04-25-2005
http://www.healthyplace.com/communities/gender/intersexuals/article_sex_police.htm
The sex police
The biology of sex is being hotly debated, as parents, doctors and researchers reevaluate what it means to be male and female.
By Sally Lehrman, 1999
This article is about Patrick took a long time in coming -- two weeks in the birth canal -- but the moment he arrived, nurses bundled him up and rushed him out of the delivery room. The Jacksonville, Fla., hospital cloistered the eight-pound, 20 1/2-inch baby in a back section of the intensive care unit and drew the curtains. One doctor after another went to visit. The infant had a well-defined penis, but with an opening at the base, not the tip. There was just one testicle, though it was producing plenty of testosterone. In most of his cells, the baby had no Y chromosome, the one that contains the genetic instructions for the body to develop as a male. The doctors assured the adoptive mother, Helena Harmon-Smith, that Patrick was a girl. They would remove the offending appendages right away. But Harmon-Smith had seen Patrick have an erection. Actually, several. "You're not cutting off anything that's working," she protested. The authorities checked the infant's internal organs and still insisted this baby would be better off as a girl. His mother refused. More tests. After 11 days, 20 doctors filed into a hospital conference room and solemnly announced that they would allow the family to raise Patrick as a boy. "We put him in a little tux and took him home," Harmon-Smith says.
Two and a half months later, Patrick's doctor warned his mother that the boy's testicle, really an ovotestis that also contained some ovarian tissue, was probably malignant. It should be removed -- like the one already taken from his abdomen. His mother finally agreed to a biopsy, just in case. When the surgeon returned from the operating room, he said the gonad was diseased. He had cut it off.
Harmon-Smith pestered the doctor for the pathology report for more than a month. Once she got it, "the first thing I read was 'normal, healthy testicle.' My heart stopped. I just cried," she says. Five years old March 24 and in the first grade, Patrick will never be able to produce semen. Katherine Rossiter, the pediatric nurse practitioner who wrote the article in the January-February 1998 nursing journal, argues that intersex activists represent only a minority, albeit a vocal one, and that allowing a baby with a tiny penis and no testicles to grow up as a boy, rather than surgically reassigning him as a girl, might harm him beyond repair. But she admits that "listening to what real people say and their arguments" has broken down some of her conviction. "I've become muddy mishmash in my thinking," she says.
The medical literature and the opinions of specialists are increasingly divided. "In some cases it's led to a human tragedy -- it might have been better not to reassign the sex of this particular child. But there are cases where it's clearly right to reassign," says Raymond Hintz, an endocrinologist and professor of pediatrics at Stanford University. "It's sometimes justified, but it's not something you do lightly."
William Cromie, a Chicago pediatric urologist who serves as secretary and treasurer of the Society for Pediatric Urology, stresses that proper treatment relies on the carefully considered opinions of parents along with ethicists, endocrinologists, pediatricians and other specialists. As many as 30 conditions may lead to a child being considered intersexed. "It's not an arbitrary, capricious decision by one person," he says. "You try to make the very best decision -- it's usually ground over by a lot of people who are very thoughtful. This is an area that's immensely complex. And lay people just plain and simple don't understand it." For a boy to be a boy, he ought to have two testicles just below a straight penis, and only one opening down there. If the genitals fall short, a pediatric urologist will almost always assign the infant a female gender, remove anything protruding too far and prescribe estrogen at puberty. A talented surgeon can construct a vagina using a piece of the bowel, although the woman who owns it will never experience any sensation inside.
The author wrote this article because the Intersex Society doesn't oppose assigning gender at birth. Instead it -- and now some medical specialists -- urges parents and doctors to refrain from surgery and be open to a change in sex identity later.
But Chase, for one, isn't waiting for culture to come to terms with biology. "I'm focused on practical changes that come quickly, not pie in the sky," Chase says. "I would much rather keep my clitoris and have orgasms than have a box to check off." Helena Harmon-Smith, Patrick's mother, says she wants children like her son to be allowed their own decisions -- and more than anything, to be recognized as real. "My son was one of the lucky few -- because he is technically both. He can be boy or girl," she says. She will never forgive Patrick's doctor for making the choice for him.
The sex police
The biology of sex is being hotly debated, as parents, doctors and researchers reevaluate what it means to be male and female.
By Sally Lehrman, 1999
This article is about Patrick took a long time in coming -- two weeks in the birth canal -- but the moment he arrived, nurses bundled him up and rushed him out of the delivery room. The Jacksonville, Fla., hospital cloistered the eight-pound, 20 1/2-inch baby in a back section of the intensive care unit and drew the curtains. One doctor after another went to visit. The infant had a well-defined penis, but with an opening at the base, not the tip. There was just one testicle, though it was producing plenty of testosterone. In most of his cells, the baby had no Y chromosome, the one that contains the genetic instructions for the body to develop as a male. The doctors assured the adoptive mother, Helena Harmon-Smith, that Patrick was a girl. They would remove the offending appendages right away. But Harmon-Smith had seen Patrick have an erection. Actually, several. "You're not cutting off anything that's working," she protested. The authorities checked the infant's internal organs and still insisted this baby would be better off as a girl. His mother refused. More tests. After 11 days, 20 doctors filed into a hospital conference room and solemnly announced that they would allow the family to raise Patrick as a boy. "We put him in a little tux and took him home," Harmon-Smith says.
Two and a half months later, Patrick's doctor warned his mother that the boy's testicle, really an ovotestis that also contained some ovarian tissue, was probably malignant. It should be removed -- like the one already taken from his abdomen. His mother finally agreed to a biopsy, just in case. When the surgeon returned from the operating room, he said the gonad was diseased. He had cut it off.
Harmon-Smith pestered the doctor for the pathology report for more than a month. Once she got it, "the first thing I read was 'normal, healthy testicle.' My heart stopped. I just cried," she says. Five years old March 24 and in the first grade, Patrick will never be able to produce semen. Katherine Rossiter, the pediatric nurse practitioner who wrote the article in the January-February 1998 nursing journal, argues that intersex activists represent only a minority, albeit a vocal one, and that allowing a baby with a tiny penis and no testicles to grow up as a boy, rather than surgically reassigning him as a girl, might harm him beyond repair. But she admits that "listening to what real people say and their arguments" has broken down some of her conviction. "I've become muddy mishmash in my thinking," she says.
The medical literature and the opinions of specialists are increasingly divided. "In some cases it's led to a human tragedy -- it might have been better not to reassign the sex of this particular child. But there are cases where it's clearly right to reassign," says Raymond Hintz, an endocrinologist and professor of pediatrics at Stanford University. "It's sometimes justified, but it's not something you do lightly."
William Cromie, a Chicago pediatric urologist who serves as secretary and treasurer of the Society for Pediatric Urology, stresses that proper treatment relies on the carefully considered opinions of parents along with ethicists, endocrinologists, pediatricians and other specialists. As many as 30 conditions may lead to a child being considered intersexed. "It's not an arbitrary, capricious decision by one person," he says. "You try to make the very best decision -- it's usually ground over by a lot of people who are very thoughtful. This is an area that's immensely complex. And lay people just plain and simple don't understand it." For a boy to be a boy, he ought to have two testicles just below a straight penis, and only one opening down there. If the genitals fall short, a pediatric urologist will almost always assign the infant a female gender, remove anything protruding too far and prescribe estrogen at puberty. A talented surgeon can construct a vagina using a piece of the bowel, although the woman who owns it will never experience any sensation inside.
The author wrote this article because the Intersex Society doesn't oppose assigning gender at birth. Instead it -- and now some medical specialists -- urges parents and doctors to refrain from surgery and be open to a change in sex identity later.
But Chase, for one, isn't waiting for culture to come to terms with biology. "I'm focused on practical changes that come quickly, not pie in the sky," Chase says. "I would much rather keep my clitoris and have orgasms than have a box to check off." Helena Harmon-Smith, Patrick's mother, says she wants children like her son to be allowed their own decisions -- and more than anything, to be recognized as real. "My son was one of the lucky few -- because he is technically both. He can be boy or girl," she says. She will never forgive Patrick's doctor for making the choice for him.
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