Intersex in context: Cultural common sense, medicine and ethics

How should health care practitioners address human sexual ambiguity?; The range of cultural response to intersex varies enormously. In India, hijras are a marginally accepted third sex who live in their own communities. Pokot intersexuals cannot raise families but may accrue great wealth. In early modern Europe intersexuals were required to adopt and live an consistent social gender. The Navaho nadle has been honoured as a "super person" whose experience of being both female and male confers special abilities.; Since the mid-20th century North American intersexed children have undergone infant gender assignment (IGA) and gender reinforcement through surgery, endocrine treatment and behaviour modification. Contemporary medical practice is rooted in the North American commonsensical view of two distinct genders. Because males and females are expected to have distinct bodies, gender identities, activities, and emotions, and to fulfil distinct legal roles, intersexed people are a socially and legally invisible population. People whose genitals at birth defy expectations of a clear gender are consigned to the care of medical specialists.; The medical profession proposes that there are only two viable psychological genders. A person must grow up identified unambiguously male or female in order to have a healthy self-identity. To forestall personal or parental ambivalence, the person's external genitalia should correspond with their gender identity. Therefore, the dominant medical paradigm holds that an intersex birth is a "social emergency" usually requiring immediate and aggressive treatment of the genitals and other bodily functions. Gender assignment is justified in terms of offering the infant the best possible future sexual function, promoting psychological development, and avoiding social stigma.; Adult intersexuals, however, relate that the experience of medicalization is itself a source of sexual dysfunction and an assault on their self-esteem. Infant gender assignment is invasive and very painful; moreover it reinforces a social schema of gender roles, which in turn perpetuates intersexuals' stigma and unhappiness. The dissertation closes with recommendations for more ethical solutions to the stigmatization of intersex.