Hermaphrodites Speak!

Hermaphrodites Speak! [Film]. Produced by the Intersex Society of North America. Available from ISNA, PO BOX 3070, Ann Arbor, MI, 48106, Fax: [phone], $30.00 (US funds).

In this paper, we review Hermaphrodites Speak!, a film that may be used as a classroom tool to facilitate the understanding of intersexuality. We also review the presentation of intersexuality or hermaphroditism in introductory human sexuality textbooks that present a biological explanation of intersexuality and tend to ignore the psychological experience of intersexuality. Written reactions by undergraduate university students who viewed the video are also presented.

Hermphrodites Speak! is a 34 minute film produced and available from the Intersex Society of North America (1996). Intersexuality is also known as hermaphroditism or pseudo-hermaphroditism. In short, it is a biological condition whereby the sexual differentiation of a fetus is affected such that the person has anatomical characteristics of both sexes (e.g., Androgen Insensitivity Syndrome, Congenital Adrenal Hyperplasia, micropenis, hypospadias, or ambiguous genitalia). In many of these intersex situations, medical intervention takes the form of genital surgery to "normalize" the appearance of external genitalia or remove gonadal tissues that could possibly pose a cancer risk later in life. This surgery has the effect of potentially impairing sexual functioning (i.e., reducing sensation, sexual response, arousal, and, in the case of penectomy or clitoridectomy or clitoral resection, the likelihood of orgasm) and resulting in lifelong hormone replacement therapy (e.g., in the case of castration or gonadectomy). In this video, seven people speak about their experiences of being intersexed. The majority of the participants in this video have had medical intervention in the form of some sort of genital surgery. This video finally gives voice to a sexual minority group who have yet to be heard by those dealing with issues of sexuality.

Video Content

The participants in the video are at the first retreat of the Intersex Society of North America. They tell their life stories; what emerges is an obviously common theme of feeling isolated--of being the only person they know in their situation. Some had not even known of the details of their intersex conditions, having had physicians provide them with inaccurate information (cf., Natarajan, 1996; a medical student won an award for arguing in favor of nondisclosure of intersex status to patients with Androgen Insensitivity Syndrome). They speak to how important and empowering the experience of meeting other intersexed people is. Their sense of relief at "coming out of the intersexed closet" is clearly visible. For example, Mani refers to how enlightening it is to "break the secrets and lies" while Max notes that "doctors who told me that it would be inappropriate for me to speak with other [intersex] individuals were just plain wrong."

The other element that is evident in the video is the anger that these individuals feel toward the medical establishment. Most have undergone infant or childhood genital surgery, often without their consent or full understanding of the implications of the procedures. Participants in the video report that their sexual functioning has been profoundly and negatively affected by the medical intervention. While medical professionals have presumably conducted genital surgery in the hopes of helping the intersexed individual, the people in this video clearly resent the procedures that were performed upon them. Their clear message is that reconstructive or cosmetic genital surgery on hermaphroditic children should not be performed.

Most of the video participants, in one form or another, speak of the physical and psychological damage done to them by medical intervention for or surgical treatment of their intersexed condition. For example, 23-year-old Angela had genital surgery in 1985 at 12 years of age and refers to her clitoris as "being taken from me without my knowledge." Mani, who does not identify as male or female but rather as third gender, describes how, at 8 years of age, she/he became the subject of a medical teaching exercise, when she/he underwent surgery to feminize her/his body: "Before the operation, I had--I don't know how many--doctors and people come in to look at the freak. And, I was taken into a teaching theater, not sedated, and the surgeon who was going to the operation on me actually did it and explained it to everybody. I had been raised in a family where I was not allowed to talk about it, where I was not allowed to show it to anybody, ... and the confusion of laying there on the table...." Mani was not told by parents or physicians why she/he was at the hospital nor why the surgery was occurring. Heidi refers to herself as being "mutilated" and as "damaged goods." Her anger is readily evident as she expresses extreme hostility toward her doctors for removing her genitals. Tom calls himself a "hypospadiac monster" while Max says "we carry these scars with us" in reference to the psychological and physical impact that medical intervention has had on them.

At the end of the film, Angela cogently articulates an important message of the video:

   "... it is very painful for me to think of how, to conceptualize that what
   has been taken is a very specific eroticism, a hermaphroditic eroticism,
   that must really scare people and really cause a great deal of anxiety. It
   is just a really special part of whatever culture that we have developed
   individually and that we are bringing together: that special part, our
   sexuality, that sacred sexuality, has been ripped from us ... I am wary of
   saying that I do not have the kind of genital sensation that I did--because
   that does not mean that I do not have great sex. It does mean that I have a
   not-so-reliable sexual response. But most importantly, it means that: that
   very special form of sexuality, arousal, and all of that that was uniquely
   hermaphroditic was taken. That is the crime."

Intersexed Portrayals in Introductory Human Sexuality Textbooks

Traditionally, introductory human sexuality text books have described intersexuality or hermaphroditism in terms of "errors" in prenatal differentiation (see Hyde & DeLamater, 2000, p. 8, who use John Money's term "errors in gender differentiation"). This "error" terminology is a trend in text books and denotes a "these people are less than perfect" attitude about the intersexed (e.g., Kelley & Byrne, 1992; Nye, 1999; Strong, DeVault, & Werner Sayad, 1999; see Byer, Shainberg, & Galliano, 1999 and Masters, Johnson, & Kolodny, 1995, who speak of surgical "correction"; and see King, 1999, p. 200, who indicates that it is "fortunate" that true hermaphroditism is rare). A more respectful manner of discussing intersexuality would be to present it as a natural, although infrequent, variation of the biological sexual differentiation process. In addition, introductory human sexuality textbooks continue the repugnant practice of illustrating intersexuality using 1960s photos where faces of the individuals have been cut out or only portions of their bodies are shown (e.g., Allgeier & Allgeier, 2000; Byer et al., 1999; Crooks & Baur, 1999; King, 1999; Rathus, Nevid, & Fichner-Rathus, 1997; Strong et al., 1999); for example, while Rathus, Nevid, and Fischner-Rathus (2000) have removed the photo of the woman whose face was cut out (1997), they have retained disembodied genitalia photos. Allgeier and Allgeier are the only authors who concede that this may have the effect of dehumanizing people who are intersexed --despite this concession, they continue to use these photos. No other groups (e.g., homosexuals, transsexuals) have their faces "blacked out" in human sexuality textbooks (Chase, 1998).

Further, few introductory human sexuality text books go beyond describing the physical manifestations of the various intersex conditions (e.g., chromosomal sex, gonads, internal reproductive structures, external reproductive structures, and secondary sex characteristics). Descriptions of the incidence of the conditions, reproductive capacity of the individual, and treatment (e.g., genital surgery in infancy or hormones at puberty) are presented (e.g., Kelley & Byrne, 1992; King, 1999; Strong et al., 1999; and Byer et al., 1999, p. 338, argue rather strongly for the need for surgery at a very early age to "correct" the genitals so that they "conform" to the assigned sex of rearing) but only rarely are the psychological processes or the experiences of intersexuals discussed. Psychobiological implications are discussed by some (e.g., the influence of sex hormones on gender identity and sexual orientation: Allgeier & Allgeier, 2000; Crooks & Baur, 1999; Kelly, 1998). "Successful" sex assignment or reassignment is often defined by the adoption by the intersexed person of the sex and corresponding gender role assigned by the health care workers as well as a "heterosexual" sexual orientation (e.g., King, 1999). Note that the definition of heterosexual is contingent upon what gender the person was assigned by the medical professionals during infancy. The person might be considered gender dysphoric if he or she does not adopt the assigned sex, gender role, and heterosexual sexual orientation. See Holmes (1995) for a discussion of the role of homophobia in intersex issues. King (1999), for example, when discussing congenital adrenal hyperplasia (CAH), states: "... most have a heterosexual orientation as adults, and some who receive treatment later marry and have babies" (p. 202). This statement may be perceived to imply that a CAH woman who does not "receive treatment" may not have a heterosexual orientation and subsequently may not marry.

A few textbooks have begun to present information regarding published case studies or gender identity development of some intersexed people (e.g., Allgeier & Allgeier, 2000; Hyde & DeLamater, 2000; Rathus et al., 2000, presenting Diamond's 1997 work) while some have begun to discuss issues raised by the Intersex Society of North America such as the opposition to infant sex reassignment surgery (e.g., Blonna & Levitan, 2000; Byer et al., 1999). The presentation of the concerns of the Intersex Society of North America, however, tend not to be incorporated into the body of the text; rather, they are set aside in "special interest" boxes (e.g., Byer et al., 1999; Hyde & DeLamater, 2000). Some have also begun to raise the question of the ethics of genital surgery on intersexual infants who cannot give consent for surgery (e.g., Allgeier & Allgeier, 2000; Strong et al., 1999). Despite this ethical question, one set of authors advocates, with authority and conviction, for parental consent for genital surgery on infants and for this surgery to occur at an early age (Byer et al., 1999). These textbooks speak inconsistently and rarely of the sexual functioning of the intersexed person as an adult (i.e., the effects of having a clitoral resection, gonad removal, and other reconstructive surgery).

In sum, currently available human sexuality textbooks often provide relatively basic biological information about intersexed conditions, convey relatively negative attitudes toward the intersexed, and rarely speak to the psychological experience of the intersexual person. This is where the video Hermaphrodites Speak! becomes a valuable resource for instructors of human sexuality courses. After seeing this video, viewers get a sense of the anger and frustration of the intersexed people directed at the medical community. As well, the film conveys the importance of meeting others who are similar to themselves; this may be analogous to the importance of "coming out" support groups for gay, lesbian, and bisexual persons who feel isolated and disconnected from the heterosexual community and experience the joy of meeting similar others (Evans & D'Augelli, 1996). Students who view the video are more easily able to empathize with people who are intersexual. In much the same way that personal contact or knowledge of a gay person increases positive attitudes toward homosexual persons (e.g., Evans & D'Augelli, 1996), the video provides a form of intimate and personal contact with people who are hermaphrodites. For students, this video puts several faces on intersexuality and de-medicalizes the conditions.

Student Responses to Hermaphrodites Speak!

In our summer 1999 introductory human sexuality psychology class, we asked students to indicate their responses to the film on a 7-point scale with one (1) being very negative to seven (7) being very positive. The students used this scale in responding to the following question: "Overall, how would you rate this video; how do you feel about the video (taking everything into consideration--content, format, information, attitude, etc.)?" Forty-four students (N = 44) responded with a mean of 5.1, indicating students were mildly positive toward the film overall (with a range of 2 to 7 and standard deviation of 1.6). The distribution was slightly negatively skewed (-0.6) indicating that there was a tendency for students to rate the video favorably. Eighteen percent (18%) of students rated the video negatively (2 or 3 on the scale), 11% gave it a neutral rating of four (4), and the remaining 70% rated the video positively (5, 6, or 7).

The written comments were particularly poignant and reflect the value of viewing the video for the students. In reading the comments, four general areas emerge:

1. Information and awareness was gleaned about intersexuality, of an empathetic nature in particular (e.g., "The intersexed have had to endure many more hardships than any of us could ever imagine" and "I would like you to know that I want every person to see this film so that they might understand and lose the fear that too many people express about intersexuals.").

2. Questioning by students of surgical and medical management in the case of an intersexual child--and in some comments, outrage that this had occurred (e.g., "In general, I feel the medical profession needs to be tolerant of difference. Perhaps revise their current procedures and understandings" and "The theme I get from this video is that we (our society) should let Mother Nature take its course [sic]").

3. The value for intersexed individuals of speaking to similar others (e.g., "Intersexed people feel as though they are alone in the world, that no one else [is] like them, yet when they get together, there are more than just them." and

"I support the making of the video both for healing and for information that has been hidden").

4. The anger of the intersexed people participating in the video (e.g., [The main thing that I got from this video was] ... "that there is a great amount of anger and frustration among hermaphrodites" and ... "However, as a general tool to educate the population at large [this film] will only alienate ... [intersexuals because of] ... their uncontrolled anger and disdain for those who were only acting on society's part NOT independently [i.e., medical teams are acting on society's behalf]"

These comments illustrate the value of the video to students who, for the most part, had been previously unaware of issues surrounding intersexuality. Most of them felt positively and viewed the video favorably. Some found the anger toward physicians expressed by the participants somewhat off-putting. From a cost-benefit perspective, it may be a more valuable and impacting experience for the viewers to see the anger, frustration, and pain of the people who have had negative dealings with medical professionals than to delete it in order to avoid alienating a subset of the viewing population (e.g., "I never realized the major emotional impact that surgery had ... the theme of mutilation was so prominent ..."). Many students indicated that they appreciated the honesty and emotion presented in the video. It may be the strength of this emotion and conviction that allows the viewers to empathize with the participants in the film.

It should be noted that the filming of the video is amateur, with poor sound and video quality. Many students suggested that the camera would have been best placed on a tripod. These technical difficulties detract from the messages of the video. On the other hand, the amateur quality may lend more authenticity to the stories. Perhaps in a follow-up educational video, the content and information in this film could be redone with a more professional videographer.

In sum, this video is useful to human sexuality instructors who are discussing issues of intersexuality. However, this video should be used as part of a lecture regarding intersexuality. That is, the video does not give the required background information about what exactly constitutes intersexuality. Students would probably be confused if they viewed the video without first having read the textbook explanations of intersexuality or if they had not had a basic lecture on the different intersex conditions (e.g., how sexual differentiation usually occurs and how it occurs differently for the intersexed). In terms of comprehensive coverage of the issues of intersexuality, the introductory human sexuality texts (and/or a "nuts and bolts" lecture) and the video, Hermphrodites Speak! complement each other; the textbooks give a dispassionate, biological explanation of the phenomenon while the video portrays important human aspects of what it is like to be intersexed. We, and many of our students, hail this film as an important educational experience in the context of learning about variations in human sexuality. Many students want greater awareness about procedures for dealing with people who are intersexed; as these students are our future health care providers, mental health professionals, policy makers, and educators, Hermaphrodites Speak! is a critical, empathetic learning experience.

REFERENCES

Allgeier, E. R., & Allgeier, A. R. (2000). Sexual interactions (5th ed.). Boston: Houghton Mifflin.

Blonna, R., & Levitan, J. (2000). Healthy sexuality. Englewood, CO: Morton Publishing.

Byer, C. O., Shainberg, L.W., & Galliano, G. (1999). Dimensions of human sexuality (5th ed.). Boston: McGraw-Hill.

Chase, C. (1998, August). Transgendered voices--identities and social construction. Symposium presented at the American Psychological Association's Annual. Convention, San Francisco, CA.

Crooks, R., & Baur, K. (1999). Our sexuality (7th ed.). Pacific Grove, CA: Brooks/Cole.

Diamond, M. (1997). Sexual identity and sexual orientation in children with traumatized or ambiguous genitalia. The Journal of Sex Research, 34, 199-211.

Evans, N. J., & D'Augelli, A. R. (1996). Lesbians, gay men, and bisexual people in college. In R. C. Savin-Williams & K. M. Cohen (Eds.), The lives of lesbians, gays, and bisexuals: Children to adults (pp. 201-226). Fort Worth, TX: Harcourt Brace & Company.

Holmes, M. M. (1995, March). Queer cut bodies: Intersexuality and homophobia in medical practice. Paper presented at Queer Frontiers: 5th Annual Lesbian, Gay, and Bisexual Graduate Student Conference, University of Southern California. Available: http://www.usc.edu/isd/archives/ queerfrontiers/queer/papers/holmes.long.html.

Hyde, J. S., & DeLamater, J. D. (2000). Understanding human sexuality (7th ed.). Boston: McGraw-Hill.

Kelley, K., & Byrne, D. (1992). Exploring human sexuality. Englewood Cliffs, NJ: Prentice-Hall.

Kelly, G. F. (1996). Sexuality today: The human perspective (5th ed.). Madison, WI: Brown & Benchmark.

King, B. M. (1999). Human sexuality today (3rd ed.). Upper Saddle River, NJ: Prentice-Hall.

Masters, W. H., Johnson, V. E., & Kolodny, R. C. (1995). Human sexuality (5th ed.). New York: HarperCollins

Natarajan, A. (1996). Medical ethics and truth telling in the case of androgen insensitivity syndrome. Canadian Medical Association Journal, 154, 568-570.

Nye, R. A. (1999). Sexuality. New York: Oxford University Press.

Rathus, S. A., Nevid, J. S., & Fichner-Rathus, L. (1997). Human sexuality in a world of diversity (3rd ed.). Boston, MA: Allyn & Bacon.

Rathus, S. A., Nevid, J. S., & Fichner-Rathus, L. (2000). Human sexuality in a world of diversity (4th ed.). Boston: Allyn & Bacon.

Strong, B., DeVault, C., & Werner Sayad, B. (1999). Human sexuality: Diversity in contemporary America (3rd ed.). Mountain View, CA: Mayfield Publishing.

BJ Rye, Department of Psychology, St. Jerome's University, Waterloo, Ontario, Canada, N2L 3G3, and Richard Humpartzoomian, Department of Psychology, University of Western Ontario, London, Ontario, Canada, N6A 5C2.