Intersex

The existence of intersex people (individuals suffering from a disorder of sexual development or DOSD) is often put forward as a counter-example to the idea that humans exist as either male or female.  The idea is that intersex people are neither male nor female, or are both, and that their existence shows that humans come in more than just two sexual flavors.  But I don’t think the existence of intersex individuals actually does show this.  In this post, I’m going to try and substantiate this claim as well as discuss the question of how intersex individuals should live their life given their condition.  

Though not all males and females are capable of producing children (some people are infertile), all children are produced by a male and a female.  There are only two human gametes; sperm and eggs.  Intersex individuals do not have some third gamete.  Disorders of sexual development do not create an extra sex--they are malformed versions of one of the two sexes.  We can see this from examining the function of sexual organs, which largely lies in their reproductive capacities.  Individuals that suffer from DOSD suffer from a disorder that affects the development of their sexual organs. It is proper to call these various conditions “disorders'' because these conditions hamper the function of the sexual organs--they usually result in infertility and other problems.  We determine whether organs are healthy or not from how well they function, and we determine function by the role such organs play in the human life.  Sexual organs clearly play a reproductive role, and when this function is hampered, we are right to call such a condition a disorder.  The proper medical response is not to postulate the existence of some third sex that has no bearing either on sexual reproduction nor its own unique gamete, but should rather be to restore function and treatment that best restores the predominate underlying sex of the affected individual.  

There are people with XY chromosomes yet female phenotype characteristics, and there are hermaphrodites that have, in a severely malformed manner, a vestigial penis and vagina.  If all humans are either male or female, how are we to determine the sex of severely disordered intersex individuals?  It’s going to be hard, but that it’s sometimes difficult to classify an individual as a male or female does not mean that they’re neither.  Epistemic problems do not necessarily entail ontic problems. The textbook Pediatric Encrinology provides, I think, a useful rubric to determine this question: “Cosmetic appearance of the reconstructed genitalia, on the potential for normal sex steroid secretion at puberty, on the potential for sexual intercourse, and on the potential for fertility,” are some of the considerations we should use to gauge a person’s sexual identity.

I think it’s useful to introduce here the idea of grades of normative power.  (This is largely taken from Pruss):

0. Normative possession of a power:  An individual belongs to a kind that should have some causal power. An adult human who lacks eyes still has normative possession of vision in this sense.

1.  First normative possession of a power: An individual has the causal power but isn’t currently exercising it. The human with closed eyes has first normative possession of a power.

2.  Second normative possession of a power: An individual has the causal power and is exercising it. The human who is seeing possesses this grade.

3.  Full normative possession of a power: An individual has the causal power, is exercising it, and the causal power is achieving its goal. The human who gains knowledge through seeing possesses this grade. 

Now replace “sight” in the above examples with “sex.”  Working backwards, a person that successfully reproduces possesses (3.)  People engaging in sexual intercourse are achieving (2.)  People that possess sexual organs capable of (2.) but not currently exercising that capability possess (1.).  People without sexual organs (think of a man that’s been bisected and no longer has genitals) possess (0.) 

Where do we place intersex individuals?  Depending on the severity of the condition, I think they’d be capable of achieving even (3.)--but most intersex individuals are infertile.  If we take a hard case, such as a man that is completely lacking genitals, it seems like he’d fall into category (0.).  This classification is what retains his status as a male--that he is the sort of being that should have the causal power to be a father, even if he no longer does.  My argument above is that all humans possess a normative power to be either male or female of at least type (0.).  

Merely infertile individuals can possess (0.), (1.), (2.) but not (3.)  They achieve (2.) through the one body union that is sexual union, in which both their bodies strive towards a common goal.  If an intersex individual possesses enough of a sexual organ that is capable of striving towards one body union, even if in a faulty way, then they achieve (2.).  If they do not possess organs capable of striving in such a way, they may be more like the man who is lacking his lower half and thus only possessing (0.).  The hard (and deeply tragic) teaching is that individuals who possess only (0.) are called to a life of celibacy, though they may have extremely strong bonds with members of the opposite sex.  This position is reflected in Western law by the idea that marriages not consummated by sexual union are not valid.  

Even granting all of this, we still have an interesting ethical question.  There are people who live and walk around that have ambiguous primary sex characteristics--they may possess both a vestigal penis as well as vestigal vagina.  How should such an individual conduct themselves in life--how should they, for instance, date?  If I’m right that every individual is either a male or a female, and if I’m also right (as I argue elsewhere) that homosexual behavior is wrong, then it follows that hermaphrodites do not have the right to pick and choose which sex they date.  They must, via the methods mentioned above, determine as best as they’re able which sex they are and live in accordance with the norms of that sex.  As the Nashville statement says, "[intersex] individuals should embrace their biological sex insofar as it may be known."  There is, of course, the possibility for error in this judgment, and unintentional wrong may be inculpable, but it is still wrong.