The condition of hermaphroditism has been recognized since antiquity. The term derives from the Greek legend of the joining of Hermaphroditos and the nymph Salmacis into a single form that was neither male nor female, but both. Culturally, men and women are distinct, yet their sexual structures arise from common bipotential precursors. This fact explains how intersexuality can result from aberrations in the sexual-differentiation pathway.
In Hermaphrodites and the Medical Invention of Sex, Alice Domurat Dreger chronicles the medical diagnosis and treatment of hermaphroditism from the perspective of both the subject and the medical community during the late 19th and early 20th centuries. She traces the advancement of medical technology and its effects on the classification of persons with intersexual disorders. The book covers the period during which sexual identity was being questioned in both scientific and medical theory and the ideas of sex, sexuality, and gender had not yet become distinct from one another.
During this time, one's "true sex" was felt to be based solely on the presence of a testis or an ovary. The number of people recognized with hermaphroditism was increasing, in part because of improved access to gynecologic care and more reporting of medical findings in the literature. This increase led to the need for criteria to define maleness and femaleness in order to keep the two sexes distinct. Also during this time, physicians emerged as the authorities in determining sex and anatomical identity. To show the effect of cultural differences in the management of intersexual disorders, Dreger has chosen to study hermaphrodites in Britain and France.
Dreger uses case histories of people with intersexual conditions and describes the responses of their physicians to illustrate why definitions of true sex were thought to be necessary. She explores the social, economic, and political ramifications of having a "mistaken" sex. In her book, the term "hermaphrodite" is used loosely to describe someone with ambiguous genitalia or someone whose external genitalia do not correspond with the internal gonads; she does not necessarily use it to imply true hermaphroditism (the presence of both testicular and ovarian tissue).
An epilogue has been added to the book to cover the treatment of intersexual conditions today and to show how history influences present-day management. Unfortunately, Dreger's description of present-day management is not up to date. Over the past few years, the voice of people with intersexual conditions has grown louder through autobiographies and the formation of support groups. Dreger has included in the epilogue the histories of people with intersexual conditions who were dissatisfied with their care.
Dreger believes that the current management of intersexual disorders remains very paternalistic. She states:||Doctors typically make decisions about sex assignment with little genuine discussion with the parents. Parents who will not consent to recommendations are subject to pressure, and even those parents who do agree to the surgeries performed do not realize that they are, by implication, consenting to the doctor's right to choose the sex of their child on the basis of a particular anatomically demanding psychosocial theory of gender identity.
She concludes with a plea for "an honest conversation" between physicians and parents. Currently, though, physicians do openly discuss with parents everything that is known about intersexual conditions. However, there is still much that is unknown about the cause of such conditions, and thus it sometimes becomes difficult to predict the future of an affected child. Decisions regarding sex assignment are made by parents with the consultation and support of their child's physicians and are individualized to each situation.
Overall, this engaging, well-written book will benefit scholars and lay readers interested in the history of sex, sexuality, gender, and medicine. The book traces the evolution of what makes a person male or female and shows how the answer has changed depending on when the question was asked and where it was asked. Dreger has succeeded in compelling the reader to ask the same question.
Reviewed by Patricia Y. Fechner, M.D.
Dreger has identified an important and suggestive topic, not only in the history of medicine, but for cultural history more generally. Hermaphrodites were, after all, only among the most striking members of the parade of anomalies that engaged the attention of both specialists and the general public at the turn of the century. Any liminal creature was apt to trigger anxieties about the defense of social as well as natural boundaries, and any breach of the barriers that divided the sexes was particularly unnerving. (Harriet Ritvo, Massachusetts Institute of Technology )
