Intersex Bodies Research Articles

Beyond inclusion politics: A critical discourse analysis of sex and gender in medical education.

Medical training refers frequently to sex and gender, yet these terms are often used vaguely and interchangeably with little critical engagement. We aimed to better understand the key discourses around sex and gender in medical training. All verbal and written instances of gendered/sexed language, occurring in lectures, slides and provided written materials, within 1year of preclerkship medical education at a single institution in Canada were recorded autoethnographically by a medical student. We analysed these instances using critical discourse analysis informed by anticolonial, feminist and queer theoretical perspectives, particularly contrasting the concepts of governmentality and ungovernability to better understand how sex and gender are deployed in medical training. Despite the proliferation of ostensibly queer- and trans-positive content in medical curricula, sex and gender were frequently communicated inconsistently and imprecisely. In addition to, and perhaps as a result of, this inconsistent use, we uncovered three key discourses of (1) gender policing, (2) misogyny and (3) gender legibility. Collectively, these discourses can illustrate how medical education governs and reinforces gender norms. The repetitive and everyday use of ill-defined and uncritical gendered and sexed language can be seen to discursively uphold systems of cisheteropatriarchy and transphobia within medicine. Trans and intersex bodies cannot be considered addendums to be tacked on to a foundation of cisnormative and inaccurate teaching in medical education. Institutional attempts to improve curricula must go beyond the addition of new modules, which can be undermined by otherwise cisheteropatriarchal understandings of sex and gender.

Nineteenth-Century Intersex Bodies and the ‘Appearance of a Double Sex’: Nadar’s Medical Anti-Illustration

Abstract This essay demonstrates that Nadar’s 1860 ‘Hermaphrodite’ series disappeared from the famed French photographer’s oeuvre because it does not function as a medical illustration. It explains the relative obscurity of the series and reveals often-overlooked biases and distortions in medical illustrations. By placing the photographs in the context of nineteenth-century European medical theories about the intersex body, and the successful illustrations, often wood engravings, that accompanied those theories in texts, it reveals that Nadar’s series contradicted rather than supported existing anatomical teachings in an artistic medium renowned for its fidelity to nature, thus posing a threat to medical authority. Whereas doctors asserted that the hermaphrodite was a biological myth, an aberration obscuring natural male or female bodies that could be easily identified by experts, Nadar’s photographs, backed by the medium’s inherent claim to indexical truth, showed the intersex body as naturally integrated and complete and thus doomed themselves to obscurity.

Uncertain Knowledge: The Medicalisation of Intersex People and the Production of Ignorance

Ignorance is produced through mechanisms related to power relations and socio-cultural context. This article examines whether the theoretical conceptualisation of agnotology may be useful when exploring intersex and the way it has been erased socially and physically. Specifically, based on the work of a PhD in Sociology and History of Science, it proposes categorising three types of mechanisms of ignorance production—cultural, epistemological and physical—with the aim of providing a greater understanding of how medicine, science and technology participate in a continuous process of erasing intersex bodies and lived experiences. Using medical literature, interviews and observations, the article focuses on a specific area of biomedical knowledge and intervention: the prenatal ‘treatment’ of Congenital Adrenal Hyperplasia (CAH) with dexamethasone or ‘prenatal DEX’. It shows how this procedure was pioneered by French doctors and how it continues to be practised in France despite numerous uncertainties and controversies inside and outside of the medical sphere.

“I’ve had constant fears that I’ll get cancer”: the construction and experience of medical intervention on intersex bodies to reduce cancer risk

ABSTRACT Purpose This paper examines the subjective experience of medical interventions on intersex bodies to reduce cancer risk. Methods Twenty-five individuals with intersex variations took part in semi-structured interviews, analysed through thematic discourse analysis. Results Intersex bodies were positioned as inherently sick and in need of modification, with cancer risk legitimating surgical and hormonal intervention. This resulted in embodied shame, with negative impacts on fertility and sexual wellbeing. However, many participants resisted discourses of bio-pathologisation and embraced intersex status. Some medical interventions, such as HRT, were perceived to have increased the risk of cancer. Absence of informed consent, and lack of information about intersex status and the consequences of medical intervention, was positioned as a human rights violation. This was compounded by ongoing medical mismanagement, including health care professional lack of understanding of intersex variations, and the objectification or stigmatization of intersex people within healthcare. The consequence was non-disclosure of intersex status in health contexts and lack of trust in health care professionals. Conclusions The legitimacy of poorly-evidenced cancer risk discourses to justify medical intervention on intersex bodies needs to be challenged. Healthcare practitioners need to be provided with education and training about cultural safety practices for working with intersex people.

The liminal (vowel) space of womanhood: Fundamental frequency, formants, and the intersex body in Brazil

Abstract Despite the significance of intersex constituencies for explaining the social nature of sex and gender, intersex linguistic and social practices remain a yet unexplored frontier within sociolinguistics. This article examines fundamental frequency (F0) and vowel formant (F1–F3) production by participants with Turner Syndrome (TS), one of the most common intersex chromosomal conditions, in Rio de Janeiro, Brazil. This analysis demonstrates significant differences in fundamental frequency and F3 among different participant groups. I argue that height, growth hormone, and chromosomes are fundamental in constructing womanhood for TS women. Along with relevant ethnographic data, these results call for a re-examination of the body within linguistic and anthropological understandings of ‘womanhood’ and ‘femaleness’. This article highlights the ways these biological factors intersect with gendered perceptions of age and maturity, which can have real-world effects on linguistic practice and the social life of intersex individuals. (Brazilian Portuguese, fundamental frequency, gender, intersex, Turner Syndrome, vowel formants, critical intersex studies)*

Cultural Awareness of Intersex in Malta: Invisibility, Stigma and Epistemic Injustice

In 2015, Malta introduced ground-breaking legal reform designed to protect the bodily integrity of intersex infants in Malta. Drawing on semi-structured interviews with healthcare professionals, lawyers, policy-makers and advocates, this article considers the extent to which this reform has improved the cultural visibility and recognition of intersex people in Malta. Engaging with literature on epistemic injustice, this article provides new evidence for a cultural silence around intersex bodies that operates not only at a level of public knowledge but also at the individual and institutional levels. Our findings relate to three categories of visibility: political, cultural and medical. While the political visibility of intersex was an important factor in the introduction and shape of law reform in Malta, our respondents felt that the legislation had had very little effect on public understandings and familiarity with intersex issues. Moreover, respondents felt that many intersex people would be unlikely to know that they were intersex due to the limited conceptual and critical resources available to them: issues such as stigma and shame further encourage the epistemic silencing of intersex issues. The lack of cultural and medical visibility has significantly limited both the intended and hoped-for effect of the legislation. The article considers the broader implications of these results beyond Malta for those seeking to use the law to improve the lived experiences of intersex people.

Intersex people’s experiences of medical interventions, sex education, and physical intimacy

ABSTRACT The study reported in this paper explores the experiences of 95 people with intersex variations constituting an international English-speaking sample who completed a mixed methods survey comprises questions designed by the authors to explore 1) genital variations and medical interventions (and pressures to undertake them), 2) experiences with sex education, and 3) experience of physical intimacy, including use of safer sex devices and sexually transmitted infections. Surgeries on minors were common and typically not consensual, often resulting in the need for revisions. Pressures for surgeries most commonly were made by doctors. Experiences of sex education often failed to be inclusive of intersex bodies, with information about menstruation and hygiene rarely provided, and many participants having to learn on their own. Participants had a diversity of experiences of physical intimacy beyond penetration. For those who had experienced penetration, vaginal intercourse was enjoyable for some, but many found it painful. Conversely, anal intercourse was enjoyed by many and rarely found to be painful. The paper concludes by highlighting the importance of an intersex-specific approach to sexual health for this population.

Intersex people's perspectives on affirming healthcare practices: A qualitative study

Intersex people have variations in their sex characteristics that do not exclusively fall within binary definitions of male and female. This community experiences discrimination in the medical setting due to the pathologization of intersex bodies, including ‘normalizing’ genital surgeries without the child's consent. While research has explored biomedical aspects contributing to intersex variations, there is limited research centering intersex people's perspectives on their healthcare experiences. The aim of this qualitative study was to understand the experiences of intersex people in the medical setting, with the goal of providing recommendations to clinicians to promote affirming healthcare practices. Between November 2021 and March 2022 we conducted 15 virtual semi-structured interviews with members of the intersex community about their experiences with healthcare providers and perspectives on how their care could be improved. Participants were recruited through social media, with the majority residing in the United States. Through reflexive thematic analysis, 4 major themes were conceptualized: (1) the exclusion of intersex people in binary frameworks, (2) the common experience of medical trauma, (3) the value of psychosocial support, and (4) systemic change to address intersex healthcare. Recommendations were generated based on participants' narratives, including a recommendation for providers to use a trauma-informed approach to care. Healthcare providers must prioritize patient autonomy and ensure consent throughout their medical visits in order to promote intersex affirming care. Depathologization of intersex variations and comprehensive teachings of intersex history and medical care must be incorporated into medical curricula to mitigate experiences of medical trauma and to relieve the burden placed on patients to be their own medical experts and advocates. Participants shared the value of being connected to support groups and mental health resources. Systemic change is needed for the normalization and demedicalization of intersex variations and for the medical empowerment of the intersex community.

Human rights violations in normalizing procedures on intersex children.

Intersex children in Brazil are still subjected to "normalizing" surgical procedures and subsequent bodily interventions to make their bodies conform to binary views of sex. Resolution n. 1,664/2003 of the Brazilian Federal Council of Medicine legitimizes interventions upon intersex bodies, being the only national normative instrument that address the subject. However, the demands of international intersex political activism have denounced how early childhood interventions for sex designation mutilate children's bodies and violate a number of human rights. This research discusses how early, irreversible, and normalizing procedures performed without the intersex person's consent are human rights violations. Based on the concept of epistemic (in)justice, we first look at the disputes surrounding the evidence that underpin medical practices. We demonstrate how such procedures violate human rights to health, body integrity, autonomy, and sexual and reproductive rights, analyzing which strategies were put into place to prevent them. We propose that intersex people be at the center of decisions regarding their bodies, that non-surgical paths be discussed with patients and their family members, and that early, invasive, mutilating, harmful, cosmetic, and unconsented surgical interventions on intersex children be prohibited. Guiding tools must introduce changes into its regulatory bias to, from an interdisciplinary perspective, include bioethical and human rights bodies, as well as intersex activists.

Violações de direitos humanos nos procedimentos normalizadores em crianças intersexo

Intersex children in Brazil are still subjected to “normalizing” surgical procedures and subsequent bodily interventions to make their bodies conform to binary views of sex. Resolution n. 1,664/2003 of the Brazilian Federal Council of Medicine legitimizes interventions upon intersex bodies, being the only national normative instrument that address the subject. However, the demands of international intersex political activism have denounced how early childhood interventions for sex designation mutilate children’s bodies and violate a number of human rights. This research discusses how early, irreversible, and normalizing procedures performed without the intersex person’s consent are human rights violations. Based on the concept of epistemic (in)justice, we first look at the disputes surrounding the evidence that underpin medical practices. We demonstrate how such procedures violate human rights to health, body integrity, autonomy, and sexual and reproductive rights, analyzing which strategies were put into place to prevent them. We propose that intersex people be at the center of decisions regarding their bodies, that non-surgical paths be discussed with patients and their family members, and that early, invasive, mutilating, harmful, cosmetic, and unconsented surgical interventions on intersex children be prohibited. Guiding tools must introduce changes into its regulatory bias to, from an interdisciplinary perspective, include bioethical and human rights bodies, as well as intersex activists.

Intersex child’s parents’ negative experiences – case study

Intersexualism is often treated as a secret in medical and family systems. According to the thesis that intersex body is pathological and requires immediate surgical and hormonal regulation, intersex persons are subject to the process which involves rapid production of normative masculinity or femininity through invasive clinical practices. The goal of the study was to diagnose the experiences of parents of an intersex child with searching for support during the treatment for both the child and themselves. The study was conducted by means of individual semi-structured interview. The results are presented as a case study. It was shown that parents do not always receive the necessary social and medical support, and their children are treated as sensations and pathologies, regardless of the fact that empathy and acceptance are critical for making the right treatment-related decisions.

Intersex awareness and education: what part can health and physical education bodies of learning and teaching play?

ABSTRACT It is well-documented that schools fail to adequately engage with contemporary content about intersex awareness and education or inclusion of people with intersex variations. Where sexuality and relationships education are the remit of Health and Physical Education (HPE) curriculum in countries such as Australia, the learning area shows little obligation/response-ability towards the needs of students with intersex variations. It also fails to pay nuanced attention to non-dominant issues, knowledge, or people with respect to sex, gender and sexuality. Similarly, the normative endosex nature/focus of HPE/PE/sport and related professional education bodies (e.g. in teaching and coaching) ignore the need for relevant and affirming content about intersex bodies. A recent project reported here, created a collective narrative addressing how such HPE bodies of learning and teaching can advocate for and enact approaches that are inclusive, affirming, visible, and supportive in promoting and upholding the human rights and health needs of students with intersex variations. The research question driving the project was: What part can HPE bodies of learning and teaching play concerning intersex awareness and education? This original empirical research draws on the methodology and theory of narrative inquiry. The narrative was created between artefacts from a cohort of second year Australian pre-service HPE teacher education students in dialogue with teacher/researcher/expert/author bodies. The paper employs a recently developed Strategic Framework for intersex inclusion that promotes a positive whole-school approach, for educational institutions to be more inclusive, humane, safe and educationally relevant for people with intersex variations. This framework assists critical reflection on project findings. We argue that such engagement, as illustrated in this project’s scope, promotes a positive and diverse understanding about intersex in educational spaces, curriculum and pedagogies, guidelines, and policies, and ultimately reflect Australian Human Rights Commission recommendations and Australian anti-discrimination legislation.

For an epistemology of transition: Paul B. Preciado, psychoanalysis and the regime of sexual difference

This paper aims to illustrate Paul B. Preciado’s thought on the epistemology of transition, which should take over from the current epistemological regime of sexual difference based on heterobinarism. Starting in particular from the lecture given by Preciado in Paris in 2019, we intend to focus on the main axes of Preciado’s thought on the topic: first and foremost, the necessity of the denaturalization of gender with respect to biological sex; the denunciation of the normalization and medicalization endured by trans or intersex bodies, “deviants” with respect to heterobinarism; the ethnocentrism and necropolitical power of medical and disciplinary institutions vis-à-vis “deviants” and “monstrous”; and the concept of “transition” elaborated by Preciado as a decolonization with respect to the epistemology and disciplinary institutions of the current regime of sexual difference.

Intersex Activism, Medical Power/Knowledge and the Scalar Limitations of the United Nations

Abstract This article considers the extent to which human rights mechanisms can ameliorate intersex rights at a sub-national, or medico-local, level. It engages with both intersex activism and the academy where the United Nations (UN) has become understood as a key mechanism through which to challenge day-to-day practices of healthcare practitioners and bring an end to nontherapeutic surgical and hormonal interventions on intersex infants and children. Using the UK as an example, this article examines how and why the UN’s engagement with intersex has had little effect on the medical regulation of intersex people. To do so, the article draws on legal geography to examine how scale prevents the UN from having a clear and lasting impact on domestic issues – particularly those in healthcare settings. The different ways in which intersex bodies are recognised and regulated at different scales, coupled with the UN’s inability to form dialogue with the institutions of the state, such as the healthcare profession, are problematic barriers to challenge practice at the medico-local scale.

Temporal sociomedical approaches to intersex* bodies.

The history of the field of intersex bodies/bodies with variations of sex development (VSD) reflects the ongoing tension between sociomedical attempts to control uncertainty and reduce the duration of corporeal uncertainty by means of early diagnosis and treatment, and the embodied subjects who resist or challenge these attempts, which ultimately increase uncertainty. Based on various qualitative studies in the field of intersex, this article describes three temporal sociomedical approaches that have evolved over the last decade and aims to address the uncertainty surrounding intersex/VSD bodies. These approaches are (1) the corrective-concealing approach, which includes early surgeries and hormone therapies intended to "correct" intersex conditions and the deliberate concealment of the ambiguity and uncertainty associated with intersex conditions; (2) the preventive approach, which involves early genetic diagnostic methods aimed at regulating or preventing the recurrence of hereditary conditions under the umbrella of VSD; and (3) the wait-and-see approach, which perceives intersex bodies as natural variations and encourages parents to take time, wait, and give their children the right to bodily autonomy. A comparison of these approaches from biopolitical, phenomenological, and pragmatic perspectives reveals that time is an essential social agent in addressing and controlling uncertainty, a gatekeeper of social norms and social and physical orders, and, on the other hand, a sociopolitical agent that enables creative social change.

Unintelligibility, personhood and curriculum silences of intersex bodies in the Life Orientation high school classroom: A case study

Despite an increase in the research that promotes affirmative gender and sexual diversity in the South African Life Orientation (LO) education, there remains an uncomfortable silence on intersex bodies. In the absence of distinctive binary classifications of external genitalia, learners with variant intersex characteristics are incapable of integration into socio-educational environments. This article explores how individuals with variant intersex characteristics learn about the self in relation to society within LO lessons. It extrapolates factors that influence the educational and psycho-social agency in and around the classroom. This phenomenological study has drawn on in-depth interviews with six individuals with variant intersex characteristics post schooling. The evidence shows that the LO curriculum privileges distinct genital developments as a marker of normal human development and means of gender identification. Previous studies found that the mutually exclusive biological sex characteristics drawn from XY (male) and XX (female) chromosomal development were major determinants of social sexual and gender embodiment in puberty lessons. Lensed through the theory of unintelligibility, bodies that deviated from this normative development were seen as ambiguous and derogatively referred to as hermaphrodites. Their personal identities were marred with constructions of freaks and abnormality. Vilifying personhood rhetoric impacted the social skills of intersex learners and their peers. Learners with intersex bodies were uncomfortable to engage with the gender binary curriculum content, facilities and school culture. Silences on intersex bodies in the LO curriculum made these learners feel invisible which led to early school dropout. This article argues for the integration of intersex knowledge that affirms, humanises and protects all gender, sexual expressions and sex characteristics in the school context. The LO curriculum is well-positioned to disrupt problematic constructions of intersex bodies as deficit and embarrassing by including variant sex characteristic developments as a norm.

Prescribing the Binary for Intersex (and Transgender) Children.

Robert Perske argued in 1972 that "there can be such a thing as human dignity in risk, and there can be a dehumanizing indignity in safety." Though Perske was referring to paternalistic care for the intellectually disabled, we can extend his counsel to the persistent attempts to impose a different kind of "safety," including efforts to enforce the gender and sex binary, as intersex surgeries were (and still are) meant to do. This article argues that when physicians surgically and hormonally alter the genitals and gonads of intersex infants, shaping their bodies to safely align with typical male and female bodies and gender roles, they unwittingly subject them to a dehumanizing indignity. Imposing the binary legislatively with anti-transgender bills is similarly harmful and can inadvertently undermine intersex care. Conservative lawmakers' tacit dismissal of young people's transgender identities parallels physicians' paternalistic, even if well-intentioned, efforts to make intersex bodies fit neatly into prescribed categories. Whether legislative or medical, these interventions promote the traditional gender and sex binary and undermine the dignity of such persons' eventual self-authorship.

Ovidian Transversions: 'Iphis and Ianthe', 1300–1650 ed. by Valerie Traub, Patricia Badir, and Peggy McCracken

Reviewed by: Ovidian Transversions: 'Iphis and Ianthe', 1300–1650 ed. by Valerie Traub, Patricia Badir, and Peggy McCracken A. E. Brown Traub, Valerie, Patricia Badir, and Peggy McCracken, eds, Ovidian Transversions: 'Iphis and Ianthe', 1300–1650, Edinburgh, Edinburgh University Press, 2019; Ebook (ePub); pp. 344; R.R.P. £25.99; ISBN 9781474448925. Ovid's Metamorphoses was a staple educational text in premodern Europe, but there are distinct disparities as to which tales have attracted the most modern scholarly attention. Ovidian Transversions fills one significant gap, the lack of interest paid to the tale of Iphis and Ianthe. A particularly useful component of the book is the inclusion of appendices translating several versions into modern English, which will allow for comparative classroom use. However, I have reservations about the volume as a whole, due to its treatment of issues of gender and especially its negligent deployment of transgender theory. Valerie Traub, in her introduction, provides a thorough introduction to the tale of Iphis and Ianthe and to its premodern reception. She then sets the parameters for a capacious critical volume, offering the little-used term 'transversion' as an 'overarching rubric' for the tale's medieval and early modern reception. Her discussion of the analytical possibilities offered by the concepts trans, trans-, and trans* cites intra-community trans debates about orthography, but does not acknowledge trans people's specific, lived experience as something which produces the analytical perspective of trans studies. The publisher's copy blurb, in describing the volume's breadth as addressing 'gender and transgender, sexuality and gallantry, anatomy and alchemy, fable and history, youth and pedagogy, language and climate change', represents with unfortunate accuracy the volume's overall approach to 'transgender' as somehow distinct from 'gender'—a novel supplement, if not in actual opposition. The volume's consistent strength is in the historicist contributions, particularly those interested in scholastic context or in the generic context of particular adaptations. Katherine Eggert's essay on Galatea offers, in relation to the status of alchemy, the stimulating concept of 'disknowledge' as a framework approaching paradox. Kathleen Perry Long offers early modern French texts concerning intersex bodies as a context to Benserade's representation of Iphis's gender in his play Iphis et Iante (1634), while Susan Lanser's reading of 'sex, youth and modernity' in the same play places it in the context of comedies of misdirected love. Nevertheless, there are significant weaknesses in the treatment of medieval Iphis texts. Miranda Griffin's piece on Christine de Pisan's use of Iphis as a metaphor for the gender transition which the narrator asserts in widowhood is one of the stronger chapters. In addition to a detailed close reading of the Mutacion de Fortune, Griffin's work is the only contribution that foregrounds transgender experience and consistently deploys pronouns other than 'she' for a character (Christine-the-narrator) after a gender-transformative experience. However, Griffin's chapter shares with other essays a striking lack of engagement with the field of premodern trans studies. Essays in the medieval section do engage with [End Page 175] contemporary theoretical work, mostly from TSQ: Transgender Studies Quarterly, and with Robert Mill's work on medieval gender; but I believe Gabrielle Bychowski is the only trans scholar of premodern literature to be cited (although Blake Gutt contributed to one of the appendix translations; and of course, I may be unaware of some contributors or cited authors' specific identities). Moreover, Karma Lochrie's paraphrase of Bychowski's work misrepresents the latter's commentary on the lack of agency afforded to trans youth today, furnishing instead a claim about the 'medicalization' of children that echoes reactionary talking points. Given her earlier work questioning the hetero/homosexual binary, Lochrie's essay is also strikingly lacking in rigour in its engagement with gender. Speaking from my own standpoint as a nonbinary trans person, her offhand description of Ovid's androgynous Iphis as 'genuinely non-binary' was promising, but the essay (and indeed the book) exhibits no engagement with current nonbinary perspectives. At the time this book went to press, 'nonbinary' was well established as a term, and perhaps the only uniting feature among the nonbinary community is agreement that physical features read...

Queer Bodies, Queer Technologies, and Queer Policies

Queer Bodies, Queer Technologies, and Queer Policies

Psychosocial Approaches and Discursive Gaps in Intersex Healthcare

Abstract Background In the past several decades, conflicting discourses have coexisted in the field of intersex studies, including the pathologizing discourse of the biomedical disciplines and the affirmative, subjective psychosocial discourse of people born with intersex bodies and their advocates. Intersex activists call for a positive discourse and a humanistic healthcare approach that accepts and protects intersex bodily autonomy and change the continuing harmful, traumatic treatments aimed at normalizing variations of sex characteristics (VSC). Methods We created a collaborative German-Israeli action study, in with 30 health care professionals, intersex activists and scholars from Israel and Germany, were gathered to learn different perspectives on intersexuality, interact and work together on projects aim to improve the care for intersex people and families. Results The participants created different collaborative projects, including “intersex workshops” for caregivers and professionals in Israel and Germany; unique materials for raising an awareness, e.g., booklets on intersex bodies with a positive and affirmative approach and language and an article for health care within the ultraorthodox Jewish community; parents' groups and implementation of programs that aim to build bridges between biomedical professionals, caregivers, parents, and intersex people in Israel and Germany. Conclusions The participants increased their knowledge and awareness of and sensitivity to intersex issues, and implemented these in their daily work and practices. The participants acknowledged the differences between the countries, especially in relation to the heightened Israeli use of assisted reproductive technology, which effect on the treatment practices, early genetic diagnosis and the preventive medical attitude. In Germany, more activism for intersex human rights and significant laws which regulate the medical treatment practices.