Gerald Callahan - Between XX and XY: Intersexuality and the Myth of Two Sexes

It might have been one of those Los Angeles days when the soup rolled in off the sea and sopped up the sky, one of those days when people were left with nothing more than sputtering electric fans and limp palm trees curdling in the oily light. It might have been, but the report doesnt mention any of that. So it might have been otherwise.

For certain, it was the summer of 1952. Harry Truman was still president, the Dodgers were in the process of losing more road games than theyve lost since, and the Ford Motor Company was preparing for its fiftieth anniversary. That summer, in the city of angels, a baby was born to two very proud parents. I will call them Frank and Laura. The babylets call her Lenorewas the second child in what would grow to be a family of twelve, and Frank and Laura were first cousins. Maybe thats important; maybe their genetics had something to do with the way Lenore turned out. Maybe not.

At birth, Lenore was everything everyone had hoped: all her digits present in the proper places and numbers, beautiful eyes and hair, pink gums and stubby toes. Everything about her looked perfect, with one tiny exception. Well, actually, not so tiny. Lenores clitoris was a little too big for a baby girl. Hypertrophied was what the doctor called it.

But after some further probing the doctor found what seemed to be a vagina, so he announced, with a big smile, Its a girl.

As the doctors words split the air that day, one door opened and another one closed. No one noticed.

Wrapped in pink, Lenore went home, and for the next several years things seemed just fine. Lenore did all the things a baby girl should do. Then, when she was six years old, Lenorelike many kids her agegot the measles. Her mother took her to see the doctor. Once again, nothing about her physical exam seemed out of order, except for that clitoris thing. It still seemed a little big, but not too big, at least not so big that anyone felt compelled to do something about it.

By age thirteen, Lenore had begun to develop pubic and underarm hair, just as any girl her age should. Curiously, though, unlike her friends, Lenores chest remained as flat as a boys, and she had not begun to menstruate.

That same year, Lenore developed tonsillitis and went to the hospital to have her tonsils removed. During Lenores intake exam, the doctor who examined hera particularly thorough sort, apparently again noticed the hypertrophy of Lenores clitoris. However, unlike the others who had noted the same excess, this doctor felt the need to do something more. When he looked at her more closely, he found that Lenores vagina was only rudimentarytoo short and too small to be functional.

This, combined with Lenores flat chest and lack of menstruation, puzzled the doctor. So he referred Lenore to the Adolescent Childrens Unit of Childrens Hospital of Los Angeles for further tests. A pediatrician there performed a complete physical evaluation. In the fall of 1966, Dr. Betty Suits Tibbs wrote up the course of that evaluation, and the story of Lenores short life to that point, in the clinical journal Pediatrics. Dr. Tibbss tale is the foundation for this story. Since Dr. Tibbss report doesnt name Lenores physician at Childrens Hospital of Los Angeles, Ill call him Dr. Brown. Here is his description of Lenore:

Pertinent physical findings revealed moderate hirsutism of the

face [facial hair] with slight acne. The thyroid gland was not

palpable. Examination of the chest revealed a normal contour but no breast development. There were no cardiac murmurs and the heart was not enlarged. Axillary hair was ample and the pubic hair formed a female escutcheon. The clitoris was hypertrophied, appearing as a small penis with a urethral opening at its base. There was a small vaginal opening posterior to the urethral opening.

According to Dr. Brown, when Lenore appeared before him, her outward physical appearance and mannerisms seemed more boyish than girlish. In addition, Lenores vagina was only about 2.5 centimeters deepabout an inchand, palpate as he would, Dr. Brown could not find a uterus in Lenores abdomen. All of this led him to suspect that in spite of her history, Lenore was in fact a boy. That seemed worth following up on, so he scraped some cells out of Lenores mouth and sent them off for analysis.

A few days later the results of Lenores tests came back. The genetic expectation for girls is that each cell will have two X chromosomes. Normally, early in the embryonic development of girls, in every cell of the embryo one of those two X chromosomes is inactivated and condenses into a small inert lump called a Barr body, or sex chromatin. The presence of sex chromatin usually identifies a cell as female. Dr. Brown could find no evidence of any sex chromatin in any of Lenores cells. So, at her next visit, Dr. Brown took some blood from Lenore and sent the white cells off for analysis. The results of those tests showed that most of Lenores cells had the right number of total chromosomes, forty-six, but the tests also showed that buried inside of every one of Lenores cells there was an X and a Y chromosome. Lenores cells were genetically male. Analysis of Lenores hormones revealed a shortage of female hormones. It all fit, except for the fact that Lenore still thought of herself as a girl.

Because of his findings, Dr. Brown referred Lenore for psychiatric evaluation. Apparently, he wanted to find out how well Lenores mind had adapted to life as a girl in spite of her Y chromosomes.

Dr. Tibbs reported the results of those tests:

The results of the psychiatric evaluation revealed a low average intelligence.... The patient never actually expressed confusion on direct query as to whether she was male or female, but did demonstrate some masculine aggressive behavior patterns and fantasies. Dreams and projective tests interpreted by both the psychologist and psychiatrist also revealed some ambivalence in her gender identity. On the conscious level, the identity patterns conformed to the assigned sex.

In other words, on a conscious level Lenore acted like a girl. But subconsciously she behaved more like a boy, which fit with the way she looked, not to mention her mysteriously silent Y chromosomes.

After that analysis, it appears that Dr. Brown suggested to Lenores parents that their daughter might be different from other children. But the parents discomfort with the subject outweighed their curiosity. Frank and Laura seemed to have little interest in exploring the possibility of Lenores apparent intersex condition. According to the report, Frank and Laura were in denial. Dr. Browns findings did, however, make Lenores parents uneasy enough to ask if Lenore was all boy or all girl. Dr. Brown and the doctors he worked with decided not to push the matter. They assured the parents that the physicians were just following up on the diagnosis of amenorrhea and hirsutism and that there were many possible causes of these symptoms, rather than dwelling on the possibilities of intersex and their ramifications. Dr. Brown and his colleagues never again raised the specter of intersex with Lenores parents.

Lenore was not the first person Dr. Brown had seen or read about with a condition like this. By the 1960s, intersex was certainly a known human syndrome, and the medical literature, albeit a patchwork of fact and opinion, contained many descriptions of intersex children. It was clear that children didnt always come in tidy packages. What was far less clear was how best to treat such babies and children. At the time, some physicians thought they could do just about anything with a childs sex. Give any baby the right clothes, the right toys, the right parents, and the right instructions, and that baby would become a boy or girl. Other physicians who studied intersex werent so certain, especially with children as old as Lenore.