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In about one out of every 1500 hospital deliveries, infants are born with ambiguous genitalia. Faced with such situations, physicians have worked towards creating a standard approach for treating these infants. Dr. John Money has been the leading theorist in this field. Between 1955 and 1972, Money and his associates developed procedures for dealing with both the intersexed infant and the parents. These procedures included quickly assigning and surgically creating a gender for each baby. Over the years, however, debate has surfaced regarding the validity of Money’s theories.
One scholar who voices opposition is Suzanne Kessler, a psychology professor at Purchase College, SUNY. In an article written in 1990, she presents and analyzes Money’s methods and their consequences. Kessler disagrees with the means by which he chooses a gender and his justifications for doing so. Since the publication of Kessler’s article, scientific evidence has emerged which disputes Money’s theories. In a July 2000 article, Dr. Chanika Phornphutkul of the Brown University Department of Pediatrics spotlights flaws in Money’s methods.
On-going research indicates that some of Money’s assumptions have proven fallacious and some of his techniques, questionable. Nonetheless, the 2000 American Academy of Pediatrics has been hesitant to retract its endorsement of Money’s methods. Through evaluation of Kessler’s ideas and Phornphutkul’s essays, I believe that the Board should suspend Money’s procedure and call for the drafting of new rules regarding infants with ambiguous genitalia.
Dr. Phornphutkul’s article outlines the three underlying principles that govern Money’s theories.
First, gender assignment should be made promptly after birth, as hesitation could result in the stigmatization of the infant. Second, the assignment should parallel the prognosis for future sexual function and fertility as closely as possible. Third, Money emphasized that an infant’s gender is highly “malleable” during the first eighteen months of its life. Because no gender identity has begun, he proposed that proper treatment (hormones) could effectively construct the gender of choice.
In her article “The Medical Construction of Gender,” Kessler criticizes Money’s theories using a variety of arguments. Money considers penis size a determining factor in gender selection, even if the baby shows genetic evidence of a particular gender. Cases have been documented in which XY (male) infants are decidedly raised female because of a “micropenis.” Kessler contends that, while important to a male’s psyche, genetics and not penis size must determine sex. Also, Money considers only two options for “natural” gender. Alternatively, Kessler proposes that an unaltered child is natural; she sees gender inducing hormones and drugs as the unnatural intruders on a natural body. Further, allowing a child to grow up before choosing a gender permits that child to first develop and then decide whether to be male or female. Finally, Money has emphasized parental appeasement over an infant’s well-being. Perhaps he did so in order to nurture healthy relationships between parents and progeny, or perhaps he did so in order to maintain good terms with the party that has access to legal proceedings. Either way, Kessler holds that the infant’s potential well-being, both physical and social, must be seriously analyzed before any drastic steps are taken.
Where Kessler began with theory, Dr. Phornphutkul advances with scientific evidence. Phornphutkul relies heavily on the research of Diamond and Sigmundson. These researchers concentrated on ambiguously-sexed infants who were born with XY chromosomes, yet were surgically made female. They followed the lives of several of these individuals into adulthood. Many were able to weather the effects of gender manipulation and, today, enjoy a normal adult life. However, a number of cases exist where gender-ambiguous infants (especially XY infants that became female) developed into confused and uncomfortable adults. Some sought sex change operations. Such cases “indicate that early sex assignment as female does not ensure female gender self-identification” (Phornphutkul 3).
Phornphutkul then states his thesis: “gender identification is a complex biological and psychological process that most certainly has both prenatal and postnatal components, although the relationship between prenatal biological processes and postnatal psychological processes is not understood” (Phornphutkul 3). For the moment, Phornphutkul concurs with Money’s idea that performance of any gender-altering procedure should occur early on, but voices opposition to the belief that gender can be controlled by external forces. Though he maintains ignorance insofar as no one truly understands the genetic processes that establish gender, his tone reveals anticipation of discovery. He says that he and his colleagues at Brown have “reconsidered and modified their approach to gender assignment” (Phornphutkul 4).
Despite Phornphutkul’s compelling evidence, the American Academy of Pediatrics has yet to denounce any part of Money’s theories, and, pending further investigation, Money’s procedure remains the medically accepted route for dealing with ambiguous genitalia. However, the tone of the paper indicates that chinks have appeared in their armor, and change seems imminent. While the Academy emphasizes that “the majority of the [XY] girls do not overtly demonstrate problems with sexual identity,” they do acknowledge the stickiness of the situation. They recommend that “caution” be exercised when a physician considers differing the “sex of rearing from chromosomal sex” (AAP 7).
Interestingly enough, it is the American Academy of Pediatrics who refer to the birth of a child with ambiguous genitalia as a “social emergency” (AAP 2). They recognize that, medically speaking, such a child is threatened by no imminent danger. Rather, it is the American perception of the abnormality that constitutes the danger. Recognizing all of this, the American Academy of Pediatrics has chosen potential medical complications over likely social antagonism. The flaw lies in that some of these individuals suffer both.
I agree with Kessler and Phornphutkul in the idea that our current method of dealing with babies born with ambiguous genitalia must be improved. “Natural” is a relative term, and these infants, barring any medical problems resulting from the condition, should remain as they were born. Further, medical science does not yet possess the knowledge to guarantee success in a genderassigning procedure. As more evidence and data become available, and as these individuals mature, the opportunity for gender-defining procedures will arise under less controversial circumstances.
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