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P r e f a c e Every aspect of the history of sexuality is controversial. Eating, fashion, sports, occupation, or political outlook can be discussed freely in public, evenbythosewhodisagree.Thereisnotthesameintensityofuneasethat accompanies these aspects of our lives as it does sexuality. A major reason for this unease comes from religion. Religions, especially the monotheistic ones, have long held strong opinions on sex, mostly regulating sexual behavior and often describing transgressions as abominations, sins, or moral crimes leading to the fury of God or those representing God’s views. A second reason for treating sexuality with fear, guilt, or embarrassment stems from our psychology. For Freudian psychiatrists, sexuality was the basis for all neurotic and psychotic conditions they interpreted or tried to help. Whether we treat psychiatric approaches with respect or disapproval as a healing science, we usually repress our sexual thoughts in public settings, and are awkwardly aware of the passing or fleeting moments of erotic awareness that shove themselves into our minds at inappropriate times. A third reason is cultural. Each community develops its own ideas about the differences in sexual behavior expected of males and females. These ideas sometimes reflect religious views, but often have their own expression in how we behave in our daily lives as men and women in society, which limits aspects of sexual behavior in public—from kissing, holding hands, exposing parts of our bodies without clothing, or hiding most of them, especially those parts usually associated with our sexual identification. xiv Preface The same unease applies to the scientific study of sexuality. Each generation learns something more about the biology, psychology, or cultural history of sexuality. Society itself changes in the way it regards children born with sex disorders, just as it does for those born with birth defects not associated with sex. Since the 1980s, terms like mongoloid idiocy, juvenile amaurotic idiocy, and gargoylism have yielded to neutral terms like Down syndrome, Tay-Sachs syndrome, and Hurler syndrome . In a similar way, older terminology in the scientific literature is yielding to a new vocabulary for the twenty-first century. All forms of human hermaphroditism are now referred to as intersexuality. The generic term “disorders of sex development” (DSDs) or “differences of sexdevelopment”isgraduallyreplacingoldertermslikemalepseudohermaphrodite (46,XY DSD), female pseudohermaphrodite (46,XX DSD), true hermaphrodite (ovotesticular DSD), XX male sex reversal (46,XX testicular DSD), and XY female sex reversal (46,XY complete gonadal dysgenesis).1Thesenewtermsmaybeeasierandmoredescriptiveforthe scientist to use, but they are more difficult for parents of such children when describing their child’s condition to relatives and friends. Some may still have an alienating connotation and may be subject to further descriptive changes, or eventually they may be switched to neutralizing eponyms—as in Turner syndrome (for the human 45,X syndrome) or Klinefelter syndrome (for the 47,XXY syndrome). In this history, I will use the older terms as they were in use at the time, but in the final chapters I will use the old or new terms (with their alternate terminology in brackets) so readers will not have to flip back and forth to Table 22.2 to know what is being discussed. Sexuality is a huge topic, and while all aspects of sexuality enter into the discussion of sex determination to some extent, the main emphasis in this book is the history of the biological processes that deal with the mechanisms and events that lead normally to male or female offspring. The term “sex differentiation” applies to the various components of our sexuality and how they are formed after the initial sex-determining event occurs. For humans, that initiating event is the union of an X- or Y-bearing sperm with an X-bearing egg. We have an XY sex-determining mechanism. It is not universal. I describe the other major forms of sex determination that occur in plants, animals, and even microbes. But once initiated, the differentiation process may also be elaborate—involving the formation Preface xv of the gonads, the formation of the internal genitals, and the formation of the external genitals. What we see at birth and assign to a gender (legally restricted on birth certificates to male or female) is often limited to the external genitals. If we see a penis and scrotum, we assign a male status to the child. If we see the clitoris, labia, and a vaginal opening, we assign a female status. On occasion (and it is very rare) there will be an inconsistency in our expectations. The baby boy may...


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