| 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."
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."
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
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
>> Web: www.isna.org.