Intersex People & Internalised Corrective Bodily Bias by Mandy Henningham & Tiffany Jones

Sex essentialism suggests people have an underlying gender ‘essence’ tied to their sex traits. Doctors can use this essentialist view to medicalise intersex bodies, justify the application of disordering terminologies to these bodies and justify modifying them to fit binary male/ female ideals (Davis, 2015). Doctors may consider an intersex person’s genotype, genital appearance, hormones, potential for heteronormative (penis-in-vagina) penetrative sex or fertility to determine their sex marker and plan future interventions. This ignores how any intersex individual’s – or anybody’s – psychological and social development may contribute to their gender identity (Jones et al., 2016). This chapter aims to explore the quantitative and qualitative findings on gender, sexuality and sexual satisfaction for intersex people to challenge essentialist ideas on bodies. To begin, this chapter will first explore literature on sex, gender and sexuality as it relates to intersex people – defined as people whose sex characteristics (anatomy, hormones or chromosomes) vary from binary male-female sex models. It will then explore sex assignment and gender rearing from birth for participants in an international study of people with intersex variations, followed by whether participants found their reared gender appropriate. It will then inspect the nuances of sexuality and satisfaction, including dating and sexual fantasies.

Sex, Gender and Sexuality Theory & Intersex People

Studies of the sex, gender and sexuality of intersex people mainly fall into two schools of thought. The first philosophy is seen in clinical studies trialling interventions on the assumption that bodies should be changed to align with existing sex/ gender models and traditionally heteronormative sexualities (e.g., Ekenze, Nwangwu, Amah, Agugua-obianyo, & Onuh, 2015). There is often a sense of ‘concern’ in such studies around the ‘danger’ of lesbianism or homosexuality. In this way, so-called disorders of sex are aligned to past disordering of sexuality. Evaluations of the cases minimise issues of sexual ‘dysfunction’ (in heterosexual terms) sometimes caused by prioritising sex presentation over pleasure. The second philosophy is seen in both individual intersex authors’ narrative studies of their sex/ gender/ sexuality experiences (e.g., Pagonis, 2015) and surveys of intersex participants’ views based on the assumption that bodily autonomy is a human right for all individuals (e.g., Jones, 2016). These studies problematized participants’ feelings of sexual disconnection, decreased sexual function/pleasure and undesired sex-based presentations where bodily sex “norm” constructions were imposed upon them from the outside via enforced medical interventions and/ or the gendered expectations of parents.

Butler (1990) argues that there are no pre-existing gendered core identities, and that gender and sexuality are instead performative, a concept that rejects essentialist values. As gender is an act of cultural expectations, this therefore constitutes no universal gender, meaning that all acts of ‘women’ and ‘men’ are open to ‘resignification’. Butler (1990) goes on to say that sex is subject to a series of social regulations that are directed by law, a form of power; this creates the formative aspects of one’s sex as well as gender, pleasures, and desires. This does not mean however that ‘anything goes’ – one’s own desires are experienced in relation to the discourses offered. Gay people may, in heteronormative societies, have fantasies of punishment or forced sex since their ‘aberrant’ desire for same sex touch cannot be enjoyed without a legitimising excuse (Butler, 1990; Sullivan 2003). Here we consider data from an international survey of people with intersex variations to consider how intersex people engage with essentialist sex, gender and sexuality ideals.

Revisiting An International Survey

An anonymous Sydney University Medical School online survey was used to collect data from people with intersex variations, hosted by Survey Monkey. It was piloted by two intersex people. The survey questionnaire contained both forced-choice (quantitative) and open-ended (qualitative) questions. Data were obtained across eleven months (August 2014-June 2015). The recruitment process targeted participants with medically recognised intersex variations who were over the age of 18 and able to discuss their sexuality over time. Processes included online advertisements and emails sent to clinics and health services, and international support organisation newsletters and webpages. Participants needed to self-select to join research. A previous publication considered only participants’ healthcare (Henningham & Jones, 2017). Here, we explore the participants’ sex, gender and sexuality, using descriptive and comparative statistical analyses undertaken in SPSS and grounded thematic analyses of written responses.

Sex & Gender

A total of 81 participants completed the survey, aged from 22 to 71yrs, with a mean age of 43yrs. Participants were from regions including North America (n=47), Europe (n=20), Asia-Pacific (12) and Africa (n=1). They were born in 19 different countries; largely America (n=38), the United Kingdom (n=10), Canada (n=9) and Australia (n=8). The majority of participants were assigned female at birth (54%), fewer were assigned male (39%). The remaining participants were assigned one sex and then reassigned another during their infancy, or were not assigned a sex. Most participants (52%) currently identified as women. Nine expanded with further detail like: ‘female probably’, ‘ambiguous female’, ‘neuter/female’, ‘butch female’, ‘female identified, non-binary at times’ and agender/female’. A smaller portion of participants identified as men (17%); only one of the men added further ambiguity, stating; ‘Male of centre, but I prefer to opt out of gender descriptors’. Some participants were gender fluid (5%), genderless (4%) and the remainder had a combination of identities.  This reflected findings in an Australian study that those assigned male at birth were more likely to have a different gender identity later in life (Jones et al., 2016). In total, almost a third of participants had identities that challenged the two gender binary norms and identified as either fluid or their own subjective interpretation of gender – one participant said, ‘gender to me is fluid and playful’. Another commented that they ‘dress in an androgynous attire and love having all the wrong sticky out body parts.  I dress as I imagine a hermaphrodite should dress’.

Gender Rearing

Of those participants who were assigned a female sex/ F sex marker, 58% felt the gender they were raised as was appropriate. Conversely, only 23% of those who were assigned male/ M sex marker at birth felt that the gender they were raised as was appropriate; 77% found their gender to be inappropriate. It was statistically significant (p <0.05) that those who were assigned as males at birth and raised as boys were more likely to feel that their gender was inappropriate. This reflected the results of an Australian-only study (Jones et al, 2016). Participants were asked ‘how do you feel about the gender you were raised?’. The most common theme to emerge from this question were participants feeling they did not fit traditional gender roles. Some participants spoke of struggling to fit in with other members of their sex and gender, or feeling like another gender altogether. Others expressed feeling like an outsider, with comments like ‘I thought I was an ‘it’ or ‘…I was banned from doing things like working out and if I tried out for girls sports I dominated them in a very masculine way, I was called a freak’. Some participants were punished for not fitting the norms of their gender of rearing, including one who commented, ‘I was hit and beat a lot for not acting ‘more feminine’’. Some directly wished they were reared gender neutral. Other others did not mind their sex being assigned but desired to have more choice in their expression of gender: ‘I think it is helpful to assign a gender at birth, but the ‘door should be left open’ allowing the child to develop naturally’. Participants influenced to enact particular gendered (feminine or masculine) expressions by their parents mostly felt negatively towards their parents. Eighteen participants expressed direct shame; nine expressed anger. Three described feeling left out; one stated, ‘it was my body but I couldn’t choose anything’.

Only three participants mentioned feeling happy with their gender rearing. One participant stated that being assigned to be a boy meant he could more easily identify with the gay male community. Another was raised gender neutral,

I picked my clothes from a certain age on, I picked if I wanted a haircut, I asked for my preferred toys. I just had to be a ‘girl’ in public at school and there I was more one of the boyish girls which was fine, I was not the only one.

This participant discussed that they were directly involved in the decision-making processes for their gender and given agency in determining their presentation and lifestyle, which led to a positive experience overall of being intersex. Another participant expressed that they were accepted for not being completely binary in terms of their activities and interests, ‘I tended to be somewhat of a tom boy growing up but that was treated as a normal and acceptable variation of being a girl’. It was notable that the three participants who were happiest with their gender of rearing were encouraged to be themselves – regardless of the way their sex, gender and sexuality did not strictly align with heterosexual and binary sex ‘norms’. This trend towards negative attitudes to rearing that did not foreground the participants’ choices reflected other research (Davis, 2015; Jones et al. 2016).

Changing Gender

Those participants who changed their gender were asked ‘At what age did you begin to think that instead of being the gender you were raised, you should have been another gender?’ A cumulative 71% wanted to be a different gender under the age of 11; the most common age bracket was between 3-5 years old (23%). The responses for a question about the age at which participants decided to affirm another gender, asked only for participants who were currently a different gender to their sex as assigned at birth, yielded diverse answers. In total 37% of participants firmly decided they would change their gender officially at 20+ years of age, followed by 12% firmly wanting to change at 16-19. Three participants stated that they waited to transition or embrace their gender identity out of fear or self-deliberation during their twenties, ‘I fought with myself over it throughout my twenties, transitioned at 30’. Two participants firmly wanted to change gender identity at 11-15 years of age, a further two firmly wanted to change genders at 3-5, and one participant between ages 6-10. When comparing this to the ages of first identifying a need to be a different gender other than the one reared, the majority of firm decisions were made later in life, despite there being signals at an earlier age. However a number of participants noted that concepts of ‘transition’ often used in participants’ discussions were inadequate, ‘I cannot transition to herma… Besides, I do not wish to undergo surgery or bodily transformation. I only wish I could get my bod back. But that is impossible’. These statements illustrated the need for discussing gender change in terms of ‘affirmation’ rather than transition; avoiding binary-only models.

Teen Dating & Sex

Courtship proved to be initially difficult for participants, as a total of 83% of participants stated that they did not feel comfortable dating during their teens. Participants were asked if they were sexually active in their teens. Most (61%) were not. A qualitative investigation of the data revealed a number of themes were reported on the topic. The most common theme around sexual inactivity as a teen was amongst participants were those who did not date in high school (16%). Some participants did not elaborate or give much further detail on this, though some discussed having interests other than sex, ‘I had no dates in my teens. I threw myself into sport, and had no sexual awareness’. Some participants said they actively avoided romantic or sexual encounters due to being intersex. One man said, ‘Had one girlfriend in high school, dated a couple of times, kissed and cuddled, but nothing sexual, I was too scared she would find out I wasn’t really a boy’. Three discussed how their avoidance was also because of their sexual orientation, for example one female stated: ‘There was no way I was going to be open to a boyfriend or to be sexually active.  I was also attracted to girls which confused me more about my sex of rearing and sexual orientation’. Six participants expressed no interest in sex in high school. One discussed being ridiculed as a result, ‘When I was a teenager I had no interest in sex… my sister insisted that I was a homosexual because I showed no interest in sex’.

In total 39% of participants were sexually active as teens. Seven participants discussed how surgery had made their experiences of sex painful or less pleasurable, for example one woman said ‘I was sexually active after vaginoplasty, but didn’t tell my male partners. It was very painful’. Three participants used sex as a means to affirm their gender identity or gain a sense of control; for example one woman said:

I had heard a certain guy was fairly small in size and knew I had a small vagina. Even though I had no interest in him what so ever and he actually repulsed me I felt I had to get this milestone over with to be considered a real girl and not a fake being.

This participant additionally experienced low self-esteem in her teens due to being intersex, and used sex as a replacement for a relationship, ‘I started sleeping with anyone who would have me, certain that no one would ever want a relationship with me and that one night stands were the best I could hope for’. Another participant similarly used sex to affirm her femininity, ‘started having sex at 15 in order TO TRY TO feel comfortable as a girl, and to prove to them and to me that I REALLY was a girl’. The final participant to emerge in this theme discussed how sex was used not only to validate their gender, but as a method of control over people, ‘Sex was validation and control over others. I didn’t actually have sex that was good and non-dissociative until decades later, after I transitioned and got new partners who wanted me the way that I actually was’.

Adult Dating & Sex

Most participants responding to a question on if they currently had a partner answered ‘yes’ (64%), whilst just over a third of participants answered ‘no’. Participants were asked if they felt comfortable dating in adulthood; more than half (54%) were not comfortable. Fourteen people expressed that they were not comfortable dating because of their body or intersex status, for example one said ‘The few occasions where I have been upfront about my intersexuality, the person generally distances themselves from me’. Three participants felt that it was too complicated and repetitive to explain their intersex variations to people, ‘I don’t think I would enjoy dating because I would feel a need to explain myself constantly to dates’. Feeling self-conscious about their physical bodies was also a concern expressed by six participants, for example one said ‘It’s complicated when your body doesn’t represent your gender identity or your sexual orientation’. Eight participants just felt uncomfortable about sex and not dating, for example one said:

Most people get frustrated to date without having sex and it often feels like I shouldn’t bother. It’s also been odd to watch people around me be comfortable with one night stands, I would love to be able to do that but I don’t feel my body allows that. People looking for one night stands want what they expect.

Only sixteen participants described being comfortable dating. Three said it had been a process to get comfortable, and one commented:

It’s often difficult and I’ve experienced abuse and hate due to being intersex but the connection with others is stronger and more fulfilling than the negative experiences are harmful, so I keep trying to make connections with others.

Trust was crucial to comfort for four participants. One commented, ‘I am currently in the longest-term relationship in my life… It took a long time to come to trust this much’. One participant commented on being part of alternative communities where alternative bodies were more valued; ‘I love dating and am out and open about being Intersex, bisexual, pagan, and into the kinky lifestyle’.

Participants were also directly asked if they experienced enjoyable sex. A total of 71% of those participants who found their reared gender appropriate were reported that they experienced enjoyable sex whereas only 43% of those who found their reared gender inappropriate discussed having enjoyable sex – a statistically significant (p <0.04) difference. Furthermore, participants who were raised as girls were the most likely to go on to experience enjoyable sex (64%) whereas only a third of those reared as boys experienced enjoyable sex. Most participants raised as gender neutral experienced enjoyable sex. Of those who commented on having had unenjoyable sex, pain or discomfort or hindered sensation were dominant themes. For example one said ‘The constant bleeding and haemorrhaging and pain (horned retroflexed deformed uterus) during my teens and 20s rather traumatized me about anything connected with the female bits’. Nine participants also experienced some form of psychological barrier when it came to sex; one said, ‘I would love to have my intersex body back and not to feel mutilated. Sometimes I’m also negatively affected by my experiences in sexual situations and become sad’. One participant said of their partners: ‘I end up panicking that the longer they interact with my genitals, the more they’ll think I’m a freak’. Five expressed that they had no interest in sex, another participant talked about only engaging in sex to please their partner.

Of the 24 participants who provided written comments on experiencing enjoyable sex, nine directly mentioned engaging in ‘non-heteronormative’ sex. Four discussed not having penetrative sex, another discussed feeling too small to penetrate but enjoying other forms of sex, including ‘Oral and anal sex as I’m too small to penetrate anything’. Two genderfluid participants discussed engaging in kink and BDSM (Bondage and Discipline, Sadism and Masochism) play, and one said ‘I assume several different roles, different genders, dominant/submissive, penetrative/receptive, etc and I enjoy it immensely’. Another participant mentioned having ‘sex in all kinds of ways with all kinds of bodies’. Three participants additionally mentioned how being comfortable with themselves allowed them to have improved sex lives, and one noted ‘It has gotten better over time’. Just under half of the participants who had experienced surgical intervention had ‘enjoyable sex’, whereas most of the participants who had not experienced surgical intervention had ‘enjoyable sex’. Only two participants highlighted positive outcomes of surgical intervention for sex: one mentioned being grateful that their vaginoplasty did not result in a loss of sexual sensitivity (though they were self-conscious with new sexual partners); the other said ‘aligning my physical sex with my gender made me more confident in approaching people’.

Sexual Fantasies

Participants were asked ‘do your sexual fantasies differ from existing experiences?’ Just over half (51%) of the participants stated that their sexual fantasies did not differ from their existing experiences. A further 13% mentioned they did not really experience sexual fantasies, whilst a few fantasised about women, a few fantasised about men and two fantasised about having sex with other intersex people. However, a notable finding of the study was that over a quarter (26%) fantasised about having different genitalia. Four participants discussed fantasising about having a different body altogether including genitalia typical of the sex they fantasised about being. One participant desired having a ‘full sized penis’, while another expressed they wanted to be ‘normal down there’ for intercourse with their spouse. Several of these individuals described these fantasies in a context of body-shaming and the difficulty of fitting in to current sexual cultures and norms. However, it is important not to conflate these ‘different genital’ fantasies with a need to pre-emptively change young intersex peoples’ bodies in anticipation of these cultures; as some desired body changes were only discovered later in life. For example; one transgender participant expressed the desire for ‘typical’ female genitalia; and she explained, ‘I have a very strong need to have sex as a female with the right parts’ as she grew older.

Moreover, several bisexual participants discussed fantasising about having different genitalia when having sex with people of different sexes in inconsistent ways throughout life. One married bisexual woman explained:

I often fantasise that I have a penis and am having sex with a woman/women. I don’t think this necessarily means anything except that I’m very much bisexual and miss having sex with women!

There were two male participants who reported fantasies about being a woman in a heterosexual relationship, ‘I have always envisaged myself as a female in a hetero relationship but, the older I get, the less significant that is’. Further, some participants discussed fantasising about having their surgically unaltered bodies back. One said, ‘I fantasize about what my life would have been like without genital surgery or having my breasts removed. I can’t seem to get excited thinking about anything else, really’. One participant fantasised about having both sets of typical genitals, stating ‘I do fantasize about have a full set of both genitals. I sort of don’t have either’. Fantasies thus played with notions of typicality in atypical combinations and queer, inconsistent scenarios. The fantasies mostly reinforced the need for individuals to retain their own anatomy where possible and their own autonomy around bodily choices, whilst showing that internalisation of sex-gender norms sometimes affected how they understood their desires.

Conclusion

Intersex people expressed a broad spectrum of sexual behaviours and fantasies in this study. Many engaged in pleasurable non-heteronormative sex. However, most treatments and gender rearing practices they were exposed to prepared them for lives in a heteronormative binary society demanding penis-in-vagina sex. These data suggested such essentialist models of sex, gender, and sexuality may not fit intersex peoples’ experiences. They suggested the importance of allowing intersex people room for personal expression and choice, regardless of the sex marker applied in their early years (although female and gender neutral markers and rearing may allow more flexibility). Further, these data suggested that some intersex people fantasise about having different bodies due to shame and cultural oppression – as internalised homophobia can stimulate punishment fantasies (Sullivan, 2003). As the ‘corrective bias’ over intersex bodies appears internalised here, a proposed term for further research is ‘internalised corrective bodily bias’; describing the disconnection between some intersex peoples’ bodies and fantasised sexual selves. It also captures how bisexual intersex participants sometimes ‘corrected’ their imagined bodies in otherwise same sex fantasises, to maintain ‘heteronormativity’. This bias may also played out when intersex people refrain from desired dating or sexual experiences; or engage in undesired sex. Internalised corrective bodily bias appeared associated with rigidly gendered rearing. Thus, enforcing strict relations between sex markers assigned at birth, bodies and gender expression to maintain gender essentialist myths can be psychologically (and physically) scarring. Medical and familial supports operating from more flexible gender theories could better support intersex peoples’ future sexual experiences and lessen their dating anxiety.

References:

Butler, J. (1990). Gender trouble: Feminism and the subversion of identity. London: Routledge.

Davis, G. (2015). Contesting Intersex: The Dubious Diagnosis. New york: NYU Press.

Ekenze, S., Nwangwu, E., Amah, C., Agugua-obianyo, N., & Onuh, A. (2015). Disorders of sex development in a developing country. Pediatric Surgery International,, 31(1), 93-99.

Henningham, M., & Jones, T. (2017). Cut it Out: Rethinking Surgical Intervention on Intersex Infants. In T. Jones (Ed.), Bent Street. (pp. 55-67). Melbourne: Clouds of Magellan.

Jones, T. (2016). The Needs of Students with Intersex Variations. Sex Education,, 16(6), 602-618. Retrieved from http://www.tandfonline.com/doi/abs/10.1080/14681811.2016.1149808?journalCode=csed20

Jones, T., Hart, B., Carpenter, M., Ansara, G., Leonard, W., & Lucke, J. (2016). Intersex: Stories and Statistics from Australia. London: Open Book Publisher.

Pagonis, P. (2015). The Son They Never Had. Narrative Inquiry in Bioethics,, 5(2), 103-106.

 

Bios

Mandy Henningham studies at the Discipline of Child and Adolescent Health, Sydney Medical School at the University of Sydney. She completed her Master of Health Science (Sexual Health) at the Health Science campus at the University of Sydney. Through this degree, she found her passion to pursue LGBTI and human rights. Mandy pursued other degrees in health such as a Graduate Certificate in Public Health and also completed a Bachelor of Health and Movement (Sport) which fuelled her passion for health and fitness. This background in health as well has led Mandy to pursue research interests in LGBTIQ sexuaity work.

Tiffany Jones is the editor of Bent Street.

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