Professional Documents
Culture Documents
Birth
Candex Louie
Department of Social Sciences
Pasadena City College
Contact: candexlouie@gmail.com
ABSTRACT
Understanding aesthetic consciousness as a phenomenon that limits emerging possibility,
this work aims to expose the binary conception of biological sex as being reductive and harmful.
This paper first turns its attention to the issue of sex determination. The process of assigning
male or female at birth poses a problem for infants who do not fit into either category. Intersex is
that do not clearly fit into the binary notions of male or female. The modern practice of sex
intervention to assimilate the intersex child to their assigned gender (Grayling 2008:48). In favor
of conforming infants to a societal standard, parts of their bodies are removed without consent,
and they are often later led to believe that the way their bodies naturally manifest is shameful and
wrong. By exploring the human body through various frameworks as being unlimited in
seeks not only to reveal the problems created by a socially informed clinical approach, but a
sexes (male and female) is reiterated in medical literature, used in determining physical health
and social status, and is likely one the first questions that parents get asked about their infants: Is
it a boy or a girl? Gender essentialism is the assumption that the binary categorization of sex is
an immutable, unchanging biological fact, and that any human would necessarily fit into one of
the two categories. However, the nature of the human endocrine system and the multiple ways
that sex can be expressed pose a problem for this binary. For example, sex can be determined by
multiple criteria, including: genitals, chromosomes, hormones, gonads, and secondary sex
characteristics, and variation within and between these sex determinants are not atypical. Quoted
London notes, “I think there's much greater diversity within male or female, and there is
certainly an area of overlap where some people can't easily define themselves within the binary
clinically known as disorders of sex development (DSDs). Intersex is a term that encompasses a
wide range of biological variation regarding sex characteristics. The Intersex Society of North
America explains, “a person might be born appearing to be female on the outside, but having
mostly male-typical anatomy on the inside.... Or a person may be born with mosaic genetics, so
that some of her cells have XX chromosomes and some have XY” (Intersex Society of North
America n.d.:para. 1). Intersex traits can manifest in multiple ways and are visible at birth in
some instances but may not become apparent until puberty in others, and in the case of
chromosomal intersex variations, traits may not take on any physically discernible characteristics
at all (United Nations for Equality n.d.:1). In a study led by Valerie Arboleda, a doctor at the
Department of Pathology and Laboratory Medicine at UCLA, “DSDs are estimated to occur in
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approximately one in 100 live births” (Arboleda et al. 2014:604). This may even be a
conservative estimate, as again, a person's intersex status is not always visibly apparent at birth.
Despite the proliferation of data suggesting that biological sex may be anything but a rigid
binary, standard practices and medical attitudes reflect strict adherence to the binary model
Theoretical Framework
Several theorists have responded to the conception of the binary, and the idea of
normative forms. For Judith Butler, an American philosopher and gender theorist, the imposition
of a binary norm on the human body greatly affects the psychological and social identity of
people who do not fall neatly within binary criteria. In Undoing Gender, Butler questions the
validity of gender essentialism through the case of David Reimer. As an infant, a significant
portion of Reimer's penis was burned off in a hospital accident, and he was subsequently made
the subject of a gender experiment by Dr. John Money, who suggested that he undergo male-to-
female surgery and live the rest of his life as a “normal girl” (Butler 2013: 744-745). Butler
argues that although Reimer is not intersex, the denial of his consent to surgery and the
subjugation to a normative ideal is parallel to the deeply traumatizing experience that intersex
children continue to face today. In Mindfields: Between Male and Female, A. C. Grayling notes
that Dr. Money actually developed the “optimum gender of rearing” model that is used to
determine the procedure for intersex cases: “This system encouraged ‘gender assignment’ of
those with ambiguous genitals, including surgical intervention at the earliest possible stage in life
to encourage the effective socialization of the resulting individual into their assigned gender”
(Grayling 2008:48). Further, in Promoting Health and Social Progress by Accepting and
Depathologizing Benign Intersex Traits, Hida Viloria, an intersex writer and activist, provides
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insight from an intersex perspective. Responding to a quote from Dr. Kenneth Glassberg
justifying intersex genital mutilation (IGM) by arguing that “society is not ready for [intersex
genitalia]” Viloria writes, “The doctor's assertion that IGM is performed because society is not
ready to accept intersex people also confirmed what I'd long suspected: that IGM exists to
benefit non-intersex people—such as our parents—rather than those subjected to it” (Viloria
2015:116).
Although he speaks more broadly about the concept of beauty and appearance, Hans-
Georg Gadamer, a German philosopher, makes a similar criticism of what he calls aesthetic
aesthetic cultural phenomena—including the binary gender system—can unfold. In Truth and
Method), Gadamer argues, “For just as the art of ‘beautiful appearance’ is opposed to reality, so
aesthetic consciousness includes an alienation from reality” (Gadamer 1997:73). For Gadamer,
aesthetic consciousness is like a lens that not only paints what is real in an abstracted or unreal
light, but also refuses to allow the subject to speak or reveal itself. Like Viloria, Gadamer seems
to suggest that understanding does not come from subjecting something (or someone) to an
aesthetic ideal.
Despite what intersex activists and philosophers seem to be calling for, in Consensus
“The birth of an intersex child prompts a long-term management strategy that involves a myriad
of professionals working with the family” (Hughes et al. 2006:554). Within the statement, they
child’s life, as well as suggested gender assignment and surgery based upon sex characteristics.
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Although the medical experts acknowledge the future autonomy of the child, the promise of a
‘long term management strategy’ reveals that the child is not really a child, but a project. In
presenting an aestheticized version of ethics, the experts fail to recognize the intersex child’s
The optimum gender of rearing model, the system developed by John Money that
encourages ‘gender assignment’ and infant genital mutilation (IGM), has framed intersex
children’s identities in ways that create lasting psychological trauma. Physician and Director of
To achieve this secure gender identity, the parents of the child with intersex
needed to be convinced that the child was the gender chosen by the physicians
and subterfuge and dissimulation were accepted tools to achieve this purpose.
Consequently, early surgical intervention to make the child look more like the
were also used with the intersexed individual so there would be no doubt as to
gender. Implicit in this reasoning, of course, is that individuals with intersex were
Daaboul notes several key points that warrant further inspection: not only are intersex
individuals framed as dysfunctional, but the binary gender assignment they receive is so crucial
that physicians are encouraged to lie to the parents and child to maintain that the gender that is
assigned is not questioned. As well, ‘surgical intervention’ in this model is encouraged based on
the notion that the gender the physician assigned has a ‘look’ about it, and to achieve this ‘look’,
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Binary Aesthetics and Psychological Harm
The optimum gender of rearing model and the process of sex determination then, does
not seem to be concerned with intersex as a medical condition, but an aesthetic condition based
on gender essentialist ideology. The bodies of intersex children are not recognized as intersex,
but instead become a space where the aesthetic binary model can come to be. By refusing to
allow intersex bodies to be as they are, physicians assert what is then physically allowable. The
reasoning behind corrective surgery is that the intersex child would otherwise grow up
psychologically traumatized, and not know how to navigate in a world where their body and sex
was not accommodated for. Intersex writer Esther Morris notes, “Many [intersex] adults argue
that correction creates its own stigma that leaves them struggling with identities and loss of self”
(Morris 2004:para. 10). As well, a model centered around concealment is not only poor medical
practice, but reinforces stigma and self-hatred. In the film Intersexion: Gender Ambiguity
Unveiled, founder of Intersex Society of North America, Cheryl Chase, shares “I remember
thinking, ‘man, I am really pissed. If I’m gonna [sic] do this, I’m gonna find the surgeon and I’m
gonna kill myself in front of him’. That's the moment I realized, the thing that is making me
miserable isn’t the clitorectomy, it’s the shame” (Chase 2012). Like Chase and many intersex
individuals, being lied to about the reality of their biology is what incurs psychological trauma
success is that in surgically altering bodies in order to reach a gender essentialist ideal,
physicians seek to reach a telos (end goal) that is not often achieved. In the case of David
Reimer, Money had planned a series of feminizing surgeries: at eleven years old, Reimer was
asked if he wanted a ‘real vagina’, even going so far as to promise that he might be able to give
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birth (Butler 2004:745). This was a blatant lie; Reimer was genetically, chromosomally, and
anatomically male despite the fact that his external sex organs were removed. Whether Money
constructed a vagina or added a complete uterus, Reimer would never be able to conceive, much
less give birth to a child. Butler also notes that in the clinic where Money was conducting these
‘gender experiments’, “[Reimer] and [his] brother were required to perform mock coital
exercises with one another, on command” (Butler 2004:745). This was traumatizing for the both
of them, and a highly questionable practice in the way of consent for certain, but Money's
intention was clear: in order to become a girl, Reimer would not only need component female
body parts, but was also expected to behave as a heterosexual female that would have
heterosexual sex. This sentiment is echoed in an interview in the film Intersexion: Gender
Ambiguity Unveiled with Esther Morris. After finding out her intersex status during a check up,
she recalls, “I was then told that I would have to have surgery, so that I could have a normal sex
life with my husband” (Morris 2012). This is noted with an air of sarcasm, as Morris is lesbian.
surgery is an interesting point because here, heterosexuality becomes a prescriptive norm. The
assertion is not only that intersex bodies are an atypical aberration, but they are an atypical
aberration because of their departure from binary and heterosexual functioning, and so are
The medical model then, is not about assessing where intersex people are or what
intersex bodies are capable of. Instead, intersex health becomes corrective: because these
people's bodies are not congruous to what is considered normal, they must be fixed. This is
problematic not only in that it otherizes intersexuality, but also in the way that normal is not
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definitive. In a study that seeks to determine a qualitative system by which to gauge whether
clitoromegaly (atypically large clitoris, associated with certain intersex conditions) is present, it
parameter confirms the diagnosis of clitoromegaly. Some authors use the clitoral index or the
clitoris width, while others prefer the clitoris length” (Kutlu et al. 2011:498). The ambiguity with
which experts approach the possibility of genitals being intersex illustrates how arbitrary and
entirely cosmetic many of these surgeries can be. In trying to conform intersex people to a binary
pathologizing intersex traits. An often-cited statistic is the risk for gonadal cancer, which has
been estimated to be as high as 22% to as low as 0-8% in intersex people who have undescended
testes in their abdomen (Deans et al. 2012:894). This variance is enough to raise questions about
the validity of this data, but as the Androgen Insensitivity Syndrome Society—an intersex
organization—notes, “The incidence of breast cancer is 1 in 8 females and yet the breasts of
young women are not routinely removed just in case they might develop breast
cancer”(“Gonadectomy” n.d.:para. 3). As well, while the internal testes do not provide
reproductive function, the androgens they produce are necessary hormones that are linked to
osteoporosis (a disease that has to do with the demineralization and subsequent weakening of
bone). Without them, the body must be regulated with hormone replacement therapy (Duhaime-
Ross 2013:para. 13). As well, there is also evidence that normal, healthy intersex lives exist
without surgical intervention. This was the case for a 70-year-old man who had previously
fathered 4 children, and in undergoing hernia surgery, was found to have a completely intact
uterus (Sherwani et al 2014:1285). He had lived his entire life with his intersex anatomy intact,
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and he had not suffered trauma regarding his identity because of its existence. This was also the
case for Viloria. She writes, “I was born with ambiguous genitalia and it was a doctor who, by
honoring my bodily integrity and not ‘fixing’ me, gave me the greatest gift I’ve ever received”
(Viloria 2015:114). She describes her relationships as being positive, and without the deep
to understand intersex individuals and discover the ways that biology diverges from the socially
conceived binary notion of sex, physicians often try to correct intersex bodies in the image of a
normative male or female one. This not only often fails in execution but illustrates a failure in
judgment. In calcifying the image of humanness, health and happiness as being one in line with
an idyllic binary body and seeking to find disease in any form of deviation from it, the doctor
does not see a patient, but an affirmation of their prejudice. The wielding of a knife is a defensive
stance against the ‘other’. It does not seek to ask, “What are you?” but rather articulates, “This is
what you are,” and in doing so, arrests the potential unfolding of truth.
Michel Foucault, a French philosopher and social theorist, similarly notes the
dehumanizing effect of the ‘medical gaze’; a pathologizing lens that sheds some light on
medicine as a discursive authority. In Birth of the Clinic, he notes, “This is the period that marks
the suzerainty of the gaze.… The ‘glance’ has simply to exercise its right of origin over truth”
(Foucault 1976:4). Foucault argues that medicine has become an institution of power, and the
danger is that its power resides in its medical gaze, one that reduces humanity to pathology. This
is evident in how the intersex person is reduced to their intersex traits and organs and is regarded
as needing correction. This detachment from humanity is a fear for Foucault because denying a
person’s wholeness is to misunderstand the issue. In treating the “problem” of internal testes in
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the abdomen without understanding how they might function in the intersex body, (providing
necessary hormones to regulate the body as well as bone growth) medical professionals with the
opinion that the intersex body needs correction miss the point of medical practice: health. An
underlying danger is the reliance on medicine as a discursive authority; because medicine touts
logic and reason, as Foucault says, it simply ‘exercises its right of origin over truth’. Rather than
confronting the truth of reality, the authority of medicine is naively clung to as it provides quick
solutions. It is in this haste to arrive at conclusions and universals that models like the optimum
Of course, while these criticisms may be valid, solutions may prove to be less than
practical, some may argue. After all, if medicine is to be discounted, then to what authority is the
case of sexing infants supposed to fall to? Identification forms and institutions often require that
any given person identifies with either one or the other of the two sexes. Is this not prioritizing
philosophy and identity politics over practicality? Despite everything, don’t intersex individuals
also need a gender? Eve Sedgwick, gender theorist and queer scholar, also notes the problem of
gender, stating, “The impasse of gender definition must be seen first of all the creation of a field
of intractable, highly structured discursive incoherence…. I have no optimism at all about the
availability of a standpoint of thought from which either question could be intelligibly, never
mind efficaciously, adjudicated” (Sedgwick 1990:90). The sentiment here is the impracticality
impasse—a situation of deadlock, a point where no further progress is possible. If gender cannot
be defined, if medicine’s authority is discounted, if the question of sex and its relationship to
gender is complicated and both concepts are essentially nebulous, and nearly every aspect of
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these social identities is problematized, where does that put the intersex individual exactly? Is
there any possible, rational, reasonable solution? Is progress possible? Anne Fausto-Sterling,
Professor of Biology and Gender Studies at Brown University, humorously attempts to mollify
this issue by redefining gender, describing a five gender model to replace the existing one: “I
argued we should also accept the categories herms (named after ‘true’ hermaphrodites), merms
(named after male ‘pseudo-hermaphrodites’) and ferms (named after female ‘pseudo-
prescriptive and clinical labels are regarding identity, while also taking a jab at the idea that
finding the right labels will somehow absolve people from confronting the complexities of
uncertainty? Jacques Derrida, a French philosopher, explores these questions through his
conception of aporia. He explains, “the non-passage, the impasse or aporia, stems from the fact
that there is no limit. There is not yet or there is no longer a border to cross, no opposition
between two sides: the limit is too porous, permeable, and indeterminate” (Derrida 2006:20).
Aporia for Derrida is a state of confusion or doubt, but not a dead end or something to be
embarrassed about. Unlike Sedgwick’s conception of impasse, which was expressed as being a
space where nothing intelligible or meaningful could be deduced, Derrida’s aporia has an open-
endedness that reflects infinite possibilities or limitlessness. For Derrida, aporia is a reflection of
the complexity of the human mind and is demonstrative of the complexity of reality. For him,
this uncertainty is not shameful, but rather, an affirmation of limitless possibility, and the real
shame is that aporia is frowned upon. The reluctance to accept aporia as a mode of being stifles
the ability for people to understand the reality of biological diversity, and the infinite nature of
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the human body. A large part of understanding problematized concepts is how problems are
conceived. If the only way problems can be addressed is by capping them off with a simple
solution, then there will always be problems that are not neatly solved, because they are by
nature limitless.
Like Derrida’s aporia, Gadamer’s notion of the ‘horizon of the question’ invites
possibility. For Gadamer, questions allow for the unfolding of truth, where problems are
questions forced into frameworks of thinking. He argues, “Problems are not real questions that
arise of themselves and hence acquire the pattern of their answer from the genesis of their
meaning, but are alternatives that can only be accepted as themselves and thus can be treated
only in a dialectical way” (Gadamer 2004:376). For Gadamer, problems remain problems
because solutions are not always available or viable, whereas questions seek to open up, inviting
further questions. Unlike problems, questions have emergent horizons, and bring about
undetermined possibilities. Does biological sex not also share this characteristic? In the infinite
possible variations of human sexual biology, from not only genitalia, but chromosomes,
hormones, gonads, as well as secondary sex characteristics, in the conception of a child, none of
these things are predetermined. The child is an emerging possibility of genetics and
In order to respect the nature of the human body as a question, rather than a problem, it
that the answer is not already apparent. Gadamer argues, “There can be no tentative or potential
attitude to questioning, for questioning is not the positing but the testing of possibilities”
(Gadamer 2004:375). He notes here that questions don’t necessarily presuppose certain answers,
and questions that would are not authentic questions. For the question of biological sex then,
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definitive or prescriptive attitudes or solutions would not respect the nature of the question, and
would deny it its horizon, treating it as if it were a problem. This is where the medical model
fails; in aestheticizing health as being synonymous with one of two normative body types,
biological sex is not allowed to exist as the varying, undetermined, continuously unfolding
Moreover, in understanding the unfolding nature of biological sex and the possibility of
intersex individuals is the act of not taking a corrective posture when it comes to intersex health.
Respecting the intersex body as a possibility rather than a problem calls for a shift in procedure
patients. It calls for studies to be done with a curiosity of the possibilities of human variance,
rather than the application of the medical gaze and ‘research’ done for the sake of affirming
culturally constructed and informed prejudices. It calls for medical attitudes that center the health
of the patient rather than focusing on what the patient is not. It calls for an invitation of dialogue
between doctors, patients, and parents rather than dissimulation and subterfuge as a means of
best shielding the family from the reality of biological sex or most effectively carrying out the
assigned gender. It calls for the end of infant genital mutilation, as it not only presupposes a
correct form of the body, but it also does not give the intersex individual the right of consent and
doesn’t allow them to be in dialogue with the physician, their caretakers, or even themselves.
Full disclosure is necessary for all parties involved to deem any surgery informed and
consensual. It calls for an openness to and consideration of the intersex person’s autonomy and
the understanding that gender and sex are complicated, but that doesn’t mean that they’re
problems, or that uncertainty about indefinite concepts makes them impossible to grapple with or
understand. Pidgeon Pagonis and Hida Viloria, intersex activists, both identify as nonbinary, not
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only because they have always felt that they didn’t fit within the gender binary, but also as a way
to identify with the reality of their intersexuality. While sex and gender are both topics that are
difficult to accurately confine or define, and any given person’s relationship with either is highly
personal, identity is best designated to the person navigating it for themselves. Personal bodily
autonomy is an important aspect of how anyone might relate to themselves, and in the violation
of bodily autonomy, an intersex child may grow distrusting, or may feel psychological shame,
which they may carry for the rest of their lives. On top of the risk of genital surgery to the
subject’s overall health and sexual pleasure, the choice is often completely out of their hands.
Alice Domurat Dreger, a historian, bioethicist, and former Professor of Clinical Medical
Humanities and Bioethics at the Feinberg School of Medicine, Northwestern University notes,
“A major failure of the [medical] model has arisen from the failure to recognize intersex people
as experts of their own experiences” (Dreger 1999:19). Recognizing and respecting intersex
experience is important for the phenomenological praxis of medical practice because it not only
requires recognizing the intersex person as a person with being, but also endeavors to understand
the intersex person as being beautiful. Gadamer explains, “the beautiful is a kind of experience
that stands out like an enchantment and an adventure within the whole of our experience and
surprising as well, like a new light being turned on, expanding the range of what we can take into
consideration” (Gadamer 2004:486). For Gadamer, the notion of the beautiful is important
because it is not only like an experience in that it is an event, but it calls attention to not only
itself but makes other things intelligible that were not previously intelligible. Beautiful here is
not used in a strictly aesthetic sense, and it does not exist as an adherence to standard
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conventions of beauty or dogmatic ideals (like traditional gender binaries, for example). For
Gadamer, beauty takes on ‘the mode of being of light’; this is to say that it has an illuminating
quality. It reveals itself in the quest for good, and in the way that the disclosure of understanding
broadens a person’s horizon, beauty allows the viewer to be closer to truth. Intersexuality too,
shares this mode of being in that it allows for the expansion of what can be considered, and what
becomes intelligible because of the way that it illuminates the state of humanity.
Virtually all of the intersex people who write in this volume stress the trauma of
being repeatedly ‘put on display’ for medical students, residents, and attending
seeing real cases, they must also recognize the psychological harm done to
make their genitalia available for visual and physical examination by students and
allows for truth to unfold, yes, but it is not in treating intersex individuals as subhuman
experiments or in forcing intersex children to reveal their genitalia that an authentic encounter is
made. The medical gaze here, especially, becomes a violating one; it exercises authority and
subjects patients to scrutiny for the sake of medical practice and education, but at what cost? The
notion that doctors always know best is a dangerous one; it not only takes choice out of the
patient’s hands but comes from a naïve trust of medicine and the clinic as being the only kinds of
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experts. The optimum gender of rearing model was made to be beneficent, but has in numerous
cases afflicted psychological and physical scarring. Rather than promoting paranoia of hospitals
and medicine as an industry, this approach is more of a reckoning: The doctor may only really
know just as much as the caretaker what the sex of the child is.
clinic by applying corrective measures to the intersex body, perhaps it would be prudent to
recognize its being and respect the human body as a question: one that manifests in many
possibilities. And rather than the shaming of intersexuality for existing outside of a traditional
model, perhaps it is Gadamer’s notion of beauty, calling for an expansion of what can be
considered. Or perhaps it is the necessary call to face aporia as the condition of the infiniteness
of human being.
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ACKNOWLEDGEMENTS
I graciously thank Dr. Anna Kryzcka for her valuable advice, patience and support, Dr. Shane
Underwood for pushing me to write this paper, and Dr. Lauren Arenson for encouraging me to
get my paper out there.
This paper is by no means an exhaustive inquiry into the issues of binary sex determination, and
further investigation into the aesthetics of the social construction of the binary ideal and its
repercussions on identity, the human psyche, and truth is required for further understanding.
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