THE SCIENCES Published by the New York Academy of Sciences « March/April 1993 + $3.50 THE FIVE SEXES Why Male and Female Are Not EnoughTHE SCIENCES + March/April 1993 THE FIVE SEXES Why Male and Female Are Not Enough by ANNE Fausto-STERLING Ny 1843 LEVI StyDAM, @ ewenty-three-year-old resident of Salisbury, Connecticut, asked the town board of selectmen to validate his right to vote asa Whig.in a hotly contested local clection. The re- quest raised a furry of objections from the opposition par- «9, for reasons that must be sae in the annals of American democracy? i was said chat Suydam was more female chan ‘male and thus (some eighty years before suffrage was ex- tended ro women) could not be allowed to cast a ballot “Toseule the dispute a physician, one William James Bar +y, sas brought in to examine Suydam. And, presumably ‘upon encountering a phallus, the good doctor declared the prospective voter male. With Suydam safely in their column the Whigs won the election by a majority of one. Barry's diagnosis, however, turned out to be somewhat premature. Within afew days he discovered that, phallus notwithstanding, Suydam menstruated regularly and had a vaginal opening. Both hisfher physique and his/her ‘mental predispositions were more complex than was frst suspected. S/he had narrow shoulders and broad hips and fele occasional sexual yearnings for women. Suydam’s “feminine propensities, such as a fondness fo gay color, for pieces of calico, comparing and placing them togeth- er, and an aversion for bodily labor, and an inability co per- form the same, were remarked by many,” Barry later ‘wrote, It isnot clear whether Suydam lost or retained the ‘oe, or whether the election results were reversed ‘Western culture is deeply committed to the idea that there are only wo sexes. Even language refuses other possibilities; thus to write about Levi Suydam I have had to invent conventions—she and hsfher—to denote some- ‘one who is clearly neither male nor female or who is per- haps both sexes atonce. Legally, oo, every adultis either man or woman, and the difference, of course, is not tiv- ial For Suydam ie meant the franchise; today it means be- ing available for, or exempt from, drat registration, as well 20. THE SCIENCES + March/April 1983as being subject, in various ways, toa number of laws gov- cerning marriage, the family and human intimacy. In many parts of the United States, for instance, two people legal- ly registered as men cannot have sexual relations without violating anti-sodomy statutes. But if the state and the legal system have an interest in maintaining a two-party sexual system, they are in defi- ance of nature. For biologically speaking, chere are many ‘gradations running ftom female to male; and depending, ‘on how one calls the shots, one can argue that along that spectrum lie at least five sexes—and perhaps even more. For some time medical investigators have recognized the concept of the intersexual body. But the standard medical literature uses the term intersex as a catch-all for thrce major subgroups with some mixture of male and fe~ male characteristics: the so-called true hermaphrodites, ‘whom I call herms, who possess one testis and one ovary (the sperm- and egg-producing vessels, or gonads); the male pseudohermaphrodites (the “merms”), who have testes and some aspects of the female genitalia but no ovaries; and the female pscudohermaphrodites (the “ferms”), who have ovaries and some aspects of the male genitalia but lack testes. Each of those categories is in self complex; the percentage of male and female charac- teristics, for instance, ean vary enormously among mem- bers of the same subgroup. Moreover, the inner lives of the people in each subgroup—their special needs and their problems, attractions and repulsions—have gone unexplored by science. But on the basis of what is known about them I suggest that the three intersexes, herm, merm and ferm, deserve to be considered additional sex- ceseach in its own right. Indeed, I would argue further that sex is a vast, infinitely malleable continuum that defies the constraints of even five categories. much less the frequency of cach of the Money of Johns Hopkins University, a specialist in the ‘Sleeping Hermaphroite, Roman, Second Century 8. MarchiApril 1993+ THE SCIENCES 21faras Brown in sexually diverse form. Recent advances in physiology and surgical technology now enable phy cians to catch most intersexuals at the moment of birth, Almost at once such infants are entered into a program of hormonal and surgical management so that they can slip quietly into society as “normal” heterosexual males or fe- males. I emphasize that the motive is in no way conspira- torial. The aims of the policy are genuinely humanitarian, reflecting the wish that people be able to “fit in” both physically and psychologically. In the medical communi- ty, however, the assumptions behind that wish—that there be only cwo sexes, that heterosexuality alone is nor- mal, that there is one true model of psychological health—have gone virtually unexamined. ‘names Hermes, variously known as the mes- senger of the gods, the patron of music, the controller of dreams or the protector of livestock, and Aphrodite, the goddess of sexual love and beauty. Accord- ing to Greek mythology, those «wo gods parented Hermaphroditus, who at age fifteen became half male and half female when his body fused T: WORD hermaphrodite comes from the Greck with the body of anymph he fell in love with, In some true hermaph- rodites the testis and the ovary grow separately bur bilaterally; in others they grow together with- in the same organ, form- ing an avo-testis. Not frequently, atleastone of the gonads functions quite well, producing ther sperm cells or eggs, as well as functional lev- els of the sex hor ‘mones—androgens or es- trogens, Although in theory it might be possi- ble for a tue her maphrodite to become both father and mother twa child, in practice the appropriate ducts and tubes are not configured so that egg and sperm can meet. In contrast with the true hermaphrodites, the pseudo- hermaphrodites possess two gonads of the same kind along with the usual male (XY) or female (XX) chromoso- mal makeup. But their external genitalia and secondary sex characteristics do not match their chromosomes. ‘Thus mers have testes and XY chromosomes, yet they also have a vagina and a clitoris, and at puberty they often de- velop breasts. They do not menstruate, however. Ferms have ovaries, two X chromosomes and sometimes a uterus, but they also have at least partly masculine exter- nal genitalia, Without medical intervention they can de- velop beards, deep voices and adult-size penises. "No classification scheme could more than suggest the variety of sexual anatomy encountered in clinical practice. 22 THE SCIENCES + March/April 1993 ‘Rima Gerona and Velery Grloin, Romulus and Remus, 1989, In 1969, for example, wo French investigators, Paul Guinet ofthe Endocrine Clinic in Lyons and Jacques De- ‘court of the Endocrine Clinic in Paris, described ninety- eight cases of true hermaphroditism —again, signifying people with both ovarian and testicular tissue—solely ac- cording to the appearance of the external genitalia and the accompanying ducts. In some cases the people exhibited strongly feminine development. They had separate open- ings for the vagina and the urethra, a cleft vulva defined by both the large and the small labia, or vaginal lips, and at pu- berty they developed breasts and usually began to men- struate. It was the oversize and sexually alertclitors, which threatened sometimes at puberty to grow intoa penis, that usually impelled them to seek medical attention. Mem bers of another group also had breasts and a feminine body type, and they menstruated. But their labia were at least partly fused, forming an incomplete serotum. The phallus (here an embryological term fora structure that during ust- al development goes on to form either a clitoris or penis) was between 1.5 and 28 inches long: nevertheless, they urinated through a ure- thra that opened into oF near the vagina. By far the most fre- quent form of true her- ‘aphrodite encountered by Guinecand Decourr— 55 percent—appeared to have a more masculine physique. In such people the urethra runs either through or near the phal- lus, which looks more like ‘penis than clitoris. Any menstrual blood exits pe- ically during urina- tion. But in spite of the relatively male appear ance of the genitalia, breasts appear at puberty Ie is possible chat a sam- ple larger than ninety- eight so-called true her- maphrodites would yield even mote contrasts and subtleties. Suffice ico sa thatthe varietiesare so di verse that itis possible co know which parts are present and what is attached to what only after exploratory surgery. ‘The embryological origins of human hermaphrodites ‘clearly fit what is known about male and female sexual de~ velopment. The embryonic gonad generally chooses early in development to follow either a male or a female sexual pathway; for the ovo-testis, however, that choice i fudged. imilarly, che embryonic phallus most often ends up as @ clitoris or a penis, but the existence of intermediate states ‘comes as no surprise to the embryologist. There are also turo-genital swellings in the embryo that usually either stay open and become the vaginal labia or fuse and become & scrotum. In some hermaphrodites, though, the choice of ‘opening or closing is ambivalent. Finally, all mammalian ‘embryos have structures that can become the female uterus and the fallopian tubes, as well as structures that‘can become partof the male sperm-transport system. Typ- ically either the male or the female set of those primordial genital organs degenerates, and the remaining structures achieve their sex-appropriate future. In hermaphrodites both sets of organs develop to varying degrees. IRSEXUALITY ITSELF is old news. Hermaph- [revista ten red ees about human origins. Early biblical scholars be- lieved Adam began life as a hermaphrodite and later di- vided into two people—a male and a female—after falling from grace. According to Plato there once were three sex- es—male, female and hermaphrodite—but the third sex was lose with time Both the Talmud and the Tosefta, the Jewish books of law, lst extensive regulations for people of mixed sex. The Tosefta expressly forbids hermaphrodites to inherit their fathers’ estates (like daughters), to seclude them- selves with women (like sons) or to shave (like men). When hermaphrodites menstruate they must be isolated from men (like women); they are disqualified from serv- ing as witnesses or as priests (like women), but the laws of pederasty apply co them. In Europe a pattern emerged by the end of the Middle Ages that, in a sense, has lasted to the present day: hermaphrodites were compelled to choose an established gender role and stick with it. The penalty for transgres- sion was often death. Thus in the 1600s a. Scottish hermaphrodite living as a woman was buried alive after impregnating his/her master’s daughter. For questions of inheritance, legitimacy, paternity, suc- cession to ttle and eligibility for certain professions to be determined, modern Anglo-Sexon legal systems requite that newborns be registered as either male or female. In the USS. today sex determination is govemed by state Jaws. Ilinois permits adults to change the sex recorded on their birth certificates should a physician attest to having performed the appropriate surgery. The New York Acad= temy of Medicine, on the other hand, has taken an oppo- site view. In spite of surgical alterations of the external genitalia, the academy argued in 1966, the chromosomal sex remains the same. By that measure, a person's wish to conceal his or her original sex cannot outweigh the public interest in protection against fraud. During this century the medical community has com- pleted what the legal world began—the complete erasure of any form of embodied sex that does not conform to a ‘male-female, heterosexual pattern, Ironically, a more s0- phisticated knowledge of the complexity of sexual sys- {ems has led to the repression of such intricacy. In 1937 the urologist Hugh H. Young of Johns Hopkins University published a volume titled Genital Abnormali- ties, Hermaphroditism and Related Adrenal Diseases. The book is remarkable for its erudition, scientific insight and ‘open-mindedness. In it Young drew together a wealth of carefully documented case histories to demonstrate and study the medical treatment of such “accidents of birth.” Young did not pass judgment on the people he studies nor did he attempt to coerce into treatment those inter- sexuals who rejected that option. And he showed unusu- al even-handedness in referring to those people who had had sexual experiences as both men and women as “prac- ticing hermaphrodites.” One of Young's more interesting cases was a hermaph- rodite named Emma who had grown up asa female, Em- ma had both a penis-size clitoris anda vagina, which made it possible for himyher wo have “normal” heterosexual sex with both men and women. As a teenager Emma had had sex with a number of girls to whom sfhe was deeply at- tracted; but a the age of nineteen sfhe had married a man, Unforeunately, he had given Emma litle sexual pleasure (hough Ae had had no complaints) and so throughout that marriage and subsequent ones Emma had kept grlftiends on the side. With some frequency fhe had pleasurable sex ‘with them. Young deseribes his subject as appearing “to be {quite content and even happy.” Inconversation Emma oc- casionally told him of his/her wish to be a man, @cireum- stance Young said would be relatively cay co bring about. Bur Emma's reply strikes a heroic blow for self-interest ‘Would you have to remove chat vagina? I don't know about chat because that's my meal ket. Ifyou did that, would have co quit my husband and goo work chink keep ieand sty as 3m My husband supports me well and even though I don't have any seul pleasure ith him, Ilo have lots wih my giends 7 EVEN AS YOUNG was illumina VY: ey wih te ligt of cen beginning itssuppresion. For his book is also an extended treatise on the most modern surgical and har mmonal methods of changing inersexuls ico either males tr females. Young may have differed from hs successors in being less judgmental and contoling ofthe patents and their families, ut he nonetheless supplied te foundation tn which cutent intervention practices were bull By 1969, when the English physicians Christopher J. Dewhurstand Ronald R. Gordon wrote The Intresual Di tier, medical and surgical approaches to intersexuality had neared a sate of rigid uniformity. [eis hardy surpris- ing cha such a hardening of opinion took place in the era of the feminine mystique—of the post-Second World War fight othe suburbs and the sti division of family roles according eo sex. ‘That the medical consensis wis not ‘uite universal (or perhaps that it seemed poised to break Sart again can be gleaned from the nearhyscerial one ot Dewhurst and Gordon's book, which contrasts marked- iy with the calm reason of Young’ founding work. Con- sider their opening description ofan intersextal newborn (One can only attempt to imagine the anguish ofthe parents ‘Thaca ncwbuun shold have deform lflecingl sone damental an ste a the very soxof the ehld.leatnpecvent which immesliacely conjure ap von of «hopeless pyeog- ili doomed to ive always som ak a onetiness od station Dewhurst and Gordon warned that such a miserable fate sould indeed, be a baby's Io should the exe be improp- tly managed; “but fortunately,” they wrote, with conrece management the outook is infincly better than the poor parents emotionally stunned by the event—or indeed tnyone without spec knowledge could ever imagine.” Scientie dogana has held fas ro the assumption tha without medical care hermaphrodites are doomed toa life of misery, Yet there are few empirial studies to back up that apsunption, and some ofthe same research gathered to build a ease for medica weatmene coment. Fran- ties Benton, another of Young’ practicing hermaph- rodites, “had not wortied over his condition, didnot wish MarshiApril 19936 THE SCIENCES 23tobe changed, and was enjoying life.” The same could be said of Emma, the opportunistic hausfrau. Even Dew- hhurst and Gordon, adamant about the psychological im- portance of treating intersexuals at the infane stage, ac- knowledged great success in “changing the sex” of older patients. They reported on twenty cases of children re- classified into a different sex after the supposedly critical age of eighteen months. They asserted that all the reclas- sifications were “successful,” and they wondered then whether reregistration could be “recommended more readily than [had] been suggested so far.” “The treatment of intersexuality in this century provides clear example of what the French historian Michel Foi cult has called biopower. The knowledge developed in biochemistry, embryology, endocrinology, psychology and surgery has enabled physicians to control the very sex of the human body. The multiple contradictions in that kind ‘of power call for some scrutiny. On the one hand, the med- ical “management” of intersexuality certainly developed as part of an attempt to free people from perceived psy- chological pain (though whether the pain was the pa- tient’, the parents’ or the physician's is unclear). And if ‘one accepts the assumption that in a sex-divided culture people can realize theie greatest potential for happiness and productivity only if they are sure they belong to one of only two acknowledged sexes, modern medicine has been extremely successful (On the other hand, the same medical accomplishments can be read noc as progress but as a mode of discipline. Hermaphrodites have unruly bodies. They do not fall nat- rally into a binary classification; only a surgical shoehorn can putthem there. But why should we care ifa “woman,” defined as one who has breasts, a vagina, a uterus and ovaries and who menstruates, also has a clitoris large enough to penetrate the vagina of another woman? Why should we care if there are people whose biological equip- ‘ment enables them to have sex “naturally” with both men and women? The answers seem to lie ina cultural need to maintain clear distinetions between the sexes. Society ‘mandates the control of intersexual bodies because they blur and bridge the great divide. Inasmuch as hermaph- rodites literally embody both sexes, they challenge tradi- tional beliefs about sexual difference: they possess the ir- ‘tating ability to live sometimes as one sex and sometimes the other, and they raise the specter of homosexuality. Ur MNT IF things were aogether diferent? Bites tact seh ee hw ge that his enabled meine to nterrene in the onoogement of inven pases ha Deca placed atthe serie mul seals, mane that the sexes have mulapiod beyond curently imaginable limits It would have fo be asvordf shaes power ac font and physkan, parent and cid, mate and female, hetcrseual and honesexutall thse oppstions and otters would have tobe dsaved ss sure of divin, Aw eit of metal weatment ul ane, one tat ould permic ambiguity na eultre that had overcome ‘Saal Givin The cena mision of medal etme Soul betopresene I. Thus hemuphrodies would be Concerned primarily nocabout whether they ean conform To socteny bur about whether they might develop poten tally it-theatening condone —herin, Eom 24 THE SCIENCES + March/April 1993 ‘mors, saltimbalance caused by adrenal malfunction—that sometimes accompany hermaphroditic development. In my ideal world medical intervention for intersexuals would take place only rarely before the age of reason; sub- sequent treatment would be a cooperative venture be- ‘ween physician, patient and other advisers trained in is> sues of gender multiplicity, T do not pretend that the transition to my utopia would be smooth. Sex, even the supposedly “normal,” hetero- sexual kind, continues to cause untold anxieties in West- ‘em society. And certainly a culture that has yet to come to zgrips—teligiously and, in some states, legally—with che ancient and relatively uncomplicated reality of homosex- ual love will nor readily embrace intersexuality. No doubt the most troublesome arena by far would be the rearing of children. Parents, at least since the Victorian era, have fretted, sometimes to the point of outright denial, over the fact chat their children are sexual beings All chat and more amply explains why intersexual chil- dren are generally squeezed into one of the two prevail- ing sexual categories. But what would be the psychologi- cal consequences of taking the alternative road—raising children as unabashed intersexuals? On the surface that tack seems fraught with peril. What, for example, would, happen to the intersexual child amid che unrelenting cru celty of the school yard? When the time came to shower in gym class, what horrors and humiliations would awaie the intersexual as hisfheranatomy was displayed in all ts non- traditional glory? In whose gym class would s/he register to begin with? What bathroom would s/he use? And how ‘on earth would Mom and Dad help shepherd him/her through the mine field of puberty? ‘N THE PAST THIRTY YEARS those questions have been ignored, as the scientific community has, with remarkable unanimicy, avoided contem- plating the alternative route of unimpeded intersexuality. Bur modern investigators tend to overlook a substantial body of case histories, most of them compiled between 1930 and 1960, before surgical intervention became ram- pant, Almost without exception, those reports describe children who grew up knowing they were intersexual (chough they did not advertise ie) and adjusted to their un- usual status. Some of che studies are richly derailed—de- scribed at the level of gym-class showering (which most intersexuals avoided without incidenos in any event, there is noc a psychotic or a suicide in che lot. Still, the nuances of socialization among, intersexuals ‘ery out for more sophisticated analysis, Clearly, before my vision of sexual multiplicity can be realized, the first openly intersexual children and their parents will have to be brave pioneers who will bear the brunt of society's growing pains. Bucin the long view—though it could take generations to achieve—the prize might be a society in Which sexuality is something to be celebrated for its sub- tleties and not something to be feared or ridiculed. ANNE Fausro-SrERLING is a developmental geneticist and profes sor of medical seience at Brown University it Providence. The sec- ‘ond edition of her book Mis OF GENDER: BIOLOGICAL. THRORIES ‘ABOUT WOMEN aND MEN, published by Basi Books, appeared last fall. She is working om a book titled Tie Sex Wac PREVALts: B- (OLOGY ANDTHE SOCIAL / SCIENTIFIC CONSTRUCTION OF SEXUALITY.Robert Gober, Untitled, 1990 MerchiApril 1993+ THE SCIENCES 25INTERSEXUAL RIGHTS AAs an intersexual I found Anne Fausto- Sterling's article “The Five Sexes" (MareiApri of intense peroneal ine dogma on intersexuality i unique and re- freshing, | understand that she has not had the chance to meet with any “cor- rected” intersexuals Ihink I ean provide some perspective on the experience. Surgical and hormoral treatment al- lows parents and physicians to imagine ‘that they have eliminated the chiles in- tersexuality. Unfortunately the surgery is immensely destructive of sexual sensi tion as well as one’s sense of bodily in- tegrcy. Because the eoemetic result may be good, parents and physicians compla- cently ignore the child's emotional pain in being forced into secally aecepeable gender. The chile’s body, once violated by the surgery is again and again subject- ed to frequent genital examinations, Many “graduates” of medical intersex body pars. Suicides are not uncommon. ‘Some former intersexuals become trans- ‘sexual, rejecting their imposed sex. Fol- low-up studies of aduls t ascertain the long-term outcome of intervention are conspicuously absent am forced towonder whether our cul- ture's concept of sexual normalcy, which defines the sexorgans ofas many as4 per centof newb sre busily sripping and uimming infant genital ro ft the procrustean bed th ‘our cultural definition of gender. But Me, Fausto‘Sterling has been wrongly in- formed that few intersexuals escape med- ical intervention. The ones Thave located have told me they fee! lucky to have cs caped with their bodies intact. How did their parents shepherd them ehrough the mine Beld of puberty? Generally, in the culcurally sanctioned way: with embar- ‘assed silence. Medical dogma on sex assignment of {ntersexuals centers on the “adequacy” of the penis. Because a lrge penis eannotbe ‘constructed from a small ene, female as- Signment is preferred. Because large eli- toris is considered “diafiguring,” exten- sive surgery is employed to remove, trim relocate it. Whereas a male with an “in- adequate” penis (small, but with normal erotic sensation) is considered tragic, the same person transformed into 4 female ‘with reduced of absent genital scasation and an artificial vagina is considered nor- smal. The capscity to inflict such mon- strous “teatmenc on children, who can PEER REVIEW Letters from Readers not consent, is ultimately a clear expres sion of the hatred and fear of sexuality that predominete in our culture. T must rake issue, though, with the terms trae hermapirodit, female pteudo- Aermephredte and male pseudotermaph- rede, They ae a heritage of Viewrian medicine—and without prognosticative value. They reflect the Vietorian belief that human sexual nazure resis entirely in the gonads, 2 concepe of gonadal deter. minis belied by the relative suecess of intersex medicine in sex reassignment. T encourage intersexvals and people close to them write tous atthe Intersex Society of North America, Post Office Box 31791, San Francisco, California 94131, where we ae assembling a support group and documenting our ives. ‘CheRYL CHASE ‘Sen Francisco, Califersia The logic of Me. Fausto-Seerling's argu: ‘ments is specious, even deranged. She r= ports chat some people suffering from ‘congenital genizal abnormalities have led hhappy lives. Buc co assume chat such eases justfy withholding corrective surgery be- ‘cause they are exemplars of some imag. ined extra sexes is truly bizarre. By che same argument. we sheild withhold cor- reetive surgery from people who suffer ongenical spinal deformities, heart con- ditions or even hatelips: their claims to special satus (and thus preservation) are juseas solidare as che ones of people with genital deformities. RP. Bip Wichita, Kensas 1M. Fausto Stedling contends that the medical community has been unreftec- about surgery #8 2 solution « observation that physicians formulate their encesprse of converting ambiguous genitals into “female” or “male” genitals as an effort to “fie [intersexed] people from peiceived psychological _ pain,” when in fact i isan effort to free the cul- ture from having to deal with the intplica- tions of gender ambiguity. Evidence (as yet unpublished) from adults whore tersexusl states were corrected in child- hhood suggests they are noc as grateful :o theit physicians of as satisied with the genital reconstruction 42 the physicians would have us believe. It appears, then, thatthe curcent management of intersex uclity is bad not only for reconstructing, jgender in theory buc aso for anyone who. has a more practical interest inthe isue, In Ms. Fausto-Steling’s utopia the aci- entitle communicy would refrain fom sur- ically correcting intersexuality, thereby ise to + world in which gender op- ‘ons would “be dissolved 28 sources "I share her desire to see gen- Ive, and Tam sympathetic wo her argument that one answer ies in halting unnecessary genital surgeries and in va- dating alernative genitals and thus ake native sexes. I think, however, that her propotal sil gives “natural” genitals (al- bitin more chan ewo forms) a primary sx tus and ignores the fact that in the every- day-world gender atvibutions are made withouc access vo genital inspection. Instead, what has primacy in everyday is the gender thats performed, regard less of che configuration ofthe Resh under the clothes. One cannot expect that sut= eons will lay down theit knives in the Service of the gender revolution. But there are people who might Function ax transformers of gender categories. The “cansgende:” community, described by the anthropologist Anne Bolin, is made up of people who are challenging the obligatory two-gender system by blend- ing public features of maleness and fe- imaleness, or by accepting bits and pieces ofthe surgical options without “going all the way.” or by doing both, People who are transgender disrupt gender in two ways: They refuse to provide the cues that would permit them co be regarded at cither male ot female. And they treat logical signs of gender (including geni tals) as bodily omaments—neither more ‘or less elective than «facelift. Ms. FaustoSterling suggests gender disruption can begin with the genital and work outward to the social categorie en the need for revolutionary disruptions tobe public events, the transgender move- ment suggests a more powerful altemative. SUZANNE J. KESSLER ‘State Universi of New York Purchase, New York Is. Fausto Sterlingsarticleleferme ‘oo questions about rue hermaphrodites: ‘What isthe chromosomal make up of their calls) And if a edie hermaphrodice could donate both the sperm and the egg foran JelsLtntase 1993+ THE SCIENCES. 3embryo, would the offspring be a tue clone, which in turn would be able to re ‘generate in che same fashion? ‘Josee L. Lansuwanan Washington, DC. {To the best of my knowledge there is no Publication acributable to me in which f Suggest, as Ms. Fausto-Steling pues it, “intersexuals may consticure as many 28 4 percent of births.” Moreover, it is epi- demiologically reckless to conjecture that ‘on the eampus of Brown University there ate 240 students with a birth defect of the sex organs that would justify theie being. diagnosed as intersexuals, that is, her maphrodites. Joins Hopkins University Balimore, Maryland Joun Moxey ‘Anne Fausto-Sterling replies: The let term responding to my article include some small fetal corections (for which Poni check my sources further one question about chromosomes (answer: ttue hermaphrodies are often chromo- fomal mosaics with both XX snd. XY isrue—I dont think clones are possible) tome crteal engagement from people fenenlly sympathetic to my point of ‘iew; and some cholere responses that lure the reader with words suchas recbes, ‘pecoas ‘and. deranged, 1 will respond ‘rey to the later two categories, ‘Since the antcle was published, [have had the pleasure of coresponding ditece Iy with Chery! Chate whose views and insighe into the issues have raised my consciousness and focused my attention tore clearly on such cliical aspects of sy urgey at os of sex nto, ‘genial searing and negative psych Sil side effects Lean ony concur with her omments about clitoral surgery T would 0 that such surgery is sometimes done even on unambiguously female infants Simply because the neonatologst thinks the baby gi’ clitoris "too fong” Mo. Chase's poine about terminology is also wellaken, though chose tous the med. ically accepted words to facilitate commu nication with the medical eommmontey. refer the outraged Mr, Bird to Ms. Chase's Teer, Far fom raising a silly is sue, Tam, with considerable jusica Suggesting that certain entrenched med cal practices be reconsidered, both forthe benef ofthe patent and forthe wel ofour culture ssa whole. Suzanne Kesser's work on the man- agement of intersexuality has aso in- formed my own. | fad her points about ‘oe giving primacy to genitalia worthy of further thought As for the number five emphasize that I chose it fort thetonical ‘alle and noc because I think a digerete rhumber ean accurately be imposed on a fet of physical and) physiologial 2 4 THE SCIENCES « Juip/Auguse 1999 tributes that actually form a continuum. ‘One feature of the academic commu- nity is the inabilicy of many of ies mem- bers co deal with che ironic. John Money's failure to see my quip about intersexuals fon the Brown Universicy campus at any- thing other than “reckless” places him among the irony-blind, Ifthe gure 4 per cent is incorrectly attributed to him, Uean only apologize, and I will be sure not to make such an'atcibution in the future. Nevertheless, did not pick the number | our of thin ait. I eook it from a paper by Julia Epstein tiled “EitherlOr—Nei- ther/Both: Sexual Ambiguity and the Ide- ology of Gender,” published in Genders (1990), Volume 7, pages 100-142. Her footnote 6 on page 131 reads as follows: “Robert Edgerton cites a statistic of 210 3 percent in... American Andhropologis 66 (1964): 1289." Dr. Iraj Reavani of Se. to0 high, while John Money asserts that the incidence of gender disorders ap- proaches $ percent.” T had hoped my tentative language about chat number would emphasize that there are really no accurate figures about the total frequency (from all causes) of in- tersexuality—and. that compiling any ‘may be impossible. My point, however, is that inerrant nt arava people ‘may think and chat che principles of reat- ‘ment, established especially by Mr. Mon- ey and his many coworkers, ae part of system of defining and reinforcing our cultural ideas aboue what counts a8 nor- imal in the world of sex and gender. both those cultural norms and their en- forcement that I challenge,