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Making The Cut
Every time a baby is born in the U.S., doctors decide whether its genitals are "normal" or not. A girl born with a big clitoris is in big trouble.
by Martha Coventry

Sarah Jones Can't Wait
A woman on a mission to marry activism and art
by Jennifer Block

Lunching With the Enemy
The Independent Women's Forum are a slick antifeminist bunch, and they're always ready for prime time.
by Susan Jane Gilman
Naked Old Ladies
These arresting portraits of aging women debunk the myth that beauty is synonymous with youth.
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The Way Forward is With a Broken Heart by Alice Walker
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White Turtle by Merlinda Bobis
Becoming Madame Mao by Anchee Minn


First Person: Childless by Choice

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There are basically three ways to make a clitoris look smaller without removing the entire organ. The most frequently used method is clitoral reduction, where surgeons free the shaft and glans from the surrounding tissue and peel away the skin that covers it. Then they cut out pieces of the shaft to shorten the clitoris before sewing the glans up tighter to the pubic bone. (It's a little like someone taking out sections of the bones in your arm and sewing your hand up closer to your shoulder.) Sometimes a surgeon will make a running stitch along both sides of the shaft and accordion the entire clitoris back, sort of squishing it against the pubic bone. The third technique is what one surgeon calls "magic with skin." The skin is repositioned around the clitoris so it looks smaller, without actually taking away any tissue.

All over this country there are people whose clitorises have been removed, either totally or partially. They range from your great-aunt's roommate in the nursing home to your neighbor's two-year-old. They include hundreds of women from every generation. Some were born clearly female; some were born clearly male but were reassigned as female and then had their genitals altered; and some were babies whose sex was not so easy to define. Although statistics for childhood clitoral surgery are extremely difficult to gather, one can extrapolate a figure from the number of babies born each year in the U.S., the number born with conditions that produce enlarged clitorises, and the number-—most of them-—who will undergo clitoroplasty. Approximately five times a day in the U.S., surgeons change the size and shape of a child's healthy clitoris. Few of these children are capable of expressing what they want. Some, if given the choice later in life, might choose clitoroplasty. But judging from the responses of women who had the surgery done either without their agreement or at an age when they were too young to know what they were agreeing to, many would have preferred to stay the way they were.

Gaby Tako was born in the Bronx just before Christmas in 1960. She arrived so fast that her mother had to give birth at home. The neighborhood doctor hurried over to help and announced to the waiting parents, "Congratulations! It's a boy!" before quickly adding that he wasn't exactly sure about that. Gaby had labia fused into a scrotal-looking sac, a vagina that shared an opening with her urethra, and a big clitoris—not an untypical presentation for a girl with CAH-—congenital adrenal hyperplasia—a condition that causes the adrenal glands to produce too many male steroids, which in the case of girls, can masculinize their genitals. One in about every 10,000 children is born with CAH. Because the disease can wreak havoc with the balance of chemicals in the body, it can be life-threatening. The large clitoris that often accompanies CAH gets bundled in with other medical concerns and often a clitoroplasty is done—primarily for cosmetic reasons. According to Cathy Kusch, spokesperson for Magic Foundation, which supports families whose children have CAH, many parents do seek second or third opinions when it comes to clitoral surgery, but in the end, the majority choose clitoroplasty. A medical paper written in 1994 affirms that "parents will feel reassured [after genital surgery on their child] when they know that their daughter can develop heterosexually just like other girls." In Gaby's case, her endocrinologist, unlike other doctors at that time, didn't think surgery on newborns was worth the risk. The decision was made to wait.

Gaby's early childhood was rough. Her body was different, and she knew it. "Between birth and age 13, I was never outright ashamed about my body because there are certain things you don't talk about in polite society. I don't remember anyone telling me that it was bad, but I picked up on the fact that I was different and that this was not a 'good' difference. The doctors would poke and prod me and because my genitals were always the center of attention, that made me ashamed."

After having put the doctors off for several years, Gaby's mother and stepfather consented to surgery for her when she was 13. The surgeon told Gaby he was going to "fix her." "But I didn't know I was broken," says Tako. "I knew I was different but not that I was broken." As she awaited surgery, Gaby fantasized about climbing out of the windows of the hospital, escaping across the rooftops. "I had no way to articulate that this was not necessary." She awoke from surgery with searing pain. The surgeons had created a bottom portion for her vagina to make an outlet for menstrual blood. They split her labia and, in a procedure popular in the 1970s, buried her clitoris under a layer of skin. "Three and a half inches of coiled phallus with nowhere to go," is how Tako describes it now.

"I felt dirty after the surgery," she says. "I was, as we say, F.I.N.E.—fucked-up, insecure, neurotic, and emotional. My genitalia were never painful before, but since then, to one extent or another, they have been a source of pain." In a postsurgical visit to the doctor, Gaby asked, "Can't we undo this?" and the surgeon answered, "Why would you want to do that?" Today, Tako, who lives as a lesbian, considers herself a product of "forced feminization."

Until about six years ago, no one challenged the established protocol of altering the clitoris of a girl like Gaby, nor of any other child in our country. The U.S. public had no idea these surgeries were going on, and most doctors considered them a necessary treatment for a rare group of people. Medical schools spend only a few hours on the subject of intersexuality, with surgery hardly mentioned at all. Intersexed children with "abnormal" genitals are depicted in medical books naked and with a black band across their eyes in photographs, lending an aura of freakishness to them. They historically have been given the label "hermaphrodite," and further categorized as "true hermaphrodites" (people who have some ovarian and some testicular tissue), or "pseudohermaphrodites" (boys with testes and some feminine characteristics or girls with ovaries and some masculine characteristics). These names also serve to marginalize the children, hiding the fact that this is a far larger group than anyone realizes. Even the doctors who care for these patients as children know little or nothing about them as they grow into their adult lives. They are "fixed," like Gaby, and lost to follow-up.

For decades it was assumed that everything was more or less all right with these patients. Ian Aaronson, a pediatric urologist with a history of performing genital surgeries on girl babies, believes that most, who are now adult women, "have no idea they had surgery done and regard themselves as absolutely fine, and they look absolutely normal"—although he acknowledges there is no proof of that. But in 1993, a letter to the editor of The Sciences magazine began to cast doubt on the optimism of people like Aaronson. In an earlier issue of the magazine Anne Fausto-Sterling had written an article that she hoped would rattle the public's narrow thinking about sexual dimorphism. With tongue-in-very-erudite-cheek, she proposed that there are not two sexes, but five—male, female, herm (for hermaphrodite), ferm (for female pseudohermaphrodite), and merm ( for male pseudohermaphrodite). At the time, Cheryl Chase, a young businesswoman, had just returned to the U.S. from Japan, where she had helped found a successful software company. Chase had been born in 1956 and named Charlie. He was a little boy with a little penis. Eighteen months later, doctors found that Charlie had a uterus and ovaries and that each ovary had a small corner of testicular tissue. But because the ovaries were found to be functional, the decision was made to change his sex of rearing.

Charlie became Cheryl. What doctors had considered a "tiny" penis was now seen as a grossly large clitoris. In order to feminize the toddler, the surgeon incised deeply to obliterate any trace of a clitoris, removing the shaft along with the glans. Chase was left with a smooth, Barbie-doll look and a thin layer of scar tissue with no erotic sensation. On the advice of the doctors, her parents destroyed all evidence of her as a boy, and when it was time for her to begin school, they moved to another town where no one knew them.

When Cheryl was ten years old, her parents told her that when she was a baby, her clitoris had been "enlarged" and had had to be removed. Everything was fine now, they continued, but she should never tell anyone what was done to her. Chase describes herself as growing into a "withdrawn, depressed adolescent, trying to steal a glance of a woman's genitals" so she could figure out what she was supposed to look like. At age 19, she went searching for her medical records. After several years of struggle, she finally obtained them and discovered what had been done to her. The fact that her parents, doctors, and relatives had hidden the truth so completely from her confirmed its unspeakable nature. Suicide beckoned. "It is not possible," she remembers telling herself. "This cannot be anyone's story, much less mine. I don't want it."

Fifteen years later, in Japan, Chase suffered a "complete meltdown." She came back to the U.S. partly because she thought there would be help for her here. There wasn't. Not a single clinician she contacted, including John Money, the sexologist at Johns Hopkins, would acknowledge that her treatment might have done more harm than good, nor would they introduce her to others like her. It was during this time that she read Fausto-Sterling's article and fired off a letter to the editor announcing the formation of the Intersex Society of North America (ISNA) complete with post-office box address. Within weeks, Chase found her postbox stuffed with letters from people from all over the country who had had cosmetic genital surgery performed on them as children. All of them had grown up thinking there was no one else like them in the world. As of today, hundreds of intersexed adults and families, and scores of physicians worldwide, have contacted ISNA.

Chase's letter to The Sciences is noteworthy for three reasons: it marked the first time a person subjected to cosmetic genital surgery as a child had publicly broken the silence around this practice. It gave intersexed people a way to find each other. And it fostered the growth of a grassroots movement to change a surgical protocol so entrenched that surgeons fly all over the world to perform it gratis as a humanitarian gesture.

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