5 Assignment 03

In your responses to Kessler, many of you point to a moment she describes in her work: when doctors encountering intersexuality are managing all that this situation can mean and become. The relevance of this moment, when intersexuality is treated as a condition that must be resolved through the successful identification of the body’s characteristics defined either as male or female, is powerful one. Kessler returns our attention to the ideas expressed by Grewal and Kaplan, and their argument that we tend to treat science as “value neutral” (2005). We might also compare this moment to the one that Londa Schiebinger describes, when human skeletons began to be understood in terms of the messages anatomists were thought to be decoding, about the worlds the female body was built to inhabit (1986).

In the cases Kessler refers to, the supposed objectivity of scientific knowledge is clearly overridden by doctors who cannot see beyond a two-gendered system. Grewal and Kaplan explain that one of the hallmarks of western science is its division between the natural and cultural world. “Nature” is defined as that which is untouched and unchanging while “culture” refers to the interpretations and ways of life that human beings have adopted in the different times and spaces (2005:1). In line with the questions Grewal and Kaplan raise, about what counts as difference, we have in Kessler’s article instances where doctors cannot see past a difference based on male and female to consider the kinds of bodily differences presented to them.

Pivotal to Kessler work as well as for the article(s) from Ann Fausto-Sterling on “The Five Sexes,” are ideas about the connection of the sex of the body (presumed as natural) to gender (which Kessler describes as a performance). But there are some presumptions that both Kessler and Fausto-Sterling make about “identity” that are worth examining. Both seem to suggest that identity is something that most people desire to be aligned with once and for all. But is “identity” something that we aspire towards? In Maggie Nelson’s book The Argonauts (2015), she stresses that identity, and gendered selfconsciousness in particular, is not something people have an immediate awareness of. Moreover, she argues that a lack of selfconsciousness about identity (and gendered identity in particular) is, for many people, something that is desirable and refreshing. I want to underline this point as it bears an important affinity to the way subjectivity is often configured in relationship to difference, as a project of assimilation.

In Suzanne Kessler’s essay is about how the society gives a model of intersexuality that provides infants a biological identity about themselves. The physician is the role of the medical pyramid, they are standing on the top and decide which gender and social issues that parents/infant should face. They belief the gender and children are malleable based the theory of Monkey and Ehrhardt’s theory, they give a statement about how intersexuality is a condition of the biological issues. There any many doctors, psychologists and geneticist agree that operative correction is necessary for infants who in the early stages of development. In the top of the society, the physician’s all theory are based on researches and data, but they do not care the nature of child birth and the psychology issues for the infants and their families. In the other hand, the morality and ethic is not allowed people who use some extreme surgery to change person’s identity.

The middle of pyramid is the parent, they have higher expectations about their child’s gender and there are many of them use some technologies to test whether it’s a boy or girl. They put too much confidence to physicians and how they should give a healthy baby. Most of them cannot accept intersexual baby, because the trust of medical construction and, lack of knowledge and how others looks them. “How others talk about?” It’s sounds a common question, but when you asked millions of parent. They will give you many argument and critical issues. The gender identify is determined by chromosome and genes from our parent. They have to know the baby is born in nature; there is nothing wrong with them. The society should accept and understand the issues and support them.

In the bottom of pyramid is the patient/infant; it’s not fair if they cannot decide their own gender identity. The relationship between patient and doctor is becomes negative. We need more help from them not only in how to solve the biological issues, they are also should be a doctor of a child, to thinking about their situation.

The focal point of Kessler’s reading is to discuss the obvious social construct that this society condones when it comes to gender. This lens has influenced doctors to make decisions, or create solutions, when it comes to intersexuality. A child that is deemed intersex is born with undefined genitals, which then results in the decision over if the child should identify as male or female. The issue with intersexuality is the fact that it is seen as a deformity that needs to be dealt with. In order for the child to be raised properly, a sex must be assigned, and it is up to the doctors to do so. However, this decision is not quite simple, as it requires a deeper look into other aspects that take part.

A big contribution to this decision are cultural and environmental factors, which ultimately shape an individual as they come into themselves and identify with their sex. In her essay, Kessler includes that both views are important when assigning a sex. The growth of a child is greatly linked to social norms. It is our environment that forces us to establish ourselves in society and sex is one of the main establishments that one must be aware of in oneself. An example of how they make these decisions is by taking a look at the links between society and the individual. Due to the fact that masculinity is related to penis size, a child would be assigned a female rather than a male if their penis was below the average size. Essentially, the societal lens is what makes the decision after all. These constructs are so heavily pressed on individuals in society that if a sex is not decided for the child then he/she will be deemed underdeveloped and out of place. Another adjustment to this issue is performing surgery so that the child may possess more of a female sex organ or more of a male sex organ, depending on which is more prominent initially. It is an important decision, however, because it will guide them to understand who to identify as in the future. Also, it tells the parents what steps they must take in order to raise their child so that they are established in society. Another important aspect that Kessler stresses is the relationship between the parents and doctors. The healthier the connection between them two, the healthier it will be between the parents and their child. This connection leads to the proper growth and establishment of the child in society as he/she grows. The focus may be on the biology of an individual but the true solution is found elsewhere; upon taming and adjusting to societal norms that can hinder the growth of an individual if decisions are made without every possible factor in mind.

Suzanne Kessler’s essay, “The Medical Construction of Gender” describes the factors that play a role in the way physicians, parents, and patients understand and manage the medical condition known as intersexuality. To begin with, an intersexed individual is one who was born with genitals that are not of a female nor male. Physicians who handle such cases consider factors, other than the biological ones usually considered by scientists, to be able to determine the gender of an individual (Kessler, page 3). However, these physicians hold a belief that being a female or male are the only natural options (Kessler, page 4). It has been said that cases of intersexual infants are usually managed using the theory of gender, which was first proposed by John Money, J.G Hampson, and J.L Hampson in 1955 and later developed in 1972 by John Money and Anke A Ehrhardt. This theory states that gender identity can be changed by the age of eighteen months. The conditions of this theory to be ‘proven’ are that the parents must be sure of whether their child is a male or female, the genitals must match the assigned gender as soon as possible, the individual must be given gender-appropriate hormones at puberty, and the person must be informed about their medical condition with explanations appropriate for their age. If the theory is ‘proven’ than it is also stated that the intersexed individual will develop a gender identity parallel to their gender assignment and will not question their assignment. Nonetheless, this theory has been supported by only a handful amount of actual cases, and more cause its prominence and resonation with modern ideas (Kessler, page 6-7). Physicians also say that an intersexed infant’s diagnosis, gender assignment, and genital reconstruction should not be put off any longer than two years since the parent’s confusion on the child’s gender or sex can increase any negative response towards the baby (Kessler, page 9). It is quite contradictory that the primary factor behind how intersexuality is to be treated is determined by a theory that, as stated in the essay, has taken a character of gospel, and it’s effective has been questioned by specialists who use it themselves (Kessler, page 8).

Suzanne Kessler’s essay, “The Medical Construction of Gender” studies the nature and factors that influence intersexuality since birth. Intersexuality refers to a condition where a person is born with a reproductive or sexual anatomy which does not resemble that of a typical male or female. In the late 20^th century, scientists used medical technology that allowed them to determine chromosomal and hormonal gender; this method was the biological aspect of it. However, physicians who handle cases of intersex, also consider the cultural factors when determining, assigning, and announcing the gender of a particular infant. These issues are only “peripheral” compared to the medical issues of intersexuality. According to the article, physicians who deal with intersex cases ultimately rely on the cultural understanding of sex.

Three major factors that affect how intersex conditions are seen and dealt with are the advancement of science technology (genital construction), questioning of the valuation of women according to reproductive functions, and gender identity or the gender that one mostly associates their self to be whether it’s male or female.  Based on the gender theory proposed by John Money and Anke Ehrhardt, gender identity is changeable until 18 months of age. The theory requires several conditions to be met in order to develop a successful gender identity that synchronizes with the gender assignment. This theory requires intimate supervision and administering of intersex infants in order to clearly decide their true genders without having to reconsider any early decisions made about the child’s sex. However, some factors and issues that arise from this can be as the parents not knowing their child’s gender even after birth, dealing with the social and cultural boundaries that are set on gender. It is a very hard process for the physicians as well as parents. And the fact that people expect the infant to be either a male or female also makes it hard to handle the condition scientifically. Since birth, the very first inference people make about the infant usually concerns their gender so society is built upon the belief that anything (any gender) other than male or female is unacceptable. While many physicians, who were interviewed, believe that it is extremely important to keep social factors out when assigning a gender to the intersex infant, they also believe that once the infant is leaves the hospital, social factors become the main contributes in assigning the gender of the baby. And instead of medically working with the condition to fully understand it, social/cultural ideologies begin to characterize the infant without any real understanding of its condition.

According to Kessler’s essay, the factors that impact the medical condition of intersex are; the advancements in medicinal analysis and technology (physical factors) and the concept of gender identity (societal factors). These factors are rooted in the concept of being that there are only two possible genders, either male or female. The intersex gender is considered not “natural” in the eyes of society, so therefore when a child is determined to be intersex, the “real” sex of the baby has to discover/reconstructed to fit into one of the two “natural” genders.

The advancements in the medical field allow doctors to control the gender of the baby if he/she has an unclear gender/ambiguous genitalia. Various methods can be applied to determine the sex of the child on the chromosomal level, allowing for guidance in shaping the gender of the child. Further procedures are applied such as genital surgery and growth hormone treatments which are used to directly change the gender of the child. An example of this is if a child has a micropenis, in which a doctor would recommend to the parents to change the gender of the child to a female by having genital surgery, changing the micropenis into a uterus.

As for the concept of gender identity, there is a bias of how gender is defined. As previously mentioned, there are only two options that is “acceptable”, either being male or female. This way of thinking influences the perception of viewing intersex as a condition that needs to be corrected immediately, so that the child may live a “normal” life. When a case involving an intersex child occurs, doctors and parents might have a hard time dealing with it as it is out of the norm in society, which might lead to negative opinions about the situation. An example of this in Kessler’s work is a situation in which parents have an intersex child, they would tell others that they had twins when the gender of the child was not determined, and when it was assigned, the parents would say that one of the twins died. Rather than saying they had an intersex child, the parents lied which shows the stigma associated with intersex children.

To conclude, Kessler’s work involved various situations and issues that involved the theory of gender identity and how it affects parents and doctors alike. As technology advances, so does the method of determining and assigning gender, which reinforces the concept of intersex being a condition that needs to be “fixed.”

In Kessler’s essay “The Medical Construction of Gender”, she brings up the complications in intersexed infants. When a baby is born with ambiguous genitals, Kessler explains that it is ultimately up to the doctors to assign a sex as soon as possible, in order for the infant to grow up with a relatively normal childhood. And through this decision making, Kessler reveals that there are cultural and environmental expectations that play an influential role. Although some biological factors like X or Y chromosomes, or reproductive systems take part in assigning a sex, it is the appearance of their genitals that is important. Kessler says that parents must be comfortable with is, or else they can dissociate with their infant and take on stress from friends and family. This would eventually leave consequences to the infant as the baby then grows up, unable to identify with his or her gender.

Which brings the topic of gender identity and gender roles. Kessler mentioned in the essay how both are considered when doctors must assign a sex. They factor in social norms because it is so influential in a child’s identity. For example, because society often ties masculinity to the size of their penis, a doctor would rather assign an infant to be female, if the infant’s penis is 3 units below the average size. This further suggested how aesthetics can overrule biological conditions of a male because they want to avoid the psychological implications the infant would have gone through growing up. Moreover, Kessler explains that the relationships kept between the parents and the doctors are critical throughout the process. She emphasized the importance of honesty and compassion throughout. Therefore, it would keep a strong relationship between them and their child. Honesty and awareness of intersexed infants is crucial, yet ignored. It is not as openly spoken about, then it should be. Society fails to understand that because of the pressures of our cultures, we are more than just our biology.

The medical experts that Suzanne Kessler interviewed mentioned that the only theory that has really been published on the topic of intersex is that of John Money, J. G. Hampson, and J. L. Hampson in 1955. The issue here is that with this resource being the only reputable source, it is hard for current doctors to dispute any claims it has made and to apply it to modern situations. There are many factors that impact the way physicians, parents, and patients of intersexuality manage the condition. From reading Kessler’s article, it seems that many of the specialists interviewed agree that biological factors, social factors, and autonomy all play a role in the successful development of the patient, but it is timing that is the most crucial aspect. Biological factors, such as the chromosomes, are determined foremost. This is to determine if the defect is affected by the genes or if the defect is purely a malfunction in the exterior development of the infant. Next, the doctors must run a series of tests on the baby which may take weeks to months. Any judgement made too early or too late can have serious consequences on the child’s psychological and physical well-being. Many doctors, especially Money, argue that regardless of the chromosomal makeup, it is also the appearance of the external sex organs that will truly influence the child in the future. To prevent any early mishaps, doctors recommend their colleagues to be careful in their choice of words and to normalize the situation as much as possible. With parents being the most present and influential, doctors recommend them to pro-long any situations that can demonstrate a specific gender for the infant until a solution becomes concrete. This includes gender revealing announcements to friends and family or choosing a gender specific name for the child. What seems to become very significant in the future for the patient is the ability to become a fully-functioning partner in intimate relationships as they mature. It is argued that there is no point in choosing, for example, the baby to be constructed as a female when she won’t be able to satisfy a male if she could have functioned better as a male with a penis. With a child of intersex, all factors and decisions must be taken into account; for any casualty can be life-changing.

In this reading, Kessler provides many factor that impact the way physicians and parents understand of intersex children. The physicians believe in the theory that gender must be determine by eighteen months gender ambiguous infant. According to the theory, the correction of gender should be take as soon as possible. If the infant is assigned to be a boy, the repair of penis will undertaken in the first year, and the surgery will be completed before the child enter school. In another hand, if the infant is girl, the repair of vulva will begun in three months, and the surgery will be done in early childhood.

The case of an intersex child will give more pressure force to the doctor rather than the parents. In this situation, the doctor will say things that are inappropriate, such as telling the parents to raise the boy infant as a girl. But the parents will more rather to just remember it’s a boy, and forget the main part of the conversations. And the reason of doctor telling the parents in the inappropriate way is that parents will get ahead and give a name and tell everyone, if the result of the identification of child gender was opposite, it will turns out the way the child has to be raised in the opposite sex.

Since in this society people are just consider for being in two kind of genders – either female or male. The culture determines how people live in the society for being a men or women. Other than this two gender, intersex child must be stand in the lower class in this condition. that’s why it’s so important to identify the clear gender of the intersex children before the child reach the puberty and work on the society.

Physicians are the ones that determine the gender (male or female) of the child when they are born. They rely on John Money and Anke Ehrhardt, where they published a theory (knowing the gender, make sure the genital matches the gender, etc…) and it was supported widely because the cases that kept showing up was related/claimed by what the theory mentioned. Physicians also used some form of the theory and applies it when deciding on the gender along with whether the genitals will fit the child’s gender (masculine penis – a certain size, and feminine vagina – if there is a opening). However sometimes there is an inexperienced physician that comes across a child with an ambiguous genital and they can make a mistake on determining what the child’s gender is. When that inexperienced physician determines the child’s gender and it is incorrect, they usually play around with their words and tell the parents/patients something else. When the parents/patients go to other physicians, who will support that inexperience physician decision, they are told how the other physician’s decision might have came to that conclusion, but other factors (hormones) will determine the gender of the child. Physicians have it kind of tough, but with the development of technology and science determining the gender of the child maybe less of an issue these days with help of virtual reality, 3d scanning, x-ray, etc… You can see the child inside the stomach before it is even born. Physicians should also try to use easier phrasing so that parents/patients understand the situation. Instead of using medical term, which can give lots of people headache, they should explain the process of how the decision was made and what the hormones/chromosomes did to make changes within the body of the baby. That way parents/patients will understand better.

Parents and patients on the other hand rely more on the physicians. For parents, the physicians tell them what gender of the child will be that way they can prepare male/female stuff (toys) and give their child a name (a male name for a boy and a female name for a girl, sometimes some parents will choose a gender neutral name that way it can accommodate both male and female). Parents also have to make a decision on whether or not their child should get surgery because sometimes the genital of the child will be to ambiguous and it is their responsibility to make a hard decision that can affect the child’s life. I think before the parents make their decision they should see more than one physician that way they have more than one opinion. For patients usually a surgery is involved to fix the ambiguous genital and other things as well. They would have to go through some diagnosis (hormonal test) to see if they are producing that specific one (testosterone for males and estrogen for females, although males and females tend to have a little of each hormone from the opposite sex to make up for the physical appearances) for their gender (this way the physicians can determine what gender they are). However that may not always be the case and sometimes a patient is lied to about the gender that they were given. They are asked by the physician to take this drug (medicine) in order to produce the hormones of that gender. The physicians also make it sound like they are normal, but in reality the surgery was done to either remove and replace the reproductive system to match the gender intended for the patient or to just adjust something (maybe size of genital, etc…). This can affect the patients mentally as they grow up being confused with their life (since it is usually a baby that gets their gender being identify). So I think physicians should make a careful decision.

Overall, the people that Kessler interviewed to come up with many different situation and issue shows us how parents and patients rely on physician who rely on Money’s theory. With how advance the society is today the error of determining the gender will decrease more, but in terms of how it is determined and why it is still being determined will probably be a mystery. It will continue for generations until someone decides to make changes and get everyone else angry at that change because after all this is how you make changes in society.

sources:

The Medical Construction of Gender: Case Management of Intersexed Infants Author(s): Suzanne J. Kessler