Hermaphrodites and the Medical Invention of Sex (review)

In this thoroughly researched book, Alice Dreger explores the intricate relationship between highly idealized cultural beliefs about men and women, and medical inquiry into the so-called hermaphrodite during the years 1870 to 1914. These years saw a massive increase in medical research about sex, the organs of the body, and hormones. Ambiguous genitalia during the first half of the century were seen as interesting (and amusing) cases that could not be treated but only displayed (a few hermaphrodites earned a living exhibiting their genitals at medical schools). But advanced medical knowledge increasingly treated all physical deviations from the norm as both social problems and medical diseases. Dreger lucidly explains the ways in which social attitudes affected scientific research. For example, she demonstrates conclusively that doctors defined gender according to deeply held beliefs about the appropriate appearance and behavior for each sex. Doctors faced with large, powerful women or small, thin men, did not draw the obvious conclusion that physical types vary enormously, as does social behavior. Instead, they sought a scientific explanation for all biological confusion, working hard to define their patients, regardless of appearance, as firmly male or female. Faced with not only ambiguous genitalia, but also men who menstruated and women who excreted semen—evidence of a complicated world of intersexed people—doctors clung all the more obstinately to their belief in the two sexes/two bodies model.

Improved scientific studies led doctors to proclaim the gonads as the sole criteria by which the sex of persons born with mixed or uncertain genitalia could be determined. Dreger traces the rise to supremacy of this single biological property through a careful examination of the medical literature of Britain and France. One of the most common ways in which doctors came to know of sex anomalies was when a woman approached a doctor to repair a “hernia,” which turned out to be a descended testicle. Thus, a Belgian woman who sought the advice of a doctor about her husband’s difficulty in penetrating her vagina, was informed summarily, “But my good woman, you are a man!” (2). When she balked at leaving her new marriage, he washed his hands of the case. But an English doctor, when faced with a similar case of an older widow, quietly performed reparative surgery so that the woman could continue to live as a woman. He informed her that he had removed the hernia, without explaining that it was a testicle. This pattern of concealing the true nature of the situation was more common in Anglo-American medicine, while the French, with equal arrogance, insisted on their prerogative to choose the patient’s sex. As time went on, doctors were determined to do away with all aberrations and by constantly refining their criteria, they successfully reassigned virtually every hermaphrodite into the “right” category of male or female.

Seemingly the more doctors knew, the more they relied on the gonad theory. Dreger acknowledges the real gains made by such pioneers as Samuel Pozzi, a surgeon who discovered the dangers of testicular cancer for hermaphrodites. But she also documents the often terrible price paid by so-called hermaphrodites who sought medical help. Herculine Barbin, whose autobiography brought him posthumous notoriety, was forced to change from a young woman to a man when she developed a penis as a teenager. (In rare cases a male baby will lack the necessary enzyme to receive testosterone, but at puberty the body no longer needs this enzyme and can receive male hormones; Barbin had been brought up as a girl and thought herself a girl until puberty.) His experience, and consequent social isolation, led to his suicide. Other cases are only known through the medical literature, which rarely admits to failure, but Dreger reproduces numerous intrusive medical photographs, demonstrating the power of science to define and coerce patients.

Dreger’s finely textured study is a major contribution to the history of medicine. Unfortunately, however, she has depended on a...