Tools for Teaching Gender and Sexuality in Health and Medicine

Teaching the gender and sexual politics of medicine, I sometimes struggle to find material that fits the needs of my undergraduates, especially those at introductory and intermediate levels. Too often, I feel stuck between popular material that has an inadequately critical approach (if any critical angle at all) and advanced, complex texts that I love and lean on in my own research, but that leave my students struggling and frustrated. For that reason alone, I celebrate the publication of both Fixing Sex by Katrina Karkazis and Infectious Ideas by Jennifer Brier, which treat the "body politics" of intersexuality and HIV/AIDS, respectively. I've taught from Karkazis's book in several courses already, and find that her extremely fluent prose and clear arguments work well for both undergraduates and graduate students. I haven't yet taught the Brier book, but expect that it, too, will fit the bill.

Fixing Sex is a theoretically sophisticated and nuanced ethnography of medical practice related to intersex conditions—now officially known as "disorders of sex development," or DSD, referring to conditions in which development of physical sex is atypical, especially when genital morphology is not typical for the chromosome pattern. (I agree with Karkazis when she writes that "my sense is that this term [DSD], though in some ways less culturally loaded than intersex, still leaves intersexuality fully medicalized and construes gender difference as a disorder requiring treatment—a position with which I do not agree" [18]. Like her, I therefore use the term intersex, though it, too, is imperfect, and I am sensitive to the fact that either term will contravene the self-chosen descriptor of many people with the conditions that get subsumed under these umbrellas.) Drawing on fifty-three original, in-depth interviews with clinicians, intersex adults, and parents of intersex children or adults, as well as participant observation in a huge range of public venues, Karkazis offers the most rounded and in-depth view of intersex that is available from any of the recent and not-so-recent texts on this subject.

The book has already been widely reviewed and rightfully praised, so I will focus on those aspects that make it especially useful for teaching. First, the triangulation of voices (clinicians, parents, and people with intersex conditions) is a structurally effective technique for decentering expert views on intersex, whether that expert be a pediatric endocrinologist or a gender studies scholar. Karkazis uses her interview material with great sensitivity, providing both lengthy quotes and the necessary context for appreciating subjects' perspectives. Second, she explores the uncertainty, subjectivity, and multiplicity that underlies clinical decisions and evaluations in this realm, providing a very student-friendly introduction to critical feminist studies of medical practice. Third, Karkazis covers historical ground that students are most likely to have encountered, specifically the David Reimer case (also known as "the John/Joan case"), offering important context and correctives to the most widely known (and badly flawed) account of this case, the book As Nature Made Him by John Colapinto (2006). Fourth, Karkazis's account is a sharp rebuttal of the idea that "good intentions are synonymous with good outcomes" (267), a lesson that I find is useful over and over again. Although Karkazis clarifies that the book is not technically an "outcome" study of the medical treatment of people with intersex conditions, and in spite of a generous and empathic tone toward the clinicians whom she identifies as "deeply committed" to their patients, Fixing Sex offers a devastating portrait of the results of medical treatment in this realm. Her interviews put the lie to the idealized versions of treatment that indicate one or two genital surgeries with good to excellent outcomes, instead detailing the more usual experience of multiple genital surgeries (especially in the case of people with congenital adrenal hyperplasia, or CAH), and outcomes that are still neither aesthetically nor functionally satisfying...