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Unlike many other cultures, the Anglo-American mainstream has always relied on a binary view of sex and gender. In the case of intersex people, who have inherent biological characteristics that don’t divide neatly into male or female, authorities have gone to great lengths to maintain a binary, as historian Elizabeth Reis explains.

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Reis writes that medical texts used by the early Puritan settlers in North America generally only talked about intersex people as infants. They identified them as a subset of “monstrous births,” sent as a warning from God.

But in one 1629 case, the Virginia General Court took up the question of how to understand an adult intersex person. Thomas/Thomasine Hall was arrested for wearing women’s clothes and having sex with a maid. Hall explained that they had been baptized as a girl, but had switched gender roles several times, and that they had genitals that weren’t clearly male or female. Asked “wether hee were man or woeman,” Hall replied, “both man and woeman.”

The court’s solution was to require Hall to wear a man’s apparel but with a woman’s hair covering and apron. Reis argues that this was not an endorsement of a middle ground in gender but a way to prevent future “deceptions” and punish Hall by making them a public spectacle.

To other authorities, “hermaphrodites” were impossible, or at least incredibly rare. In 1741, English physician James Parsons insisted that most so-called hermaphrodites were really women with large clitorises. Since many (male) doctors weren’t even aware of the clitoris, he wrote, it was no surprise that “at the first sight of a large Clitoris, divers odd Conjectures should arise.” Parsons and other influential doctors argued that a true hermaphrodite would have two fully functional sets of genitals. Anyone else could be sorted into a correct sex.

In one 1843 case, Reis writes, a Connecticut man’s right to vote hinged on a medical examination. Two doctors determined that his genitals were more male than female, but one of them later changed his mind after discovering that the man menstruated.

Nineteenth-century doctors also debated the merits of surgery for “correcting” atypical genitals. In 1849, one reported on his removal of testicles growing inside a girl’s labia, which he claimed restored her interest in girlish activities. But others were horrified by the procedure, which, given the state of surgery at the time, would have been painful and dangerous. The authors of one medical jurisprudence text warned that such an operation “removes merely the external.”

But, Reis writes, in the twentieth century surgery became much more standard. Despite being aware of invisible chromosomal and gonadal differences, many doctors preferred to assign individuals a sex based on how easily they could shape them into the appearance of one or the other standard binary configurations.

It’s only since late in the twentieth century that intersex people have been able to organize and win more control over their own treatment, including determining what, if any, medical interventions they want for themselves.

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The Journal of American History, Vol. 92, No. 2 (Sep., 2005), pp. 411-441
Oxford University Press on behalf of Organization of American Historians