SYG8 - THE FIVE SEXES, REVISITED The emerging recognition...

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The emerging recognition that people come in bewildering sexual varieties is testing medical values and social norms By Anne Fausto-Sterling As Cheryl Chase stepped to the front of the packed meeting room in the Sheraton Boston Hotel, nervous coughs made the tension audible. Chase, an activist for intersexual rights, had been invited to address the May 2000 meeting of the Lawson Wilkins Pediatric Endocrine Society (LWPES), the largest organization in the United States for specialists in children's hormones. Her talk would be the grand finale to a four-hour symposium on the treatment of genital ambiguity in newborns, infants born with a mixture of both male and female anatomy, or genitals that appear to differ from their chromosomal sex. The topic was hardly a novel one to the assembled physicians. Yet Chase's appearance before the group was remarkable. Three and a half years earlier, the American Academy of Pediatrics had refused her request for a chance to present the patients' viewpoint on the treatment of genital ambiguity, dismissing Chase and her supporters as "zealots." About two dozen intersex people had responded by throwing up a picket line. The Intersex Society of North America (ISNA) even issued a press release: "Hermaphrodites Target Kiddie Docs." It had done my 1960s street-activist heart good. In the short run, I said to Chase at the time, the picketing would make people angry. But eventually, I assured her, the doors then closed would open. Now, as Chase began to address the physicians at their own convention, that prediction was coming true. Her talk, titled "Sexual Ambiguity: The Patient-Centered Approach," was a measured critique of the near-universal practice of performing immediate, "corrective" surgery on thousands of infants born each year with ambiguous genitalia. Chase herself lives with the consequences of such surgery. Yet her audience, the very endocrinologists and surgeons Chase was accusing of reacting with "surgery and shame," received her with respect. Even more remarkably, many of the speakers who preceded her at the session had already spoken of the need to scrap current practices in favor of treatments more centered on psychological counseling. What led to such a dramatic reversal of fortune? Certainly, Chase's talk at the LWPES symposium was a vindication of her persistence in seeking attention for her cause. But her invitation to speak was also a watershed in the evolving discussion about how to treat children with ambiguous genitalia. And that discussion, in turn, is the tip of a biocultural iceberg--the gender iceberg--that continues to rock both medicine and our culture at large. Chase made her first national appearance in 1993, in these very pages, announcing the formation of ISNA in a letter responding to an essay I had written for The Sciences, titled "The Five Sexes" [March/April 1993]. In that article I argued that the two-sex system embedded in our society is not adequate to encompass the full spectrum of human
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SYG8 - THE FIVE SEXES, REVISITED The emerging recognition...

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