What separates womanhood from manhood? This question has transfixed the medical community in America since its founding. But the need to enforce a binary gender––male or female––tells a darker history about the struggle for acceptance of people born with intersex traits. Elizabeth Reis, a professor at the Macaulay Honors College at the City University of New York and author of Bodies in Doubt: An American History of Intersex, has dedicated her research to bringing awareness to intersex history, specifically the medical management of people born with atypical sex development.
As we began our conversation, Reis took me back to the mid-18th century. “Doctors were trying to figure out: When is somebody a woman? When is somebody a man? What bodily characteristics were required?” Before medicine was capable of studying hormones, chromosomes, and gonads (ovaries and testes), doctors only had genitals (and a person’s social presentation) to help provide answers. “That idea of determining a person's ‘true sex’ permeated all of intersex history.” And this is where intersex history merges with the history of homosexual oppression.
“Physicians were determined to figure out a person’s sex if it wasn’t immediately clear because they wanted to promote heterosexuality and eliminate homosexuality,” Reis told me. “The doctors of the late-18th and the 19th centuries thought that if a person wasn't sure if they were male or female, that might then lead them to become attracted to a same-sex person.” Cue the fear of homosexuality.
In early America, so-called corrective surgeries on people's genitals were, of course, not medically possible. The techniques and medicine had not been invented yet. “But what the doctors did want,” said Reis, “was for the person to choose their gender and stick with it.” For some people, choosing a stable gender identity proved difficult.
Reis found evidence of a person with intersex traits in a two-page document from a Virginia court in 1629. The person at the center of the case sometimes went by the name of Thomasine Hall and at other times lived as Thomas Hall. “One of the things that struck me in this case was the nosy townspeople,” said Reis. “They stormed into Hall’s room at night, ripped off his clothes, and tried to examine his body.” Hall, who at the moment of intrusion was presenting as a man, described his anatomy on record by saying, “I have a piece of both.” The court sentenced Hall to an unusual punishment: to wear half women’s clothing, half men’s clothing. As Reis described it, “It was a sanction that marked Hall as somebody whose gender fraud (from the court’s perspective) would no longer be able to deceive others.”
Reis found other people who may have had intersex traits by examining divorce proceedings. Divorce was rare, even throughout the 19th century, but it was grantable for specific reasons, one of them being if the marriage was never consummated. As Reis outlined for me, “A person would have testified that the marriage remained unconsummated. Then the court would have had a doctor examine the person’s genitals. And based on those findings, the court could rule, ‘Because this person is a perfect male, no, your divorce is not granted.’” Enforcing the binary maintained social relations, including heterosexual marriage, as they were then understood.
As Reis’s research entered the late-19th century, when physicians began to professionalize, she found evidence of intersex management in their medical journals. “The first surgery that I found was in 1849,” Reis told me. “That was a four-year-old girl who had internal testes. And this is where you can see how much people cared about homosexuality even from this early case.” The doctor, worried that internal testes might “inspire” sexual desires toward women, opted for surgery. He even claimed that the girl would be “reviled by all humans” if he didn’t operate. The doctor reported the surgery a medical success, but ethically, Reis argues, it was a nightmare.
“Few of these surgeries were medically necessary,” said Reis. “And that is a key point with intersex politics today: such surgeries have been driven by what doctors (and some parents) have seen as a social necessity.” And it's this conversation, one of ethics and necessity, that would guide Reis’s research into the 20th century and today.
In the 1950s, a Johns Hopkins psychologist, John Money, believed intersex cases should be handled at infancy. He reasoned that because a baby’s gender identity is malleable for the first 18 months of life, surgery would be an easy solution to “correct” intersex conditions. “Money wrote hundreds of articles with his team, and many doctors were happy with his strategy,” Reis told me. With a few exceptions, the medical community eagerly welcomed his idea for infantile surgery, and unfortunately, the idea continues to be welcomed today.
But intersex advocates have pushed back. Reis explained: “This is what intersex advocates are against. They're against surgery on non-consenting infants. The parents are consenting, but the parents aren't the patients. It is a human rights violation to tamper surgically with somebody's genitals and prevent that person from developing their own sexual self-authorship in terms of their gender, their reproductive possibilities, and their sexuality.”
In a potential move toward change, one major hospital, the Lurie Children's Hospital in Chicago, announced in July 2020 that it would stop cosmetic infant surgeries. It stated: “We empathize with intersex individuals who are harmed by the treatment that they received, according to the historic standard of care, and we apologize and are truly sorry. The medical field has failed these children.”
“We're in a different era now, where people are more comfortable with difference,” concluded Reis. Thanks to disability politics, as well as transgender and queer visibility, society has worked toward becoming more aware. And though the fight for acceptance continues, especially in Republican-controlled states like Texas and Florida, Reis still sees hope: “The silver lining of this terrible climate is that it's brought trans and intersex activists together. All people deserve to make their own decisions about how their bodies look and function.”
To read more of Reis’s phenomenal work, see:
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