Segregation, Sex, Science and Sport

One of the most educated discussions on the segregation of the Sexes is over at Science and Sport.

While I don't agree with some of the premises, nor the conclusions, at least the discussion is rational and educated, based on science (mostly) and facts (most of which are accurate), rather than opinion, superstition, and misconception.

How at least some Intersexed people see the situation is elucidated in An Intersex Perspective on Caster Semanya. A sample (and you should really read the whole thing):

The main thing that saddens me about this story is the emotional tone of the commentaries. Other athletes, people on the street, and low media blogs are full of sneers and winks and nosewrinkled disgust. The major media bring in scientists and voice patronizing sympathy for how humiliating this must be for Caster, meanwhile capitalizing on the prurient interest in the story to gather viewer attention. Underneath it all is a widespread impulse to yank down Caster's pants and let everyone have a good look. It's a freakshow, with an intersex person the object of millions of prying eyes.

Some basic themes that will be familiar to anyone intersex arise over and over in the news coverage. There's ignorance of the very existence of intersex people, evinced in frequent speculation by laypeople that Caster must have had a sex change or engaged in doping. There's confusion of physical sex with gender identity, with detractors, including some of Caster's competitors, referring to her with male pronouns and speaking disparagingly of her butch appearance. There's racist scientific hubris, with Western sports scientists asserting that they can determine Caster's "true" dyadic sex after doing an exhaustive investigation of her chromosomes, hormone levels, anatomy, gonadal tissue, and psychology, while speaking derisively of the ASA's investigation as being unsophisticated. And most of all, there's the overwhelming belief in the myth of dyadic sex. Caster must be female or male; intersex cannot exist as a sex category.

One depressing sideline of this insistence that Caster must have a definitive dyadic sex is the regularity with which the term "pseudohermaphrodite" is raised by detractors. I've posted on how this term emerged in Western medical science to try to define away the existence of intersexuality ( see here.) Basically, in trying to erase the challenge intersex people place to the medical ideology of sex dyadism, doctors in the 20th century decided to call all intersex individuals who did not have ovotestes as their gonads "pseudohermaphrodites," no matter what their anatomy or experience. Somebody can be raised female, with average-looking genitalia and secondary sexual characteristics such as breasts, living a typical valorized heterosexual life, femme as can be (housewife, reader of romance novels, cookie-baker), yet all unaware, have internal testes and androgen insensitivity syndrome. If she goes to a doctor for treatment of infertility, suddenly she'll find herself labeled a "male pseudohermaphrodite." The medical term defines her as "really a man," not even intersex, let alone a woman. Anyone with testes is "really a man" according to this scheme of classification--which reveals the sex politics and semantics in supposedly "objective" science.

Those same politics emerge from the mouths of Caster's detractors. She is a "pseudohermaphrodite," they claim--not a woman, not even intersex, but a man trying to cheat honest female competitors.

Here's an irony for you. According to Western medical practice, the majority of infants discovered to be intersex are assigned female. This is done for surgical convenience (it being considered easier to remove an "inappropriate" penis than create an "appropriate" one), and due to a covert assumption about gender psychology, that women can deal better with gender ambiguity than can men. So we're assigned female, told we are "really women," subjected to mutilating infant surgery, expected to identify as female, not intersex, told to keep our medical history, if we know it, a secret, and sent out to live dyadic female lives. Many of us carefully live by the rules. But it turns out that if we do as we are told, we are still subject to being outed, discredited, mocked, and returned unceremoniously to the status of intersex oddity, as Caster's life illustrates--accused of breaking the rules.

A quick aside: the words "Hermaphrodite" and "Pseudohermaphrodite" are deprecated, just as are the words "Negro" and "Half-caste".

They can still be used as specific technical terms for a small number of IS conditions; "Hermaphrodite" meaning that both ovarian and testicular tissue is present, and "pseudohermaphrodite" meaning a person with cross-gendered fertility - a biological male capable only of female reproduction, or the reverse. And the latter term is not in general use.

Anyway... yes, this is how Intersexed people are treated, in general. The binary gender model is a good approximation, but it's treated as Revealed Truth, and anyone not fitting neatly and squarely into one or the other of the two recognised categories is anathematised. Even if that's very obviously the biological reality, with no question of "lifestyle choice".

Regarding the biology, and the mass ignorance thereof... in the comments section of the previous post, commenter "Sidney" wrote:

Hi Zoe,
After reading the Daily Telegraph of London, I read some of the 299 comments and per usual everybody has an opinion about something they know nothing about. All speculative! As a Urologist, who lectures on this very subject to medical doctors, let me tell you what I think I know from reading the AP from Pretoria, SA. Caster Semenya has a probable genetic Disorder of Sexual Development known as Partial Androgen Insensitivity Syndrome, probably Grade 5 or 6, where the external genitalia are female-like and the internal genitalia are vestigial testes, which produce Testosterone and Estrogen. I say probable because we cannot know if she has any ovarian tissue mixed with the testis tissue until these vestigial organs are examined under the microscope by a pathologist. This will probably never happen, unless it is presented to her as a condition for receiving female hormones. At this moment everyone is assuming she is an XY woman. Now somebody said she had three times the normal female Testosterone level, which according to this one lab gives her less than their normal male values. Now every lab has its own normal values and we have not seen any numbers. So here are the values from just one lab, not her testing lab.

http://www.bloodindex.org/normal_laboratory_values.php

Determination Normal Reference Value
Testosterone: Conventional units SI units
Female 6–86 ng/dl 0.21–3 nmol/L
Male 270–1070 ng/dl 9.3–37 nmol/L

But it doesn't matter what her serum Total or Free Testosterone is because the definition of PAIS implies that the cells which receive T cannot utilize it because their Androgen Receptors will not bind the T effectively. That's why she has female external genitalia at birth. Interestingly the research in this area is so complete that the Chromosomal mutation on the Androgen Receptor can be identified. Usually these women and I say women, because that is how they have been raised and gender identify as female, are diagnosed in their teens because they cannot menstruate or conceive. Now in truth I know no more about her physical condition than what I read in the newspapers. Is the London Daily Telegraph a tabloid or the cousin to the New York Daily News? Poor Girl !!!!

I'd put the UK Daily Telegraph at about the level of the LA Times. Not quite the WSJ, but not the late unlamented National Inquirer either. As is the Australian Daily Telegraph (which is the one with 299 comments).

To explain the grades of PAIS - partial androgen insensitivity syndrome - from the AIS Support Group :

Grades of Partial AIS

In AIS Grades 5 and 4, the clitoris is enlarged. In Grade 5, there may be partial fusion of the labia majora (outer vaginal lips), in which the posterior (back) portion of the labia form a web of tissue across the back part of the vaginal outlet. In Grade 4, this fusion extends further forward, covering both the vaginal opening and the true urethral opening. The cavity formed by the fused labia, through which urine exits, is called a urogenital sinus.

The labial fusion can be surgically divided, making the vaginal opening accessible for pressure dilation (a non-surgical way of lengthening the vagina). This division is a relatively minor operation, and is unlikely to adversely affect erotic sensitivity, but it should be performed by a physician familiar with this type of surgery. Vaginal dilation can be successful in Grade 4 AIS, and should always be attempted before surgical vaginoplasty is planned.

In Grade 3 and the more masculinized form of Grade 4, the labia are completely fused, so that the urethral opening is at the base of the clitoris/penis. The fused labia may have a rugose, or wrinkled appearance and form a bifid, or double, scrotum. The fusion is then more properly called 'labio-scrotal fusion'. The phallus has the appearance of a large clitoris, or a small, bent, penis, bound down in structures called chordee. The chordee is formed from the same tissues that form the labia minora in the female and the frenulum of the penis and the tissues surrounding the urethra (corpus spongiosum) on the underside of the penis in the male. It is not true that the presence of chordee makes erections painful.

In Grade 2, the genital appearance is that of a male with hypospadias, that is, with a urethral opening located somewhere on the underside of the penis. There may be an open gutter running from the urethral opening to the glans of the penis.

To say that Alice Dreger is a controversial character amongst IS and TS circles is like saying that the inside of the Sun is moderately warm. Certainly her spirited defence of Dr Bailey, her mentor, is, well, full of it.

Not so her article on Intersex generally. In fact, it's difficult to believe that it's been written by the same person. Another example of how opinions can differ between reasonable people, and that demonisation of one's opponents just because they obtusely differ from your own Perfect Opinion is almost always a mistake. One she's been guilty of too, I might add.

Anyway, her article is a polished summary of Intersex, one I'm going to keep as a reference for the layperson. One that's worth reading in toto¹. And apart from going into the biology, she has something else to say too:

Why do you sound so grumpy about this sometimes?

Because honestly, this is not the first time these issues have come up. Why is Caster Semenya having her life tossed about in the international media like this? There’s no good excuse at this late date in history for sporting officials to still not have a clear policy about how they’re going to manage sex anomalies among athletes competing as women.

I’m also annoyed because the treatment of Semenya in a lot of the media has carried the message that “real” women are not powerful. It frustrates me that Semenya has had to get a pretty hair-do to compete as a woman in the court of public opinion.

Finally, I’m tired of seeing all my friends born with atypical sex have to face so much fear and stigma every time these issues hit the news. I wish that the media would realize, every time they cover these stories, they are impacting the psyches of every one out there who has a sex anomaly or who loves someone born with one. That includes lots of parents of wonderful little girls and boys who deserve to have their parents not worry so much about stupid public reactions to known conditions.

Which is to say: Please stop calling these people hermaphrodites! They’re our friends, neighbors, children, lovers, doctors, lawyers, teachers, military personnel, florists, counselors, bus drivers, and priests.

Not forgetting the odd (and sometimes very odd) Rocket Scientist.

Support for people with AIS:
AISSG - AIS Support Group
OII (Organisation Intersex International) Australia
Intersexnews Blog
Sophia Seidelberg (OII)
AISSG - Australia

1) For all fans of the Wizard of Oz, remember this: Outside of a Dog, a Book is Man's best friend. And inside a Dog, it's too dark to read.

UPDATE: Segregation, Sex, Science, Sport... and Suicide.

Lawmaker Butana Komphela, chair of South Africa's sports committee, was quoted as saying: "She is like a raped person. She is afraid of herself and does not want anyone near her. If she commits suicide, itwill be on all our heads. The best we can do is protect her and look out for her during this trying time."

ENOUGH! Even the strongest material has a breaking point.