Intersex(es) and informed consent: How physicians' rhetoric constrains choice

Theoretical Medicine and Bioethics

Volumn 25, Issue 1, 2004, Pages 21-49

  Hester, J David ^a  

^a Interfakultares Zentrum fur Ethik   (Germany)

Author keywords

"Optimal gender policy"; Informed consent; Intersex; Perelman Olbrechts Tyteca; Rhetoric and the frameworks of argumentation

Indexed keywords

CANADA; CLINICAL PROTOCOL; EUROPE; FEMALE; GENDER IDENTITY; HEALTH CARE POLICY; HERMAPHRODITISM; HUMAN; INFORMED CONSENT; MALE; MEDICAL DECISION MAKING; MEDICAL ETHICS; MEDICAL SOCIETY; PARENT; PEDIATRICS; PHYSICIAN; PRACTICE GUIDELINE; REVIEW; SOCIAL PSYCHOLOGY; SURGICAL TECHNIQUE; UNITED KINGDOM; CHILD; DECISION MAKING; DOCTOR PATIENT RELATION; ETHICS; INFANT; INTERPERSONAL COMMUNICATION; NEWBORN; PATHOLOGY; PERSUASIVE COMMUNICATION; PRESCHOOL CHILD; PROFESSIONAL PATIENT RELATIONSHIP; SEX DIFFERENTIATION DISORDER; STANDARD;

PROFESSIONAL PATIENT RELATIONSHIP;

CHILD; CHILD, PRESCHOOL; CLINICAL PROTOCOLS; COMMUNICATION; DECISION MAKING; HUMANS; INFANT; INFANT, NEWBORN; INFORMED CONSENT; PEDIATRICS; PERSUASIVE COMMUNICATION; PHYSICIAN-PATIENT RELATIONS; SEX DIFFERENTIATION DISORDERS;

EID: 3042527382     PISSN: 13867415     EISSN: None     Source Type: Journal    
DOI: 10.1023/B:META.0000025069.46031.0e     Document Type: Review

References (194)

1. H.F.L. Meyer-B ahlburg, "Gender Assignment in Intersexuality," Journal of the Psychology of Human Sex 10 (1998): 1-21;
2. cf. also idem, "Gender Identity Development in Intersex Patients," Child and Adolescent Psychiatric Clinic North America 2 (1993): 501-512;
3. idem, "Gender and Sexuality in Classic Congenital Adrenal Hyperplasia," Endocrinology and Metabolism Clinics of North America 30/1 (2001): 155-171;
4. idem, "Gender Assignment and Reassignment in Intersexuality: Controversies, Data, and Guidelines for Research," in S.A. Zderic, D.A. Canning, M. C. Carr, and H. Snyder, eds. Pediatric Gender Assignment: A Critical Reappraisal (Dordrecht: Kluwer Academic/Plenum Publishers, 2002), pp. 199-223;
5. American Academy of Pediatrics RE9958, "Evaluation of the Newborn With Developmental Anomalies of the External Genitalia," Policy Statement 106/1(2001)
6. A. Fausto-Sterling, "The Five Sexes: Why Male and Female are Not Enough," The Sciences (March/April 1993): 20-25.
7. Cf. "Recommendations for Treatment," developed by the ISNA, available at www.isna.org.
8. J. Money, J.G. Hampson, and J.L. Hampson, "Hermaphroditism: Recommendations Concerning Assignment of Sex, Change of Sex, and Psychological Management," Bulletin of Johns Hopkins Hospital 97(1955): 284-300;
9. idem, "Imprinting and the Establishment of Gender Role," Archives of Neurology and Psychiatry 77 (1957): 333-336.
10. See also J. Money, Sex Errors of the Body and Related Syndromes: A Guide to Counseling Children, Adolescents, and Their Families, 2nd edn. (Baltimore: Paul H. Brookes Publishing, 1994);
11. J. Money and A. Ehrhardt, Man and Woman, Boy and Girl (Baltimore: The Johns Hopkins University Press, 1972).
12. AAP Policy Statement RE 9958, cited in n. 1, above.
13. Besides the many first-person narratives in the collection of essays by A. Dreger, Intersex in the Age of Ethics (Hagerstown: University Publishing Group, 1999), see also www.isna.org/librarylbibonline.html for links to many essays available on line.
14. Cf., e.g., AAP Policy Statement RE9958, cited in n. 1, above: "Because of the remaining uncertainties with regard to the long-term psychological and physical aspects of treatment among these patients, ongoing counseling of the parents and the affected child is advisable." C. Migeon, A. Wisniewski, and J. Gearhart, Syndromes of Abnormal Sex Differentiation: A Guide for Patients and Their Families (B altimore: The Johns Hopkins Children's Center, 2001), has a section on "Psychological Treatment" and a section on "Support Group Contact Information." Recent publications by H.F.L. Meyer-Bahlburg also note the value of counseling; cf. "Gender Assignment and Reassignment in Intersexuality," cited in n. 1, above.
15. E. Nussbaum, "A Question of Gender," Discover (2000): 92-99;
16. R. Marion, "The Curse of the Garcias," Discover (2000): 42-44;
17. A. Yronwode, "Intersex Individuals Dispute Wisdom of Surgery on Infants," Synapse: University of California at San Francisco Medical School (1999).
18. Cf. A. Fausto-Sterling, Sexing the Body: Gender Politics and the Construction of Sexuality (New York: Basic Books, 2000), pp. 82-83 (Table 4.1), pp. 88-91 (Table 4.2).
19. See "Draft Statement of the British Association of Paediatric Surgeons (BAPS) Working Group on the Surgical Management of Children Born with Ambiguous Genitalia" (July 2001), Appendix: Clitoral Surgery, available at http://www.baps.org.uk/documents/Intersex%20statement.htm.
20. N.K. Alizai, D.F. Thomas, R.J. Lilford, A.G. Batchelor, and N. Johnson, "Feminizing Genitoplasty for Congenital Adrenal Hyperplasia: What Happens at Puberty?" Journal of Urology 161/5 (1999): 1592-1593.
21. S.M. Creighton, C.L. Minto, and S.J. Steele, "Objective Cosmetic and Anatomical Outcomes at Adolescence of Feminising Surgery for Ambiguous Genitalia Done in Childhood," Lancet 358/9276 (2001): 124-125.
22. L.S. Baskin, A. Erol, Y.W. Li, W.H. Liu, E. Kruzrock, and G.R. Cunha, "Anatomical Studies of the Human Clitoris," Journal of Urology 162/3.2 (1999): 1015-1020, has determined that the current model of innervation underlying modern clitoral recessions is wrong.
23. See also B. May, M. Boyle, and D. Grant, "A Comparative Study of Sexual Experiences," Journal of Health Psychology 1/4 (1996): 479-492,
24. R.W. Dittman, M.E. Kappes, and M.H. Kappes, "Sexual Behaviour in Adolescent and Adult Females with Congenital Adrenal Hyperplasia," Pscyhoneuroendocrinology 17/2-3 (1992): 153-170, for long-term follow up studies on sexual practices of patients having undergone clitoroplastic surgery.
25. The North American Task Force on Intersexuality, founded in 2000 by pediatric urologist Ian Aaronson of the Medical University of South Carolina in Charleston, is the first concerted, systematic effort by the medical community to look at all the clinical data and gather all the information available regarding clinical responses to genital ambiguity and their long-term outcomes.
26. Cf., e.g., W. Reiner, "Case Study: Sex Reassignment in a Teenage Girl," Journal of the American Academy of Child and Adolescent Psychiatry 35/6 (1996): 799-803.
27. S. Holmse, J.M. Kirk, M.O. Savage, and R.S. Kirby, "Surgical Reinforcement of Gender Identity in Adolescent Intersex Patients," Urologia Internationalis 48 (1992): 430-433.
28. M. Diamond and H.K. Sigmundson, "Sex Reassignment at Birth: Long-Term Review and Clinical Implications," Archives of Pediatric and Adolescent Medicine 151 (1997): 298-304.
29. M. Diamond and H.K. Sigmundson, "Sex Reassignment at Birth: Long-term Review and Clinical Implications," Archives of Pediatric and Adolescent Medicine 151 (1997): 298-304.
30. However, note S. Bradley, G. Oliver, A. Chernick, and K. Zucker, "Experiment of Nurture: Ablatio Penis at 2 Months, Sex Reassignment at 7 Months, and a Psychosexual Follow-up in Young Adulthood," Pediatrics 107/1 (1998), electronic article 9, http://pediatrics.aappublications.org/. The provenance of this article has recently come under question.
31. Cf. J. Colapinto, As Nature Made Him: The Boy Who Was Raised As A Girl (New York: Perennial Press, 2001).
32. See also, however, the discussion in F.M.E. Slijper, "Long-Term Psychological Evaluation of Intersex Children," Archive of Sexual Behavior 27/2 (1998): 125-144.
33. H. Beh and M. Diamond, "An Emerging Ethical and Medical Dilemma: Should Physicians Perform Sex Assignment Surgery on Infants with Ambiguous Genitalia?" Michigan Journal of Gender and Law 7/1 (2000):1-63;
34. K. Kipnis and M. Diamond, "Pediatric Ethics and the Surgical Assignment of Sex," Journal of Clinical Ethics 9/4 (1998): 398-410.
35. K.-K. Ford, "'First, Do No Harm' - The Fiction of Legal Parental Consent to Genital-Normalizing Surgery on Intersexed Infants," Yale Law and Policy Review 19 (2001): 469-488.
36. Ford questions the legal exceptions to the three criteria (informed consent, voluntariness, and competency) of informed consent that provide the basis for medical intervention: emergent condition and parental "substituted judgment." Cases of intersexuality do not meet the legal standards for either exception.
37. See also S. Creighton and C. Minto, "Editorial: Managing Intersex," British Journal of Medicine 323 (2001): 1264-1265;
38. Kipnis and Diamond, "Pediatric Ethics and the Surgical Assignment of Sex," cited in n. 16, above.
39. C. Perelman and L. Olbrechts-Tyteca, The New Rhetoric: A Treatise on Argumentation (University of Notre Dame Press, 1969).
40. J.D.H. Amador, Academic Constraints in Rhetorical Criticism of the New Testament: An Introduction to a Rhetoric of Power (Sheffield: Sheffield Academic Press, 1999).
41. F.A. Conte and M.A. Grumbach, "Pathogenesis, Classification, Diagnosis, and Treatment of Anomalies of Sex," in L. De Groot, ed. Endocrinology (New York: Saunders, 1989), pp. 1810-1847.
42. M. Blackless, A. Charuvastra, A. Derryck, A. Fausto-Sterling, K. Lauzanne, and E. Lee, "How Sexually Dimorphic are We? Review and Synthesis," American Journal of Human Biology 12 (2000): 151-166.
43. A. Fausto-Sterling, "The Five Sexes, Revisited," The Sciences (July/August 2000): 18-23.
44. Cf. http://www.phd.msu.edu/DNA/cf_fact.html from Michigan State University DNA Diagnostic Program.
45. Cf. http://www.ndss.org/aboutds/aboutds.html#incidence of the National Down Syndrome Society.
46. Cf. http://www.cbc.umn.edu/iac/facts.htm#whatis of the International Albinism Center of the University of Minnesota.
47. Cf., e.g., J. Hutcheson, "Ambiguous Genitalia and Intersexuality," eMedicine Journal. Pediatrics, Urology. www.emedicine.com/ped/topic1492.htm.
48. Cf. also R. Rosenfield, A. Lucky, and T. Allen, "The Diagnosis and Treatment of Intersex," Current Problems in Pediatrics 10/7 (1980): 1-66;
49. K. Glassberg, "Gender Assignment in Newborn Male Pseudohermaphrodites," Urology Clinics of North America 7/2 (1980): 409-421.
50. AAP RE9958, cited in n. 1, above; Hutcheson et al., "Ambiguous Genitalia and Intersexuality," cited in n. 27, above.
51. Cf., e.g., "Draft Statement of the BAPS Working Party," 1.2(b , cited in n. 10, above;
52. see also Hutcheson, "Ambiguous Genitalia and Intersexuality," Treatment: Consultations, cited in n. 27, above;
53. Migeon et al. Syndromes of Abnormal Sex Differentiation, "Endocrine Treatment," cited in n. 7.
54. Compare also AAP RE9958, cited in n. 1, above: "All female infants virilized because of CAH or maternal androgens are potentially fertile and should therefore be raised as girls."
55. Quotes from P.K. Donahoe, D.M. Powell, and M.M. Lee, "Clinical Management of Intersex Abnormalities," Current Problems in Surgery 28/8 (1991): 517-579: 527. Compare also AAP RE9958, cited in n. 1: "The size of the phallus and its potential to develop at puberty into a sexually functional penis are of paramount importance when one is considering male sex of rearing."
56. S. Oberfeld, A. Mondok, F. Shahrivah, J.F. Klein, and L.S. Levine, "Clitoral Size in Full-Term Infants," American Journal of Perinatology 6/4 (1989): 453-454.
57. "A micropenis is...defined as having a stretched length of less than two and a half standard deviations below the mean for age or stage of sexual development." J. Riley and C. Wodehouse, "Small Penis and the Male Sexual Role," Journal of Urology 142 (1989): 569-571. For a newborn, that means a minimum acceptable length of 2.5 centimeters.
58. "Never assign a baby to be reared, and to surgical and hormonal therapy, as a boy, unless the phallic structure, hypospadiac or otherwise, is neonatally of at least the same caliber as that of same-aged males with small-average penises." J. Money, "Psychological Counseling: Hermaphroditism," in L. Gardner, ed. Endocrine and Genetic Diseases of Childhood and Adolescence (Philadelphia: WB Saunders, 1975), pp. 609-618, at p. 610.
59. Cf. L. Tiefer, "The Medicalization of Impotence - Normalizing Phallocentrism," Gender and Society 8/3 (1994): 363-377.
60. Reilly and Woodhouse, "Small Penis and the Male Sexual Role," cited in n. 34, above.
61. W. Reiner, "Sex Assignment in the Neonate with Intersex or Inadequate Genitalia," Archives of Pediatrics and Adolescent Medicine 151/10 (1997): 1044-1045.
62. M. Hendricks, "Into the Hands of Babes," Johns Hopkins Magazine (2000). www.jhu.edu/~jhumag/0900web/babes.html
63. A.P. van Seters and A.K. Slob, "Mutually Gratifying Heterosexual Relationship with Micropenis of Husband," Journal of Sex & Marital Therapy 14/2 (1988): 98-107.
64. Cf. the now infamous quote, "you can dig a hole, but you can't build a pole," referring to the reasons for the prevalence of feminizing genitoplastic. M. Hendrick, "Is it a Boy or a Girl?" Johns Hopkins Magazine (1993): 10-16.
65. Cf. F.M.E. Slijper, S.L.S. Drop, J.C. Molenaar, and R.J. Scholtmaijer, "Neonates with Abnormal Genital Development Assigned me Female Sex: Parent Counseling," Journal of Sex Education and Therapy 20/1 (1994 : 9-17;
66. M. Rohatgi, "Intersex Disorders: An Approach to Surgical Management," Indian Journal of Pediatrics 59 (1992): 523-530.
67. AAP RE9958, cited in n. 1, above. See also Migeon et al. Syndrome of Abnormal Sex Differentiation, cited in n. 7, above, which provides a detailed but accessible primer on "normal" and "disordered" pathways of sex differentiation.
68. Migeon, Syndromes of Abnormal Sex Differentiation, "Endocrine Treatment," cited in n. 7, above; cf. also AAP RE9958, cited in n. 1, above.
69. M. Forest, "Inborn Errors of Testosterone Biosynthesis," Pediatric and Adolescent Endocrinology 8 (1981): 133-155.
70. L. Peris, "Congenital Adrenal Hyperplasia Producing Female Hermaphroditism with Phallic Urethra," Obstetrics and Gynecology 16/2 (1960): 156-166;
71. F.M.E. Slijper et al., "Neonates with Abnormal Genital Development," 10-11, 14, cited in n. 42, above
72. P. Lee, T. Mazur, R. Danish, J. Armhein, R.M. Blizzard, J. Money, and C.L. Migeon, "Micropenis. I. Criteria, Etiologies and Classification," Johns Hopkins Medical Journal 146 (1980): 156-163;
73. Forest, "Inborn Errors of Testosterone Biosynthesis," cited in n. 45, above.
74. A. Natarajan, "Medical Ethics and Truth Telling in the Case of Androgen Insensitivity Syndrome," Canadian Medical Association Journal 154/4 (1996): 568-570. This essay was written while the author was a student, and it was the second-place winner of the 1995 Logie Medical Ethics Contest. Interestingly, since becoming a practitioner the author has distanced herself from this position, and now advocates full disclosure (with caveats) and cooperation. The essay has proven an embarrassment to the CMAJ, although the Editors stood by their decision to award her the Logic Medical Ethics prize.
75. Recently, however, published guidelines by the AAP and Johns Hopkins have emphasized the need for physicians to turn parents and patients to resources and support groups to help them understand the full implications of intersexed patient. It is not clear, however, to what extent this shift has made an impact upon clinical, daily patient-physician interaction, as physicians continue to report a hesitation to be completely candid with patients or their families. Cf. Marion, "The Curse of the Garcias" and Nussbaum, "A Question of Gender," both cited in n. 8, above.
76. L. McCullough, "The Ethics of Gender Reassignment," presentation at 1999 Pediatric Gender Reassignment Conference: A Critical Reappraisal (Wyndham-Anatole Hotel, Dallas, TX, April 30, 1999).
77. Cf. A. Balsamo, "On the Cutting Edge: Cosmetic Surgery and the Technological Production of the Gendered Body," Camera Obscura 28 (1992): 207-237.
78. An example of such literature includes: P. Wright and A. Treacher, eds., The Problem of Medical Knowledge: Examining the Social Construction of Medicine (Edinburgh: Edinburgh University Press, 1982);
79. P. Brown, ed., Perspectives in Medical Sociology, 2nd edn. (Prospect Heights: Waveland, 1996), pp. 92-122;
80. E. Armstrong, "Diagnosing Moral Disorder: The Discovery and Evolution of Fetal Alcohol Syndrome," Social Science and Medicine 47/12 (1998): 2024-2042;
81. H. Arksey, "Expert and Lay Participation in the Construction of Medical Knowledge," Sociology of Health and Illness 16/4 (1994 ):448-468;
82. P. Conrad, "Medicalization and Social Control," Annual Review of Sociology 18 (1992): 209-232.
83. B.J. Good and M.-J. DelVecchio Good, "'Learning Medicine': The Constructing of Medical Knowledge at Harvard Medical School," in S. Lindenbaum and M. Lock, eds. Knowledge, Power and Practice: The Anthropology of Medicine and Everyday Life (Berkeley: University of California Press, 1993), pp. 81-107.
84. S. Hirschauer, "The Manufacture of Bodies in Surgery," Social Studies of Science 21/2 (1991): 279-319.
85. M. Berg and G. Bowker, "The Multiple Bodies of the Medical Record: Toward a Sociology of an Artifact," The Sociological Quarterly 38/3 (1997): 513-537.
86. The most important theorist of the performativity of gender is J. Butler. See her Gender Trouble: Feminism and the Subversion of Identity (New York: Routledge, 1990); Bodies That Matter: On the Discursive Limits of "Sex" (New York: Routledge, 1993); The Psychic Life of Power: Theories on Subjection (Palo Alto: Stanford University Press, 1997).
87. S. Kessler and W. McKenna, Gender: An Ethnomethodological Approach (Chicago, IL: University of Chicago Press, 1978)
88. can also be mentioned here, as can be the collection of essays assembled by A. Kroker and M. Kroker, eds., The Last Sex: Feminism and Outlaw Bodies (New York: St. Martin's Press, 2001);
89. The Hysterical Male: New Feminist Theory d 88 See also E. Grosz, Volatile Bodies: Toward a Corporeal Feminism (Bloomington, IN: Indiana University Press, 1994);
90. Body Invaders: Panic Sex in America (New York: St. Martin's Press, 1987).
91. See also E. Grosz, Volatile Bodies: Toward a Corporeal Feminism (Bloomington, IN: Indiana University Press, 1994);
92. E. Grosz, Space, Time and Perversions: Essays on the Politics of Bodies (New York: Routledge, 1995);
93. J. Price and M. Shildrick, Feminist Theory and the Body: A Reader (New York: Routledge, 1999);
94. S. Bordo, Unbearable Weight: Feminism, Western Culture and the Body (Berkeley, CA: University of California Press, 1995);
95. K. Davis, Embodied Practices: Feminist Perspectives on the Body (Thousand Oaks: Sage Press, 1997);
96. A. Balsamo, Technologies of the Gendered Body: Reading Cyborg Women (Durham: Duke University Press, 1997).
97. Perelman and Olbrechts-Tyteca, The New Rhetoric, p. 116, cited in n. 19, above.
98. See A. Dreger, Hermaphrodites and the Medical Invention of Sex (Cambridge: Harvard University Press, 2000), pp. 110-138,
99. Fausto-Sterling, Sexing the Body, pp. 71-73, cited in n. 9, above.
100. J.D. Hester, "Rhetoric of the Medical Management of Intersexed Children: New Insights into 'Disease,' 'Illness,' 'Curing' and 'Healing,'" Genders 38 (Fall 2003). www.genders.org
101. S. Taha, "Male Pseudohermaphroditism: Factors Determining the Gender of Rearing in Saudi Arabia," Urology 43 (1994): 370-374.
102. See also H. Al-Attia, "Gender Identity and Role in a Pedigree of Arabs with Intersex due to 5 Alpha Reductase-2 Deficiency," Psychoneuroendocrinology 21 (1996): 651-657.
103. Cf. J. Money, "Psychological Counseling: Hermaphrodism," in L.I. Gardner, ed. Endocrine and Genetic Diseases of Childhood and Adolescence (Philadelphia: W. B. Saunders, 1975), pp. 609-618. See especially p. 613 where he states that "medical terminology has a special layman's magic in such a context; it is final and authoritative and closes the issue."
104. H. Meyers-Seifer and N. Charest, "Diagnosis and Management of Patients with Ambiguous Genitalia," Seminars in Perinatology 16 (1992): 332-339, at 338.
105. Cf., e.g., D.M. Hester, Community as Healing (Lanham, MD: Rowan & Littlefield, 2001).
106. M. Schildreck, Leaky Bodies and Boundaries: Feminism, Postmodernism and (Bio)-ethics (London: Routledge, 1997), p. 72.
107. Al-Attia, H. "Gender Identity and Role in a Pedigree of Arabs with Intersex due to 5 Alpha Reductase-2 Deficiency." Pscyhoneuroendocrinology 21 (1996): 651-657.
108. Alizai, N.K., D.F. Thomas, R.J. Lilford, A.G. Batchelor, and N. Johnson. "Feminizing Genitoplasty for Congenital Adrenal Hyperplasia: What Happens at Puberty?" Journal of Urology 161/5 (1999): 1592-1593.
109. Amador, J.D.H. Academic Constraints in Rhetorical Criticism of the New Testament: An Introduction to a Rhetoric of Power. Sheffield: Sheffield Academic Press, 1999.
110. American Academy of Pediatrics. RE9958, "Evaluation of the Newborn With Developmental Anomalies of the External Genitalia." Policy Statement 106/1 (2001).
111. Arksey, H. "Expert and Lay Participation in the Construction of Medical Knowledge." Sociology of Health and Illness 16/4 (1994): 448-468.
112. Armstrong, E. "Diagnosing Moral Disorder: The Discovery and Evolution of Fetal Alcohol Syndrome." Social Science and Medicine 47/12 (1998): 2024-2042.
113. Balsamo, A. "On the Cutting Edge: Cosmetic Surgery and the Technological Production of the Gendered Body." Camera Obscura 28 (1992): 207-237.
114. Balsamo, A. Technologies of the Gendered Body: Reading Cyborg Women. Durham: Duke University Press, 1997.
115. Baskin, L.S., A. Erol, Y.W. Li, W.H. Liu, E. Kruzrock, and G.R. Cunha. "Anatomical Studies of the Human Clitoris." Journal of Urology 162/3.2 (1999): 1015-1020.
116. Beh, H. and M. Diamond. "An Emerging Ethical and Medical Dilemma: Should Physicians Perform Sex Assignment Surgery on Infants with Ambiguous Genitalia?" Michigan Journal of Gender and Law 7/1 (2000 ): 1-63.
117. Berg, M. and G. Bowker. "The Multiple Bodies of the Medical Record: Toward a Sociology of an Artifact." The Sociological Quarterly 38/3 (1997): 513-537.
118. Blackless, M., A. Charuvastra, A. Derryck, A. Fausto-Sterling, K. Lauzanne, and E. Lee. "How Sexually Dimorphic are We? Review and Synthesis." American Journal of Human Biology 12 (2000): 151-166.
119. Bordo, S. Unbearable Weight: Feminism, Western Culture and the Body. Berkeley: University of California Press, 1995.
120. Bradley, S., G. Oliver, A. Chernick, and K. Zucker. "Experiment of Nurture: Ablatio Penis at 2 Months, Sex Reassignment at 7 Months, and a Psychosexual Follow-up in Young Adulthood." Pediatrics 107/1 (1998), electronic article 9. http://pediatrics.aappublications.org/.
121. British Association of Paediatric Surgeons. "Draft Statement of the British Association of Paediatric Surgeons (BAPS) Working Group on the Surgical Management of Children Born with Ambiguous Genitalia" (July 2001). www.baps.org.uk/documents/Intersex%20statement.htm.
122. Brown, P., ed. Perspectives in Medical Sociology, 2nd edn. Prospect Heights: Waveland, 1996.
123. Butler, J. Bodies That Matter: On the Discursive Limits of "Sex." New York: Routledge, 1993.
124. Butler, J. Gender Trouble: Feminism and the Subversion of Identity. New York: Routledge, 1990.
125. Butler, J. The Psychic Life of Power: Theories on Subjection. Palo Alto: Stanford University Press, 1997.
126. Colapinto, J. As Nature Made Him: The Boy Who Was Raised As A Girl. New York: Perennial Press, 2001.
127. Conrad, P. "Medicalization and Social Control." Annual Review of Sociology 18 (1992): 209-232.
128. Conte, F.A. and M. A. Grumbach. "Pathogenesis, Classification, Diagnosis, and Treatment of Anomalies of Sex." In Endocrinology. Edited by L. De Groot. New York: Saunders, 1989, pp. 1810-1847.
129. Creighton, S. and C. Minto. "Editorial: Managing Intersex." British Journal of Medicine 323 (2001): 1264-1265.
130. Creighton, S.M., C.L. Minto, and S.J. Steele. "Objective Cosmetic and Anatomical Outcomes at Adolescence of Feminising Surgery for Ambiguous Genitalia Done in Childhood." Lancet 358/9276 (2001): 124-125.
131. Davis, K. Embodied Practices: Feminist Perspectives on the Body. Thousand Oaks: Sage Press, 1997.
132. Diamond, M. and H.K. Sigmundson. "Sex Reassignment at Birth: Long-Term Review and Clinical Implications." Archives of Pediatric and Adolescent Medicine 151 (1997): 298-304.
133. Diamond, M. and H.K. Sigmundson. "Sex Reassignment at Birth: Long-Term Review and Clinical Implications." Archives of Pediatric and Adolescent Medicine 151 (1997): 298-304.
134. Dittman, R.W., M.E. Kappes, and M.H. Kappes. "Sexual Behaviour in Adolescent and Adult Females with Congenital Adrenal Hyperplasia." Pscyhoneuroendocrinology 17/2-3 (1992): 153-170.
135. Donahoe, P.K., D.M. Powell, and M.M. Lee. "Clinical Management of Intersex Abnormalities." Current Problems in Surgery 28/8 (1991): 517-79.
136. Dreger, A. Hermaphrodites and the Medical Invention of Sex. Cambridge: Harvard University Press, 2000.
137. Dreger, A., ed. Intersex in the Age of Ethics. Hagerstown: University Publishing Group, 1999.
138. Fausto-Sterling, A. "The Five Sexes: Why Male and Female are Not Enough." The Sciences (March/April 1993): 20-25.
139. Fausto-Sterling, A. "The Five Sexes, Revisited." The Sciences (July/August 2000): 18-23.
140. Fausto-Sterling, A. Sexing the Body: Gender Politics and the Construction of Sexuality. New York: Basic Books, 2000.
141. Ford, K.-K. " 'First, Do No Harm' - The Fiction of Legal Parental Consent to Genital-Normalizing Surgery on Intersexed Infants." Yale Law and Policy Review 19 (2001): 469-488.
142. Forest, M. "Inborn Errors of Testosterone Biosynthesis." Pediatric and Adolescent Endocrinology 8 (1981): 133-155.
143. Glassberg, K. "Gender Assignment in Newborn Male Pseudohermaphrodites." Urology Clinics of North America 7/2 (1980): 409-421.
144. Good, P.J. and M.-J. DelVecchio Good. " 'Learning Medicine': The Constructing of Medical Knowledge at Harvard Medical School." In Knowledge, Power and Practice: The Anthropology of Medicine and Everyday Life. Edited by S. Lindenbaum and M. Lock. Berkeley: University of California Press, 1993, pp. 81-107.
145. Grosz, E. Space, Time and Perversions: Essays on the Politics of Bodies. New York: Routledge, 1995.
146. Grosz, E. Volatile Bodies: Toward a Corporeal Feminism. Bloomington: Indiana University Press, 1994.
147. Hendricks, M. "Is it a Boy or a Girl?" Johns Hopkins Magazine (1993): 10-16.
148. Hendricks, M. "Into the Hands of Babes." Johns Hopkins Magazine (2000). www.jhu.edu/~jhumag/0900web/babes.html.
149. Hester, D.M. Community as Healing. Lanham: Rowan & Littlefield, 2001.
150. Hester, J.D. "Rhetoric of the Medical Management of Intersexed Children," Genders (Fall 2003). www.genders.org.
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