Ambiguous sex is a biological phenomenon where an individual bares an intermediate characteristic between male and female. It can also be congenital; referring to chromosomal aberration, genital ambiguity or sexual developmental dysfunctions. The intersex individuals do not have a definite sexual orientation and may assume intermediate sex between male and female both physically and psychologically.
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Various studies and research have been carried out in this field of science to come up with amicable solutions to these anomalies. The medical practices and surgeries carried out on intersexual individuals have raised controversial debates and concerns on moral and ethical aspects of the practices.
History of The Research
In the ancient world and pre-modern society, intersex individuals were grouped together as a ‘third gender’ and most cultures sidelined these group of people and considered them as cursed or a disgrace to the community among many other mythical stories and beliefs.
It was until the Victorian era that medical personalities referred the intersex people to as ‘true hermaphrodite’; that is possessing both the ovarian and testicular organs. Female pseudo-hermaphrodite were considered to be those individuals with a more pronounced female genitalia but with male anatomy while male pseudo-hermaphrodites had a more elaborate male genitalia but with pronounced female anatomy.1
In the nineteenth century, there was significant scientific research and development on this field of sexuality as a result of pressure emanating from the feminist, the anthropologist and the intersex lobby groups who were eager to find remedies to these ambiguous biological phenomena.
A series of research works were carried out by biomedical specialists across the globe to find a distinct biological benchmark bordering the two sexes and they later exemplified that gonadal tissues could be used as the cut-line to distinguish male from female species despite the other morphological and anatomical attributes that may come with it as a result of genetic and hormonal imbalances.
In 1910s, the medical practitioners used advanced technologies to carry out more sophisticated procedures like biopsies and laparotomies that made it possible to identify true ‘hermaphrodite’ from other normal cases.
The physicians at George Washington Medical School, will under their intersexual research, identified cases where the patients bear extreme feminine characters and anatomy and upon careful examination, they were found to have testes.2
Such individuals find it hard to identify their place in the society and cannot freely interact with the rest of the community because of their sexual orientation. Most of them resolve to undertake surgical operation so as to incline towards a particular sexual orientation fully.
The first serological experiment to be performed on an intersexual was in the year 1967 by a physician Harold Grafinkel using a technique called ethnomethodology that used to perform surgical gender transformation.
This technique was later used by Kessler and McKenna who argued that the ‘hermaphrodites’ did not have a place in the society due to the cultural beliefs and norms of the communities was only acquitted to two genders hence any intermediate forms were seen as a wreck on the social havoc or a natural defect as a result of other supernatural forces.
At the present, more technical approaches and techniques are being used to perform surgical operations and hormonal treatments on such cases. Scientific research and investigations are still being done in this field to build on the present techniques and come up with other efficient ways to attend to intersexuality cases.
Recent Discoveries and Development
The intersexual medical practices have covered a milestones over time due to a series of innovations and technological developments in this field of science including advanced anatomical gender identification system that is used to distinguish sex orientation of intersex individuals effectively.
This was successfully disseminated by John Money and endorsed by a medical pediatrics association. He argued that the sex of a child is more or less determined by psychosocial aspects and not nature and should be identified and oriented early enough to ensure smooth transition and transformation of the child’s sexual anatomy.3
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This will enable the child’s sexual orientation to match his or her morphology and anatomy as they grow. The boundaries separating masculine and feminine characters among the intersex infants can be very thin; hence, it is an uphill task for the physicians to clearly draw a distinctive line more so in the five-sex system.
Current Status of the Research
Surgical operations to be carried out on intersex individuals wholly depend on the cause of the phenotypic sexual disorder. The recent technological advances on surgical procedures have made it possible for the intersexuals infants to go through a hormonal program that enables them to smoothly slip into the society as ‘normal’ males or females.
Most medical institutions that have specialized in treating intersexual infants are riding on the management policies and principles constituted by psychologist John Money and psychiatrist JohnHampson and Joan Hampson. John Money argued that in the early infant stages of up to about eighteen months after birth, sexual orientation could be completely transformed and reassigned.4
Despite the contradictions and ethical concerns, the physicians categorically stated that the sole aim of the operations is to give the babies an identity that is “acceptable” in the society and to save them from the psychological trauma and confusion that comes with intersexuality.
The treatment protocol used should be on the basis of medical and ethical principles as exemplified by McCollough. In most cases, the core reason for the genital operations to be done on the infants is to save their lives and significantly improve their physical and anatomical appearance in accordance to the gender assigned.
Pediatric medical organizations have endorsed North America Task Force on Intersexuality (NATFI) to look into the issues of sexual ambiguities in babies. Professionals in the fields of endocrinology, ethics, urologist, psychology, intersexual medical society and other advocacy groups have linked up with NATFI whose main objective is to constitute a scientific sex nomenclature.
There are some legal requirements and obligations under the medical pediatrics association principles that all medical institution oughts to adhere to before undertaking such crucial operations one of them being; adequately informing the concerned parties of the operations before proceeding to reassigning the child’s gender.
They are also entailed to the full range of information like the repercussions of the operations and any other possible options at their disposal. The child most importantly is also entailed to know of the surgical operation that was done on them when they become of age, and he or she may have the right to either accept or reject the gender assignment.
In the state of Illinois, adults are allowed to change their sex status recorded on their birth certificates upon producing an official medical report of a successful surgical operation and attested by a qualified physician.
There is also the question of inheritance, paternity and eligibility among other legal aspects that require definite identification of the gender of the client hence appropriate legal measures, procedures and documentations ought to be availed to avoid contradictions or cases of an accusation of fraud.
Unethical medical practices
In talking about ethics, we mean conducting oneself or behaving in a morally upright manner and upholding human dignity and integrity in all your undertakings. All medical practitioners are expected to carry out ethical medical practices in the course of treating ailments or abnormalities in their patients.
There are cases where the medics carry out uncouth or personal medical faults and keep their clients and other concerned parties in the dark to cover up for their absurd or accidental medical practices.
For instance, there was a case where a doctor accidentally ablated an infant’s penis while circumcizing it, and after seeking consultations from sexologist experts and a team of physician, they resolved to reassign the infant female genitalia and subjected it to hormonal treatment hence completely changing its sexual orientation.5
Such medical cases are considered unprofessional and unethical as it totally affects the livelihood of the infant both physically and psychologically and also that of its immediate family in coping up with the gender transformation.
Psychological trauma and depression
It is also against the moral and ethical values of the society for physicians to tamper around with the gender of infants whose lives have not been endangered by their sexual orientation or whose parents preferred a particular gender over the other hence requested for sexual reassignment.
Such practices are a disgrace to human dignity and absurd more so to the innocent infant who may find it unbearable to cope with the sexual reassignment.
In tackling these cases of ambiguous sex or psychosocial problem, genital surgical operation is not the ultimate remedy to this eventuality as it leaves far-reaching effects of psychological trauma and depression when one realizes that his or her genitalia had been operated on and requires frequent visits to the physician for checkups and hormonal treatment.
This may seem to infringe into one’s privacy hence resulting in adverse psychological torture. A research conducted by professor Martin Malin at the Child and Family Institute to find out whether the intersexual patients were comfortable with the genital surgeries and most of them categorically stated that they preferred their ‘abnormal’ genitalia than the ‘manipulated’ ones.6
One may also feel cheated if he or she was never informed about the situation early enough hence it is wise for the parents to leave the babies with their current situation until they become of age and make their own decision with the help of a chancellor and psychologist, this could be the most appropriate option.
Despite this development, the medical practitioner could be entitled to go ahead with the surgery in case where the conditions could be worsened if not attended to as a result of metabolic reactions and hormonal imbalances causing congenital adrenal hyperplasia (CAH);that is life-threatening to the newborn hence immediate medical attention is recommended.5
Technical Aspects and Limitations
The patient is entailed to know of the operations and treatments being administered to them when they are of age. They should be adequately informed of the physiological changes that have been done on their bodies and medical their implications.
Any deceptions or hidden truths even if with good intentions to protect the intersexual and their family is considered absurd and naive in accordance to the medical governing ethics.6
The parents should be fully involved in the whole transformation process and a medical counselor should be provided to offer counseling services to the patient and the family at large. After the operation, there is need to make a follow-up on the children until their adulthood to ensure they respond well to the medication and general psychological well-being.
Recent research from George Washington Medical School showed that cosmetic effect on clitoral size readjustment was excellent though it resulted in sexual insensitivity, absence of sexual gratification and orgasm among the patients.7 In some cases, the surgeries resulted to other secondary infections and defects like stenosis, bacterial infections and trauma.
Remarks and Conclusion
What determines sex in human beings are the chromosomes where normal males pose XY chromosomes while that of normal females XX.8 In the case of ambiguous sex, such individuals do not bear the normal chromosome sets in terms of numbers or alignment hence ending up with “abnormal” sexual orientations.
Most parents prefer taking their babies for surgical operations in case of such eventuality so that they could be assigned a definite gender that is either male or female.
For the infants who are born with an enlarged clitoris of more than 2.5 centimetres in length, are operated on to reduce its size and make it appears more tender and “feminine” while those born with penile lengths of less than a centimeter long are also assigned a female gender by completely removing the penis and testis if present and enhancing there female genitalia, they are also administered to hormonal program to make them appear more feminine both physically and psychologically.9
Babies born with adequate phallus mass are assigned male gender, but the surgeons are required to perform a series of surgical procedures to make it more prominent and masculine.
The experience by the intersexual surgeons working on infants with such abnormalities has shown that it is much easier to assign an infant a female gender than it is to assign it a male gender because of the technicalities that comes with reconstituting afunctional male genitalia with sophisticated erectile muscles and ducts as opposed to female genitalia that only needs to be an opening large enough to allow penetration of an average penis size.
In conclusion, an intersex individual ought to be accepted by the society and accorded respect and equal treatment that is given to their ‘normal’ counterparts. They also need to be encouraged and appreciated since most of them end up with low self-esteem and a feeling of rejection by the society.
For those who opt for genital surgical operation, there is great need to stick to the medical prescriptions to the latter and maintain regular check-ups so as to avoid any complications in future.
There is also a great need for the intersexual victims to have a personal medical psychologist and chancellor to help them cope with the psychological pressure and trauma that normally comes with intersexuality. The community has a role to play in accepting such individuals just as they are and accord them the moral support that they badly need since no one chooses to be born that way.
1 Milton Diamond and H. Keith Sigmundson, Sex Reassignment at Birth: Long-Term Review and Clinical Implications, Archives of Pediatrics and Adolescent Medicine 15 (1997): 298-304.
2 For a more in-depth biography, see John Colapinto, The True Story of John/Joan, Rolling Stone, 11 December 1997, pp. 55ff.
3 Diamond and Sigmundson, “Sex Reassignment,” p. 303.
4 Suzanne J. Kessler, “The Medical Construction of Gender: Case Management of Intersexed Infants,” Signs 16 (1990): 3-26; compare the advice given by Cynthia H. Meyers-Seifer and Nancy J. Charest, “Diagnosis and Management of Patients with Ambiguous Genitalia,” Seminars in Perinatology 16 (1992): 33239.
5 Lee, “Producing Sex,” p. 45.
6 Melissa Hendricks, “Is It a Boy or a Girl?” John Hopkins Magazine (November, 1993): 10-16, p. 10.
7 Barbara C. McGillivray, “The Newborn with Ambiguous Genitalia,” Seminars in Perinatology 16 (1991): 365-68, p. 366. 16. Kurt Newman, judson Randolph, and Kathryn Anderson, “The Surgical Management of Infants and Children with Ambiguous Genitalia,” Annals of Surgery 215 (1992): 644-53, pp. 651 and 647.
8 Reilly and Woodhouse, “Small Penis,” p. 569.
9 Diamond and Sigmundson, “Sex Reassignment,” pp. 300301.
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Diamond, Milton. Sex Reassignment at Birth: Long-Term Review and Clinical Implications. Port Elizabeth: Cambridge Publications, 1997. Print.
Hendricks, Mellisa. Diagnosis and Management of Patients with Ambiguous Genitalia. Pottie VG: Oxford University press, 1993. Print.
Hopkins, John. “Is It a Boy or a Girl?” Pottie VG: Oxford University press, 1993. Print.
Judson, Randolph. Genitalia Seminars in Perinatology. Oxford: Oxford UP, 1998. Print.
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Reilly, Windson. Surgical Management of Infants. New York: Perennial-Harper, 1993. Print.
Sigmund, Bond. “Sex Reassignment.” New York: Oxford University press, 2003. Print.
Woodhouse, Johns. “Small Penis.” Toronto: Sage Publications, 1999. Print.