Between The Sexes

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The truth came as a relief, although Kelli, now 10, is still grappling with the significance of gender in her life. A stocky, surefooted kid whose interests range from gardening and landscaping to marble collecting and woodworking, Kelli suffers from attention-deficit/hyperactivity disorder, which, she says, actually makes her feel more self-conscious than being intersexual. When asked what she wants to be when she grows up, she replies, "A carpenter. Maybe I'll be a male carpenter." Why a male carpenter? "Because I'd be taken more seriously."

True hermaphrodites like Kelli are thought to be quite rare. But less extreme cases of intersexuality occur more often than you might think. One estimate from a scientific review published in 2000 is that they represent 0.2% to 2% of live births. About 30 genetic and hormonal conditions can give rise to intersexuality, leading, in some folks, to an obvious mixture of male and female sex traits. In others the variation is far less noticeable, producing, for example, the premature development of body hair. Indeed, many intersexuals probably live their whole lives as men or women without ever suspecting the complexity of their nature.

For years doctors believed that the best treatment for an obviously intersexual newborn was a swift one. The reproductive system and genitalia were surgically refashioned to conform to one sex or the other. (In practice, this often meant deciding that the child should be a girl because, in the indelicate phrasing of the surgical world, "it's easier to make a hole than build a pole.") The goal was to minimize the amount of time the child spent with a nonstandard body in the hope that he or she would find it easier to develop a conventional sense of gender. As in Kelli's case, there was also concern that "extraneous" reproductive tissues might be more likely to become malignant.

In recent years, however, the need for swift and irreversible intervention has been called into question. Adult intersexuals are stepping from the shadows to talk about their experiences, including the harmful effects they attribute to extensive childhood surgery. Some complain that they were assigned the wrong sex at birth. Others are more upset about the secrecy and shame their condition often elicited from their family. There is growing evidence that such surgery can interfere with the ability to achieve sexual gratification, that it can cause chronic incontinence and that the cancer risk may be exaggerated.

As these issues have emerged, the American Academy of Pediatrics (A.A.P.) has begun to reconsider its policy of endorsing early surgery for intersexuals. Dr. Ian Aaronson, a professor of urology and pediatrics at the Medical University of South Carolina, who helped write the A.A.P. guidelines, is coordinating what he hopes will be the largest-ever follow-up study of intersexuals to see what effects, good or bad, surgery has had on their emotional, psychological and sexual well-being.