Hermaphrodites and the Medical Invention of Sex (review)

Alice Domurat Dreger. Hermaphrodites and the Medical Invention of Sex. Reprint. Cambridge: Harvard University Press, 2000. xiii + 268 pp. Ill. $16.95 (paperbound).

Whether seen as portents of evil, legal conundrums, sexual menaces, or medical monsters, hermaphrodites have long challenged the basic Western assumptions about the existence, stability, and "naturalness" of the categories of male and female. In nineteenth-century Europe, the body of the hermaphrodite became, according to Alice Dreger's noteworthy study, an important locus of several contested domains. Dreger tracks the various and shifting criteria of defining/diagnosing true sex. What, according to medical theory, makes a man a man, and a woman a woman? Is it the configuration of the genitalia? The dominant set of reproductive organs? The gonads? The gender? All of the above? Dreger does a wonderful job of showing how the definitions of sex shifted over time, across national boundaries, and between medical luminaries vying for authority over the (mis)gendered body.

As the nineteenth century progressed, Dreger argues, fewer and fewer patients met the ever-narrowing criteria that defined a "true" hermaphrodite. By the turn of the twentieth century, only individuals with both ovarian and testicular tissue counted as "true" hermaphrodites; individuals with all other combinations of sexual organs (ovaries and penis, testicles and uterus, etc.) were labeled "pseudo" or "spurious" hermaphrodites. Thus, Dreger shows, medical men managed to narrow the number of people who did not "truly" belong to one sex or the other. All "true" hermaphrodites in this scheme were sterile beings, unable to reproduce--and thus belonged to neither sex, rather than to both.

Dreger's research is remarkable, and much of what she documents is the encounters between physicians and their hermaphroditic patients. Many of these cases were viewed by physicians as cases of so-called mistaken sex--individuals whose sex was misdiagnosed at birth and who were raised as the "wrong" sex. The physician's task here was to determine to which sex the individual ultimately belonged. The relationships between sex, what would now be called gender, and sexuality were central to these encounters as physicians examined and weighed the various characteristics that could be construed as male or female. A patient's countenance, sex role, interests, and mannerisms were as important as the configuration of his or her genitals. The direction of the individual's sexual desire was also a crucial factor--cases where a married woman was diagnosed as being "really" male were especially disturbing to a physician's sense of social order. By the end of the century, what Dreger has dubbed the "Age of Gonads" dominated medical theory in this arena. Theoretically, an individual's sex was solely determined by the gonads: women had ovaries; men had testicles. In practice, however, genitals and gender continued to matter.

Dreger deftly weaves together a number of historical themes: the doctor-patient relationship; the tensions between medical theory and medical practice; biological classificatory systems, and the problems that arise when "specimens" fail to fit neatly into binary categories; the historically contingent relationships between sex, gender, and sexuality. While the medical voices in this book tend to dominate the narrative, Dreger admirably keeps the patients' perspective in the foreground as much as she can. A few of these individuals left memoirs; some of them were famous in their own day. But most of them were ordinary men and women with not-so-ordinary bodies, whose interaction with the medical community was sometimes beneficial, sometimes cruel, sometimes tragic. Medical men used these individuals to tell stories and jokes, to advance their social agendas and their careers. Dreger uses their stories to analyze an important historical moment when the assertion of medical authority over sexual bodies became both increasingly important and increasingly problematic.

Stephanie H. Kenen
Harvard University

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