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were many possible causes of these symptoms, “rather than dwelling
on the possibilities of intersex and their ramifications.” Dr. Brown and
his colleagues never again raised the specter of intersex with Lenore’s
Lenore was not the first person Dr. Brown had seen or read about
with a condition like this. By the 1960s, intersex was certainly a known
human syndrome, and the medical literature, albeit a patchwork of
fact and opinion, contained many descriptions of intersex children. It
was clear that children didn’t always come in tidy packages. What was
far less clear was how best to treat such babies and children. At the
time, some physicians thought they could do just about anything with
a child’s sex. Give any baby the right clothes, the right toys, the right The Puzzle of Intersex 5 parents, and the right instructions, and that baby would become a boy
or girl. Other physicians who studied intersex weren’t so certain, especially with children as old as Lenore.
Lenore’s age complicated matters. Still, Dr. Brown felt he had to act.
Almost everyone accepted that something had to be done. The child
had to be either a “she” or a “he.” But before he made his final decision, Dr. Brown wanted to investigate further. He told Frank and Laura
that the doctors needed to do a laparotomy on Lenore so they could
determine why she wasn’t menstruating. A laparotomy is an invasive
procedure requiring a sizable incision through the abdominal muscles
and some degree of poking around inside the patient’s abdominal cavity.
Many important things reside inside that cavity, such as the liver, pancreas, and gall bladder, so there is significant risk associated with a laparotomy. Regardless, at their doctor’s suggestion, Frank and Laura agreed
to the surgery. So did Lenore. They all wanted to know why she wasn’t
menstruating. In fact, Lenore, now fourteen, went so far as to thank the
doctors for “making themselves available to her at this time.”
During the exploratory surgery, the doctors discovered that Lenore
had two undescended testes. They also found a uterus of sorts and rudimentary Fallopian tubes. That confirmed everything Dr. Brown and the
others suspected—that Lenore, who had been raised for fourteen years
as a girl and whose genitalia were mostly those of a girl’s, in fact had not
only the chromosomes but also the gonads of a boy.
Some minds were probably made up even before the surgery. But
now the doctors agreed on the spot: Lenore’s life might just as well continue as a girl’s life. So during the laparotomy, the doctors took it upon
themselves to remove Lenore’s testes. They later told Lenore and her
parents that her gonads were abnormal, so the doctors removed them.
It isn’t clear whether the doctors ever told the parents or anyone else
that those “abnormal” gonads were, in fact, testes and not ovaries. They
did say that it was because of this abnormality that Lenore did not menstruate. Once again the doctors assured the parents that there was no
doubt about Lenore’s sex. The orchidectomy, or removal of the testicles,
was the first step in shoring up that reassurance. Further procedures
would set it in concrete. 6 Between XX and XY Three months after the laparotomy, the doctors took Lenore back
into surgery (the report is a little vague about the justification for this
surgery) and performed a clitorectomy; that is, they cut off Lenore’s
too-small penis or too-large clitoris (whichever it was) to make her look
more feminine. Then Dr. Brown administered a full course of estrogen
To the doctors, it seemed that the only remaining problem was
Lenore’s lack of ovaries. Simply by providing her with the hormones
that nature had denied her, the doctors could give Lenore that final
push down the road to womanhood. In part, at least, the doctors were
right. Injections would provide Lenore with the estrogen she lacked
and stimulate secondary sexual development, especially breast formation. But beyond that no one knew for sure what all those hormones
It appears that each of the physicians involved felt certain that
Lenore’s best future was as an assigned and surgically simplified, chemically enhanced female, regardless of her Y chromosomes and her testes. We can’t know all of the factors involved in their decision, but it’s
probable that Lenore’s fourteen years spent as a girl played a part. It’s
also likely that the difficulty of reconstructive surgery to make genitalia
appear more masculine influenced them as well. And perhaps there
were other factors. One thing is clear in Dr. Tibbs’s report: no one considered the option of leaving Lenore as they found her. Lenore, as she
came to them, didn’t fit into either of the two spaces human minds
reserve for human beings—she wasn’t clearly a boy or a girl. Empathy,
morality, and kindness surely played a role in the doctors’ decisions, but
so too did a certain deep predisposition.
Even though Lenore had been swimming in a pond of male hormones for over a dozen years, the doctors...
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This document was uploaded on 02/04/2014.
- Spring '14