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Unformatted text preview: salvation. And with the proper upbringing, a child could become anything his/her parents/physicians wanted
him/her to be.
A second study made a similar but more narrowly focused assessment of seventy-two of the same seventy-five adult 46,XY patients
included in the first study. The conclusions of this study were very similar to those described above. Thirty-two of these people were assigned
male sex and forty female. The majority of these people said they were Outcomes 135 mostly satisfied with their assigned sex and had never felt unsure about
their gender. Furthermore, the majority did not think that a third sex
category should be created, did not think that their genitals looked
abnormal (even though the majority of the men thought their penises
were too small), were generally satisfied with their sexual function, did
not think surgical correction of ambiguous genitalia should be postponed until adulthood, and believed that their own surgeries should
not have waited until they were adults.
Again, the data suggested that most of these people could be either
men or women and be happy.
Another study, carried out in England in 2003, addressed more
directly whether 46,XY individuals might live happily as females.10 As
mentioned, complete androgen insensitivity syndrome causes 46,XY
fetuses to develop female external genitalia. And because some testosterone is converted to estrogen at puberty, these people may experience
normal breast development. But their complete androgen insensitivity
prevents normal development of pubic and underarm hair. So most
women with complete androgen insensitivity syndrome aren’t aware of
it until they reach puberty. Then, lack of menstruation leads them to a
physical exam and the discovery of undescended testes. At that point,
usually, a doctor removes their testes and begins estrogen therapy. The
studies at Johns Hopkins had also examined this aspect of intersex and
the satisfaction of XY females.
In both studies, all 46,XY persons with complete androgen insensitivity were satisfied with their assignments and rearing as females. In
addition, in this study 46,XY women were similar to 46,XX women
in all behavioral categories examined, had heterosexual erotic interests,
and had married into heterosexual relationships as often as the control
Clearly, a Y chromosome is not enough to make a baby boy, nor
does it make for abnormal or unhappy women.
But complete androgen insensitivity may be an exception. These
children do not have ambiguous external genitalia. For the most part,
they look, act, and feel like other girls. Nor does sex assignment require
any early surgery. In fact, sex assignment occurs pretty much on its 136 Between XX and XY own. Usually it isn’t until puberty that decisions have to be made, and
these are different sorts of decisions from those made by children with
ambiguous genitalia. So this syndrome and the people it affects fall, perhaps, into a special nook. Regardless, complete androgen insensitivity
syndrome and the women it creates prove one thing—there is more to
sex determination than chromosomes.
Sensation after Surgery: The Downside of Clitoral Modification
Early in the modern era of research on intersex, someone started, but
never published, a rumor that some African tribeswomen who had
undergone ritual clitorectomy continued to exhibit normal sexual
responses. Therefore, according to this rumor, a clitoris was unnecessary for a woman’s normal sexual function. Because of that, the solution
to the problem of large clitorises was obvious: simply cut them off. So
until the late 1970s and early 1980s, clitorectomy was the procedure of
choice when sexual assignment included surgery.11
In the mid-1980s, though, some physicians finally questioned the
prevailing wisdom about cutting off clitorises and suggested that that
the clitoris might be “an erotically important sensory organ that was
worth saving” during surgical sex reassignments.12 It is surprising that
it took this long for physicians to begin to question women about their
surgeries and even more surprising that it took this long for the surgeons to appreciate the sensory importance of an intact clitoris, no matter how large.
Since that time, genitoplasties, often called clitoroplasties, have
mostly replaced clitorectomies in sex-assignment surgery. The intent of
clitoroplasty is to provide for a number of things including an acceptable cosmetic appearance (acceptable to both physician and patient)
and (where possible) normal, satisfying intercourse in adolescence and
adulthood. It has been generally assumed (especially by physicians, but
also by parents) that the outcome of clitoroplasty is preferable to either
clitorectomy or doing nothing.
For that reason, and based on patient satisfaction like that described
in the Johns Hopkins studies, in several disorders of sex development, Outcomes 137 clitoroplasty and vaginoplasty remain the methods of choice. And clitoroplasty and vaginoplasty appear to offer great options to those born
with disorders of sex development, their parents,...
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- Spring '14