Intersex in America: A Cultural History of Uncertainty

How does culture deal with bodies that fail to conform to the norms of sexual dimorphism? And what is at stake in managing these bodies? Focusing on the last three hundred years of American cultural and medical history, Elizabeth Reis's study reveals the different strategies employed to make sense of intersexual bodies. Often viewed as monstrosities up until the eighteenth century, these bodies were subject to a range of different medical explanations over the following two hundred years. The changing understanding of intersex was characterized by the tension between a focus on the gonads as the true marker of sex and the competing consideration of secondary sex characteristics, as well as what we would nowadays define as the individual's sexual orientation and gender identity. At the same time, the increased availability of medical technologies opened up the possibilities of elective and nonelective surgical alteration of genital appearance and the construction of allegedly normal male and female bodies. Drawing on a large number of historical cases, Reis describes the relation between these developments and reveals how cultural understandings of intersex evolved. In doing so, she also exposes the contradictory nature of cultural constructions of sexual difference.

Taking the reader up to the present day, Bodies in Doubt concludes with a consideration of recent attempts to replace intersex with the alternative term disorder of sex development (DSD) or, as Reis suggests, the less stigmatizing "divergence of sex development" (153). Reis illustrates that we have come a long way from delegating sexually ambivalent bodies to the sphere of the fantastic, monstrous, or humanly impossible; however, the concluding discussion of the nomenclature controversy reminds us that the uncertainties evoked by the intersexual body are not history but continue to be negotiated today. If the emergence of the intersex movement in the past fifteen years and the growing academic interest in intersex studies have resulted in a new focus on intersex as a human reality, the very meaning of sexually ambivalent bodies as well as how we should speak about these bodies remains, as the book's title suggests, in doubt.

Reis's study is of particular interest as it illustrates that this uncertainty not only concerns the construction of sexual dimorphism but also affects more general understandings of what counts as normal, natural, and human in a specific historical moment. The history of intersex, Reis suggests, is not only a history of changing figurations of physical sex but also a history of the cultural figuration of human experience and identity as such. Throughout Bodies in Doubt, for instance, Reis points to the close relationship between intersex and homosexuality. She explains how the desire to safeguard the norms of heterosexuality and marriage would influence the decisions doctors made when trying to signify the sexually ambiguous bodies of their patients. At the same time, there were anxieties that "hermaphroditism [could be] just a cover for a same-sex sexual relationship" (68). Convincing doctors that such individuals were members of the opposite sex, patients could potentially gain the right to change sex and thus fraudulently claim a social and legal identity that legitimated an otherwise illicit relationship between members of the same sex. The fear of deception also forged an association between sexual changeability and racial instability in nineteenth-century America where "the unnerving possibility that individuals could suddenly change sex paralleled early national preoccupation with race, racial categories, and the possibility of changing racial identity" (36). Pointing to the interrelation of sex and sexuality as well as sex and race, Bodies in Doubt is at its strongest when it reveals how far-reaching cultural norms were implicated in managing sexually ambivalent bodies.

Unfortunately, at times, the analysis of the intersections between the medical treatment of intersex and the wider cultural context breaks off all too soon. The relation between the mutable sexual and racial body, for example, remains isolated and is not taken up in later chapters. Another oversight regards the changing cultural relationship between America and Europe...