Ms. Magazine
 
ON THE SITE:
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.
Editor's Page
The Pale Males
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Book Reviews
On the Ms. bookshelf
An American Story by Debra J. Dickerson
Manifesta by Jennifer Baumgardner and Amelia Richards
Scapegoat by Andrea Dworkin

The Way Forward is With a Broken Heart by Alice Walker
Stolen Harvest by Vandana Shiva
White Turtle by Merlinda Bobis
Becoming Madame Mao by Anchee Minn

ALSO IN THE ISSUE:

First Person: Childless by Choice

Special Report: A Married Woman's Right to Live

Ms.Cellaneous
Women to Watch
Just the Facts
Word: Tenderhearted

Uppity Women: Go, Granny, Go

Your Health:
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Poetry: In Search of an American Language

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Columns: by Megan Koester, Patricia Smith, and Gloria Steinem

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Justine Marut Schober is a pediatric urologist who specializes in surgery on children's genital and urinary systems. A respected surgeon in a male-dominated field, she has performed many clitoroplasties. In the late 1980s, as a pediatric urology fellow in London, she first began to wonder about the wisdom of changing a child's healthy genitals. "Even though we were taught to be very conservative with surgery, the more I thought about it, the more uncomfortable I became."

Back in the U.S., she was shocked to find that feminizing genitoplasties, including clitoroplasties, were used even more widely than in England. But she continued to perform them, even as her discomfort grew. Soon she began to seek out grown women who had been subjected to this procedure as children. She found Cheryl Chase and, through her, many others. "One of the worst things I learned was that they felt deprived of choice. Because this surgery might not be their choice. And with this surgery, you may deprive people of sexual sensitivity or possibly orgasmic potential or even just the right to have sex in the gender they feel most comfortable. It just started sickening me. I looked at the literature and there was nothing that told me if this surgery helped or hurt. That's when I stopped."

At a recent meeting of intersex specialists, Marut Schober described new research that shows the clitoris is more densely laced with erotic nerves than formerly believed, nerves one cannot avoid cutting in a clitoroplasty. She also pointed out that no one has ever found or cited a single case to support the long-term physical and psychological success of this surgery. And that is the most confounding issue. We simply do not know. Ian Aaronson may be right, maybe the good outcomes do outweigh the bad, but only now are studies being designed to register all patients with atypical sexual anatomy in order to accurately assess their quality of life and to follow them all the way through childhood and into adulthood.

Activists like Cheryl Chase and health care providers like Justine Marut Schober are calling for a new protocol-raise children with atypical genitals in a gender most appropriate to their bodies, provide counseling for them and their families, and allow decisions about genital plastic surgery to be made by the person whose genitals will be changed, at an age when they, not their anxious parents or well-meaning doctors, can give informed and educated consent. As William Reiner, a pediatric urologist turned child psychiatrist at Johns Hopkins, puts it, "If you've got a 14-year-old girl who comes in and says, 'I absolutely cannot tolerate this. It makes me think I'm a boy. I'm a girl, and I want my clitoris made smaller,' then after appropriate counseling, if she's still serious, we have to listen to her. She's a human being. She's not an adult, but so what? In other words, you can leave these clitorises alone for a long time and let the kids decide what they want to do."

Journalist John Colapinto recently wrote a book called As Nature Made Him: The Boy Who Was Raised as a Girl. It's about the boy John Money put forth as evidence that we can make a child any sex we want if we get to her or him early enough. Although Money was considered the leading exponent of genital surgery from the mid-fifties on, Colapinto points out that even then, research showed that surgery was not necessary. In his book, Colapinto reports on a careful study done in 1951 in the U.S., four years before the establishment of surgical protocols for atypical genitals. The study investigates 250 people with atypical genitals who were left untreated as babies. The study also includes interviews with ten people who either never received surgical or hormonal treatment or chose it when they were old enough to make their own decisions. Colapinto comments that the lives of these individuals, "only strengthened the investigator's impression that the condition of the genitalia plays a strikingly insignificant part in the way a person develops a stable and healthy gender identity, not to mention a secure and confident self-image."

This positive picture of gender development with either a large, healthy clitoris or a small, healthy penis was painted by none other than John Money, whose work helped convince four generations of doctors that such a clitoris or penis would cause a child irreparable difficulty. The study was Money's Ph.D. dissertation, never commercially published or distributed. After reading of this study and knowing what followed-—the long, unexamined practice of cutting into children's genitals to make them more acceptable-—the practice seems like a sad, avoidable mistake.

A big clitoris on a girl or woman in the 1600s, when discovered by a witch hunter, was seen as a "devil's teat." It alone was enough to condemn her to death. We are more civilized today. We're beyond witch hunting, and we're appalled by countries that routinely clitoridectomize their daughters. But we still treat a bigger than average clitoris on a child as fair game. If her parents or doctors want it made smaller, it will be made smaller. She can do nothing to stop it. But the world is changing. People with atypical genitals are no longer solely relegated to "interesting case" status and tucked away in medical books. Their stories, in their own voices, can be read in books, magazines, or on the Web. These stories bring a new and crucial perspective to an old and damaging view of difference.

Recently, a pediatric endocrinologist wrote to me that he believes children born with atypical genitals face difficulties in our culture, whether their genitals are surgically corrected or not. "The point," he said, "is how to make the landing as soft as possible." In the fall of 1999, the North American Task Force on Intersexuality was created to develop that soft landing. The task force is a small group of strange bedfellows-psychologists and surgeons, social scientists and medical doctors. Ian Aaronson, Justine Marut Schober, and William Reiner are members, as is Cheryl Chase. People are talking to each other at last and change is in the air. The story of clitoridectomy in the U.S.-—a procedure whose name, technique, and intention changes with the society it serves-—began with Isaac Baker Brown, but it just might end with us.

Martha Coventry writes about medicine, family, and the "beauty of the world" from her home in the Midwest.

Contact the Intersex Society of North America at P.O. Box 3070, Ann Arbor, Mich. 48106-3070

>>e-mail: info@isna.org
>> Web: www.isna.org.