From: An Amish couple walks into a hospital, only there's no joke here. This could be the hook to a story Dr. Tracy Bekx, a pediatric endocrinologist at the University of Wisconsin, Madison, told me. Having safely given birth with a midwife on their farm in rural western Wisconsin, the family she was called in to attend found themselves in a thoroughly modern setting -- with an ancient predicament.
Their newborn had a noticeably large clitoris, a tell-tale sign of congenital adrenal hyperplasia (CAH) -- the most common of the conditions grouped together under the term intersex or disorders of sexual development (DSD).
Historically, and still today in many places, the solution to these conditions is surgery; this implies, of course, that there is a problem. In fact, the variable terminology named above stems from this very issue -- is intersexuality an identity or a disorder?
Removal of some flesh would make this little girl look the prescribed ways we've determined she should. All her chromosomal, hormonal, physical -- and eventually behavioral -- traits would tell a single story. It's a tale many have been asked to tell, even when they don't believe it.
However, she was being seen in Madison where Dr. Bekx and her colleague Dr. Aaron Carrel help ensure that the tendency is to hold off on surgery unless it's medically necessary. In large part thanks to the activism by and on behalf of people with intersex conditions--many of whom have testified to dissatisfaction with their surgically altered bodies--momentum is gaining toward waiting till the child can express its gender identity. However, Dr. Carrel reports this practice is far from universal; as "the parents sometimes feel great relief that things 'look normal'."
Even when nature doesn't supply it, we're content to invent, reify and enforce a standard.
The Way God Made Them
Gender expression occurs across a spectrum. For all our pink-wearing, doll-loving princesses, we find tree-climbing, car-collecting "tom-boys" -- or kids who shift easily between these as the mood, toys and company inspire them. This range of gender expression is certainly not as wide for boys. However, as more men (and boys) embrace traditionally feminine pursuits, we will see the bandwidth of what's acceptable include more frequencies.
But what about sex? How many sexes are there in humans? Is it quite obvious or subject to interpretation? Perhaps sex, like gender, is simply a man-made convention, upheld more by social norms than biological "fact."
By gender I mean our presentation in the world. The roles we choose, or are required to play; the clothes we wear and the preferences we demonstrate. Gender can be understood as the coupling of two more concrete notions: gender roles and gender identity. For some lucky people, these two are a natural match -- for others the disparity between them causes great difficulty.
Gender roles are perhaps most familiar to us. This is "father knows best" and mother having dinner on the table. It's a set of social conventions that tell women to behave in certain ways and men in others. Gender identity, on the other hand, is what an individual feels compelled to do -- the roles he or she (or none of the above) elects to play in any given interaction.
Gender identity can be fluid. Gender roles shift more like tectonic plates. Drifting imperceptibly over time, these seemingly fixed foundations can then accelerate and collide, shake and demand our attention. The legalization of abortion was just such a quake. It challenged our assumptions about what women "are," how they differ from men, and what they're put on earth to do. Some people are still jolted by the impact of this event and feel the earth is a shaky and unstable place ever since.
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