Gendering Sex: The Sociology of Sex

Posted: Thu, Oct 24, 2024

Sex Assignment at Birth Is Not a Metaphor

The traditional model for the management of intersex newborns:

Sex is a clear-cut division between males and females.
Those born with “ambiguous” genitalia have a “true” sex waiting to be discovered by science/medicine.
It is medically urgent that the ambiguity be surgically “ﬁxed” early on.
While some physicians now support limited transparency, this is a very recent development.

Why the urgency?

Parents: Suzanne Kessler reports that “the physicians [that she interviewed] acknowledge that diagnosis, gender assignment, and genital reconstruction cannot be delayed for as long as two years, since a clear gender assignment and correctly formed genitals will determine the kind of interactions parents will have with the child. The geneticist argued that when parents ‘change a diaper and see genitalia that don’t mean much in terms of gender assignment, I think it prolongs the negative response to the baby. . . . If you have clitoral enlargement that is so extraordinary that the parents can’t distinguish between male and female, it is sometimes helpful to re-duce that somewhat so that the parent views the child as female.’ Another physician concurred: parents ‘need to go home and do their job as child rearers with it very clear whether it’s a boy or a girl.’”
Gender identity development: According to Anne Fausto-Sterling, many physicians “emphasiz[e] that nuanced scientiﬁc understanding of anatomical sex is incompatible with a patient’s need for clear-cut gender identity.”
- Luckily, on John Money’s extraordinarily influential theory, gender identity is highly malleable during early childhood. So, the theory goes, if surgical interventions are completed in time, intersex children will come to develop gender identities that align with the sex and genitalia they were surgically assigned.
- But Money’s theory has been debunked by David Reimer’s case.
Sexual orientation development: With successful surgical interventions, intersex children will develop “appropriate” partner and sexual preference (i.e., PIVI).
Trauma of castration: Kessler writes, “Money suggests that if reduction of phallic tissue were delayed beyond the neonatal period, the infant would have traumatic memories of having been castrated. . . . Although physicians speculate about the possible trauma of an early childhood ‘castration’ memory, there is no corresponding concern that vaginal reconstructive surgery delayed beyond the neonatal period is traumatic.”

Why not full transparency? Pp. 64–65.

Parents are usually told that their child has “underdeveloped” genitalia, as if all that needs to be done is to let the genitalia grow just a little bit more and the child will reveal themself as either female or male.
Information is also usually (partially or fully) withheld from intersex children themselves, even when they grow up. “An intersex child assigned to become a girl, for instance, should understand any surgery she has undergone not as an operation that changed her into a girl, but as a procedure that removed parts that didn’t belong to her as a girl.”

So how do you determine the “true” sex of an intersex newborn?

Patricia Donahoe’s recommendations are highly illustrative: “Genetic females should always be raised as females, preserving reproductive potential, regardless of how severely the patients are virilized. In the genetic male, however, the gender of assignment is based on the infant’s anatomy, predominantly the size of the phallus.”

If the child has the potential to bear children later in life, they should be assigned female and raised as a girl.
If no, we’re in the business of male sex assignment, and it comes down to penis sizes:
- The child should be assigned male only if they have a “normal”-sized penis (p. 57).
  - “Young boys should be able to pee standing up and thus to ‘feel normal’ during little-boy peeing contests; adult men, meanwhile, need a penis big enough for vaginal penetration during sexual intercourse.”
- But if their genital is not large enough for a penis but too large for a clitoris, clitoral reduction (or even removal) should be performed.

Some more recent developments:

In July 2020, Lurie’s Children Hospital in Chicago became the first U.S. hospital to apologize for performing intersex surgeries.
A few months later, Boston Children’s Hospital also announced that it “will not perform clitoroplasty or vaginoplasty in patients who are too young to participate in a meaningful discussion of the implications of these surgeries, unless anatomical differences threaten the physical health of the child.”
In July 2021, New York City Health & Hospitals announced that they would defer all unnecessary intersex surgeries until the child is old enough to meaningfully participate in a decision.

Sexing the Sex Chromosomes

The standard picture: the X and the Y are a heterosexual couple (p. 911), if not rivals in a battle of the sexes (p. 912).

Problems:

The X carries important genes involved in spermatogenesis, but plays no special role in “female” sexual development (these genes are located elsewhere).
Most men also carry an X, and because most men carry only one copy of X, they are much more susceptible to X-linked recessive diseases.
The X is not female-determining; the Y is responsible primarily for initiating male sexual development.

How we came to gender the X female & the Y male:

Privileging the sperm: sperms with the X produce females and those with the Y produce males.
- But sperms are not sex-determining; only the Y is.
The “greater male variation theory”: “While females enjoy the security of a second X, it dulls their potential for extraordinariness. Males are superior where it counts: intelligence.”
X mosaicism:
- The Barr body: in cells with two X’s, one becomes inactive early on in embryonic development.
- In those with XX chromosomes, about half of their cells express the material X and the other half the paternal X.
- This genetic mosaicism reinforces social “conceptions of women as more mysterious, contradictory, complicated, emotional, or changeable.”