That same year lenore developed tonsillitis and went

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Unformatted text preview: uriously, though, unlike her friends, Lenore’s chest remained as flat as a boy’s, and she had not begun to menstruate. That same year, Lenore developed tonsillitis and went to the hospital to have her tonsils removed. During Lenore’s intake exam, the doctor who examined her—a particularly thorough sort, apparently— again noticed the hypertrophy of Lenore’s clitoris. However, unlike the others who had noted the same excess, this doctor felt the need to do something more. When he looked at her more closely, he found that Lenore’s vagina was only rudimentary—too short and too small to be functional. This, combined with Lenore’s flat chest and lack of menstruation, puzzled the doctor. So he referred Lenore to the Adolescent Children’s Unit of Childrens Hospital of Los Angeles for further tests. A pediatrician there performed a complete physical evaluation. In the fall of 1966, Dr. Betty Suits Tibbs wrote up the course of that evaluation, and the story of Lenore’s short life to that point, in the clinical journal Pediatrics. Dr. Tibbs’s tale is the foundation for this story. Since Dr. Tibbs’s report doesn’t name Lenore’s physician at Childrens Hospital of Los Angeles, I’ll call him Dr. Brown. Here is his description of Lenore: Pertinent physical findings revealed moderate hirsutism of the face [facial hair] with slight acne. The thyroid gland was not The Puzzle of Intersex 3 palpable. Examination of the chest revealed a normal contour but no breast development. There were no cardiac murmurs and the heart was not enlarged. Axillary hair was ample and the pubic hair formed a female escutcheon. The clitoris was hypertrophied, appearing as a small penis with a urethral opening at its base. There was a small vaginal opening posterior to the urethral opening. According to Dr. Brown, when Lenore appeared before him, her outward physical appearance and mannerisms seemed more boyish than girlish. In addition, Lenore’s vagina was only about 2.5 centimeters deep—about an inch—and, palpate as he would, Dr. Brown could not find a uterus in Lenore’s abdomen. All of this led him to suspect that in spite of her history, Lenore was in fact a boy. That seemed worth following up on, so he scraped some cells out of Lenore’s mouth and sent them off for analysis. A few days later the results of Lenore’s tests came back. The genetic expectation for girls is that each cell will have two X chromosomes. Normally, early in the embryonic development of girls, in every cell of the embryo one of those two X chromosomes is inactivated and condenses into a small inert lump called a Barr body, or sex chromatin. The presence of sex chromatin usually identifies a cell as female. Dr. Brown could find no evidence of any sex chromatin in any of Lenore’s cells. So, at her next visit, Dr. Brown took some blood from Lenore and sent the white cells off for analysis. The results of those tests showed that most of Lenore’s cells had the right number of total chromosomes, forty-six, but the tests also showed that buried inside of every one of Lenore’s cells there was an X and a Y chromosome. Lenore’s cells were genetically male. Analysis of Lenore’s hormones revealed a shortage of female hormones. It all fit, except for the fact that Lenore still thought of herself as a girl. Because of his findings, Dr. Brown referred Lenore for psychiatric evaluation. Apparently, he wanted to find out how well Lenore’s mind had adapted to life as a girl in spite of her Y chromosomes. Dr. Tibbs reported the results of those tests: 4 Between XX and XY The results of the psychiatric evaluation revealed a low average intelligence. . . . The patient never actually expressed confusion on direct query as to whether she was male or female, but did demonstrate some masculine aggressive behavior patterns and fantasies. Dreams and projective tests interpreted by both the psychologist and psychiatrist also revealed some ambivalence in her gender identity. On the conscious level, the identity patterns conformed to the assigned sex. In other words, on a conscious level Lenore acted like a girl. But subconsciously she behaved more like a boy, which fit with the way she looked, not to mention her mysteriously silent Y chromosomes. After that analysis, it appears that Dr. Brown suggested to Lenore’s parents that their daughter might be different from other children. But the parents’ discomfort with the subject outweighed their curiosity. Frank and Laura seemed to have little interest in exploring the possibility of Lenore’s apparent intersex condition. According to the report, Frank and Laura were “in denial.” Dr. Brown’s findings did, however, make Lenore’s parents uneasy enough to ask if Lenore was “all boy or all girl.” Dr. Brown and the doctors he worked with decided not to push the matter. They assured the parents that the physicians were just following up on the diagnosis of amenorrhea and hirsutism and that th...
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This document was uploaded on 02/04/2014.

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