No abstract

Since 1990, when Suzanne Kessler published her foundational feminist critique of the modern-day medical treatment of children with intersex, much has changed in intersex politics, practice, and theory. This essay traces some key points of progress and considers in particular the relationship of academic feminism and intersex advocacy; proof of and reasons for success in intersex medical advocacy; and intersex identity politics, especially with regard to the nature-nurture debate and terminology (intersex versus hermaphroditism versus disorders of sex development). The authors are university-based academic feminists who have worked intensively as volunteers and as paid directors at the Intersex Society of North America, the longest-running and best-known intersex advocacy and policy organization. In this work, they draw on the published literature as well as their own activist and academic experiences. They argue that, in the last fifteen years, much progress has been made in terms of improving the medical and social attitudes toward people with intersex, but that significant work remains to be done to ensure that children born with sex anomalies will be treated in a way that privileges their long-term well-being over societal norms. They also argue that, while feminist scholars have been critically important in developing the theoretical underpinnings of the intersex rights movement and sometimes in carrying out the day-to-day political work of that movement, there have been intellectual and political problems with some feminists' approaches to intersex.

We explain here why the standard division of many intersex types into true hermaphroditism, male pseudohermaphroditism, and female pseudohermaphroditism is scientifically specious and clinically problematic. First we provide the history of this tripartite taxonomy and note how the taxonomy predates and largely ignores the modern sciences of genetics and endocrinology. We then note the numerous ways that the existing taxonomy confuses and sometimes harms clinicians, researchers, patients, and parents. Finally, we make six specific suggestions regarding what a replacement taxonomy and nomenclature for intersex should do and not do, and we call for the abandonment of all terms based on the root "hermaphrodite".

s part of a larger project, a multidisciplinary group convened by The Hastings Center, Garrison, NY, met to consider medical, psychosocial, and ethical issues associated with the care of children born with atypical genitalia or later found to have other conditions now commonly grouped together as "intersex." These children may have congenital adrenal hyperplasia, gonadal dysgenesis, hypospadias, partial or complete androgen insensitivity syndrome, etc. This commentary reflects the deliberations of the group, which concluded that none of the appearance-altering surgeries need to be performed quickly; families with children with intersex conditions require multidisciplinary care; children with intersex conditions deserve to know the truth about their bodies; families and health care professionals will benefit from rigorous longitudinal studies; and health care professionals need additional training about intersex conditions and sexual health generally.