While there is a deeply felt appreciation of diversity, the multiculturally aware and conscious person understands that culture alone, born out of different environments and different collective experiences shapes different collective purposes, thought and characteristic behavior and makes human beings different; that culture is the lens through which undifferentiated human spirit focuses to realize its purposes.

An adequate exploration of sexism cannot begin without preliminary discussions of the distinction between biological sex and gender and the rich, crosscultural variability of gender role and gender identity. Most people who use the terms sex and gender more often than not use them interchangeably.

For the purposes of this essay, sex refers to an individual's anatomical structures which are essential to reproduction as opposed to the sexual act or coitus (Ferrante, 1995; Denney and Quadagno, 1988; Carroll, 2004). Sex defined in this way is a biological concept, a way of classifying species into discrete sets of primary sex characteristics.

Female Primary Sex Characteristics

The anatomical structures which comprise the primary sex characteristics of females are known collectively as the vulva and contain the labia majora, labia minora, clitoris, vestibule of the vagina, hymen, bulbs of the vestibule, Bartholin's glands, and mons pubis. The ovaries, fallopian tubes, uterus and vagina comprise the important internal structures/.

The Vulva

The Vulva is the external sexual organ of women. The above view (A) shows the external view of the female vulva as normally seen when the woman is standing up. View (B) shows the vulva when it is opened, and from the top down one can clearly see the Veneris Mons, clitoral hood, clitoris, and labia minora.

The Vocabulary of the Vulva

The external female genitals are collectively referred to as The Vulva. All of the words below are part of the vulva.

Mons Veneris.

The mons veneris, Latin for "hill of Venus" (Roman Goddess of love) is the pad of fatty tissue that covers the pubic bone below the abdomen but above the labia. The mons is sexually sensitive in some women and protects the pubic bone from the impact of sexual intercourse.

Labia Majora

The labia majora are the outer lips of the vulva, pads of fatty tissue that wrap around the vulva from the mons to the perineum. These labia are usually covered with pubic hair, and contain numerous sweat and oil glands, and it has been suggested that the scent from these are sexually arousing.

Labia Minora

The labia minora are the inner lips of the vulva, thin stretches of tissue within the labia majora that fold and protect the vagina, urethra, and clitoris. The appearance of labia minora can vary widely, from tiny lips that hide between the labia majora to large lips that protrude. The most common metaphor for the labia minora is that of a flower. Both the inner and outer labia are quite sensitive to touch and pressure.

Clitoris

M : Mons veneris  A:  Hood of Clitoris  B:  Clitoris  C:  Opening of Urethra  D:  Labia minora  E:  Labia majora  F:  Opening of Vagina  G:  Vestibule (Bartholin's Glands H:   Anus

The clitoris, as seen in the above illustration is the small oval 'button" between the top of the labia minora and the clitoral hood, is a small body of spongy tissue that is highly sexually sensitive. The clitoris is protected by the prepuce, or clitoral hood, a covering of tissue similar to the labia minora. During sexual excitement, the clitoris may extend and the hood retract to make the clitoris more accessible. Some clitori are very small; other women may have large clitori that the hood does not completely cover.

Female Internal Sexual Anatomy

The opening to the urethra is just below the clitoris. It is not related to sex or reproduction, but is instead the passage for urine. The urethra is connected to the bladder. Because the urethra is so close to the anus, women should always wipe themselves from front to back to avoid infecting the vagina and urethra with bacteria.

Vagina and Hymen

The hymen is the traditional "symbol" of virginity, although being a very thin membrane, it can be torn by vigorous exercise or the insertion of a tampon.

The above llustration shows an imperforate hymen that completely closes the vagina; this rare condition requires surgical intervention to provide for a normal flow of blood once menstruation begins.

Perineum

The perineum is the short stretch of skin starting at the bottom of the vulva and extending to the anus. The perineum in women often tears during birth to accomodate passage of the child, and this is apparently natural. Some physicians may cut the perineum preemptively on the grounds that the "tearing" may be more harmful than a precise scalpel, but statistics show that such cutting in fact may increase the potential for infection.

Breasts or Mammary Glands

Although the mammary glands (breasts), which are essential to the maintenance of offspring, are not involved in the process of procreation, they are considered essential components of the female's primary sex characteristics.

Breast Composition

The breast is a mass of glandular, fatty, and fibrous tissues positioned over the pectoral muscles of the chest wall and attached to the chest wall by fibrous strands called Cooper's ligaments. A layer of fatty tissue surrounds the breast glands and extends throughout the breast. The fatty tissue gives the breast a soft consistency.

Image courtesy of NCI/NIH

The glandular tissues of the breast house the lobules (milk producing glands at the ends of the lobes) and the ducts (milk passages). Toward the nipple, each duct widens to form a sac (ampulla). During lactation, the bulbs on the ends of the lobules produce milk. Once milk is produced, it is transferred through the ducts to the nipple.

The breast is composed of:

Arteries carry oxygen rich blood from the heart to the chest wall and the breasts and veins take de-oxygenated blood back to the heart. The axillary artery extends from the armpit and supplies the outer half of the breast with blood; the internal mammary artery extends down from neck and supplies the inner portion of the breast. http://imaginis.com/breasthealth/breastanatomy.asp#breast_composition

Female Secondary Sex Characteristics

Tara Kuther writes:

Secondary sex characteristics are the physical characteristics that differentiate males and females. For girls, secondary sex characteristics include breast development, the growth of pubic hair and leg hair, and changes in oil and sweat producing glands, which often lead to acne. These developments are very public events with implications for social development because the changes in girls' appearance influence how others perceive and behave towards them. early adolescence. (http://www.parentingteens.com/livingwteens4.shtml)

Male Primary Sex Characteristics

The anatomical structures which comprise the primary sex characteristics of males are:

the penis and scrotum as the important external structures, and the testes, epididymis, vas deferens, seminal vesicles, ejaculatory ducts, prostrate gland, and Cowper's glands as the important internal organs .

The Penis and Scrotum

Male external genitalia

The penis and scrotum are the external sexual organs of men.

Vocabulary of the penis and scrotum

glans

The glans is clearly visible inthe above illustration as the head of the penis. The glans in uncircumcised men is usually covered by the prepuce. The glans is highly sensitive, as is the corona, the ridge of flesh that connects the glans to the shaft of the penis.

corona

The 'crown,' a ridge of flesh demarcating where the head of the penis and the shaft join.

foreskin, prepuce

A roll of skin which covers the head of the penis in uncircumsized men.

urethra, meatus

The opening at the tip of the penis to allow the passage of both urine and semen.

scrotum

The scrotum is a sac that hangs behind and below the penis, and containts the testes, the male sexual glands. The scrotum's primary function is to maintain the testes at approximately 34 C, the temperature at which the testes most effectively produce sperm.

Testes
The male sexual glands, testes are ovoid, somewhat rubbery structures, about 4.5 cm (3.5 to 5.5 cms) long in adults. The left usually lies somewhat lower than the right. The testes produce sperms and a hormone - testosterone. Testosterone stimulates the pubertal growth of the male genitalia, prostrate, and seminal vesicles. It also stimulates the development of masculine secondary sex characteristics, including the beard, body hair, muscle development and the male voice. Each testicle produces nearly 150 million sperm every 24 hours. One cycle of sperm production takes 3 months.

http://www.bio.davidson.edu/people/jeputnam/companat/restricted/CA7_Re_HumanTestisEpi.jpeg

Epididymis
On the back surface of each testis lies the softer, comma-shaped epididymis. The epididymis is where sperms mature. The sperm wait here until ejaculation or nocturnal emission.

Seminal vesicles
The seminal vesicles produce semen, a fluid that activates and protects the sperm after it has left the penis during ejaculation

Vas deferens
The ducts leading from the epididymis to the seminal vesicles. These are cut during vasectomy.

The Prostate gland
Also contributes to the semen. It also prevents urine from mixing with the semen and disturbing the pH balance required by sperm, by squeezing shut the urethral duct to the bladder

Corpa cavernosa
The corpora cavernosa are the two spongy bodies of erectile tissue on either side of the penis, which become engorged with blood from arteries in the penis, thus causing erection.

Ejaculatory Ducts
The path through which semen travels during ejaculation.

It would seem from the foregoing that the differences between males and females are based upon primary and secondary sex characteristics which are clear and distinct.

INTERSEXUALITY

http://www.pbs.org/wgbh/nova/gender/fs.html8%26sa%3DG

Joan Ferrante (1995) discusses findings from a growing body of evidence that suggests that the distinctions between male and female are not so clear cut. She contends that because a significant number of babies are born intersexed, the line between male and female is not as sharply drawn as one is taught to believe. "Intersexed" is the term given by the medical profession to people with some mixture of male and female characteristics:

The intersexed group includes three very broad categories:

• true hermaphrodites, persons who possess one ovary and one testis;
• male pseudohermaphrodites, persons who possess testes and no ovaries, but some elements of female genitalia; and
• female pseudohermaphrodites, persons who have ovaries and no testes but some elements of male genitalia.

(The terms hermaphrodites, male pseudohermaphrodites and female pseudohermaphrodites are not only cumbersome, but suggestive of a certain cognitive bias that some have traced back to the Victorian period. While thay are still in use in some areas of this discourse, they are used here only for their historicity.)

Berdache Jordan is an intersexual. She is labeled (in her words) "medically/biologically as an Intersexual...with a DNA chromosome karyotype of 46 XXXY (mosaic)" Here is an excerpt from her story:

The only term that was known, as far as I was ever told, was that I was an Open Birth, meaning I had ambiguous genitalia, that I could not be identified by the people who examined me as either a male or a female. These people were a Catholic Sister and a Veterinarian, both in a small western town, dealing with a premature and abandoned miscarriage.

This was a condition ascribed to the youth and/or illness of my biological Mother at the time of my birth. In certain conversations discussing me, I had overheard this on various occasions. I recall that I was stripped naked many times and exhibited to other adults. As a small child, from age 2-4, I remember that I enjoyed being the center of attention and awe and speculation by adults.

The man I knew as Dad was, I believe, related to me. Whether he was, in fact, my biological parent is unknown. His sibling and a younger sister were suspected to be in an incestuous relationship. My genealogical research indicates that my genetic condition existed in the family. Two of three "brothers" immigrated from Germany and came to America. The youngest was listed as the "wife" of the older sibling on passports and ship manifests. German/Gypsy/Native American lineage, I have reason to believe, carried my rare DNA karyotype. Research is continuing at this time.

True Hermaphrodite

I am one of several types of true hermaphrodites. The XXXY (mosaic) karyotype is extremely rare. One theory of the cause of my own condition has a lot of support. It maintains that two ovum were produced simultaneously in my mother and the eggs fertilized independently as maternal twins. During gestation the eggs merge into a single fetus, one ova was destined as male the other as female.

My understanding is that sometimes both ova might well have been male XY or female XX, in which case the child would have both distinctive DNA chromosome karyotypes, a XY/XY or a XX/XX (mosaic).

These people would appear perfectly male or female unless some medical situation required a chromosome karyotyping. That is an unusual procedure. How many are like this is unknown, as few are tested. They, like me, would have two separate chromosome karyotypes, similar to Siamese Twins sharing one body to varying extents. It is also my understanding that present fertility drugs today may make this condition much more common. In my case, my karotype is XX/XY, hence I have characteristics of both male and female.

Confusion and Abuse

I was given a boy's name and a separate girl's name by my "Father" and his wife, my "Mother," with two birth certificates. Neither was recorded at the time, but awaited a future decision. Eventually, I was "recorded" later as a male, but called by an ambiguous nickname of a comic strip character, a child that no one knew what sex the child was, which was fitting (from Barney Google).

I was left "as is" awaiting further physical development. From the age of four to sixteen years old, I was sexually, physically and mentally abused by several members of my own family. Then I was able to stop the most invasive abuse by choosing to be a male, at age fifteen, accomplished by taking massive doses of testosterone to effect secondary male sexual characteristics. ( Deeper voice, body and facial hair, that allowed me to pass as a male.)

If you refer to the sexual abuse links, you may get some idea of the traumas caused by this abuse. The intersexual condition caused me to be abused by both "normal" sexes. Something seemed to drive others to experience their sexual fantasies, with me as the unwelcome recipient. Personally, all I derived was pain, frustration, and fear of failing to please those I was dependent on as a child. I suffered extreme feelings of guilt when I learned what these acts were.

Not Everything Bad

Not all of my life was bad or sad. Many parts were humorous, as I kept my own sense of humor, much of which was due to my masquerade as a macho male, as I perceived and played that role in many all-male environments, ie: military, jails, and prison. I never succumbed to a male/male relationship, due to inhibitions and prior abuse by homophobic males. Actually, the only way I could even have a homosexual relationship would be to have sex with another like myself (not likely), so homophobia is not an issue with me.

In public, I have been, in all respects, a male heterosexual. And like many real males, I've felt woefully inadequate for much of that time. I had several advantages as a partner: insight, companionship, and communication, and my own desire for lengthy foreplay.

Although inadequate, I was married for eighteen years to two "normal" women. However, when I revealed my condition (to the extent, I was aware of it), they reacted first with disbelief for a few years, then rejection, as they had homophobic reactions, social concerns with "their being bisexual," worries about themselves being gay. Both sought "normal" affairs while married, unable to accept me as is, and mostly unable to deal or cope with their own sexuality .

A Good Parent

Having raised three children alone through pre-teen and teenage years (11 years), I can appreciate the problems of single parenting. With two girls, I discovered the bias and prejudices of a male dominated school system. With 90% of discretionary funds expended on male sports activities, I resented and fought the system on behalf of my daughters, and my son, feeling he too was being brainwashed into participating in aggressive sports.

No one that knows me could fault me on my parenting skills. The idea that a gay, lesbian or gender dysphoric person is unfit as a parent for "normal children" is ludicrous! My own children never knew my intimate identity, until a local laboratory gossip leaked my DNA tests results. The two oldest have not changed and support me, however, my youngest daughter (15) was teased at school and chose to go live in another state with my ex-wife. They are all heterosexual as far as I know, but perhaps they are more tolerant of others, having known, loved and respected me.

http://www.healthyplace.com/communities/gender/intersexuals/index.html

Lynn Conway (2000-2004) summarizes the most recent data on intersexuals.

Although most infants appear to be either normal boys or normal girls, various genetic and developmental effects can lead in some cases to infants having ambiguous genitalia, so that even the doctors can't be sure whether it's a boy or a girl. In other cases, the genitals look correct for one gender, but aren't consistent with the infant's genes. In yet other cases the child's genes are something more complex than just XX or XY, and the child's gender identity and physical gender trajectory as they mature may be difficult to predict in advance. Children having these genital and/or genetic variations are called "intersexed". Intersexed babies are produced in about one in every 1000 births.
 
For example, in about one in 13,000 births an XY (genetic male) fetus is unresponsive to fetal male hormones, and develops genitals that look like a girl's, except for a lack of internal reproductive organs. These XY "complete androgen insensitivity syndrome" (cAIS) infants are simply declared to be girls and are raised as girls. Although they cannot bear children, they often develop into slender, attractive women who have a female gender identity. It's rumored that a number of beautiful models have been AIS girls.
 
In other births, a "partial androgen insensitivity syndrome" (pAIS) results in the external genital appearance may lie anywhere along the spectrum from male to female. Incredibly, many of these girls are never told about the true nature of their conditions, because their doctors and families feel such shame and embarrassment about thes "terrible secret" that these girls have male genes. Instead they are usually told things like "you didn't develop any female internal organs, and thus can't have babies", and often discover the truth about themselves by accident later in life ...
 
Our society is almost completely unaware of the existance of cAIS girls, and this had led to many problems for them. For example, for more than thirty years the International Olympic Committee (IOC) has conducted genetic "gender-testing" on all women athletes to make sure that they were "really female" (this was done to prevent "sex changes" from competing). In quite a number of cases these tests turned up cAIS girls, identified them as "males", and disqualified them from competition. These were truly tragic mis-identifications, since the presence of the Y chromosome in AIS girls does not make them males either genitally or in gender identity, nor does it confer any strength advantage to them. These mis-genderings were often made public, resulting in total humiliation for the women involved. In a significant recent reversal of this dreadful policy, the IOC has just dropped all such gender-testing for the upcoming summer games. ai.eecs.umich.edu/people/ conway/TS/TS.html

For the most part, intersexuals have "slipped under the radar" of every day activities for most people. The exception to this is amateur and professional sports, particularly the Olympic games. According to Matt Guilbeault:

Ever since 1934, when the first intersexual was discovered thirty eight years after the establishment of the modern Olympic Games, the global sports world grew concerned over males masquerading as females in sporting competitions. This became the foremost of concerns in the 1960's, after many other incidents came to light. Thereafter, in 1968 the International Olympic Committee (IOC) required all individuals in sporting events, to provide evidence of their femininity (de la Chapelle, 1986). Since then the American College of Physicians, and the American College of Obstetricians and Gynecologists have denounced sex testing, in all sports, as intersexuals were evidently being discriminated against (Cahn, 1994). However controversy still prevails to this day, and little inclusion of intersexuals under any jurisdiction has been provided. http://members.fortunecity.com/dikigoros/intersexism.htm

Perhaps the most highly publicized after-the-fact case is that of Spanish hurdler Maria José Martinez Patino, who although "clearly a female anatomically, is, at a genetic level, just as clearly a man" [Micheal D. Lemonick, "Genetic Tests Under Fire." Time, 24 February 1992, 65.].

Upon giving her the test results, track officials advised her to warm up for the race but to fake an injury so as not to draw the media's attention to her situation [Grady, 1992]. Patino lost her right to compete in amateur and Olympic events but subsequently spent three years challenging the decision.

The IAAF (International Amateur Athletic Federation) restored her status after deciding that her X and Y chromosomes gave her no advantage over female competitors with two X chromosomes [Gina Kolata, "Track Federation Urges End to Gene Test for Femaleness." The New York Times, 12 February 12 1992, sec. A, p. 1; sec. B, p. 11; Lemonick, 1992] (Ferrante, 1995, p.394).

Guilbeault chronicles this and eighteen other cases of intersexuals in amateur and professional sports on his website. Three are cited here:

Maria Jose Martinez Patino

One such person who had to pay this small price was Spanish hurdler Maria Jose Martinez Patino, who was "subjected to a lifetime ban from national competition" when "testing revealed an XY chromosome configuration in 1986." At 24 years of age, as the national Spanish record holder for the 60 meter hurdes, she did not know that she had androgen insensitivity syndrome (AIS), which does not allow some genetic males to metabolize androgens, as they extragonadally aromatize into estrogens, and feminize the body into the female habitus. Having a completely normal female body, with the exception of her lacking internal reproductive structures, her situation is common-place in the athletic world. For with elite training, hormonal replacement therapy, and exercise induced amenorrhea, many elite female athletes never have menstruated. Thus those athletes with AIS may easily go undetected. According to Ferguson-Smith (1992) and Dingeon et al (1992), on both sides of this argument, this is the most common form of intersexuality being discriminated against today. http://members.fortunecity.com/dikigoros/intersexism.htm

Eva Klobukowska

Polish sprinter Eva Klobukowska became the first public victim of the sex chromatin test in 1967, at Kiev, USSR, at the European Cup; even after several British Ahtletes at that time, failed the test and were quietly counselled about their new found abnormalities. This occured a year after passing the "old-style gynecological examination" in 1966, when she competed at the European Cup Championships in Budapest. She was found to have an XXY karyotype (Turnbull, 1988): "one chromosome too many to be declared a woman for the purposes of athletic competition" (Donohoe et al, 1986). After a gynecological examination, which proved to be normal, she was immediately banned from competition, and publically humiliated all over the world, because of her extra chromosome (Ryan, 1976). A few years after Miss Klobukowska became pregnant and gave birth to a healthy baby (Sherrow, 1996).http://members.fortunecity.com/dikigoros/intersexism.htm

Erika Schineggar

... Erika Schineggar of the Australian National Ski Team, ... won the 1966 downhill ski title. The following year when sex testing was brought in, the officials banned her from competition, due to her intersexism. Later she chose to compete in cycling and skiing as a male, while undergoing four genital surgeries (Ryan, 1976). She changed her name to Eric, got married, and became a father (Donohoe et al, 1986), which unlikely had anything to do with fertility.http://members.fortunecity.com/dikigoros/intersexism.htm

The Intersex Society of North America (ISNA), a group of intersexual who articulate the issues affecting intersexuals, offers its own unique perspective of transgender issues:

AMBIGUOUS GENITALIA

When a newborn's gender can not be readily determined at birth because its genitalia does not appear clearly male or female, the child is said to have ambiguous genitalia and may be considered to be intersexed.

Located on the top half of the Y chromosome is a gene called the "SRY" gene. This is the gene that "turns on" the process that will send males down one path of development and females down another. When the SRY gene is present, around the sixth week of the life of the fetus, the gonads which at this point are neither male nor female begin to change into testes. At the same time any female reproductive development stops or "regresses" e.g. disappears. As the testes produce testosterone, the penis, scrotum, and urethra form. During the 7th to 8th month of the pregnancy, the testes will descend into the scrotum.

When the SRY gene is absent, the gonads will change into an ovaries and female reproductive development will proceed forming the uterus and fallopian tubes. Male reproductive development stops or "regresses". Several genetic and environmental factors can influence this development, leading to ambiguous genitalia which may make determining the child's gender difficult.

ANDROGEN INSENSITIVITY SYNDROME

Maria Patino exhibited what is called complete androgen insensitivity syndrome or CAIS. Let us review in more detail Maria's story

It was this test that Maria Patino took in 1985 to prove she had no unfair advantage over the other women hurdlers. When her results came back, however, there were no Barr bodies in her cells - genetically she was a male, the test said. Meet officials told her she would not be allowed to compete, and advised her to fake an injury and leave. But convinced that she was just as female as the other competitors, she continued training and entered a meet in Spain several months later. Ignoring a warning not to compete from the president of the Spanish athletic federation, she won her event, but the following week she was kicked off the Spanish national team, stripped of her titles and barred from competition. Two and a half years later she was reinstated by the International Amateur Althetics Federation.

Maria does not have two X chromosomes. She has one X and one Y. Genetically, she is that one male in twenty thousand births who had a defect in his "androgen receptors"

http://www.cell-works.com/images/androgen-receptor-lg.gif

Androgen receptors are large molecules that the allow male hormones (androgens) to "work on" various tissues in the body. These receptors attach themselves to cellular membrane of gonadal tissue. They are like scanners sensing out the correct chemical keys that will bind the male hormone to gonadal tissue and set off a variety of biochemical events that eventually lead to such things as the growth of the penis and scrotum.

It is the binding action of the receptors which set these events in motion. If the receptors are defective, the body will not respond to testosterone and the other male hormones. this is called "androgen insensitivity." The XY fetus will develop testes around the eighth week of gestation, start producing testosterone (androgen) and send it out into the body. But because of the defective receptors, the body does not respond. It cannot detect any male hormones, so the genetically male fetus never develops into a complete male . The testes still do produce Mullerian inhibiting factor, however, so the Mullerian ducts atrophy and the fetus never develops a uterus, fallopian tubes or the upper part of the vagina.

On the subject of Androgen Insensitivity Syndrome, the ISNA submits the following:

ISNA advocates against vaginal surgery on infants.

Because AIS is a genetic defect located on the X chromosome, it runs in families. Except for spontaneous mutations, the mother of an AIS individual is a carrier, and her XY children have a 1/2 chance of having AIS. Her XX children have a 1/2 chance of carrying the AIS gene. Most AIS women should be able to locate other AIS women among siblings or maternal relatives. (1998, http://www.isna.org/FAQ.html)

A FUTURE FOR INTERSEXUALS

Anne Fausto-Sterling

http://www.naz.edu/news/photos/annefaustosterling.jpg

Anne Fausto-Sterling (1993) envisions a more accepting future for intersexuals:

Herms, merms and ferms might become the most desirable of all possible mates able as they are to pleasure their partners in a variety of ways. Furthermore, the existence of three additional sexes would open up possibilities for the rest of us.It would become difficult to maintain a clear conceptualization of homosexuality, for example, and perhaps its current contentious status would fade from view.

If we envision the world in fives instead of twos, it would also be more difficult to hold onto rigid constructions of male and female sex roles....

Should we have only two sexes?My answer would be a resounding no. (Anne Fausto-Sterling, "The Five Sexes: Why Male and Female are not enough," The Sciences, March/April 1993, 2024.)

While Fausto-Sterling may be considered sympathetic to plight of intersexuals, she is not an intersexual.

AN INTERSEXUAL'S RESPONSE

Cheryl Chase of the ISNA

http://ai.eecs.umich.edu/people/conway/TS/Cheryl%20Chase1ss.jpg

Cheryl Chase is an intersexual and is an eloquent voice for transgender people. Her letter addressed to Fausto-Sterling is instructive:

As an intersexual I found Anne Fausto-Sterling's "The Five Sexes" [March/April] of intense personal interest. Her willingness to question medical dogma on intersexuality is unique and refreshing. I understand that she has not had the opportunity to meet with any "corrected" intersexuals; I believe that I can provide some perspective on the experience. Surgical and hormonal treatment allows parents and doctors to imagine that they have eliminated the child's intersexuality. Unfortunately the surgery is immensely destructive of sexual sensation and of the sense of bodily integrity.

Because the cosmetic result may be good, parents and doctors complacently ignore the emotional pain of the child forced into a socially acceptable gender, his/her body violated by the surgery, and again during frequent genital examinations. Many "graduates" of medical intersex corrective programs are chronically depressed, wishing vainly for the return of body parts, and suicides are not uncommon. Some are transexual, rejecting their imposed sex. Follow-up of adults to ascertain the long term outcome of intervention is conspicuously absent.

I find myself forced to wonder whether a concept of sexual normalcy that defines the sex organs of up to 4% of newborn infants as "defective" is not itself defective. Intersex specialists are busily snipping and trimming infant genitals to fit the Procrustean bed that is our cultural definition of gender.

Ms. Fausto-Sterling has been wrongly informed that few intersexuals escape medical intervention. Those I have located have told me that they feel most lucky to have escaped with their bodies intact. How did their parents shepherd them through the mine field of puberty? Generally, in the culturally sanctioned way: with embarrassed silence.

Medical dogma on sex assignment of intersexuals centers on the "adequacy" of the penis. Because a large penis cannot be constructed from a small one, female assignment is preferred. Because a large clitoris is considered "disfiguring," extensive surgery is employed to remove, trim, or relocate it.

While a male with an "inadequate" penis (small, but with normal erotic sensation) is considered tragic, the same individual transformed into a female with reduced or absent genital sensation and an artificial vagina is considered normal. The capacity to inflict such monstrous "treatment" on children, who cannot consent, is ultimately a clear expression of the hatred and fear of sexuality which predominate in our culture.

I must take issue though, with the terms true, female pseudo-, and male pseudohermaphrodites.They are inheritances from Victorian medicine, and without prognosticative value. They reflect the Victorian belief that human sexual nature rests entirely in the gonads, a concept of gonadal determinism belied by the relative success of intersex medicine in sex reassignment...

(Chase, 1993 @ http://www. isna. org/ letters.html)

By what or whose authority does Cheryl Chase speak? By virtue of the fact that she is an intersexual and can authetically represent the intersexual's experience. Ms. Chase's personal story is as instructive as her letter to Fausto-Sterling :

Cheryl Chase's clitoris was surgically removed when she was 18 months old. She appears to be a clean cut woman in her forties, and as she speaks about the series of operations that were performed on her, she fills the room with a sense of her loss and anger. Chase was born a true hermaphrodite, a condition in which the gonads have elements of both ovarian and testicular tissue. The testosterone produced by the testicular elements in her gonads caused her clitoris to be unusually large, resembling a small penis. Like others recognized at birth to have ambiguous genitalia, or whose genitals do not match their chromosomal sex, she was classified as an intersex individual.

Initially doctors thought Chase should be reared as a boy, and she was named Charlie. But further consultation with different doctors led to the decision to raise her as a girl. She was renamed Cheryl. Her parents decided, under medical advice, to have her clitoris removed, in order to "normalize" her appearance toward that of a girl. This clitorectomy was meant to help her develop a female gender identity. When she was eight, doctors removed the testicular portion of her gonads, to reduce the risk they would undergo cellular changes that could lead to cancer. At no time was she truthfully told the purpose of the surgeries.

At the age of 35, Chase had a nervous breakdown. Although she had been able to access her medical records in her early 20s, support groups in which to discuss her condition did not exist. The years of secrecy, unexplained surgeries, and sexual dysfunction caused by removal of her clitoris had taken a huge toll on her. "Until I was 35, I was ashamed and terrified that people would find out that I was different than a woman. Like many, supposedly happy and successful patients, I was silenced."

Instead of retreating from the pain of her experience, she took the revolutionary step of founding the Intersex Society of North America (ISNA), a San Francisco based peer support and advocacy group. Initially just a loose association on the internet, ISNA now has 1,400 members, holds retreats for intersex people, has produced a video, lobbies, holds demonstrations, maintains a website, and puts intersex people in touch with each other throughout North America. The latter may be their most important function. "Every intersex person we have met with has had a common experience, in that it was immensely transformative and positive for them to meet other people like themselves," says Chase.

http://www.kindredspiritlakeside.homestead.com/Rights_for_IS.html

A surprising number of physicians regularly recommend that "ambiguous external genitals" of intersex infants be surgically altered so that the child will grow up appearing to be a "normal" male or female, especially those "girls" born with an enlarged or protruding clitoris or those "boys" born with a "micropenis."

It is estimated that about 90% of intersexual infants who appear to be "female" undergo genital surgery to make them appear "normal." According to Anne Scheck (1997), these operations are usually performed shortly after birth, at the age of six weeks to fifteen months although they are sometimes done later.

Who has the right to decide whether or not surgical intervention is necessary to make genitals look more acceptable, especially for children? Whose interests are being served? These are political questions and a political debate rages.

FEDERAL PROHIBITION OF FEMALE GENITAL MUTILATION ACT (1995)

While the 1995 Federal Prohibition of Female Genital Mutilation Act places restrictions on genital surgery, the same is permitted if deemed "necessary to the health of the person on whom it is performed." OCRT,1998; http://www.religious tolerance.org/fem_cira.htm)

Doctors who do perform "corrective" genital surgery on children claim in doing so they "prevent psychological and mental trauma for the child...." Activist groups such as the Intersex Society of North America, the National Gay and Lesbian Task Force and others are vigorously trying to modify the law, so that genital surgery cannot be performed without the informed consent of the individual. Some pediatricians defend the practice of infant genital surgery. The following citations are excerpted from the Ontario Consultants on Religious Tolerance website:

"I don't think it's an option for nothing to be done. I don't think parents can be told, this is a normal girl, and then have to be faced with what looks like an enlarged clitoris, or a penis, every time they change the diaper. We try to normalize the genitals to the gender to reduce psychosocial and functional problems later in life."

Dr. Justine M. Schober, a pediatric urologist at Hamot Medical Center in Erie, Pa. has said:

"The truth is, genital surgery is being done, but we don't know what the outcome of it is, sexually or otherwise. We don't have any long-term studies."

David Thomas, a pediatric urologist at St. James's University Hospital and Infirmary in Leeds, UK conducted a scouting study. It involved only about a dozen intersexual individuals aged 11 to 15 who had been subjected to genital surgery. Results were not encouraging. Dr. Thomas reports:

"Every girl required some additional vaginal surgery...

The results are indifferent and frankly disappointing."

Estimates on the number of intersexuals in North America range from 1 in 50 to 1 in 1000. Intersexuality is sometimes caused by genetics, sometimes by rare hormonal levels during pregnancy, and sometimes by unknown causes.
(OCRT,1998; http://www.religioustolerance.org/fem_cira.htm)

Intersexuality is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APA). This is cause for controversy.

According to Robert Bray (1996):

The subject of Gender Identity Disorder (GID) has emerged in the media and within the gay and lesbian movement as transgender visibility and activism continues to grow. GID is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APA). While some transgender people use a GID diagnosis to qualify for hormone treatment, surgery and, in limited cases, antidiscrimination protections based on disability, the diagnosis can be used to pathologize transgender people and "gender-variant" youth i.e., those children who exhibit behavior that may be viewed as "pre-homosexual" or "pre-transsexual." (http://www.gendertalk.com/GTransgr/ngltf1.htm)

GID is a controversial subject that deserves sensitive treatment. It has broad implications for the civil rights, health and well-being of transgender people.

...[T]here is a growing number of jurisdictions with civil rights policies that prohibit discrimination against transgendered people without reference to GID.These include the state of Minnesota as well as its cities, Minneapolis and St. Paul; San Francisco and Santa Cruz, Calif.; Seattle, Wash.; and Cedar Rapids, Iowa.

In addition, the European Court of Justice recently held that employment discrimination against transsexual people violates the fundamental human right to be free of discrimination based on sex.

Many transgender activists believe these laws represent the beginning of a new era in transgender liberationa time in which they can attain equality and health care not through a diagnosis of "mental illness," but through a progressive and comprehensive civil rights agenda. (http://www.gendertalk.com/GTransgr/ngltf1.htm)

It was asserted elsewhere in this series of essays that "racial" categories based on biology e.g., phenotypes and genotypes, had little if any scientific validity and should not be used to classify human beings. Can the same be said of sex as a biological category?

Both males and females produce estrogen and androgen, biological females can potentially have the same hair follicle distributionfor mustaches, beards and body hair as biological males and some men have breasts. The closer one looks at the sets of primary and secondary sex characteristics, the less "absolute" the distinctions between males and females.

This is not to say that there are no biological differences between males and females, just that "no fixed line separates maleness from femaleness" (Ferrante, 1995, p. 395). In fact, sharp distinctions between the sexes do not originate in biology but in culture.

Culture, not biology, sets absolutist, either/or boundaries dividing the sexes. Culture, asserting its prescriptive authority, can either deny the existence of human beings with primary and secondary sex characteristics that vary widely from culturally recognized and established central tendencies of male and female anatomy or validate them. Culture can make them "freaks of nature," or accept them.

Culture conceives, standardizes, teaches/models, and sanctions normative cognitive/affective and behavioral characteristics for men and women.

GENDER

Beliefs, values, and attitudes regarding how men and women should think, feel and act; what they should look like, all comprise the social construct known as gender. According to Carroll:

Gender is socially constructed; that is, societies decide how gender will be defined and what it will mean. For example, in American society, conceptions of "masculinity" and "femininity" have been seen as mutually exclusive; that is, a person who is feminize cannot also be masculine and vice versa (Spence, 1984). But research has shown that masculinity and femininity are independent traits that can exist in people separately (Spence, 1984; Bem, 1978). Bem (1978) suggests that this can lead to four types of personalities; those high in masculinity and low in femininity; those high in femininity and low in masculinity; those low in both ("undifferentiated"); and those high in both ("androgynous"). Such categories may challenge traditional thinking about gender. So may examples of ambiguous gender categories, such as transsexualism or asexuality. In fact, the more one examines the categories of gender that really exist in the social world, the clearer it becomes that gender is more complicated than just splitting the world into male and female. (Carroll, 2004, p. 81)

A more thorough discussion of gender and gender role will be undertaken in part 2 of this essay. Gender identity and gender variance are appropos for this discussion of intersxuality and transexuality which fall under the rubric of transgenderism.

GENDER IDENTITY

Gender identity refers to what Dennis P. Saccuzzo and Rick E. Ingram call one's "deeply ingrained sense of being male or female" (Saccuzzo and Ingram, 1993, p. 191). Gender identity for most people matches their primary and secondary sex characteristics, or as described in the foregoing section, their biological sex. As such, most males "feel" male, prefer being male and regard their primary and secondary sex characteristics with some measure of pride and relief.

The same may be said for most females who in spite of their subordination and oppression in many human cultures, take pleasure in "feeling" female and derive considerable pride and satisfaction (and relief) from the match of their biological sex with their "sex-typed" beliefs, values, attitudes and behaviors or to take liberties with Betty Friedan's now classic term, their "feminine mystique." There are, however, some human beings whose biological sex does not match their sense of being male or female.

GENDER VARIANCE

People who are unable to conform to societal gender norms associated with their physical sex or who choose not to are described as gender variant. Individuals can choose to be gender variant in some form. Choosing some form of gender variance does not mean one is "born that way."

According to Jessica Xavier:

Transgendered people are the most stigmatized and misunderstood of the larger sexual minorities (Gay, Lesbian, Bisexual, Transgender). Since gender follows physical sex for most people, transgenderism and even transsexualism are almost impossible to understand by those who are not transgendered themselves. Thus one of the primary challenges facing gender educators is to place transgendered experience into a context by which it can be readily understood. While transgendered people are most familiar with gender variant expressions and cross-gender identities, there are many other forms of gender variance exhibited by all kinds of people - regardless of their social or gender identities. Revealing these other forms of gender variance will show an audience how common it really is – and thus provide the all-important context for them to understand transgendered people.
http://www.gender.org/resources/files.html#gvm

Why is it important to understand transgendered people? To eliminate the fear and oppressive or self destructive behaviors that issue forth out of that fear when encountering people who are different. The multiculturally aware and conscious person embraces difference, seeking out the common human pathos behind it while attempting to treat others as he or she wishes to be treated.  S/he seeks to alleviate distress and emotional pain, especially that which comes from prejudice.  To understand transgendered people means to understand better all human beings and ourselves.

But what, really, does the term transgendered mean? Xavier instructs:

Transgender is an umbrella term used to describe visibly Gender Variant people who have gender identities, gender expressions or gendered behaviors not traditionally associated with their birth sex.  Transgender can also mean anyone who transcends the conventional definitions of 'man' and 'woman', and who use a wide variety of terms to self-identify. Transgendered people are usually categorized by their Gender Vector, which describes the direction of the gender change. The two gender vectors are Male-to-Female (MTF), or Female-to-Male (FTM). It's important to clarify two common misconceptions about transgenderism : Transgender is not a sexual orientation. However, it is a sexual identity that has become politicized, and so it is now commonly added to the list of other sexual minorities, which are sexual orientations – as in Gay, Lesbian, Bisexual and Transgender. Transgender is often mistakenly understood to mean Transsexual. Transsexual people, who have undergone or seek to undergo sex reassignment, comprise a minority within the transgender population. Most transgendered people do not wish to change their sexual anatomy.

TRANSSEXUALITY

Silvia Rivera
1951-2002
Transsexual Activist
http://www.ifge.org/news/images/SylviaRivera.jpg

Transsexuals are individuals who believe that their gender identity is markedly different from their primary and secondary sex characteristics. Saccuzzo and Ingram (1993) describe the transsexual with considerable pathos and compassion:

[S]ome people feel that their "real" gender is different from their body. This psychological phenomenon is known as transsexualism. If the person dresses in the clothes of the opposite sex, it is known as transvestism; this is very different from transsexualism because the person, usually a man, is comfortable with his anatomical sex.

Most transsexuals are men who feel that, by a cruel twist of fate, they are really women trapped in male bodies. Thus, while biologically male, psychologically the person experiences himself as a female. The man thus feels great discomfort with his anatomical sex, wishes to live as a woman, and often wishes to be rid of his genitals, which he may consider to be a deformity.

Although these people may feel an attraction to members of the same biological sex (homosexuality), they believe they are heterosexual because in their minds, they are in fact the opposite biological sex. Thus, while a transsexual man may feel an attraction to other men, he does not believe he is homosexual because he believes he is really a woman. Further, transsexuals desire to be loved by a man who is attracted to women, not by a man attracted to other men (Saccuzzo and Ingram,1993 p. 192).

It needs to be emphasized here that transsexuals are not necessarily hermaphrodites (having one ovary and one testis) or so-called pseudohermaphrodites (having the external genitalia of one sex but the internal sex organs of the other sex or both sexes) as described in the foregoing section.

Transgender people can and do adjust into the gender roles and functions that the culture demands of those who match the obvious physical characteristics of the cultural "male" or "female."

What makes an individual a transsexual is the belief that one's gender identity is different from his or her biological sex.

The power of this belief is demonstrated not only in the transsexual's dismissal of the notion of his or her homosexuality or the fact that he or she is attracted to men or women who are attracted to the opposite sex, but in the willingness to undergo sex-reassignment surgery. Saccuzzo et al., continue:

The willingness of some people to have surgery to remove genitals and transform them into another sex should be enough to convince you of their conviction that they are trapped in the body of the wrong sex. (p193)

http://members.tgforum.com/bobbyg/kathyr1ka.jpg

Minhee Kim, writing for the Human Sexuality Web, describes in detail the sexual reassignment surgical process (SRS):

What is the SRS?

Sex reassignment surgery refers to the administration of surgery to change the sex appearance according to one’s sex identity. There are two kinds of surgery.

1. Genital surgical sex reassignment: surgery of the genitalia and/or breasts performed for the purpose of altering the morphology in order to approximate the physical appearance of the genetically other sex.
2. Non genital surgical sex reassignment: any and all other surgical procedures of non-genitalia or non-breast, conducted for the purpose of effecting a more masculine appearance in a genetic female or for the purpose of effecting more feminine appearance in a genetic male.

As a former step of SRS, there is a hormonal sex reassignment, which is the administration of androgen to genotype females, and administration of estrogen and/or progesterone to genotype males, for the purpose of effecting somatic changes in order for the patient to more closely approximate the physical appearance of the other sex.

Who does SRS?

SRS should be done by specialists, called Clinical behavioral scientists. They should have documented training and experience in the diagnosis and treatment of a broad range of psychological and sexual conditions. They should have proven competence in general psychotherapy, sex therapy, and gender counseling and therapy.

When is SRS performed?

The time that people start feeling of belonging to the opposite sex is 2-3 years of age. According to the outcome of many researches, early treatment would prevent unnecessary sufferings. Physical outcome of an early treatment can be expected to be more satisfactory by comparison with starting later, especially MFs (male to female). This is an enormous and lifelong advantage instead of having to live with a deep voice and other scar. Thus, the earlier the SRS is performed, the easier transsexuals can adjust themselves according to their sex identity, and they can avoid the confusion about themselves. But SRS is usually performed at the age of 18-21. There are two reasons for this long delay. First, most children with gender identity disorder will not grow up to become transsexuals. Second, adolescents in many countries are still legally dependent on the consent of their parents when deciding on medical treatment.

Procedures of SRS

Step1.

Clinical behavioral scientists gather the information of SRS applicant to differentiate between the transsexuals and other types of gender disorders. To do this, they interview about general and gender development of the applicant, the way the parents have dealt with their child’s gender disorder, the family backgrounds of the parents themselves, identification figures, relationship with same sex and opposite sex parents, first conscious cross gender feelings, aspects of sexuality, and so on. Applicant must have a confirmed, working diagnosis of transsexuals and have completed at least 3 months of psychotherapy in order to obtain evaluation for hormone therapy. During this time, the MF transsexual patient can start electrolysis, if desired, to remove unwanted facial hair.

Step 2.

Upon receiving a written evaluation for hormone therapy, the applicant may then take a copy of the evaluation to an endocrinologist who offers monitoring of relevant blood chemistries and routine physical examinations. This is especially important because hormone therapy may have some irreversible effects and may lead to mild or serious health-threatening complications. However, if a patient is followed by a qualified physician who explains what the patient may expect from the hormones, both positive and negative outcome, and regularly monitors the patient’s lab work, he is less likely to run into complications. If MF patient has not already started electrolysis for removal of the beard, it should be started during the early stages of hormone therapy.

Step 3.

The next step is a period of one to two years of cross living while the patient continues hormone therapy. The patient lives 24 hours a day in the gender of choice. Thus, this period is called "real life test". During this time, the patient must demonstrate stability and prove functional ability, become self-supporting, and be socially active. Hormone therapy should be started as a partial hormone therapy. It blocks the action of sex steroids in a reversible way. The MF bodies do not masculize any further, and FMs (female to male) stop menstruation and sometimes experience a weakening of breast tissue. On the contrary, full hormone treatment is not reversible. It masculinizes the female body, and feminizes the male body. It is given before 18. Minimal duration of the real life test is 1 year for FMs, 1.5 years for MFs. This difference is due to the fact that the gender role change seems to have more impact on the life of MF than on that of FM, and MFs need more time to adjust to the new situation.

Step 4.

At the end of a cross living, an orchidectomy (to remove the sex glands of a male) may be performed for the MF transsexuals. Implants or breast augmentation and other optional non-genital surgical sex reassignment procedures are often done at this time. Mastectomy (to remove the breast) and hysterectomy (to remove the uterus) for the FM transsexual is usually begun after one year of cross living. Most patients consult a plastic surgeon for the mastectomy and a gynecologist for the hysterectomy. It is also recommended that the FM transsexuals be in complete understanding with the surgeon who does his phalloplasty (to implant the male sex organ to female). Some FMs who have been on androgen for a while tend to get so much clitoral enlargement, that they choose not to have that phalloplasty at all.

Step 5.

At this point, final psychological evaluation before surgery should be decided. Two written evaluations are required by at least two clinical behavioral scientists; at least one of which is a doctoral level clinical behavioral scientist and one of whom has known the patient in a professional relationship for at least six months, before surgical approval.

Step 6.

Operating surgery.

Step 7.

Post operative or follow-up care after a patient has completed SRS, for a period of at least three months is required, however, six months are recommended. This is a period of recovery, necessary for immediate psychological and social readjustment.

How do transsexuals feel after SRS?

On the whole, most of the transsexuals who have performed SRS were satisfied with sex change itself. Nevertheless, many of them were dissatisfied with the way their new physical appearance. The reason for dissatisfaction is first, MFs have to do with retention of bodily features and aspects of the overall appearance that could not be changed completely by either surgery or hormonal manipulation. For example, remains of the beard, large feet and hands, quality of the voice, and persistence of Adam’s apple. Social pressure on woman to pay more attention to their appearance is also one of the reason. FM transsexuals are usually dissatisfied with their new genitals. But, the most important thing is that they could live in the new gender role feeling that their identity is fitting to themselves. They have more comfortable relationship with other people around their environment.
http://www.umkc.edu/sites/hsw/gendid/srs.html

As mentioned earlier in this essay, many activist groups, e.g.Transexual Menace, International Conference on Transgender Law and Employment (ICTLEP), National Center for Lesbian Rights (NCLR), International Gay and Lesbian Human Rights Commission, FTM (Female-To- Male) International, Intersex Society of North America ("Hermaphrodites With Attitude"), International Foundation For Gender Education, GenderPAC, BiNet USA, Gay and Lesbian Alliance Against Defamation are advocating for the transsexual and transgender communities.

THE STORY OF ERIN SWENSON

On November 4, 1996, Daniel Pederson, wrote in Newsweek Magazine :

The Trustees of the Greater Atlanta Presbytery voted to sustain or continue the ordination of transsexual minister, Rev. Erin Swenson...

The issue before the Presbytery of Greater Atlanta was this: since Erin Swenson had completed her transsexual medical procedures, could she retain the ordination she had received when she was Eric, a man? . . . Evidently impressed by Swenson’s quiet dignity, the panel took less than an hour to vote to retain Swenson’s ordination. It was close—186 to l61. And it was historic; this was the first time that any mainstream church had upheld the ordination of a transsexual Christian minister.

 . . . Swenson says that she’s neither a publicity hound nor an exhibitionist. “I’m no she/male or drag queen,” she says, “and I don’t want to fight society.But I have as much right as anyone to practice my livelihood.”  . . . Since 1973, Swenson’s ministry had been diverse:  pastor and preacher, chaplain at a psychiatric center, instructor and supervisor of seminarians at Emory University’s Candler School of Theology.

For the past 12 years, Swenson has also run a private marriage counseling practice. She does not have a congregation. . . . Last week’s close vote left many unsatisfied.

“You can’t father two children without being a male” says the Rev. Don Wade, who thinks the surgical solution “ruled out the power of God to bring healing.”

Wade filed a formal protest after last weeks vote and an appeal to a higher level might follow . ..

ERIN SWENSON PRESBYTERIAN MINISTER AND TRANSGENDERED

As of 2004, no such appeal to higher authorites has materialized.  Rev. Swenson's story is so illustrative of the transgendered expericnce that a closer look at the life of this remarkable individual is warrented John Blake, writing inthe Atlanta Constitution gives us this profie:

The Rev. Erin Swenson's heart thumped wildly. She was so close to panic that her fingertips tingled. The crowd inside Shallowford Presbyterian Church in Atlanta stared at her in disbelief. Swenson, an ordained minister and father of two daughters, had just walked to the front of the church in a green dress, heels and an eggshell-white blouse. She was going to speak publicly for the first time about a 42-year-old secret that had driven her at times to thoughts of suicide.

Swenson told the hushed crowd that she was a woman born in a man's body. Now that she had taken steps to correct that, she made an unprecedented request before the assembly of Presbyterian church leaders: Allow her to retain her ordination as a minister, even though she had switched genders.

"I understand that the changes in my life may seem to be bewildering, or even outrageous," Swenson said in a calm, measured voice. "But they are not intended to be so."

Swenson made her request on Oct. 22, 1996. Some 1,000 delegates from the Presbytery of Greater Atlanta had gathered for the group's annual assembly, where Swenson's ordination was the chief topic of debate. Some delegates questioned her motives. "Didn't you think about your family?" "Aren't you mocking God?" "Is it true that you wore your wife's clothes?"

As the questions droned on, Swenson closed her eyes to recite her favorite prayer. When her turn came to speak, Swenson walked to the front of the church and steadied herself by looking at a huge wooden cross that loomed over the pulpit. Then she prayed again.

God, help me keep my heart open to people.

FINDING SUPPORT

Five years later, Erin --- formerly Eric --- Swenson is stepping back in the spotlight. She and her ex-wife, one daughter and father are finally talking about the extraordinary journey --- as a family and as individuals --- they have taken together since that autumn morning.

Today, Swenson has no official congregation, but she leads an unofficial one --- a transgendered support group that meets in her cozy Grant Park office. Since the Presbytery's vote in 1996, she has become a leader in the transgendered community (transgendered is the umbrella term for cross-dressers, transsexuals and those born with ambiguous sexual characteristics). Part of Swenson's appeal comes from her soothing personal presence. A marriage therapist by training, she has a gentle, empathetic voice and a relentlessly jovial manner. With her shoulder-length blond hair and 5-foot-9 frame, Swenson, 53, can melt into a crowd as a woman.

Other transgendered people don't slip so easily into their new gender. Some members of her support group --- balding 6-footers sporting lipstick and linebacker shoulders --- seem trapped in gender limbo. They don't look like a woman or a man. Swenson goes around the room to find out how everyone is doing. Most of them share the same stories: losing their families and careers and being taunted by strangers in public. The conversation ranges from hormones to hairstyles. Swenson holds up a recent article about a Catholic priest who is undergoing surgery to become a woman.

"I don't feel so lonely now," she tells the group, chuckling.

They don't get it.

"When I'm with ministers, I'm the transsexual," she explains. "When I'm with transsexuals, I'm the minister."

The isolation started when Swenson was a child. One night, when he was 11, Eric had a startling dream. He saw himself walking down an enchanted road. Each step around a bend would gradually reveal a subtle transformation, from male to female. Swenson emerged from the road permanently female.

"It was probably the first transgendered experience that I really had," Swenson says. "The dream was so vivid that I began to use it as fantasy. I would comfort myself with it at night."

It was not the type of dream that young Eric thought he could share in his "sexually repressed" household. Born in Buffalo, N.Y., Eric had moved with his family to Atlanta when he was 10. His father, Karl, was a branch office manager for a national manufacturing firm. His mother, Ruth, who died of ovarian cancer in 1991, was a housewife. He has two younger sisters, Jana and Jill.

Swenson's secret life began with that dream. That same year, he crept into the powder room of his parents' home and used wadded-up bathroom tissue to create breasts under his T-shirts. Other cross-dressing experiences would follow, with Eric using his mother's clothes. He would pledge never to do it again, but eventually break his vow.

Swenson's family had no clue. Eric was not effeminate. He was a member of the high school wrestling team and excelled at such traditionally male hobbies as electronics and carpentry. "There was absolutely nothing that led me to believe that there was a gender problem," says dad Karl Swenson, 83. "He did all the boy things. He never showed any interest in dolls or males."

Eric prayed for deliverance, but none came. He joined the Mount Vernon Presbyterian Church in Sandy Springs the same year he first cross-dressed. He was elected to the Presbytery's Youth Council. Church leaders groomed him for the ministry. But the desire to be a woman did not evaporate. The boy looked for salvation elsewhere.

"I grew up believing that when I fell in love, I would be cured," he says.

SHORT-LIVED 'HEALING'

In 1967, Swenson met Sigrid Lyons at Camp Calvin, a Presbyterian youth camp in Hampton. Both were youth counselors. Swenson was 20, awkward and inexperienced around women. Still, he recalls being "intensely, terribly" attracted to Lyons, a slim, vibrant woman with dark good looks. Lyons, then 23, noticed Swenson as well. She thought he was handsome, smart and great with kids. Six months later they got married. Swenson's desire to cross-dress evaporated. "She healed me," Swenson says. "She gave me my life back."

The healing lasted three months.

While his wife was away one morning, Swenson put on her clothes. Afterward, he curled up in a fetal position on his bed and cried. "I was devastated," he remembers. "I felt lost."

As Swenson's gender confusion intensified, he became increasingly aloof from his wife. Their sex life disappeared. Swenson threw himself into school to escape his inner turmoil. After graduating from Georgia Tech with a degree in electrical engineering, he earned two master's degrees from Columbia Theological Seminary in Decatur and a doctorate. Then he immersed himself in church work. After he was ordained in 1973, Swenson served as pastor at churches in Dalton and Lithonia. He also became a chaplain at a psychiatric center, an instructor at Emory University's Candler School of Theology and a counselor at a mental retardation counseling center. In 1984, he opened a marriage therapy practice.

Swenson's reputation grew. He was a compassionate counselor and a renaissance man --- an accomplished singer, small-plane pilot and an electronics whiz. And yet he was miserable. He was still secretly dressing as a woman with his wife's clothes.

"The war inside of one's self is incredible," Swenson says. "It's like being at odds with your own molecules."

Sigrid initially had no idea her husband was at war. She never caught him cross-dressing; she never noticed her clothes amiss. "There were glimmers, but they were things that I stuffed. . . . ," she says. "This was back in the 1960s and 1970s. This was a different world."

The couple's personal problems were superseded by another concern. In 1976, their younger daughter, Lara, was born 10 weeks premature. She had cerebral palsy, which would require constant therapy and multiple operations.

"Our family was so structured and couched in routines that couldn't be broken," says Cerjan, the couple's elder daughter. "I think that's how we got by for some time. I had some friends who didn't like to come to my house because . . . it was so sad."

Swenson began to hint at suicide to his wife. He drove aimlessly around the city at night thinking about taking his life with a car crash. His guilt over the divide between his public image and his private life deepened. "I was working in therapy with clients about being self-actualized and authentic when I was the phoniest person in the room," he says.

By 1994, Swenson was desperate.

MOMENT OF DECISION

Years of counseling with five therapists had not helped Swenson. He wouldn't even open up to his therapists. He had read volumes on transsexualism and sex reassignment surgery, and thought that might be his answer. Finally, a therapist recommended that Swenson contact Margaret Lamacz, a psychiatrist in Baltimore who specialized in counseling transgendered people.  Swenson flew to Baltimore but wasn't forthcoming when he met Lamacz. He told Lamacz that his struggles came from "low self-esteem." Lamacz told Swenson his problems were deeper.

" 'You know what you are,' " he recalls her telling him. " 'You don't need a diagnosis from me. You've known it for a long time. You're just afraid that people aren't going to be able to accept it.'

"Those were the words that I needed to hear," he says.

Swenson decided at that moment that he would undergo surgery to become a transsexual. "The flight back to Atlanta that evening was magical," he says. "I felt free."

Swenson's family felt otherwise when he finally told them.

"I just felt sick," his wife says.

His older daughter's reaction was delayed. She reflexively hugged him when she heard the news. Then she walked to her car and bawled. "I was hurt for a few days, and then I was plain furious," Cerjan says. "I couldn't see how he would disrupt our family this way. I thought he was being self-centered."

Swenson's father cried. His two sisters still have not recovered. Both still will not talk publicly about Swenson. To win his family's support, Swenson took the same approach he would later take with the church: He talked constantly to them. He told them he suffered from a medical condition known as "gender identity disorder." He told them that his desire to be a woman was not a choice. And he told them that he might take his life if he were forced to keep living as a man. The process took six months.

"There didn't seem to be an alternative," his father recalls.

Swenson's family members accepted his rationale intellectually, but each had to find their own way to accept it emotionally. Swenson's father thought about his father-in-law, a Klansman and a homophobe. "I felt subconsciously, if I was truly going to be the opposite end of the spectrum of my father-in-law, I better darned well start showing it," he said.

Sigrid thought about protecting the person she still loved.

"If other people were going to accept her and be able to stay with her, I had to be a major part of that," she says. "If I had just gone absolutely crazy and become adversarial, then people would have to take sides."

Eventually, something unexpected took place within Swenson's family. They discovered that they felt closer to Erin than Eric.

"My father was always very distant, closed off," Cerjan says. "Erin seems to be a very open person, easy to get close to. It's a more honest relationship. She's able to be who she is with me. And to me, you can't be close to somebody unless you're able to be yourself."

Erin became her hero, Cerjan says.

"She's become a role model for me," she says. "That was not something that I had expected to happen. But she showed me that you can really be yourself and do what makes you happy. And in doing that, you can make yourself better for other people."

MOUNTING A CAMPAIGN

Not surprisingly, members of the church were a harder sell than Swenson's family. Like many mainline denominations, the Presbyterian church is embroiled in a running debate on homosexuality. When the 11-member Committee on Ministry received Swenson's request in 1994 to approve a name change, the panel was unanimously opposed.

"I took my stance, as the gay basher that I've been, that this was not a proper thing," says Jim Siephert, a committee member. "I thought it was messing with creation."

Swenson made her request for practical and spiritual reasons. She wanted to retain her ordination because it was central to her identity. But she also wanted to retain health insurance for her daughter, Lara, something that would be jeopardized if she lost her ordination.

Swenson mounted a campaign to change the committee's stance. She wrote letters to committee members. God, she insisted, calls a person, not a gender. The committee remained unconvinced. So Swenson personally lobbied them. She had lunch with them, met with them in their offices and homes.

They were impressed. After 18 months of letters and meetings with Swenson, they agreed to support her.

"I found Erin authentic, sincere, trying to see herself in the will of God, not trying to create an issue," says David Fry, now chairman of the committee.

Members also began reading about gender identity disorder. They concluded that Swenson's case was not a homosexual issue, but rather a gender one. Even Siephert changed his mind. He became convinced that Swenson had been carrying a "crucible" for years that she had no control over.

"I finally put aside my preconceptions and prejudices and looked at it from the standpoint of the person."

But would the Atlanta Presbytery follow the committee's decision? The committee took 18 months to support Swenson. The Presbytery had one morning to decide.

Representatives from at least 1,100 metro churches packed into Shallowford on the day of the vote. The debate took an hour. The tone of the discussion varied from sympathy for Erin to incredulity. The debate ended with Swenson's brief speech at the front of the church.

The vote stunned most people. The Presbytery of Greater Atlanta voted 186-161 to retain Swenson's ordination. Swenson closed her eyes in relief when the decision was announced. The decision made Newsweek magazine. It was the first time a mainstream church had upheld the ordination of a pastor who had become a transsexual.

Karl Swenson was in the audience that day, sitting next to his daughter. "I was real proud of the way she handled herself on that occasion," he says. "She kept her cool and just did me proud. I apologize to nobody for what she's done."

Five years later, Erin Swenson is a member of the committee that held her professional fate in its hands, and Siephert is one of her closest allies. "I don't shake hands with her, I hug her," he says. "I told her, 'I hug broads.' I'm not ashamed to hug her or to converse with her so that people know I'm not just a friend --- I'm affirming."

STARTING OVER

Swenson's family has also found a way to affirm her, but it's still a challenge. During the same year Swenson won the church victory, Swenson and Sigrid divorced. Eric changed his name to Erin. And Swenson finally had his surgery. His father helped pay the $14,000 needed for the operation.

Now Swenson is starting over. Virtually all her former clients have left her. She and Sigrid sold their home. Swenson lives in an attic apartment near Grant Park that she rents for $325 a month. Sigrid and Swenson remain close. They call each other when the other's car breaks down. Swenson does laundry at Sigrid's house. Both continue to care for Lara. People often mistake them for a lesbian couple.

"We have a 30-year history together, most of which we were married, raising two girls," Sigrid says. "I accept her as a woman, but I see her almost as nongender. She's just Erin. She's my best friend."

Karl Swenson carries his own sorrow. Like Sigrid, he still accidentally calls Erin "he" on occasion. "He was my only son," he says of Eric, his voice dropping to a whisper.

Erin Swenson's life remains busy. She works on a computer help desk for an Atlanta company and counsels people at nights and on the weekends.

And she still misses Eric's wife. "She is my mate for life," Swenson says. "She may be married again. I'm sure I won't. But no matter what happens, I am married to her forever."

But Swenson doesn't miss Eric. In her tiny apartment there are no traces of him. The place is full of books, discarded computer parts and stuffed animals. Does she ever think of him? She pulls a picture of a bearded Eric from a box nestled in a closet.

"He seems like somebody who just doesn't come around anymore," she says, looking at the picture before gently placing it back in the cardboard box. She closes it with a smile.

God help me keep my heart open to people.

For years, Swenson recited that prayer before counseling marriage clients. It was her way of reminding herself to not judge people who came to her for help. Today, Swenson is learning to extend that acceptance to herself.

"I don't think of myself as a woman," she says. "I don't think of myself as a man. I say I'm a transsexual. But labels are like stones in a stream. They're good to cross the stream, but if you stay on them, you don't really go anywhere.

"Maybe the one label that I do like is, if someone asked me who I really am, I would say, 'I'm a child of God.' " Reprinted from the Atlanta Journal-Constitution, Sunday, 9 July 2000

GENDER IDENTITY DISORDER

Previously in this essay, Robert Bray mentioned the conflict between some transsexuals and some transgender people regarding the so-called Gender Identity Disorder. He referred to those transsexuals anticipating sexual reassignment surgery who favored keeping the GID in the DSM because they can get medical insurance coverage for the surgery if GID remains a "disorder." That conflict has required the consolidation of positions among advocacy groups. The following statement (1996) regarding the position of the National Gay and Lesbian Task Force on the rights of transgendered people and the so-called gender identity disorder is attributable to Kerry Lobel, NGLTF executive director:

NGLTF is sensitive to the differences of opinion within the transgender community on GID and the implications of GID on insurance payments, civil rights and other issues of concern to transgender people. Thus, instead of supporting wholesale GID eradication, we support GID reform. Reform means another diagnosispossibly medicalthat does not pathologize transgender people or gender-variant youth and children.

Reform also means increased funding for research on transgenderism and full participation by transgender people in policy decisions that affect their lives.We are particularly concerned with the use of GID against children.

Gender-variant youth, whether they grow up to be gay, lesbian, bisexual, transgendered or not, should not be stigmatized or mistreated because of a GID diagnosis. The struggle for transgender people in 1996 invokes the struggle of gay and lesbian people in the early Seventies when the National Gay Task Force (NGTF) was successful in helping remove homosexuality as a mental disease. We are aware that transsexual people have unique concerns in their lives, including medical treatments such as hormones and surgery, that are different from being gay or lesbian. However, we believe no one whether gay, lesbian, bisexual, transgender or intersex (hermaphrodite) should have to accept being pathologized as mentally ill in order to attain wholeness, completeness and civil equality.

NGLTF strongly supports civil rights protections and affordable health care for transgenders. We loathe discrimination and violence perpetrated against transgenders and stand in solidarity with transgender people in their struggle for visibility, inclusion, equality and justice. (http://www.gendertalk.com/GTransgr/ngltf1.htm)

Kathryn Wilson on her website speaks to the current status of G.I.D. Reform:

Twenty-seven years after the American Psychiatric Association (APA) voted to delete homosexuality as a mental disorder, the diagnostic categories "transvestic fetishism" (TF) and "gender identity disorder" (GID) in the Diagnostic and Statistical Manual of Mental Disorders, or DSM, continue to raise questions of consistency, validity, and fairness. Recent revisions of the DSM have made these diagnostic categories increasingly ambiguous, conflicted and overinclusive. They reinforce false, negative stereotypes of gender variant people and at the same time fail to legitimize the medical necessity of sex reassignment surgeries (SRS) and procedures for transsexuals who urgently need them. The result is that a widening segment of gender non-conforming youth and adults are potentially subject to diagnosis of psychosexual disorder, stigma and loss of civil liberty...

The transgender community and civil rights advocates have long been polarized by fear that access to sex reassignment procedures would be lost if the GID classification were revised. This division over issues of psychiatric stigma versus access to SRS has allowed little dialogue and no progress on GID reform in over two decades. In truth, however, transsexuals are poorly served by a diagnosis that both stigmatizes them unconditionally as mentally deficient and undermines the legitimacy of sex reassignment procedures that have been easily dismissed as "elective" and "cosmetic" by insurers, governments and employers. GID reform is not a question of less stigma versus improved SRS access, it is a question of less stigma and improved SRS access. We need dialogue among people who wish to move beyond division and polarization to proposals for diagnostic reform that will lead to consensus and forward progress...

It is time for the medical professions to affirm that difference is not disease, nonconformity is not pathology, and uniqueness is not illness. It is time for culturally competent psychiatric policies that recognize the legitimacy of cross-gender identity and yet distinguish gender dysphoria as a serious condition, treatable with medical procedures.It is time for diagnostic criteria that serve a clear therapeutic purpose, are appropriately inclusive, and define disorder on the basis of distress or impairment and not upon social nonconformity. It is time for medical policies which, above all, do no harm to those they are intended to help...

A Text Revision to the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders was published by the American Psychiatric Association in August, 2000. The purpose of the Text Revision was to correct, update and enhance the educational value of the 1992 DSM-IV. Most changes were limited to the descriptive text sections and not the diagnostic criteria, hence the title, Text Revision. Unfortunately, in revising the text of the DSM-IV, the APA squandered an opportunity to reduce the burden of stigma and prejudice that members of the transgendered community face each day. The DSM-IV-TR, like its predecessors, may too easily be interpreted to deny the existence of healthy, well adjusted gender variant people and to provide a justification for discrimination against them.. http://www.transgender.org/tg/gidr/

It has been asserted in previous essays that beliefs not only influence one's perceptions but one's notions of reality as well. There is no more powerful example than that of the transsexual to attest to this. Yet where does this identity come from? In the case of the transsexual, it certainly doesn't come from the primary and secondary sex characteristics.

Gender identity is best explained as a combination of factors including one's biological sex (primary and secondary sex characteristics), the sets of specific culturally defined beliefs, values attitudes and behavioral patterns associated with being male or female. This includes certain naturally selected drives and impulses which the individual experiences and interprets as the essence of his or her maleness or femaleness.

In other words, the sense of being male or female is derived from having the sex characteristics declared by one's culture as being male or female; thinking, feeling and acting in the ways the culture prescribes as appropriate for males and females; and interpreting and understanding genetically determined drives and impulses which may be associated with cultural notions of masculinity or femininity.

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