Intersex in the Age of Ethics (Ethics in Clinical Medicine Series) (Paperback)

~ Alice Domurat Dreger (Author, Editor)

Editorial Reviews

From The New England Journal of Medicine

What is the relation among anatomy, sexual identity, and sexual practices? The authors of Intersex in the Age of Ethics argue that an ethical clinical response to intersexuality (i.e., the intermingling, in varying degrees, of male and female sex characteristics) will be possible only when this question can be answered on the basis of well-documented, long-term case studies of the lives of intersexual persons. To date, this information has not been collected and clinical practice is based on ill-founded assumptions.

This book reflects the search for an interim solution. It combines reviews of changing medical responses to intersexual persons with first-person accounts by intersexual people and their families. The 21 chapters develop a convincing case for the position that the relations among anatomy, sexual identity, and sexual practices are not rigidly fixed, but can vary in highly personal, unpredictable ways. The authors argue that, until better information becomes available, the least damaging course of action is to delay medical intervention until a person is in a position to make an informed decision about the options.

Social and medical attitudes toward people who do not conform to conventional categories of sex are influenced by our understanding of how anatomy influences social behavior. Until recently, the assumption in Western societies has been that anatomy determines sexual identity and, therefore, sexual preferences. In this view, there is a direct relation between a particular kind of body and both a particular sexual identity and a particular set of sexual practices. Sexual identity and practice follow from the body in a predictable and consistent manner. Given this assumption, it is hardly surprising that so much medical attention has been given to categorizing, defining, and reshaping intersexual bodies. The understanding is that once these unruly bodies have been made to conform, appropriate identities and practices will follow seamlessly.

In Victorian times, this shaping of the intersexual body was achieved by a kind of "conceptual surgery." The gonads were designated as the defining anatomical characteristic, and all other considerations were deemed irrelevant. If ovaries were present, the person was defined as female and would be expected to have only male sexual partners; if testes were present, the person was defined as male and would be expected to have only female sexual partners. By defining a sex for each ambiguous body, appropriate behavior was established for each person with such a body. The way in which such people experienced their bodies, identities, or sexual desires was not considered. Bodies mattered only to the extent that they were vehicles for ensuring that a person behaved in socially appropriate ways. As the range of clinical techniques expanded through the 20th century, the conceptual reduction of intersexual bodies was replaced by surgical reduction. The bodies of intersexual infants were carved to fit the social categories these children would be required to inhabit as adults. The birth of an intersexual baby became a "medical emergency," and the infant's ambiguous body was surgically "cured" to save the adult from social pathology.

As the first two parts of this book establish beyond doubt, the underlying assumption, that anatomy determines sexual identity and therefore practice, is not borne out in the life experiences of intersexual persons. Although we do not yet understand exactly how a person acquires a sexual identity or comes to desire specific types of sexual contact, it is clear that behavior cannot be predicted on the basis of an infant's gonadal, genital, or genetic makeup. As a result, surgical treatment of intersexual infants does not facilitate the unproblematic acquisition of a stable sexual identity, even though it is undertaken almost solely for this purpose. On the contrary, early surgery sometimes creates new problems: loss of sexual feeling, loss of fertility, lifelong urinary pain and dysfunction, and the social difficulties that follow from these conditions. The authors point out that being intersexual is a lifelong experience, irrespective of whether a person undergoes "corrective" surgery. Medical interventions, whether surgical or hormonal, do not "cure" a person of an intersexual condition. Rather, such interventions create further uncertainty with respect to the already ambiguous intersexual body, often compounding rather than reducing distress and confusion.

Although this book is full of diverse voices and styles of writing, it is a tightly focused collection with a consistent point of view. Each of the 21 chapters contributes to the development of the overall argument, and each chapter also has its own story to tell. These stories are variously academic and personal, powerful and unassuming, moving and disturbing, sad and joyful. However, all contributions are informative and compelling. No reader will put down this book unchanged.

Yvonne Marshall, Ph.D.
Copyright © 2000 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Review

Here is the volume that clinicians, teachers, counselors, parents, feminists, and philosophers have needed to understand intersexuality. Cheryl Chase, Founder, Intersex Society of North America (ISNA) --Letter from Ms Chase

See all Editorial Reviews

Product Details

• Paperback: 240 pages
• Publisher: University Publishing Group.; 1st edition (June 20, 1999)
• Language: English
• ISBN-10: 1555721001
• ISBN-13: 978-1555721008
• Product Dimensions: 8.9 x 5.9 x 0.6 inches
• Shipping Weight: 12.8 ounces (View shipping rates and policies)
• Average Customer Review: 5.0 out of 5 stars  See all reviews (4 customer reviews)
• Amazon.com Sales Rank: #503,897 in Books (See Bestsellers in Books)

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Customer Reviews

Most Helpful Customer Reviews

20 of 21 people found the following review helpful:

5.0 out of 5 stars The Benchmark And Landmark Book, December 28, 1999

By	Ms. Caron Rachelle Burke (Hartford County, Connecticut) - See all my reviews

This review is from: Intersex in the Age of Ethics (Ethics in Clinical Medicine Series) (Hardcover)

Alice Domurat Dreger has written what may well come to be regarded as the definitive work on intersexuality. By employing a collective and inclusive approach, Ms. Dreger is able to provide both personal and medical perspectives on intersexuality provided by individuals, their families and compassionate medical providers. She provides a brief forward to each chapter on the author and topic content which is illuminating and helps to assist the reader to focus on the material. This is a well-written book which, for the first time in a single printed volume, provides material solely dealing with intersexed individuals. This landmark book provides compelling reasons, based on the telling of personal odyssies, why only those people affected should be the decision makers in their care. I hope that every intersexed person, every family member or parent of an intersexed individual reads this book. And I pray that every medical professional who treats intersexed individuals, beginning with obstetricians, pediatricians and pediatric urologists, takes to heart the suggestions for adapting care to a patient-directed philosophy of medical care.

8 of 8 people found the following review helpful:

5.0 out of 5 stars A book with lessons for everyone, May 7, 2000

By A Customer

This is not only a book for practitioners of medicine or individuals dealing with their own intersexuality. This is a book that has lessons to offer to everyone, lessons on ethics and how other human beings should be treated, lessons on sexuality that would improve the human race if only we would learn, lessons on parenting and the heavy burden of making decisions about another human's life. The lessons on what sex and sexuality really involve should offer insights to all of the five (or more) sexes that inhabit this planet. I found the wealth of new information useful and interesting, but I also found that the tales of individuals and their histories greatly enhanced my understanding of the real impact of the facts presented. The consistent history of parents and doctors making decisions on behalf of young children should make us all pause the next time we set out to make a decision for or about another human being- a patient, a child, an aging parent, whoever- and ask oursevles whether we really understand the consequences of what we are doing, whether we are really the one who should be making the decision, and whether there is any way to allow the decision to be made by the individual who will in the end bear the consequences of what we decide. This book made me laugh, it made me cry more than once, and I was suprised at how much I learned about myself. By the end I felt like I wanted to meet and talk to most of the contributors to the book.

6 of 6 people found the following review helpful:

5.0 out of 5 stars A book with lessons for everyone, May 7, 2000

By A Customer

This is not only a book for practitioners of medicine or individuals dealing with their own intersexuality. This is a book that has lessons to offer to everyone, lessons on ethics and how other human beings should be treated, lessons on sexuality that would improve the human race if only we would learn, lessons on parenting and the heavy burden of making decisions about another human's life. The lessons on what sex and sexuality really involve should offer insights to all of the five (or more) sexes that inhabit this planet. I found the wealth of new information useful and interesting, but I also found that the tales of individuals and their histories greatly enhanced my understanding of the real impact of the facts presented. The consistent history of parents and doctors making decisions on behalf of young children should make us all pause the next time we set out to make a decision for or about another human being- a patient, a child, an aging parent, whoever- and ask oursevles whether we really understand the consequences of what we are doing, whether we are really the one who should be making the decision, and whether there is any way to allow the decision to be made by the individual who will in the end bear the consequences of what we decide. This book made me laugh, it made me cry more than once, and I was suprised at how much I learned about myself. By the end I felt like I wanted to meet and talk to most of the contributors to the book.