INTRODUCTION: LESSONS FROM THE OCTOPUS

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The paternalistic surgery-centered model of intersex treatment has been incisively critiqued in recent years. Feminist and antihomophobic analyses have shown how traditional medical protocols privilege male genitalia and heterosexual relationships, in particular through the assumption that penis-vagina penetration within the context of heterosexual marriage is proof positive of a successful surgical outcome. And queer analyses have begun to show that the dichotomous ossification of a patient’s gender identity — another clinical goal — is both unrealistic and politically objectionable. First-person testimonies by patient advocates have largely substantiated these critiques of medical practice. There seems, then, to be a clear narrative of contestation and subsequent change emerging in the treatment of intersex. In other words, we have learned “lessons from the intersexed,” as Suzanne Kessler puts it, initially about genders and gonads, but subsequently about the meaning of ethical patient care.1 Yet, the history of intersex treatment, which now includes the recent history of its ethical critique, is marked by a curiously disjointed temporality. If there is a lesson to be learned from the intersexed, it is structured by multiple deferrals: the deferred revelation of the outcome of David Reimer’s medical management, on which much intersex treatment has been based; the now seemingly self-evident barbarity of surgical procedures that for years appeared reasonable to many clinicians and parents; the difficulties of choosing treatments, even with informed consent, that will have effects at once long-lasting and unpredictable; the inherent latency in follow-up studies of clinical outcomes, with or without surgery; the dilemma of surgical improvement whereby progress for future patients requires the use of experimental techniques on patients in the present; the stubborn asynchrony between cultural change in gender politics (and sexual politics) and con-