Impact on the Treatment of Intersexuals

“Sexual differentiation is a complex process which results in a newborn baby who is either male or female. If errors in development occur, sexual development is abnormal and the sex organs of the baby are malformed. In such cases, individuals may develop both male and female characteristics. This is referred to as intersexuality.”

As an unwitting landmark test case and somewhat social experiment, the John/Joan fiasco has irrevocably impacted the manner in which physicians and professionals approach infants born “intersexed.” Though the controversy on what defines “gender” is far from being resolved, the consequences of “John’s” unfortunate tragedy have forever changed the annals of medicine and the resultant treatments of individuals with ambiguous external genitalia.

This case is important in many aspects of treating intersexuals. Even though John was genetically born a male (hormonally normal, with gonads intact upon birth), he was essentially “robbed” of his maleness once his penis was destroyed in the botched operation with the subsequent removal of his testis to facilitate his sexual reassignment. Even with the profound physical transformation of his external characteristics, his psychic sense of self was manifested and set biologically from birth.

At an unfathomable cost, the serendipitous, yet tragic act of changing “John’s” gender has gone on to provide an intimate look of the pathology of the nature vs. nurture controversy. Emerging out of the shadowy penumbra of what defines gender, we’re finally able to home in on the overwhelming evidence of biological influences, primarily those that are prenatal in origin. John’s internal and unconditional feelings (not based on the somewhat staged circumstances at hand) fueled his inclinations and naturalistic drive towards masculine behaviors.

The truth of his original gender was unbeknownst to him until he was on the verge of imploding from this cosmic disconnect…the inexplicable feeling of an unrelenting cognitive dissonance that he couldn’t explain away or rationalize. It is this very powerful mechanism: of the body’s ability to direct itself towards gender identity rather than one that is socially prescribed, despite what superficial physical traits one has. John’s own comments reflect the dilemma of the pressure to adhere to the confines of having distinctly male or female genitalia:

“…these people gotta be pretty shallow if that’s the only thing they think I’ve got going or me; that the only reason why people get married and have children and have a productive life is because of what they have between their legs…If that’s all they think of me, that they justify my worth by what I have between my legs, then I gotta be a complete loser…

Because we still understand so little on the intricate interplay and subtleties of hormonal influence in children born intersexed, Dr. Diamond argues, looking back in retrospect, for physicians to hold off on sexual reassignment until the child reaches puberty, when the endocrine glands begin to function more fully.

His thought is that this process should be somewhat self-directed, as the “body” naturally signals the brain, sending cues for the direction of sexual and self identification. Unfortunately, puberty typically does not begin until late childhood, and for parents and the child itself, living with undifferentiated or ambiguous genitalia for this length of time can be difficult, wrought the confusion and even guilt.

So much of what society interprets as “male” or “female” traits are anachronisms from a culture replete with stereotypes and limitations. These were especially true coming out of the 1950’s where traditional roles were fairly stringent and unforgiving to those who challenged them. By the time the Feminist Movement and Women’s Lib erupted in the 1970’s (when John’s procedure took place) the medical community was also in the nascent stages of understanding the cultural constructs of what makes us male or female. The “Battle of the Sexes” became bigger than Billie Jean King and Bobby Riggs on a tennis court…it began to shape a whole new way of looking at who are and why we are. The case of John/Joan became a microcosm for studying these universal questions whose answers many of us take for granted. At least now, 30 years after the fact, children born intersexed may finally be able to decide for themselves.