Johns Hopkins Magazine -- September 2000
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Making Room for Ambiguity

Seven years ago, we brought you a story about infants born with ambiguous genitalia ("Is It a Boy or a Girl?" November 1993), which examined a variety of intersex disorders and the surgical innovations Hopkins physicians were undertaking to give these children a shot at a "normal" life. Soon after the story was published, we heard from activist Cheryl Chase, director of the Intersex Society of North America (ISNA). She angrily took us to task for producing an article that was, in her opinion, horribly one-sided. Her position: much of the genital corrective surgery we so optimistically described, in which surgeons "can sculpt female genitalia out of what appears male, and craft male genitalia out of what looks ambiguous," was unnecessary. In her own case and the case of others, she wrote, "disfiguring" surgery performed on intersex infants can leave them irreparably scarred, both physically and psychologically.

We took Chase's criticism seriously. As journalists, we're charged with exploring all sides of issues--of responsibly seeking out dissenting viewpoints and sharing them, if warranted, with our readers. Had we erred in not at least mentioning the position taken by "fringe" advocacy groups like Chase's ISNA? We filed her letter away, but the questions it raised remained in our collective conscience. And writer Melissa Hendricks shared with me her desire to revisit the subject of intersex disorders at some future date.

Flash forward to 2000 and the newly released findings of prominent Hopkins psychiatrist/urologist William Reiner. Reiner has spent a career treating children with intersex disorders. He now believes that in some cases physicians should put off doing gender reassignment surgery until a child is old enough to articulate an informed opinion. Conventional thinking--much of it pioneered here at Hopkins several decades ago--holds that nurture can win out over nature: that a genetic male can, with the right surgery and upbringing, grow up to be a well-adjusted female. According to Reiner, and some other experts, patients and their families from across the country, it's time to re-examine that basic premise.

The trajectory of advances in science and medicine rarely proceeds in a neat, straight line. This time around, with "Into the Hands of Babes", we bring you a story in all its messy complexity.

Sue De Pasquale, Editor