We have drafted a submission to the World Professional Association for Transgender Health (WPATH) 7th Standards of Care, and the APA’s draft Diagnostic and Statistical Manual of Mental Disorders 5th edition.

We’d like to invite feedback on the proposed submission. We’d be grateful for any comments or thoughts by the end of Wednesday 23 May. Feedback can be sent to info [at] oiiaustralia [dot] com. Comment can also be made on our Facebook page.

Here’s the draft submission in PDF format:
DRAFT SOC7 and DSM5 submission

The full documentary version of Intersexion has won two awards at its first showing on the big screen.

Intersexion won ‘Best NZ Documentary’ and ‘Best Editing’ at the Documentary Edge festival currently taking place in Auckland and Wellington.

The people behind the movie, Grant Lahood, Mani Mitchell and John Keir, have told interviewees:

The reaction to the film at our first two screenings has been tremendous with audiences staying behind afterwards to ask lots of questions and it’s been clear from the comments we’ve been getting just what a powerful effect the film is having on people.

Intersexion - movie flyer.

About the movie:

Every new parent asks: “Is it a boy or a girl?” But what happens when doctors cannot answer that question? One baby in 2,000 is born with genitalia so ambiguous that it is impossible to tell if the child is male or female. That startling but little known statistic means the number of intersex babies equals two rugby teams every year. Their birth certificates – instead of showing “male” or “female” — are sometimes marked “I” for indeterminate.

Director Grant Lahood follows Mani Bruce Mitchell, NZ’s first “out” intersex person, as he/she travels to meet other intersex people living in America, Ireland, Germany, South Africa and Australia.

Several members of OII are interviewed in the movie, including OII Australia president, Gina Wilson. We hope to see this in Australia at some point.

External link

Read more about Intersexion at the Documentary Edge Festival site.

In anticipation of the first showing of a full documentary version of Intersexion, Mani Mitchell has been interviewed by the New Zealand Herald. It’s a great piece, which shows Mani’s humanity as well as Mani’s own perspective on surgery, one that is shared by very many intersex people:

She remembers being eight-years-old and going in to hospital for “normalising” surgery. It had “devastating effects, both in terms of how I felt about myself and later on as an adult my own sexual functioning.”

“You destroy sensitivity. You destroy functionality.

“I used to say I was a head that towed a body around. I was completely cut off and numb from my own physical body.”

Finally, aged close to 60, Mani can finally say, “I’m comfortable in my own skin”.

An initial version of Intersexions was fantastic. We congratulate Mani for the interview, and Mani and director Grant Lahood for what promises to be an excellent documentary.

Internal links

• For a medical research paper on satisfaction with surgery see the results of a German study of people with AIS in the Journal of Clinical Endocrinology & Metabolism, for example.
• Report on Intersex documentary “Intersexion (Is He Or Isn’t She?)”.

External link

• Intersexion world premiere in the NZ Documentary Edge Festival, 2012.

The Second NSW Survey Of LGBTIQ People And Relationships is currently looking for responses from intersex and other people:

MOST OF OUR COMMUNITIES’ RELATIONSHIPS ARE BASED ON LOVE AND RESPECT. SOME ARE BASED ON ABUSE AND CONTROL

This online survey has been developed to gain a better picture of lesbian, gay, bisexual, transgender, intersex or queer (LGBTIQ) experiences of, and attitudes towards, intimate partner abuse.

It will also give us a better understanding of how we can improve support services for the LGBTIQ community, and how we can educate mainstream services to respond more appropriately to LGBTIQ people experiencing abuse.

The survey can be found here, at the Another Closet website.

The Private Lives 2 (‘PL2′) concluding survey report, recently launched by GLHV, BeyondBlue, the Movember Foundation and La Trobe University’s ARCSHS contained a couple of disappointing paragraphs on intersex people:

PL1 had included intersex in its terms of reference but the number of intersex respondents was 18 which accounted for only 0.33 per cent of the total sample (N=5,476). This was too small a number to provide statistically meaningful data or inter GLBTI comparisons. In the absence of the resources needed to undertake an intensive intersex recruitment strategy, it was decided not to include intersex as a separate category in PL2.
The difficulties in recruiting intersex respondents both as part of GLBTI and mainstream population health surveys suggest the need for novel strategies for engaging with this group. This is all the more pressing given the range of health and legal issues facing intersex people, and their families, as they age (Styma 2006).

The PL2 survey found “high levels of psychological distress” in LGBT communities. From GNN:

Although the new survey indicates a greater acceptance of GLBT people and improvements in their general health, the new findings present a “disturbing picture”, he said, particularly in relation to the mental health of young people aged 16 to 20 years.

The report found transgender people were also particularly vulnerable to mental health problems.

The outcomes of both studies will inform future activities by the sponsoring bodies, by the National LGBTI Health Alliance, and by government. We strongly encourage participation in the NSW study.

The term intersex was first used by science in the early 20th century to describe human beings whose biological sex cannot be classified as clearly male or female. An intersex person may have the biological attributes of both sexes or lack some of the biological attributes considered necessary to be defined as one or the other sex.

Intersex is always congenital and can originate from genetic, chromosomal or hormonal variations. Environmental influences such as endocrine disruptors can also play a role in some intersex differences. The term is not applicable to situations where individuals deliberately alter their own anatomical characteristics.

Intersex people represent a significant percentage of the population.

THE Organisation Internationale des Intersexués (OII) is the world’s largest intersex organization with members representing almost all known intersex variations.

OII is represented in Australia by Organisation Intersex International Australia Limited, a not-for-profit company. This is OII Australia’s website.

Sociologist Georgiann Davis Ph.D. recently had published her paper on DSD in Sociology of Diagnosis, Advances in Medical Sociology, Volume 12, 155–182.

The paper, “DSD is a perfectly fine term”: Reasserting Medical Authority Through a Shift in Intersex Terminology is a hugely important critique and highly recommended reading.

The context

Even though the diagnosis carried with it a surgical medical response, the intersex diagnosis was often kept from patients whose internal and/or external genitalia didn’t match their sex chromosomes at birth. By the 1990s, the medicalized treatment of intersexuality was heavily critiqued by intersex activists upset that they had been lied to about their medical condition, surgically modified in ways that left them with diminished sexual desire, minimal ability to reach sexual pleasure, and in some cases, an increased likelihood of incontinence. Intersex activists responded by protesting outside of pediatric medical association meetings accusing doctors of pediatric “mutilation.” While their confrontational strategies were initially ignored by the medical profession, by the year 2000, the American Academy of Pediatrics (AAP) acknowledged that their historical treatment of intersexuality left their profession in a state of “social emergency”

…By the year 2000, Chase was delivering a plenary address to the Lawson Wilkins Pediatric Endocrine Society, a group she was once protesting against. This successful activist encroachment into medical turf was highly unusual for two overlapping reasons. It marked the first time an activist’s perspective was solicited by organizers of a major medical conference. And, it was “the first time that the society’s annual symposium was devoted to intersexuality”. One of the consequences of this challenge seems to be a nosological change, from intersex in the 1990s to DSD in 2006. I argue this shift was a reaction to activist challenges to medical jurisdiction over intersexuality, and doctors’ insistence on the DSD terminology was a reassertion of their medical authority.

Georgiann comes to her research as a feminist sociologist with an intersex background. Her research was based on 62 in-depth face-to-face interviews with 36 intersex people, 14 parents and 9 medical professionals between October 2008 and August 2010. Over 100 hours of interview data was collected.

Findings

Georgiann found that medical professionals held essentialist understandings of gender:

Most medical professionals I spoke with held essentialist understandings of gender that were neatly tied to stereotypical western, white, and middle class expectations of femininity and masculinity…

This was as true of women doctors as much as of men:

Talking to Dr. D., a well-respected endocrinologist, she went on to explain:

“My experience with girls with [congenital adrenal hyperplasia] suggests to me that it’s pretty hard-wired. A lot of the CAH girls are significant tomboys…”

Explanations for gendered behaviors were grounded in hormonal exposure during gestation.

Medical professionals correlate sex, gender and sexual orientation, each aligned for heterosexual, gender-normative behaviour:

Consistent with a binary logic that suggests sex, gender, and sexuality are all neatly correlated, most doctors used each interchangeably in justifying their essentialist gender views…

Medical professional’s essentialist assumption that there is a rigid correlation between sex, gender, and sexuality resonates with the nomenclature shift from intersex to the pathologizing disorder of sex development…

Medical professionals view gender as something that should function, and to function properly it must be in line with sex and sexuality… The problem with such approach is that medical professionals are in a position of authority to define and treat these social constructions how they see fit.

The powerful, authoritative position of medical professionals is clearly shown in the case of Dr C.:

Medical professionals made it clear during the interview that parents welcomed their professional opinion with little resistance or hesitation. However, such wasn’t true for all families. Dr. C. recounted a recent consultation with a family that was very critical of his recommendations:

“The father said, “[Doctor], can I ask you a question?” I said, “Absolutely, this is your forum. I’m at your disposal. You’re hiring me.” He said, “Why should we do anything?” And I acted physically surprised, I’m sure I did. And I said, “Well, I’m concerned that if you raise this child in a male gender role without a straight penis, he’s not going to see himself as most other males and he’s not going to certainly be able to function as most other males.” And the father said, “Well, in our family we like to celebrate our differences and not try to all be the same and feel the social pressure to do everything like everyone else does.”… I said, I do have to say one thing, and I think it’s of key importance that you both see a psychiatrist.”

Conclusions

Georgiann argues that the use of terminology like DSD is a reassertment of medical control over a biological phenomenon, concluding:

The success of early intersex activism, centered on framing intersexuality as a social rather than biological condition, was short lived. Medical professionals needed to maintain their authority in the face of intersex activism, and they did so linguistically through a reinvention of the intersex diagnosis. The new DSD terminology constructs “sex” as a scientific phenomenon, and a binary one at that. Under such frame, intersex experts neatly link intersexuality to science, and thus are able to justify surgery. This places intersexuality neatly into medical turf and safely away from critics of its medicalization. At the same time, the connection to science increases medical credibility, which in light of intersex activism, is necessary.

…With the new DSD terminology, intersexuality has been returned to medical turf where medical professionals, notably surgeons, are able to reclaim authority over the intersex body…

Georgiann Davis is Assistant Professor of Sociology at Southern Illinois University at Edwardsville and can be contacted via her website. Her paper, in Sociology of Diagnosis, Advances in Medical Sociology, Volume 12, 155–182, can be found here.