POSTSCRIPT / May 17 2012 / Thursday

By FEDERICO D. PASCUAL JR.

Philippine STAR Columnist

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What to do with kid in intersex situation?

INTERSEX: Taking as a cue Bible-toting boxing champ Manny Pacquiao’s jabbing President Barack Obama for favoring same-sex marriage and the flap over a transgender candidate in a recent beauty contest, we share this piece on the male-female question.

The article is written by E. Christian Brugger, a Senior Fellow of Ethics and director of the Fellows Program at the Culture of Life Foundation, Washington, DC.

In an earlier column, he mentioned a condition called “intersex,” where the sex of a child, because of the anomalous formation of physical characteristics that ordinarily distinguish a male from a female, can be very difficult to determine. Below, all the way down, he elaborates:

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ABNORMALITIES: Formerly referred to as “hermaphroditism” (from the names of the Greek deities Hermes and Aphrodite, the male and female gods of sexuality), intersex is actually a group of conditions under the larger category of disorders of sex development.

Because of genetic and/or anatomical abnormalities, a child may possess both male and female biological characteristics. Such children may have ovaries, a partial or whole uterus and a penis, or an abnormally large clitoris that appears like a penis. Or they may have a partially formed vagina, with one ovary and one testicle, or rudimentary tissue of both (“ovotestes”), or just one, or neither.

The discrepancy between the external genitals (penis, vagina) and the internal genitals (the testes and ovaries) may be coupled with chromosomal anomalies. Rather than the ordinary patterns of sex chromosomes (XX-female or XY-male), they may have only a single sex chromosome (XO), or an extra sex chromosome (XXY or XXX), or chromosomal sex reversal (XY-female, XX-male). The condition is quite rare.

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TORTURED LIFE: In the past, doctors routinely responded to an intersex birth by recommending genital surgery, more often than not, the construction of female genitals since vaginas were easier to make than penises. This was the case whether or not the sex of the child was a settled fact.

The trend was partially due to the bogus theories on sex and gender of the infamous Johns Hopkins psychologist and “sexologist” John Money (1921-2006). He drove a wedge between the concepts of “genital sex,” a crude function of biology, he thought, and “gender identity,” which he believed was more basic to personal identity and was the product of how a child was raised (i.e., was “socially constructed”).

When Money came across the boy David Reimer in 1966, victim of a botched circumcision that burned off most of his penis, the doctor recommended that physicians “reassign” the boy as a female by amputating his testicles, surgically constructing a vagina, pumping him full of female hormones to “feminize” him and raising him as a girl (given the name “Brenda”).

The experiment was a total failure. David lived a tortured life of confused identity, later rejecting his imposed female identity and finally shooting himself in the head in 2004 at the age of 38.

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PANGENDERIST: In the last 10 years, clinical overconfidence on how best to respond to intersex births has moderated. Most doctors reject the Money thesis that gender is malleable enough to erase and reassign at will.

But according to the Intersex Society of North America, there is still a tendency to rush to “cure” the condition early on by using surgical, hormonal and psychological treatments.

Unfortunately, the ISNA simultaneously advocates a pangenderist view of sex and gender. It denies that every human person is either male or female, that intersex is an anatomical/chromosomal disorder, and that “normalizing” intervention is necessary. It asserts that the condition is merely an “anatomical variation from the ‘standard’ male and female types.”

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CHURCH VIEW: Brugger notes that while no official Catholic teaching has addressed the problem of the intersex condition, these points seem consistent with what the Church holds:

1. Because of the Christian doctrine of creation, especially the teaching of Divine Revelation that human persons are made “in the image of God … male and female” (Genesis 1:26-27), we must reject the view that the intersex condition represents a person who is not or may not be either ontologically male or female.

It may be difficult, even effectively impossible to determine with certitude; but our lack of certitude should not be taken as an indication of a factual ambiguity about the nature of the intersex person, only ambiguity in our measure of knowledge.

2. If the sex of a child is certain, as it may be in the case of some partial intersex conditions, then, parents are justified in adopting therapeutic interventions aimed at correcting the disorder and normalizing the body anatomy and chemistry in line with the child’s sex.

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TELL THE CHILD: Any rush-to-judgment as to the question of the child’s sex and hence any simplistic surgical assignment of sexual identity would be gravely immoral because it would be unfair to the child.

Parents should have “moral certitude” of their child’s sex before they make permanent surgical interventions determining the sex one way or the other. Moral certitude is reached when all reasonable doubts to the contrary have been dispelled.

Does the absence of moral certitude mean that parents should raise an intersex child genderless, or as a kind of “third gender”? No. The ISNA recommends that after rigorous testing (hormonal, genetic, diagnostic) and consultation with other families with intersex children – and for Christians, after importunate prayer to God on the child’s behalf — parents should “assign” a gender to their child based upon the best evidence. They avoid going to the extent of genital assignment surgery.

The parents and doctors then carefully observe the child over time. If serious reasons arise for reassessing their original judgment, then a careful reassessment with the assistance of trustworthy experts should be undertaken. If the child adjusts well, then they should continue confidently to raise him consistent with their original decision. They should always tell the child the truth about his or her condition as appropriate to his or her age.

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(First published in the Philippine STAR of May 17, 2012)

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