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Beyond the Binary

By: Sai Siddhaye

This January, Senate Bill 201 failed its first vote in the California Senate. This bill would have banned cosmetic genital surgery on intersex infants until the age of six, and would have been an important protection of bodily autonomy for a community that has been mistreated for decades. This alone demonstrates how little intersex people are included in decisions of their own health and legal rights. Intersex people make up a non-negligible portion of the global population, yet are rarely acknowledged in conversations about sex and sexual health. In our binary-oriented culture, there is little space for nonconformity of any kind. Discourse surrounding gender and sex often hinge on biological essentialism, and frame the world as biologically male and biologically female. Though these arguments are usually targeting trans and nonbinary identities, they also fail to create a space for intersex people, and therefore ignore the role that biology and genetics actually play in the development of sex characteristics. Over the course of the past century, intersex people have been one of the many marginalized groups who have been violently mistreated by the healthcare and legal systems; to understand the harm that has been done, we must learn the history of intersex discrimination and what intersex people themselves have been fighting for. 

In the 1960s, a psychologist named Dr. John Money developed the theory that individual gender comes from a process of socialization. This challenged earlier European beliefs about gender and sex being indistinguishable, and was extremely controversial. However, Dr. Money’s separating of gender and sex was not necessarily a precursor to the way that gender and sex are viewed now. Today, separating gender and sex can be interpreted as a subversion of bioessential gender constructs, but it was not always this way. Dr. Money’s ideas about how gender is socially constructed was not a rejection of gender constructs and roles, but rather was a way to impose hegemonic ideas of masculinity and femininity on people to change their gender  and further alienate gender nonconforming people. Separating sex and gender, therefore, was a way for Dr. Money to stabilize the idea of a sex binary. The deeply problematic nature of his theories came to light in the case of David Reimer. David, born as Bruce Reimer, suffered damage to his penis as an infant, and was subsequently raised as a girl under the forceful guidance of Dr. Money. Reimer underwent genital surgery and hormone replacement therapy–as was very common for intersex infants or children with genital abnormalities–and was never told of his medical history. Despite his change in sex, his own gender identity did not change, and Reimer suffered from intense gender dysphoria and depression, eventually committing suicide after multiple previous attempts. The consequences that Reimer faced as a result of Dr. Money’s intervention demonstrates the importance of having autonomy over one’s own body, and how gender and sex are far more complex than what we understand. 

Intersex is tied to transness medically and socially because of the implications of gender nonconformity that it produces. Dysphoria has become a precursor to access trans health, even though transness and intersex can exist without medical intervention; dysphoria is a product of socially imposed bioessential ideology, not an inherent indicator of transness. This is why trans and intersex activists have been fighting for the right to choose what to do with their own bodies for decades. The Intersex Society of North America was founded in the 1990s as a source of community for intersex people, as well as a tool to advocate for people who have been harmed by the healthcare system. Though it closed its doors in 2008, their website remains as a resource and their work is being carried on by interACT. Many intersex activists have been highly involved with educating people about intersex lives and how to support them. Mani Mitchell created the documentary Intersexion, which discusses the ways that social stigma, a lack of resources, and violent medical practices makes it very difficult for intersex people to retain their bodily autonomy, and why they are worse off because of it. This documentary also features others involved in intersex activism, including Hida Viloria and Tiger Devore, who describe how genital surgeries negatively impacted their health with long-term effects. One huge takeaway is this: many intersex people do not want cosmetic genital surgery. It infringes on their autonomy and imposes on them a sex binary that does not exist. 

This brings us back to California Senate Bill 201. This bill would have prohibited medically unnecessary cosmetic genital surgeries on children until they could provide informed consent, allowing them to choose what to do with their own bodies. Not only would it have preserved the bodily autonomy of intersex children, but it would have also given them the option to live outside of the imposed sex binary. This bill sparked controversy, and uncovered the practice of addressing parents’ distress by performing surgery on their infant. It was introduced in 2019, and rejected by the California Senate on January 13, 2020. This loss demonstrates how little the general public knows about intersex issues, health, and experiences; as bodily autonomy continues to be politicized and argued, intersex health must be advocated for just as much as women’s health and reproductive rights. Until everyone can choose what to do with their own bodies, the fight continues.