Hermaphrodites and the Medical Invention of Sex.

Hermaphrodites and the Medical Invention of Sex. By Alice Domurat Dreger. Cambridge, MA: Harvard University Press, 1998, 266 pages. Cloth, $35.00.

In Hermaphrodites and the Medical Invention of Sex, Alice Domurat Dreger looks at the debates concerning intersexed people which circulated in the medical communities of France and Britain in the late 19th and early 20th centuries. In so doing, Dreger has also offered insight into our own fin-de-siecle quandaries about the limits of the usefulness of the concepts of sex and gender as categorizations of human beings.

Then, as now, those who would shore up the intertwined social edifices of sexism and heterosexism have need of clearly-defined dividing lines between sexes, between genders, and between sexual orientations. In this book, Dreger shows how the expertise of late 19th- and early 20th-century medical professionals was called upon to proclaim the true sex of those intersexed or hermaphroditic individuals whose bodies threatened to muddy the waters.(1) Dreger argues that gradually, over the time period under study, doubly-sexed people known as hermaphrodites were discovered to exist in numbers which caused some alarm to medical professionals. It is Dreger's thesis that this was disturbing to medical men (and Dreger takes pains to emphasize that almost without exception they were men) because it opened up the possibility of mistaken sex and, therefore, of unwitting homosexuality, neither of which were taken lightly either by medical men or by the public of the day. During this period, feminists were challenging axiomatic beliefs about proper gendered divisions in social relations, while homosexuality was in the process of becoming defined as a characterological trait rather than as a moral lapse. Against such a backdrop of social change, it was seen as extremely important that each and every individual be either male or female. If medical men allowed that there might be more than two sexes, then they might be viewed to be contributing to the collapse of the basis for gender hierarchy and to anarchy in the realm of sexuality.

Dreger chronicles how a few doctors first identified and then repaired a leak, called hermaphroditism, in the containment complex of sex/gender/sexuality. Dreger starts her exposition with a prologue, in which she introduces her readers to some of the parameters commonly used to define and determine sex categories. It is in this prologue that Dreger misses an opportunity to clear up a common bit of grammatical correctness which leads to a great deal of conceptual confusion. Throughout the book, Dreger uses sexual as an adjective where she might have used sex with greater clarity. This is especially glaring in a later chapter which she devotes to lamenting the problem of the conflation of sex with sexuality. However, in the end, this oversight does no significant damage to the overall purposes of her work.

Chapter 1 introduces the idea of the Age of Gonads, which Dreger pegs as spanning the years 1870-1915. The Age of Gonads, Dreger argues, was a response to a seeming rash of hermaphroditism which broke out at the beginning of this period of feminist and homosexual mobilization. Dreger indicates that it was more likely that the outbreak was a result of increasing numbers of people falling under medical scrutiny and an artifact of entrepreneurial publishing endeavors of medical men than of any actual increase in the number of hermaphroditic people alive at the time. In the Age of Gonads it was insisted that each and every human being must have one and only one true sex, which could be definitely determined on the basis of a careful examination of gonadal tissues. All other indicators of sex were thereby rendered moot. In chapter 2 Dreger delves into the sometimes symbiotic relationships between hermaphrodites and the doctors who studied them. Some doctors made their reputations and fortunes by becoming expert about hermaphroditic people. Some hermaphroditic people also made names and livings for themselves by becoming famous for their hermaphroditism. Dreger further points out in this chapter that the contributions of both hermaphroditic people and doctors who studied them also benefitted many other people by increasing medical and scientific knowledge about embryology, evolution, hormones, and other related areas of interest.

In chapter 3 Dreger takes her readers "In Search of the Veritable Vulva." Not surprisingly, medical men of the Age of Gonads did not always find it a simple matter to determine the exact nature of the gonads which persons contained within them. Exploratory surgery at that time was ill-advised for any number of purely practical reasons. Thus, doctors had to resort to other clues. Failing to make the kind of distinctions that many people make today between sex, gender, and sexual characteristics, medical men of the day relied upon physical appearances, gendered, and sexual behaviors to help them to determine the status of inaccessible gonads. Telling but not necessarily definitive signs of true sex included: external genitalia, menstruation or ejaculation, breast and pelvic size and shape, body hair distribution, sexual orientation, bravery or modesty; any of which might be thrown into further question by variations from stereotypical British or French race, ethnicity, age, or socially unacceptable sexual practices.

All of these concerns about establishing the "true" sex of individuals reached their pinnacle in questions of sexuality. In chapter 4, Hermaphrodites in Love, Dreger sheds some light on why she believes sex determination mattered so much then (and now). Sexuality was then believed to follow from one's gonads as truly as did all other aspects of one's sex and gender. Thus, if a person desired sexual relations with someone who appeared to be of the same sex as themselves, this implied that an inversion of sex must accompany the apparent inversion of sexuality. Homosexuality came to be thought of as a kind of behavioral hermaphroditism and those who practiced it were often known as congenital inverts. Evidence of hermaphroditism was therefore routinely searched for on the bodies of homosexual people. When it was not found there, it was presumed to exist in hidden and inaccessible parts of the body; a presumption and a search which is still actively upheld by many scientists today.

Dreger concludes her main text with a chapter called The Age of Gonads, which might more aptly have been called, The End of the Age of Gonads. In this chapter Dreger delineates how doctors came to so narrowly define "true" hermaphroditism that they made it impossible for anyone to actually qualify as one. As Dreger puts it, "the only possible true hermaphrodite was a dead and dissected hermaphrodite or, at best, a castrated one. After all, the only way one could convincingly provide evidence of true hermaphroditism was by removing, slicing, and microscopically examining the whole gonad" (p. 149). With many people who were previously declared to be "true" hermaphrodites failing, or unable to take, this rigorous test, history was rewritten. Those who had once been known as "true" hermaphrodites were reclassified as pseudo-hermaphrodites whose true sex was knowable even if unknown.

However, by 1915, when new medical techniques allowed for the microscopic examination of living gonadal tissues, some individuals were found to qualify as true hermaphrodites. Although the gonads could no longer unequivocally be counted upon to clearly designate a sex in every case, the prevailing opinion was maintained that every human being must have only one sex, and that anomalous behaviors and bodies must be brought into line. In those stubborn cases where behavior patterns could not be changed by medical fiat, medical wisdom decreed that surgical cutting should be used to create congruence.

Today's treatment protocols and their affects on the lives of intersexed people form the subject of the epilogue, Categorical Imperatives. In this final segment Dreger contrasts the modernist approaches of doctors with the post-modernist ones of intersexed people themselves. Typically, doctors today assume that intersexed newborns must have a single sex of either female or male. Sex is assigned on the basis of heterosexist assumptions about what constitutes "proper" sexuality and by making best guesses about the possibility of particular infants to perform as heterosexual female or male adults. Surgical procedures are widely recommended to be undertaken as soon as possible after the birth of intersexed infants to repair those aspects believed to have been born broken. However, Dreger reports that intersexed people consider such medical protocols and procedures to be colonization of their bodies. They wish to keep their bodies intact and their sex, gender, and sexual options as open as they find comfortable on an individual basis. They demand that they be allowed to determine their own lives free from the paternalism, shame, and unnecessary genital scarring which current medical practices promote.

Overall, Hermaphrodites and the Medical Invention of Sex is an excellent book. There are spots where Dreger seems to simplify complex issues, and there are many places where I would enjoy a more wide-ranging historical context in which to ground the events being discussed. These shortcomings, however, are minor when placed against the larger value of this book. There is simply very little written on the topic of intersex which is accessible to a non-technical readership. Dreger's book, clearly written and easy to read, makes an ideal companion to Suzanne Kessler's outstanding and highly readable 1998 book about contemporary medical management of intersexed infants, Lessons from the Intersexed. Together, the two books provide interested readers with a comprehensive and compassionate view of the current issues facing intersexed people and the medical professionals who treat them. I recommend Dreger's and Kessler's books as a set to intersexed people, their families, and loved ones; to medical personnel of all stripes; to those interested in the history of medicine or of sex/gender/sexuality; and to those people interested in contesting the boundaries that surround and contain alternate forms of sex, gender, or sexual expression.

(1) Dreger finds the term hermaphrodite more appropriate both for the purposes of historical accuracy and for conceptual correctness She explains that medical contentions of late 19th- and early 20th-century Britain and France defined hermaphrodites as having sex characteristics of both females and males, whereas intersexed people were seen to be individuals whose sex characteristics were neither male nor female. Dreger's book is most specifically about hermaphrodites.

REFERENCES

Kessler, S. (1998). Lessons from the intersexed. New Brunswick, NJ: Rutgers University Press.

Holly Devor, Ph.D., Sociology Department, University of Victoria, Box 3050, Victoria, BC, V8W 3P5, Canada; e-mail: [e-mail].