5 Assignment 03

In “The Medical Construction of Gender,” by Suzanne Kessler, it is shown how doctors and families deal with intersexuality in the case of new born babies showing these physical characteristics. When infants are born with ambiguous genitals, they cannot be defined as male or females by their doctors.  Therefore, infants are subjected to chromosome, hormonal and other tests to verify their biological identity. This situation creates a stressful moment for doctors and parents because having a neutral sex baby is seen as problematic. However, the point that Suzanne illustrates is that doctors are not neutral in determining the infant’s sex. Doctors base their opinions not only in scientific facts but also in how the genitals of these infants look. These decisions taken by doctors, parents and society come from a common ground. People have fixed ideas about sex and gender roles. And people have fixed expectations about how a male or female should be like.

When a baby shows XX chromosomes, that baby is defined as a girl. On the other hand, when a baby shows YX  chromosomes that means the baby  is a male in terms of biology. Yet Suzanne states that sometimes the infant sexes are not defined by the chromosomes because doctors have their own opinions about intersexuality. There is a lot of pressure in the sphere of the professional setting where doctors discuss and analyze what is the better decision to make. If the baby would fit in society as a boy or girl, and if the life of the baby would be successful in terms of “reconstruction of genitals,” the subsequent surgeries that will be involved, hormonal treatments as adults, sexual life, procreation, and in terms of socialization, what gender would correlate to the physical characteristics of the baby. The most salient feature for making decisions is the size of the male’s penis.

Moreover, parents feel puzzled by the situation because intersexuality is not discussed publicly even though the five percent of the population has been identified as intersexual. Doctors ask parents to hide the situation from family members and friends until the “issue” is resolved. Parents avoid talking about it. It is taboo, and people deal with this situation in terms of fear of judgement. All these factors increase the level of  urgency to solve the situation although babies are born healthy.

Suzanne shows that sex is questionable in terms of biology sciences, as gender is questionable in terms of definitions of society.  Any infant born with ambiguous genitals could live his or her life as any other person identifying as male, female or both.  What is more important is to see how the child would be socialized.

In order to understand how physicians, parents, and patients manage the medical condition called intersexuality, Kessler conducted several interviews with medical experts who deal directly with pediatric intersexuality. All of these physicians agreed that the way in which they manage cases of intersexed children generally comes from theories on gender from John Money and Anke Ehrhardt which state that “gender and children are malleable; psychology and medicine are the tools used to transform them” (8). Doctors believe that the decision on whether a newborn’s gender is male or female must be made as soon as possible. They base their decisions off of chromosomal makeup (or biology), whether or not the genitals will be able to grow to perform adequately and whether or not hormones can help match their gender identities. However, Kessler notes that these physicians fail to imagine a culture that could possibly have more than two genders, and that their decisions are influenced by both medicine and societal factors.

Parents have a certain amount of expectations on sex and gender when their baby is born which translates to pressure on physicians. However, with intersexed cases, physicians have to be very careful as to what they say to parents. Educating the parents on the intricacies of intersexuality and making sure they understand the reasons why their child was born with incomplete genitalia is crucial. Doctors stress that they are not choosing the child’s gender, but are merely completing their sexuality by “reconstructing” their sex organs and genitalia. Interestingly, doctors also inform the parents that “social factors are more important in gender development than biological ones” (16). In other words, as soon as parents are told what sex their child is, it is up to them to raise their intersexed child as male or female according to societal norms.

While Kessler does not speak much about the patient’s point of view (presumably because she focuses on infants), she does give examples of how an intersexed patient may feel based on discourse with the experts. They seem to think that having “normal-looking” genitals is important when dealing with gender identity. It made me think of the phrase “if it looks like a duck, swims like a duck and quacks like a duck, then it is a duck”. Doctors would argue that if a once-intersexed male teenager has a “normal” sized, functioning penis after puberty, it is likely he will “feel” like his gender, even if he has had to take testosterone his whole life in order to make this possible.

Suzanne Kessler’s, “The Medical Construction of Gender” focuses on the harmful ways western society’s social construct of gender has influenced medical knowledge and decisions in regards to intersexuality. When a child is born intersex, they have genitalia that does not possess female or male qualities and are therefore gender ambiguous. It is then up to the family and medical professional(s) to make gender decisions on the child’s behalf. As imaginable, making gender decisions regarding someone who cannot yet think for themselves has its many flaws. Gender biases and societal pressures often get in the way of ethics and the ultimate welfare of the intersex individual.

A definitive gender is required on every child’s birth certificate. Yes, every child. This rule does not exclude those whose genitalia is ambiguous to gender during infantry. This requirement is one of the many aspects of pressures imposed on the medical community in regards to early assignment of gender. Pros of early gender assignment argue that parents need to know the gender of their child in order to begin to properly raise it as male or female as early on as possible. However, this is only true if one deems gender identity necessary in raising a child. By that logic, gender identity is necessary in developing any kind of significant relationship with any gender ambiguous person.

Intersexuality in infants is also subject to gender bias. Due to our patriarchal society’s preference of men, many families and doctors alike find themselves bias toward deeming intersex infants male. This can ultimately be extremely detrimental to the individual because the decision made for them during infantry regarding their gender has a 50/50 chance at being wrong. In fact those decisions are very often wrong, and the individual must face a society that will ostracize them for a gender issue imposed upon them before they could even possess conscious thought.

In Suzanne Kessler’s “The Medical Construction of Gender,” she introduces interviews from medical experts, to deal with conditions of intersexuality. By her claim, it is represented “biological sex” and “culturally constructed gender” as having a close relationship. Infant intersexuality and ambiguous genitals had been studied for quite a time. The study was not only restricted on the physical part, but put an emphasis on the connection between psychological, cultural issues.

In a commonly accepted way, people are assigned of their gender at the time of delivery. Then, it forms and builds their identity throughout lives. Therefore when a child has an ambiguous genital, the initial assignment process should be done in an extremely careful sense to avoid possible trauma and various side effects. Nowadays, the intersex conditions are treated as fixable. Physicians try to tell the parents and patients by normalizing the intersex condition. It helps them to think in a positive way, and not to be discouraged. From this point, cultural factors play an important role. It is vital because in socializing stage, gender assignment significantly affects on how those children are raised and how people treat them. Physicians say social factors outweigh biological factors. Parents and community construct child’s identity, in which gender plays a big part. This stage is crucial not just for children with genital ambiguities, but to any children.

The whole process of gender assignment and construction has ambiguity and limit in some point. It is true that sometimes, doctors eventually get to treat the gender how they want to construct. However, to avoid confusion in both parents and patients, the process should not include any psychological discomfort, anxiety and humiliation. In the article, Kessler says the biological sex is transformed into a culturally constructed gender. Partly agreeing to her opinion, I think rather than being transformed, it gets blended into cultural and social world with the acceptance of reconstructed gender.

In the essay “The Medical Construction of Gender”, Suzanne Kessler showed that physicians in eighteenth and nineteenth centuries decided the gender of the infants by biological factors, and parents and their children with intersex just followed the data that was given from laboratory. However, as the time passed, people started to realize that cultural factors are more important than biological ones to decide the sex of the patients. There are the factors that changed considerations of physicians, parents and patients towards intersexuality.

In eighteenth century, people thought gender is decided by the complex tests such as genetics, and physicians were choosing the gender of male or female by the size of the penis. For example, if penis was too small compare to ‘normal size of penis, physicians told parents that it as clitoris and asked them to take surgery to remove it. However, when the endocrinologist asked there’s no point of taking all tests if parents are going to choose gender by genitalia, parents were hard to choose their child’s gender.

This problem appeared because parents weren’t knowledgeable enough to understand intersexuality. For instances, people in France started to choose the neuter names like Jean, because they were unsure of their child’s sex. Therefore, physicians were also started teach the parents about intersexuality, and normalized the intersexuality to them. For example, physicians teach parents normal fatal development characteristics of male and absence of maleness shows that baby has femaleness. In addition, they also make parents believe their baby is normal by telling them its small defects like mole or hemangioma. Most importantly, physicians started to mention that social factors are more important than the biological factors for development of gender. Although they used all biological tests to figure out the gender, they said it’s really depend on how people treated their child as male or female.

In conclusion, physicians, parents and patient add lots of effort to decide the gender from either male or female, but just as Suzanne Kessler mentioned, most important thing is not putting gender just into either female or male but consider intersexuality as a gender.

Suzanne Kessler’s essay, “The Medical Construction of Gender” is an investigation into intersex infants, and the various methods that their doctors use to “create” a gender for the infant or decide upon the gender. Issues arise when the cultural idea of gender is reinforced by the actions of doctors who intend to “correct” inter-sexuality in their patients. To doctors, there may be more than one gender, but there are only two distinct biological sexes, something that often influences the medical procedures that infants who are born as intersex undergo.

Doctors use the theory of gender developed in 1972 that states that gender is changeable in an infant but only for up to 18 months. This theory is successful only when certain conditions are met beforehand a sex change operation, such as the genitals being made to match the chosen gender as quickly as possible, and being able to administer gender hormones when the child is in puberty. According to this theory, a child will identify with the gender chosen for them through these procedures and will accept their gender identity.

The doctors interviewed in Kessler’s essay state the importance of the professionals involved choosing a gender, and assigning it immediately without any doubt. The urgency of acting quickly is emphasized by the Money theory. The amount of chromosomes and intersex infant is born with can be used to diagnose the issue and identify the true gender of the child, and often help in choosing which procedure is best.

The fact that doctors ultimately want an intersex child to be one gender, and to identify as that gender illustrates the way inter-sexuality is viewed in society. Parents and doctors view intersexuality as a medical condition that must be fixed with urgency, which reinforces the notion that there are only two genders. While it is in the best interest in terms of simplicity to give a gender to an intersex infant, its cultural impact is larger than expected.

Even before a child is born, parents want to know if the child is a boy or girl. However, when intersexuality is introduced to parents they find it hard to identify with their baby since the question of is it a boy or girl becomes the most important question to them and the doctors. Parents want their children to fit in and be able to tell people they know that they had either or girl or boy, which forces the baby to be identified as either one, so the baby can fit into the culture that puts people into two genders, male or female. Any other “gender” is generally seen as unaccepted. Since these genders are so set in stone, doctors are pressured to quickly identify the baby’s gender, mostly by looking at if the baby has male or female looking genitals. Usually if the doctors see the baby has a something resembling a developed clitoris they say it is male, or if there are genitals that look similar to female ones then the baby is identified as female. Surgery can be used to make them look either more male or more female and causes no trauma to the baby if done at the right time.
The gender these babies are given determine how their parents will raise them, and, most likely, what their gender will be their whole lives. This is important so they can fit into society and be seen as a male or female instead of telling someone they are intersexual, which will make them seem weird to the majority of society. The surgeries done by doctors are also important so the baby itself won’t get confused later in life about what gender they are and how to handle that. The gender is identified right away, most importantly, so the baby will live a happy life without questioning what gender they are if they do not wish to.

Kessler provides many factors that impact the way the medical community explains biological gender to parents of intersex children. The physicians base their assessments of gender ambiguous children on theories that gender must be determined by eighteen months, without this announcement the child’s community won’t know how to treat the baby. Based on the social constructs of gender that the parents are assumed to uphold, the physicians are under extreme pressure to clearly determine a gender and saving the family from potential embarrassment of a boy playing with a doll or a girl playing with a truck. This theory of malleability is rooted in the plasticity of children and gender, not a fluidity of gender as if putting a dog in a cat suit would change its bark to a meow.

The major psychological issues of castration far out-weigh vaginal reconstructive surgery so it is not uncommon to construct an aesthetically appropriate penis and hope for the best, especially if the parents have a preference to raise a boy over a girl. If the child can pass as male with believable genitalia then it is best for the child to be raised that way, otherwise you risk raising a tomboy and further obscuring gender norms. The physicians and parents aren’t the only factors, birth certificates need to be filled out for the state with a definitive gender, an assignment often must be made before any hormonal testing can determine a biological gender. The most disturbing idea of this reality is that a team of people, if the determination of the natural gender takes too long, are deciding what opportunities will be provided for this baby before it can recognize faces, tastes or smells and under the preference of social factors over biological. If the child struggles with the management decision in adolescence then, miraculously, the child is treated as if it was not an abnormality, which it isn’t, and that gender is not as clearly defined in biology as it is demanded to be in society. Ultimately, if a gender preference did not exist in Western society then fluidity of gender would be more acceptable and physicians could focus on the health of the baby and not concern themselves with what toys it will be bought for birthday parties.

Kessler’s “The Medical Construction of Gender” explores the way physicians handle cases of intersexuality with infants. Intersexuality is when an infant doesn’t have an identifiable gender (i.e. the genitals of the newborn don’t fit the defined characteristics of a boy or girl). Kessler interviewed six medical experts – a clinical geneticist, three endocrinologists, one psychoendrocrinologist and one urologist. Research indicates that hermaphrodites are rare – it is more common that the infant has ovaries or testes but the genitals are ambiguous. Attitudes towards intersex are influenced by advancement in surgery, modern feminism, and new attention focused on the psychology of a “gendered identity”. Because gendered identity is so important, it is thought that assigning a gender to an infant with ambiguous genitals must be done as fast as possible so the child can properly grow into a male or female gender.

In 1955, John Money, J.G. Hampson and J.L Hampson (later developed in 1972 by Money and Anke A. Ernhardt) argued that gender identity is changeable in the first few years of development (from 18 months to a few years old) – this way the proper genitals, information and hormones can be administered to the child and it wouldn’t retain the potential trauma of undergoing surgery.

Some physicians argue that it is necessary to assign a gender early because parents need to know how to deal with their child (assuming it is difficult to parent a child without an assigned gender). If gender is not properly announced, it can be difficult for the parents to understand how to proceed (i.e. how to name and begin to raise their child as a boy or a girl). If physicians aren’t careful about how they speak to the parents and the patients, they can misconstrue the perception of gender. This can result in physicians lying to patients due to their bias about what they think would be good or bad for the parents or patient. Kessler concludes that it is important to understand the concept of what is natural – sometimes surgery is performed in an attempt to return the body to what it is supposed to be (i.e. a gendered male or female). It is argued that these physicians perpetuate male or female gendered identities, creating anxiety for the patient and parents involved rather than a proper understanding of the child’s condition.

In her essay “The Medical Construction of Gender”, Suzanne Kessler explains that an intersexed infant is a baby who is born with undefined genitals. In the late 20^th century scientists could determine the infant’s gender through out a chromosomal and hormonal test, which is normally taken to be the real, natural, biological sex of the infant. Kessler interviewed six different specialists and all of them agreed that the management of the intersexuality cases is based on the theory proposed by John Money. According to this theory, it is crucial that the gender of an infant is assigned immediately, color is use to determines a infant’s sex (pink for female, blue for male), genitals must be made to match the assigned gender, and if an infant needs a correction it should be done as soon as possible, otherwise, the infant could have traumatic memories.

The gender assignment is very important for specialists, parents and infants, because this will determine the kind of interaction that the community, including parents, will have with the child as it grows into adulthood. Another factor that is even more important than the chromosomes is the penis sizes. Scientists consider that a good size of penis is enough to determine that an infant could be defined as male. According to society’s standards, masculinity includes an average penis size in the male case if the child penis is smaller than the norm, or for some reason it cant function as a regular penis, then that child’s genitals re-constructed to look and function like a vagina, a vagina is suppose to have enough space for a regular size penis which ultimately will define the sex in the female case. Social factors are very important because after the physician assign the infant’s gender, parents are encouraged to create the credibility of that gender in their community. The option of a third gender is unacceptable to society, and therefore all children born neither male nor female are considered abnormal and deformed. Kessler points out that hermaphrodites are a third gender category.