I will tell you right now that it does not matter what I write, there will be a significant number of people upset. As I pointed out, this has become one of the subjects that touches upon the area of sexuality that is such an area of debate in this country. Today, I will write more on the medical side of the question.
If you look at the list of conditions that are listed as being intersexual in my earlier post, several of them will respond to medical treatment, but several will not. This does not diminish the anguish, particularly since our society is so sexually oriented. But, for instance, Kallmann syndrome is treatable with hormone therapy. CAH is now part of the newborn screening that is done and can be kept at bay with hormone therapy. But, some are clearly not treatable by a similar therapy. And, in some cases, the child is born with altered genitalia so that it may be difficult to tell the gender of the child at birth until more extensive testing is done. It is the non-treatable cases and the ambiguous cases that are now the subject of much debate among some.
I will qualify what I say next by saying that it is my personal opinion, as some of these areas are new enough that I would not wish to claim that my views represent Orthodoxy.
Before I became a priest, I had laboratory professional training. I have a post-baccalaureate specialty in blood banking. I have done and published research in the area of practical genetic research. Frankly, I hold a very typical medical attitude that if someone has a syndrome that can be treated with modern hormone therapy, then though the child may present as an intersexual, I would put that in the same classification as diabetics that can be treated with insulin. This is particularly true since some of the conditions are not simply in the area of gender, but also affect growth, osteoporosity, etc. Those conditions that are treatable and involve a whole syndrome of symptomology that needs to be treated for the health of the person (that is to decrease morbidity and mortality) would not seem to me to be a true intersexual. That is, they are simply persons with a genetic makeup that is causing them medical problems in several areas, one of which happens to be gender development. And, these conditions are currently manageable. Thus, I find that some of the “advocates” are simply stretching the point in listing some of these diseases as though they were intersexual.
Interestingly enough, many in the LGBT movement used to agree in the sense that they did not wish LGBT to be classified as a genetic deficiency. One can read LGBT literature in which the argument is particularly made that being LGBT is not purely an issue of genetics, as though it were something like Down’s Syndrome. Rather, it is my understanding that many LGBT folk today would say that they are, as with any human being, a mixture of nature, nurture, and choice. I suspect if I said this wrongly that someone will post and correct me.
But, others have a much harder path to follow. They may be born so that they have dual gonad structures, or undeveloped gonad structures, or permanent androgyny, etc. The old advice given to parents was to choose a gender for a child and have their sexual organs surgically altered to match. Often female was a default choice simply because there would be no possible “performance” problems to face up to in the future, and, modern genetic testing was not available.
Nevertheless, I agree with those who nowadays say that this would be an inappropriate approach today. I would argue that the infant ought to be evaluated both biochemically and genetically to see if there is a gender that can be determined, and that if surgery is necessary, the surgery should help the external appearance match the evaluation. I agree with those who say that it seems contradictory that Christians back then would take someone who was phenotypically a boy, convert them to a girl, and have them live out their lives as though they were female. That approach seems to contradict some of the very arguments that have been used to disagree with LGBT people. At the same time, it seems clear to me that some of the arguments that allege “butchery” in dealing with some of the intersexuals are also inappropriate. If someone is phenotypically a boy but in gestation something did not go quite right and the presentation is ambiguous, I see no problem in making appearance and phenotype match. That is not “butchery” but medicine.
Nevertheless, frankly, there are cases where it is not clear immediately which gender a person is. And, those cases, frankly, will need to be handled more on a case by case basis. In some cases, there may be a need to wait and do follow-up testing as the child gets older. Some of these people would be the ones I would tend to classify as the “true” intersexuals. Some, like Miss Semenya, may simply not be “noticed” until much later in life. Had she not been a world-class athlete, it might never have been noticed.
So, now that we have gone over some of the medical aspects, the question is, “What does the Church have to say to intersexuals with respect to marriage and living out one’s life?”
===MORE TO COME===
I just wanted to thank you for adressing this topic.
Father – you are a blessing to read.
On homosexuality, I do not support the 100% nature or 100% nurture side of the argument (and don’t get me started on “it’s a choice”). By the time a gay person reaches puberty it’s all been said and done.
But intersexed persons raise another question for our culture (and by extension, the Church). Our perception of polarity here is wrong. Persons are not male or female, but on a spectrum. We might say “A majority of persons are perceived (by self or others) as either male or female but other persons fall in other places on a spectrum.”
The using medical procedures in this context is very troublesome: the traditional (RCC) argument against sex change operations has been not damaging the physical temple built by God. I would suggest that the same respect for the physicality be made here. Unless there is some serious debility that would require surgery for a “normal life” perhaps it is our culture that need to change to accommodate the intersexed. If we insist on binaries (and medical procedures to fit people into our binaries), we are, perhaps, doing damage to what God has given us.
Is it possible in their personhood, that the intersexed show us a new and different icon of God than we have hitherto been willing or able or mature enough to see?
Father Huw, on the surgery question I was quite careful to stipulate that the appropriate biochemical and genetic evaluation should be done before any surgery. Let me give you an example from real life.
A baby is born with what are either sealed labia or undeveloped male reproductive organs. X-rays and biochemical and genetic testing show that this is a full female but simply with sealed labia. It is an easy surgery to separate and reconstruct the labia. The baby will grow up to be a “full” female. The case that I just quoted comes right out of one of my old medical textbooks on what we can do today. In the 19th century, one of the more famous cases was where the seal was up higher, where it was not noticable. The girl began to menstruate at the appropriate time but there was no outlet and so ended up dying after less than a year from a swollen and infected belly.
This is why I talked about the “true” intersexuals and the ones who are not. Some apparent intersexual cases are more akin to people who are born with a split palate. There is no genetic or biochemical problem, but somehow something went wrong in gestation. To fix what went wrong in gestation does not deny anything about the person, rather it affirms it.
The same is true with some who have biochemical problems that can simply be fixed by either adding the missing enzyme or hormone or by blocking in part the excessive enzyme or hormone. Again, they are genetically clearly of one gender or another, but a problem in another area of their endocrinological system may impact some of their primary and almost always impacts their secondary sexual characteristics.
I would argue that the true intersexual is one who is indeed genetically mixed. And, those do need to be discussed and not simply “dealt” with.
Ok, Father, I see we’re on the same ticket here. Thanks for those examples.