View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by ResearchArchive at Victoria University of Wellington “It’s a... does it matter?” Theorising “boy or girl” binary classifications, intersexuality and medical practice in New Zealand Geraldine Christmas A thesis submitted to the Victoria University of Wellington in fulfilment of the requirements for the degree of Doctor of Philosophy Victoria University of Wellington 2013 Abstract This thesis investigates the clinical management of intersexuality in New Zealand and support for intersex New Zealanders and their families. My research is informed by the narratives of New Zealanders with intersex conditions, parents of children with intersex conditions, registered nurses, specialist clinicians, representatives from community/support organisations and a former member of parliament. This thesis also investigates medical teaching in New Zealand: not only about intersex anatomy but two key issues which shape society – gender and sexuality. Feminist, postmodern and queer theorising about these issues also inform this thesis in relation to traditional assumptions about gender and sexuality, and medical recommendations for sex assignment and rearing. Historical accounts of societal attitudes and medical thinking towards sex classification, sexuality and intersexuality also inform this thesis. Despite New Zealand‟s reputation as an egalitarian democracy, my findings show that judgemental attitudes towards difference still exist in parts of New Zealand society. This is discussed with reference to poststructuralist and oral history theorising about societal power structures and research on sensitive topics. Undertaking research in New Zealand, on what can be regarded as a sensitive topic, can be difficult in terms of maintaining confidentiality in a small population. The implications of practising medicine in New Zealand are highlighted as, due to its smaller population, the number of intersex individuals coming to clinicians‟ attention is small compared to some other countries. From my findings, it appears that specialist clinicians and medical schools in New Zealand rely on medical models from other countries with larger populations, which have a greater number of babies born with intersex conditions and consequently more specialised medical practice and education. The narratives of intersex people and their parents also highlight the implications of living in a smaller population. This is not only with regard to medical experiences (such as hospitals which often have little experience of intersex issues), but also societal prejudices and judgements towards lesser known variations of sexual anatomy. Acknowledgements Firstly, I am grateful to my supervisors Dr Alison Laurie and Dr Lesley Hall, of the Gender and Women‟s Studies department at Victoria University of Wellington (VUW), for their expert supervision and guidance. Without them I would not have successfully completed this thesis. I also wish to thank Dr Sue Cornforth, at the Faculty of Education, VUW, and Professor Charles Daugherty, Assistant Vice-Chancellor (Research), VUW, for their guidance, support and encouragement. I am also grateful to Dr Kathy Nelson at the Graduate School of Nursing, Midwifery and Health, VUW, for her invaluable advice and feedback on preparing my ethics application. Dr Carmen Dalli at the Department of Early Childhood Studies, VUW, who searched her files and provided me with papers by Dr John Money from his visit to VUW in the 1980s. She also kindly let me spend an afternoon in her office so I could read through and photocopy Money‟s papers. I thank Sheila Law at the Faculty of Education, VUW, for her much-appreciated help and support. Sue Kelly at the Postgraduate Students‟ Association (PGSA), VUW, kindly provided me with a key to a quiet office space at the university‟s Kelburn Campus, which greatly assisted my study. Staff at the Wellington Medical School Library – notably Janine Faulknor, Maxine Schutte and Stephanie Houpt, who allowed me access to journals and books (some centuries old) from the library‟s historical collection, and helped me undertake searches on library databases. Lynette Shum at the Oral History Centre (OHC) of the Alexander Turnbull Library (part of the National Library of New Zealand) instructed me on how to use a digital recorder, and booked digital recorders for my field trips. Linda Evans of the OHC archived copies of some recorded interviews (as requested by participants) and also booked digital recorders. Mani Mitchell, Executive Director of the Intersex Trust Aotearoa New Zealand (ITANZ), lent me DVD copies of television documentaries and current affairs reports on intersex matters, and e-mailed me encouragement and support. Sue Russ, Senior Policy Analyst of the Ministry of Social Development, lent me a DVD copy of the San Francisco Human Rights Commission televised hearing (2004) on the medical ii management of intersex people. Jack Byrne, Senior Policy Analyst at the Human Rights Commission, Elizabeth Kerekere, Chair of Tiwhanawhana Trust and Joanne Neilson, President (2008-2010) of Agender New Zealand, for their help, time and advice on research matters. My manager, Damien Grant, at my day job at the NZ Transport Agency, supported me in having time off to undertake fieldwork, meet with my supervisors and complete this thesis. I am especially grateful to Sarah (see List of participants chapter), who enabled access to some participants, her words of encouragement in e-mails, and her hospitality when I undertook fieldwork in her region. Finally, I am forever grateful to the participants who invited me into their homes and workplaces, and shared their insights and views with me. iii Contents Abstract i Acknowledgements ii 1 Introduction 1 My personal standpoint 1 The key issues and questions 2 What‟s different about New Zealand? 3 What this thesis aims to bring to the body of knowledge 5 Definition of terms 6 How this thesis is structured 9 PART ONE: SETTING THE SCENE – THE PAST AND PRESENT 2 Feminism, gender and “questionable” bodies – what‟s already been said? 13 The 19th century – the origins of “women‟s problems” 13 The colonial “gaze” (and abhorrence) 16 Second wave feminism – “women‟s problems” questioned 18 Medical power and status – “the expert” 22 The medical “gaze” 28 Clinicians and the management of intersexuality 29 Academic perspectives on intersexuality and medical institutions 32 3 The Romans, the Church and the 19th century: “evil” and “curious” bodies 39 Early civilisations 39 The founding of Rome 41 The medieval period 42 The 16th century – Ambrose Paré 43 The 19th century – dissections, discoveries and “interesting cases” 46 4 The 20th century: natural variations and “nature versus nurture” 54 Magnus Hirschfeld and the case of Lili Elbe 55 Hugh Young and the development of urology 57 John Money and the implementation of “gender policy” 60 “Nature versus nurture” and “the twins case” 66 5 The scientific basis of sexual differentiation 72 Typical sexual development 72 Differences of sexual development (DSDs) 76 Disrupted development of the primordial gonad 77 Gonadal dysgenesis 78 Male pseudohermaphroditism – incomplete masculinisation of a genetic (46,XY) male 81 Female pseudohermaphroditism – virilisation of a genetic (46,XX) female 86 v PART TWO: PERSPECTIVES ON SEX, GENDER AND INTERSEX 6 Theoretical approaches to sex and gender 89 Second wave feminism – Greer, Millett and Firestone 89 Biological determinism 94 “Brain sex” 95 Third wave feminism 96 Feminist poststructuralist theory 98 Postmodern feminist theory 99 Queer theory 103 7 People‟s first hand experiences – what‟s already out there? 107 Experiences in New Zealand 107 Experiences in other countries 111 The right to choose one‟s gender 117 The desire for intersex embodiment 120 PART THREE: RESEARCH FINDINGS AND MEDICAL PRACTICE 8 Methodologies and methods 123 Theorising oral history 124 Research on sensitive topics 126 Maintaining confidentiality in New Zealand 129 Feminist research methodology – ethics, dilemmas and principles 131 Queer methodology 133 Lectures and tutorials at tertiary institutes 134 Specialist clinicians and registered nurses 135 Community/support organisations 136 Methods 139 9 Medical practice and management 143 The first question: “Is it a boy or a girl?” 143 Sex assignment 148 Surgery and hormone administration 152 Support – peer and social issues 162 10 Parents‟ experiences with “experts”, hierarchies and empowerment 167 When parents received their child‟s diagnosis 167 Parents‟ experiences with medical professionals 172 11 People‟s experiences and understandings about surgery and gender 183 Experiences with surgery 183 Gender – “How would you describe yourself?” 195 12 Education and awareness – different approaches to sexual differences 202 “Reproduction and Endocrinology” lectures – Auckland Medical School 202 Paediatric surgery seminars – Christchurch School of Medicine 204 Mr Chris McEwan – plastic surgeon 207 “Identity and Diversity” lecture – midwifery programme 210 vi Registered nurses 213 Rainbow Youth 216 Georgina Beyer – human rights and gender identity in New Zealand 219 13 Conclusions and recommendations 223 Reflections on my research 223 Medical rationales, health concerns, gender and sexuality 224 Narrators‟ understandings about clinical procedures and gender 226 Support and acceptance in New Zealand 227 My findings, issues and theoretical positions 228 Recommendations 231 Future research 234 Finally... 235 List