A young woman, age 22, is about to
marry. During an exam, she tells the nurse that she never had a period. On
further examination, she learns she has a condition they called testicular feminization
syndrome. As the story unfolds, viewers learn about what we now call Differences of Sex Development or DSD. It's also been called intersex.
I won’t spoil the show for you!
As usual, the series tastefully
deals with difficult subjects. Different characters display different emotional
responses as the story unfolds. The care is provided by the Christian sisters serving
women and their families in one of London’s poor areas (Poplar). If you want to
see the show, it is Episode
5 of Season 8.
INTERSEX or Disorders
(Differences/Diverse) of Sex Development (DSD)
Currently, scientists refer to the woman’s condition in the
episode as a type of intersex or DSD condition called Androgen Insensitivity Syndrome
(AIS). People with this AIS condition are genetically male (XY) but resistant
to the male hormones (androgens). Thus, the person has many physical traits of
a woman but has a man’s genetic presentation. There can be variations from partial
to complete AIS.
Intersex is a
somewhat older term for a broader category of people with atypical sex
conditions, which includes people whose sexual anatomy does not fit the usual
appearance of male or female. In 2005, a name for a broad category of atypical
sex conditions was created as Disorders
of Sex Development or DSD. External
genitalia can vary as can internal sex organs. The observable sexual
characteristics can differ from the chromosomes (XY, XX, XXY). Some conditions
are evident at birth and some are evident at puberty (Read more in this article
from Pediatrics).
In case you are tempted to think there are three, four or
five sexes, let’s be clear that mismatches between chromosomes and sexual
anatomy can vary and be complex. As one example, some people are mosaics—having
a mix of different chromosomes where some cells in the body have the female
(XX) and others the male (XY). For more information on advances in the scientific
understanding of variations in gene variations leading to differences in sex
development, see Conway (2014).
You might wonder how many people are born with such a
condition. So far, the data do not reveal a clear number because different
conditions have been identified as being a part of DSD. The conditions are not
frequent (see e.g., NYT).
Media reports picked up on the writings of Fausto-Sterling, which suggested
intersex conditions were more common than we might think, but Leonard Sax
challenged her data and notes the problem of who ought to be included in a
category when attempting to estimate the number of children born with a
condition that could be identified as intersex.
Based on his analysis and
definition of intersex, human sexuality remains a dichotomy for almost all
humans with the birth of a child with intersex occurring less than 2 out of
every 10,000 births (See Leonard
Sax, 2002).
Current medical practice focuses on people with DSD, which
includes conditions of Turner and Kleinfelter syndromes and the hypospadias.
When all the DSD conditions are part of the definition of a sexual difference, the number of children born with a sex difference is about 1 in 100 live births (Sandberg, Pasterski, & Callens, 2017).
So, you can do the math to appreciate how many people in your school, place of worship, organization, or business have a DSD condition. Every child with a condition necessarily involves one or more adults, but knowing the numbers does not predict how many will need what type of medical and psychological care and support. Perhaps the numbers do allow us to be more sensitive to the way we write and speak about human nature and sexuality.
The word “Disorders” in DSD is understandably unacceptable
to some. On the one hand, an identifiable medical condition is part of the
cultural process to obtain care paid for by health insurance. On the other
hand, those who wish to avoid stigma would prefer a term such as Differences of
Sex Development or Diverse Sex Development.
Another term in use by the US
National Institute of Health is SGM, which refers to Sexual and Gender
Minorities and thereby includes those who identify as lesbian, gay, bisexual
and transgender as well as those with nontraditional sex development or DSD.
Some people classified with DSD live their lives not knowing
of their condition. Some parents and families have made surgical changes
(gender assignment surgery). Others postpone surgery until the child is old
enough to understand their gender identity.
Adjustment to conditions varies
with the individuals and the parents as well as the specific biological
condition. A study by Davis (2014) provides examples of how different people with
a DSD condition respond to diagnostic terminology.
RELIGION and CULTURE
Religious texts and traditions historically treated sex as
binary (created male or female). Christian women have used the text to advocate for equality with men as males and females were created in the image of God:
So God created mankind in his own image,in the image of God he created them;male and female he created them.Genesis 1: 27 NIV
Unfortunately, this oft quoted text leaves out people born with mixed sexual anatomy.
While
differences in external sex anatomy may be seen, the study of internal
differences and chromosomal differences has been relatively recent. The idea
that humans had 46 chromosomes was established in the 1950s (nature).
Anyway, as it turns out, when it comes to sexual anatomy and genetic
conditions, some people are mixed and not simply "created male or female" (See APA topic on intersex
conditions for more detail).
When it comes to moral and social implications of being one
sex or the other, some people refer to the male and female binary division as a
premise in one argument or another. I’ll leave it to the religious scholars to
help the faithful integrate science and faith. Frankly, it isn't easy and there are many claims to methods of integration.
Many won’t see any conflict. Others won’t be interested
unless a family member is involved. And others may truly experience a spiritual struggle when interpretations of sacred texts are used to condemn some aspect
of one’s identity, which in the current discussion means the lack of a distinct
male or female biologically-based identity.
For religious parents of intersex (or DSD) children and
individuals with an intersex (or DSD) condition, the emotional distress and emotional
responses depicted in the aforementioned Call
the Midwife episode can be real.
Healthcare professionals, mental health
workers, policy makers, and religious leaders would do well to be appraised of
the medical facts and lived realities of people who do not neatly fit familiar patterns. In short, despite the role of diagnoses in obtaining medical care,
including psychological care, the diagnosis does not directly lead to identifying how
individuals and their parents experience the reality.
And it might be helpful, if those so certain about human
nature and the causes of various conditions, could imbibe a dose of humility
when it comes to faith and science.
On the one hand, the religious binary sex enthusiasts ought to consider medical realities.
On the other hand, the
statistically challenged crusaders tempted to inflate low frequency conditions
ought to consider a rigorous approach to defining conditions and obtaining
frequency data.
Cite this post (APA style)
Cite this post (APA style)
Sutton, G. (2019, April 29). Male or Female or What
Sex Understanding Intersex. [Blog post].
Retrieved from https://dividedchristians.blogspot.com/2019/04/
male-or-female-or-what-sex.html
Retrieved from https://dividedchristians.blogspot.com/2019/04/
male-or-female-or-what-sex.html
References
Conway, G. S. (2014). Disorders of sex development (DSD): An
overview of recent scientific advances. Psychology & Sexuality, 5(1),
28–33. https://doi.org/10.1080/19419899.2013.831213
Davis, G. (2014). The power in a name: Diagnostic
terminology and diverse experiences. Psychology & Sexuality, 5(1),
15–27. https://doi.org/10.1080/19419899.2013.831212
Read more about sex and Christian cultures in
A House Divided: Sexuality, Morality, and Christian Cultures
Available on Amazon and other bookstores worldwide.
Intersex and An American War Hero
Smithsonian Magazine examines the possibility that the "father" of the U.S. Cavalry was intersex based on his skeleton.
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