Human Hermaphrodites

Hermaphroditism is when an animal has both testicular and ovarian tissues. Sometimes one gonad becomes a testis while the other becomes an ovary; sometimes the gonads become "ovotestes" containing a mixture of male and female components. Hermaphroditism occurs rarely in human populations, and the view that it is pathological (i.e., a disease state) is changing. Although hermaphroditism is often associated with infertility, that is not always the case. Indeed, in the 1600s, a hermaphrodite living as a woman was put to death after having impregnated his/her master's daughter (see Fausto-Sterling, 1993). The medical problems of hermaphrodites are not usually that of sex but of other bodily functions thrown out of register by anatomical shifts (such as tumors from undescended testes).

Anne Fausto-Sterling (1993, 2000) and Alice D. Dreger (1998) have written eloquently about the problems of hermaphroditism. Often, if not always, she claims, the problems are those of a society that insists on one sex per body and that is uncomfortable with the concept of hermaphrodites. The hermaphrodites, themselves, seem rather well adjusted. Indeed, our language does not recognize any sexual system except that of dualism, and one can't even write about the experiences of hermaphrodites without using phrases such as (s)he or his/her.

Classifying newborn infants as to whether they are male or female is usually straightforward. One looks at the phallus and sees whether it is a penis (long) or clitoris (short). One looks to see if there are two labia (vaginal lips) or if they have fused into a scrotum. One also can look to see if the urethra (the excretory tube from the bladder) opens through the phallus (as in males) or if it has a separate opening (as in females). However, sometimes nature does not give you an either/or situation. Guinet and Decourt (1969) for instance, described 98 cases of "true" hermaphroditism, wherein a person had both ovarian and testicular tissue. In some cases, the phallus is somewhere in between that of a penis and a clitoris. In some cases, the labia were partially fused and the urethra ran close to the phallus. In such cases, the menstrual blood exited during urination. Some hermaphrodites had penises and large breasts.

Hermaphrodites have created some interesting situations. In 1843, Levi Suydam, a 23 year old resident of Salisbury, Connecticut, asked the town magistrates to validate his right to vote as a Whig in a particularly divisive local election. The opposition party raised objections, saying that Levi was really a woman and therefore unable to vote. A doctor examined him and declared that he had a penis and was therefore a man. Duydam voted and the Whig candidate won by a single vote. Within a few days after the election, Suydam had his monthly menstrual bleeding (Fausto-Sterling, 1993). Hugh Young (1937) relates that one of his patients, a hermaphrodite named Emma had a penis-sized clitoris and a vagina. Raised as a girl, she could have "normal" heterosexual relationships with both men and women. And she did. She functioned sexually as both male and female all her adult life.

However, as medicine became more sophisticated, it decided that society did not tolerate hermaphrodites and parents wanted their babies to be either male or female. In the early 1900s, "true" sex was said to be the sex of the gonads. Thus, people having androgen insensitivity syndrome were classified as "really" males, even though their entire physical appearance and usually their sexual orientation was female (Dreger, 1998). It was thought that society could not deal with people who were not either one or the other sex. (And, as Dreger demonstrates, this was stated explicitly by several physicians). Our birth registries still demand that a newborn be quickly placed into one or the other category, and in the early 1900s, knowledge of the "true" sex of a person was thought to be critical to prevent inadvertent homosexual relations. Our current classification scheme of male and female pseudohermaphrodites reflects this gonadal (and later, chromosomal) assignment of sex. A male pseudohermaphrodite (usually caused by androgen receptor mutations) has a female phenotype but male gonads, while a female pseudohermaphrodite (usually caused by congenital adrenal hyperplasia where the adrenal gland secretes testosterone) has a male phenotype but has ovaries.

Starting in the 1960s, babies born with ambiguous genitalia were "assigned" a sex that seemed appropriate based on the genitalia that they had. Those with large phalluses had their labia closed and became males, while those with smaller but still larger than normal phalluses had them surgically shortened and became females. In the 1990s, some of the individuals who were surgically assigned their sex founded the Intersex Society of America (ISNA) and lobbied to speak to physicians to have them change their usual practice of surgically amending nature. Their arguments convinced many physicians that having a baby of ambiguous sex was not a medical emergency, that interventions should be reversible, and that time should be taken to discuss these issues with parents and patients with such conditions. Some physicians have argued that having a child with ambiguous genitalia is an emergency to the parents of such a child who want to know what sex their child is and to tell their friends and relatives that they have either a girl or a boy. The arguments of the ISNA group are summarized in an article by Alice D. Dreger and in presentations comparing surgical intervention with what they hope will be a patient-centered therapy approach.

Fausto-Sterling contends that sex is a continuum rather than a collection of discretely defined phenotypes. She proposes that along this continuum are five points: male, ferm (female pseudohermaphrodite), hermaphrodite, merm (male pseudohermaphrodite), and female. Each has variations that shade into the neighboring point. She estimates the frequency of all sexually mosaic conditions (hermaphrodites and pseudohermaphrodites) in humans to be about 1% of the population.

Hermaphrodites have a long history. Indeed, many traditional cultures believed that the original person was perfect. Perfection means having no wants that need to be satisfied, so the first person was hermaphrodite. This can be seen in Plato's Symposium, where the original form of humanity was hemaphrodite, but when they got too numerous Zeus, decided to split them in half. After having done so, he finds that the now-separate sexes spend all their time trying to join themselves back together. Zeus decides to help these creatures by moving their genitalia such that when any two embraced, they might conceive and thus propagate. In some interpretaions of Genesis, the primal Adam was a hermaphrodite, and the cleaving of this original person into male and female is evidence of the Fall. So, as the saying goes, "No one's perfect."

Literature Cited

Dreger, A. D. 1998. Hermaphrodites and the Medical Invention of Sex. Harvard University Press, Cambridge.

Fausto-Sterling, A. 1993. The five sexes: Why male and female are not enough. The Sciences (March/April): 20-24.

Fausto-Sterling, A. 2000. The five sexes, revisited. The Sciences (July/August): 19-23.

Youg, H. H. 1937. Genital Abnormalities, Hermaphroditism, and Related Adrenal Diseases, quoted in Fausto-Sterling, 1993, op. cit., p. 23.

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