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This exploration is essentially a sequel to that on the binary logic of "us and them" (Us and Them: Relating to Challenging Others, 2009). There reference was made to the subtleties of intersexuality highlighted in this period by the widely publicized difficulty of determining the gender of Caster Semenya, a world record-breaking athlete who had run as a woman.
The question here is whether the recognized tangible intermediary conditions of intersexuality -- a challenge to the absolute distinction made between male and female -- offer ways of thinking about other radical polarizations. Clearly society has a very heavy investment in the binary distinction between male and female, whether in sport, salary scales, skin colour, "two culture" frameworks, or mutually challenged civilizations. This is notably evident in civil status registration and associated institutionalization (schools, prisons, military service, religion, etc) -- but is most ironically evident in public toilet facilities. As under the apartheid regime of South Africa, people have to choose how they "pass" as one or other -- or have that determination made for them.
And yet the complexities of the reality of intersexuality highlight the possibility of more complex classifications in many such domains. What is it that enables reflection on intermediary conditions? The issue in what follows is not the specifics of intersexuality but how it might be used as a metaphor for more general reflection -- especially in the light of learnings from the problematic dynamics associated with intersexuality.
Whereas both the productive and dysfunctional dynamics associated with polarized perspectives are well known, those associated with intermediary conditions are not. Is it possible that there may be fruitful insights between the polar extremes. In a period in which the world is preoccupied by extremism in various forms -- in which it has invested heavily -- is it possible that intermediary conditions may offer new possibilities to otherwise blocked situations?
It is perhaps not surprising that there is no universal classification of conditions of intersexuality. It is perhaps not surprising that three months was the time required by the International Association of Athletics Federations to determine whether Caster Semenya was female or male -- or otherwise. This of course raises the question of how facile is the assumption that any individual is simply one or other extreme, rather than a mix that may be neither suspected nor immediately visible.
Part of the problem is the degree to which people are socially conditioned to expect that someone should be either one or the other. The two extremes are "normal". Anything otherwise is "abnormal" and is typically surgically corrected and/or otherwise disguised.
|Ovaries / Testes||Androgen /
|Wolffian Ducts||MIS (Müllerian inhibiting substance)||Mullerian Ducts||External
|Normal Female Development||XX||ovaries develop||no androgen produced||Wolffian Ducts regress||no MIS produced||Mullerian Ducts develop||external genitalia are female||feminizing puberty||.|
|Complete androgen insensitivity syndrome (CAIS) development||XY||testes develop||androgen produced, but body can not respond||Wolffian Ducts regress||MIS produced||Mullerian Ducts do not develop||external genitalia are female||feminizing puberty without menses||.|
|Partial Androgen Insensitivity Syndrome (PAIS) development||XY||testes develop||androgen produced, but body partially unresponsive||Wolffian Ducts develop minimally||MIS produced||Mullerian Ducts do not develop||external genitalia are ambiguous||
feminizing puberty with estrogen therapy
|partial masculinizing puberty with testosterone therapy|
|Complete Gonadal Dysgenesis||XY||streak gonads||no androgen produced||Wolffian Ducts regress||no MIS produced||Mullerian Ducts develop||external genitalia are female||feminizing puberty with estrogen therapy||.|
|Partial Gonadal Dysgenesis||XY||partial testes determination||variable amount of androgen produced||some Wolffian Duct development||variable amount of MIS production||some Mullerian Duct development||ambiguous external genitalia||feminizing puberty with estrogen therapy
||masculinizing puberty with testosterone therapy|
|5-alpha-Reductase Deficiency||XY||testes develop||testosterone but no DHT produced||Wolffian Ducts develop||MIS produced||Mullerian Ducts regress||ambiguous external genitalia||
feminizing puberty with removal of testes and estrogen therapy
|testes left intact, partial masculinizing puberty|
|Complete Testosterone Biosynthetic Defect||XY||testes develop||no androgens due to enzyme deficiency||Wolffian Ducts regress||MIS is produced||Mullerian Ducts regress||external genitalia are female||feminizing puberty if given estrogen therapy||.|
|Partial Testosterone Biosynthetic Defect||XY||testes develop||partial production of androgens||some Wolffian Duct development||MIS produced||Mullerian Ducts regress||ambiguous external genitalia||feminizing puberty with estrogen therapy||partial masculinizing puberty with testosterone therapy|
|Micropenis||XY||testes develop||androgens early in fetal life, deficient later in fetal life||Wolffian Ducts develop||MIS produced||Mullerian Ducts regress||micropenis||feminizing puberty if given estrogen therapy||partially masculinizing puberty if exposed to testosterone|
|Timing Defect||XY||testes develop||androgen produced at incorrect time||Wolffian Ducts develop||MIS produced||Mullerian Ducts regress||external genitalia range from female to ambiguous||feminizing puberty with estrogen therapy||partially masculinizing puberty with testosterone therapy|
|46,XX CAH||XX||ovaries develop||no testicular androgens but excessive adrenal androgens produced||Wolffian Ducts regress||no MIS produced||Mullerian Ducts develop||ambiguous external genitalia||feminizing puberty if treated with cortisol||.|
|Klinefelter Syndrome||XXY||small testes at puberty||often decreased androgen production||Wolffian Ducts develop||MIS produced||Mullerian Ducts regress||male external genitalia with small penis||.||masculinizing puberty with possible decreased androgen production|
|Turner Syndrome||XO||gonadal streaks develop||no androgen produced||Wolffian Ducts regress||no MIS produced||Mullerian Ducts develop||external genitalia are female||feminizing puberty with estrogen therapy||.|
|45,XO/46,XY Mosaicism||XY||partial testes determination||variable amount of androgen produced||some Mullerian Duct development||.||some Mullerian Duct development||ambiguous external genitalia||feminizing puberty with estrogen therapy
||masculinizing puberty with testosterone therapy|
|Normal Male Development||XY||testes develop||androgen produced||Wolffian Ducts develop||MIS produced||Mullerian Ducts do not develop||external genitalia are male||masculinizing puberty||.|
The issue has been more recently dramatised in public debate through the cases of Conchita Wurst (winner of the 2014 Eurovision Song Contest), and of Chelsea Manning (Chelsea Manning sues US military over denial of gender dysphoria treatment, The Guardian, 23 September 2014).
C. Cooky and S. L. Dworkin. Policing the Boundaries of Sex: A Critical Examination of Gender Verification and the Caster Semenya Controversy. Journal of Sex Research, 50,, 2013, 2, pp. 103-111
Anne Fausto-Sterling. Sexing the Body: Gender Politics and the Construction of Sexuality. 2000 [text]
Dan Christian Ghattas and Heinrich Bã¶ll Foundation. Human Rights Between the Sexes. 2013 [text]
Morgan Holmes (Ed.). Critical Intersex, Ashgate Publishing, 2009 [contents]
Katrina Karkazis. Fixing Sex: Intersex, Medical Authority, and Lived Experience. 2008 [text]
Organisation Intersex International Australia, Submission on the ethics of genetic selection against intersex traits. April 2014 [text]
San Francisco Human Rights Commission. A Human Rights Investigation into the medical "normalization" of intersex people. [text].
Leonard Sax. How common is intersex? A response to Anne Fausto-Sterling. Journal of Sex Research 39, 2002, pp. 174-9 [text]
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