiguous genitalia.
This can also relate to a 3 year old boy who shows extreme cross-gender
identification. Much of the dilemmas that parents will probably come across when
raising the young boy will have to do with societies opinion on the matter. Just like
PIAS children that have ambiguous genitalia, growing up around other children that
fit the gender norm can be difficult. Many times these children like to dress in
opposite sex clothing and play with toys that dont normally represent there given
sex. A perfect example of this is the interview we watched with Barbra Walters on
the little boy Jazz that wanted to be a little girl. When Jazz was very little he seemed
to know that he wanted to be a little girl. Jazz was attracted to stereotypical girl toys,
and girl accessories. He also loved dressing like a girl. The parents made the
executive decision to let their child decide what gender he fully felt comfortable in,
and Jazz chose to be a little girl. I was very moved by this story because its not very
often that we hear about parents giving the child a choice. It also cant be easy for a
parent to realize that this perfect little boy that they gave birth to, is suddenly
unhappy in the gender that he was placed into.
Other things to think about as a parent, is whether or not the child will want
a medical intervention. The surgery to change this 3-year-old boy to a girl would be
the same as I discussed earlier. The goal with these surgeries is for the patients to
come out with a functional and desired penis or vagina. The little boy would also go
through hormone replacement therapy to change his secondary sex characteristics
so that they would resemble a girls. But in this case with a 3-year-old child I dont
think this kind of intervention is necessary at such a young age. He may still need
time to figure out his gender and maybe he feels comfortable dressing and acting
like a female but still wants the genitalia he was born with. Often times I think we
assume that the goal of a person who identifies as cross-gendered is for them to
eventually get reassignment surgery, but sometimes people are okay with their
queer or ambiguous gender.
Many of the dilemmas that parents will probably face with a young boy like
this can stem from social pressures put on them by their community. As 3 years old
the boy will probably be starting out in daycare and/or preschool so his friends that
he makes will already know him as a boy. When he begins playing with female toys
or even dressing in more feminine clothing his playmates may exclude him because
of his queer behavior. But at the same time kids at this age havent yet developed a
full sense of gender norms. Its usually the parents of these children that sometimes
have problems with this kind of behavior. This is because their gender schemas are
so far developed that it difficult for them to understand anything else. If parents
arent able to categorize this young boy then he may not be invited over for play
dates, and then he wont be able to socialize like a normal 3-year-old boy. There can
also be a religious factor that comes into play. There is also the risk of this little boy
being unhappy if he isnt aloud to express his psychological gender. Many children
tend to become depressed when theyre restricted from the gender they want to be.
Some will lash out as of form of attention because they are not getting the proper
help they need. These are just some of the dilemmas parents may come across when
raising a 3-year-old boy that is showing tendencies of cross-gender identification.
Its clear that in either case that was discussed the main dilemma that
seemed to keep coming up was the fact that families with these kinds of children
would have the constant battle of their community to deal with. Our society doesnt
seem to be ready to fully accept these kinds of children and adults into our world. I
think it will be interesting to see how this phenomenon grows in the next few years.