Sally Gross

“IS IT a boy or is it a girl?” This is generally the first question asked after the birth of a baby, whether by the newly-born infant’s mother, father, their relatives or their friends. As what is perhaps the earliest interrogation of a neonate’s identity, it is treated as peculiarly fundamental, and clearly involves the assumption that any given person is indeed invariably either unequivocally and exclusively male or unequivocally and exclusively female in physical terms. This assumption is indeed borne out in the majority of cases and a straightforward answer to the question can be given. In a relatively small but significant minority of cases, however, this is not so. Something in the order of one in 2,000 infants is born intersexed,1 that is to say, with a body which is in some significant respect neither unequivocally and exclusively male nor unequivocally and exclusively female.
There does not appear to be any single canonical definition of intersexuality. The best one known to me is one put forward by Cheryl Chase, the Executive Director of the Intersex Society of North America (ISNA), in the course of a discussion in which I was involved. Cheryl Chase characterised intersexuality as atypical congenital physical sexual development, and this rough-and-ready definition manages to include all and only those who are liable to be identified and subjected to medical treatment as intersexed. In many (but not all) cases, the genitals of newly-born intersexed infants look ambiguous, and it is generally this which makes it difficult, if not impossible, truthfully and unequivocally to say whether the infant is a boy or a girl. It is important to note that “intersex” is an umbrella-term which covers a range of degrees and types of ambiguity which can come about in different ways.
At a genetic level, generally speaking, people have two sex-determining chromosomes, one of which is what is called an “X” chromosome because of its shape when examined under a microscope, and the second of which may be either another “X” chromosome or a “Y” chromosome – so-called because it is Y-shaped. As a rough rule-of-thumb, two “X” chromosomes in combination in each cell of a person’s body yield a feminine bodily type, and an “X” and a “Y” chromosome in combination yield a masculine bodily type. In what follows, I shall refer to these combinations as the “XX” and “XY” chromosomal patterns respectively.
Intersexuality sometimes results from the breakdown of this rule-of-thumb in connexion with the “XX” and “XY” chromosomal patterns. There is a syndrome called “Androgen Insensitivity Syndrome” (AIS), for example,2 in which the sex-determining chromosomal pattern is XY, but in which people are born with either clearly female or ambiguous genitalia. While still in the womb, the gonads of people affected by AIS develop into testes rather than ovaries, and their testes produce the male hormone testosterone, but a peculiarity of their cells connected with the syndrome makes it impossible for testosterone to masculinise their bodies. In the absence of a masculinising hormonal trigger, or when the masculinising effect of such an hormonal trigger is blocked, any foetuses develop along feminine lines: developmentally, female bodiliness rather than male bodiliness is nature’s “default”. The genitalia of people with complete AIS are unequivocally female in form, as is the way in which the body develops with puberty, although the vagina is often short or rudimentary, and infants with the complete form of the syndrome are almost invariably classified as female at birth, raised as girls, and identify as female. Investigation (not infrequently initiated because of a failure to menstruate with the onset of puberty) reveals the absence of a womb and shows the gonads, which are in the abdominal cavity, to be testes. There are various degrees of partial forms of AIS, in which genital appearance ranges from predominantly masculine, through a range of “in-betweens” in which an infant could be described with equal justification as having a clitoris which is somewhat larger than usual or a smaller than usual penis, to predominantly feminine. There is a similar range of ambiguity running from fully developed vaginal labiae (the lips of the vagina) to fully-developed scrotal sacs, and these too are encountered in many forms of intersexuality in general and in partial AIS in particular.
Congenital Adrenogenital Hyperplasia (CAH), in which the adrenal glands produce a hormone which has a masculinising effect on people with the XX chromosomal pattern from the time they are in the womb, sometimes results in virtually complete masculinisation of the genitalia and of the body from puberty onwards, and it too can produce a range of degrees of genital ambiguity. In what is called Klinefelter’s Syndrome, the cluster of sex-determining chromosomes is XXY rather than XX or XY and, although the vast majority of people born with this syndrome are classified as male at birth and live and identify as male, it is a moot question as to whether the chromosomal pattern is to be construed as XX – notionally the “female” pattern – with an extra “Y” chromosome, or whether it is to be construed as XY – notionally the “male”pattern, with an extra “X” chromosome.3 Many other forms of “gender-blending” at the chromosomal, gonadal, genital and hormonal levels, occur in nature and are manifested in intersexuality. There are cases of what is called “chromosomal mosaicisms”, in which some of a persons’s tissue consists of cells containing the “XX” chromosomal pattern, while other tissue consists of cells the “XY” pattern. The gonads are sometimes mixed, including both an ovary and a testis, what is called “an ovotestis” (a mixture of both ovarian and testicular tissue) or rudimentary ovarian and perhaps testicular streak-tissue which does not constitute a developed gonad or set of gonads.4
As a brute physical phenomenon, the bodiliness of people who are born intersexed challenges cherished assumptions about sex and gender made by many people within Western society. A variety of social institutions, including the dominant canons of medical practice and conceptions, much of the domain of the law itself, and some of the religious teachings which have loomed so large in the history of the West, tend strongly to support the notion that sex and gender is a dichotomy, and that any given human being is either determinately and unequivocally male or determinately and unequivocally female.5 Congenitally intersexed physicality gives the lie to this dichotomous model of sex and gender. It is scant wonder, therefore, that fundamentalist Christians, who could be expected strongly to support the dichotomy which looms so large in the idealised model of the family, should feel threatened by the phenomenon of intersexuality and should seek to find religious arguments against it. It is not uncommon for Christian fundamentalists, faced with intersexuality as a brute fact, to adduce scriptural grounds for the condemnation of avowed intersexuality, at least, as “unnatural” and as something which is at odds with the will of God as expressed in the order of creation. This theological condemnation of lived intersexual identities also finds expression in unconditional support for surgical interventions, as early as possible, aimed at making the unacceptably ambiguous bodies of intersexed infants and children conform to the dichotomous model in which there is no room whatsoever for ambiguity. Such apparently religiously-motivated endorsement of surgery is insensitive to the fact that in most cases surgery is not necessitated by any real threat to the life or health of the infant, so that it is purely cosmetic in character. It is also insensitive to the fact that such aesthetically-driven surgical interventions frequently give rise to medical problems later in life, and can therefore be directly detrimental to the health of an otherwise flourishing intersexed person.6
Two Biblical proof-texts in particular tend to be cited as part of this rejection of intersexual identities and to provide scriptural support for the argument that intersexed bodies must surgically be cut into conformity with the male/female dichotomy. The first of these texts is Genesis 1:27:
So God created man [the Hebrew is Adam ()] in his own image, in the image of God he created him; male and female he created them.
This is claimed to show that human beings are, by virtue of the divine ordering of creation itself, either male and not female or female and not male, and that nothing intermediate or ambiguous is sanctioned. The second of these proof-texts is Numbers 5:3 which, in connexion with those who contract particular ritual defilements, commands that “you shall put out both male and female”. Those who brandish this verse argue that “both male and female” means everyone who is human, and that this implies that the scriptural criterion for being human excludes anyone who is not unambiguously male or unambiguously female. Both proof-texts, but particularly Genesis 1:27, are cited in defence of an absolute division between the sexes which will not tolerate anything in between. Let us therefore look at Genesis 1:27.
I am not personally a Biblical literalist, and doubt that the two Biblical stories of creation (a priestly account, in Genesis 1:1 – 2:3, and what is called the Yahwist’s account, in Genesis 2:4 – 2:24) were even intended to be taken literally. For all that, it is interesting to note that Genesis 1:27, the proof-text for Biblical literalists who wish to argue that hermaphroditism is somehow unnatural or unscriptural, is perhaps more “herm-friendly” than many Biblical literalists realise or than translations suggest; and there are early Jewish exegetical traditions which undermine its use as a scriptural warrant for the rejection of intersex identity.
Both Genesis 1:27 and Numbers 5:3 have sometimes been used, in discussion with me, to argue that God created all human beings determinately male or determinately female with nothing in-between. At a more personal level, they have also been used to argue that an intersexed person such as me does not satisfy the Biblical criterion of humanity, and indeed even that it follows that I am congenitally unbaptisable and must therefore be said not to have been baptised validly.7 The use of either of these passages in this way is in fact odd and indeed rather comical, for there is a Rabbinical gloss on Genesis 1:27 which suggests that “Adam”, at least, most certainly did not have a clear and unequivocal gender identity, and indeed that Adam was an hermaphrodite.
The verse states, in the original Hebrew:
(va-yivra’ ’elohim ’et ha-adam be-tzalmo, be-tzelem ’elohim bara’ ’oto, zakhar u-neqevah bara’ ’otam) ‘and God created the man in his image, in the image of God he created him [ (’oto), masculine singular, matching the gender of the noun (’adam) ], male and female he created them [ (’otam), masculine plural this time, which can also be used for sets of nouns which include masculine and feminine nouns]. The shift from (’oto – singular) to (’otam – plural) with reference to (ha-’adam “the man”) is odd, and it seemed clear to the Rabbis that it begged explanation. It is against this background that the following tradition is found:

Rabbi Yirmiyah [Jeremiah] ben ’El’azar said: When the Holy One Blessed be He created the primal man [i.e. “the primal Adam”], he created him an androgyne, and it is therefore said: “male and female he created them” (Genesis 1:27).8

This is an anecdotal gloss, of course, but it responds to the undeniable oddness of the grammatical shift from singular to plural in the Hebrew. The very fact that the language of the verse gave rise to this gloss in a religious context which valued careful attention to the fine detail of the text is surely telling. It suggests that to use the verse in support of a razor-sharp division of humankind between male and female is perhaps misguided.
What, then, of Numbers 5:3? The phrase which tends translated as “male and female”, and which is taken to imply that the division between male and female is an all-inclusive and immutable dichotomy rather than a continuum, reads (mi-zakhar ve-’ad neqevah), “from male to female”, in the original Hebrew. The form “from A to B” which is used here, however, surely suggests a continuum of some sort – precisely the kind of continuum which Biblical fundamentalists allege to be unscriptural. The form itself points to the logical possibility that there are “in-betweens”. It is thus clear that examination of the original Hebrew has again revealed that it is not the best verse to use if one wants a proof-text to “demonstrate” that physical intersexuality is an offence against the divine order of creation.
On the subject of Rabbinical traditions about intersexuality, Tractate Yevamot in the Babylonian Talmud (leaf 64a) contains a tradition to the effect that Abraham and Sarah were intersexed. It states:
Abraham and Sarah were [each of them a] (tumtum), as it is said: “Look to the rock from which you were hewn, and to the quarry from which you were digged”; (Isaiah 51:1) and it is written: “Look to Abraham your father and to Sarah who bore you”; (Isaiah 51:2). Rabbi Nahman said in the name of Rabbah bar Abuha: Sarah our mother was an (’aylonith,) as it is said: “Now Sarai was barren; she had no child”; (Genesis 11:30) – she did not even have a womb.
The terms tumtum () and ’aylonith () are intersex categories. A (tumtum) is a person whose physical sex is indeterminable because there are apparently no genitalia, although determinate natal sex can sometimes (but only sometimes) be revealed by means of the surgical removal of an occlusion.9 An (’aylonith) is a woman without a womb – clearly someone who might suffer from complete androgen insensitivity syndrome. The Talmudic Rabbis were observant and shrewd, and seldom “missed a trick”. It is therefore not surprising that there are Talmudic references to other intersex conditions. A modern commentator speculates that one type of condition in this category noted in the Mishnah and Talmud corresponds to Klinefelter’s Syndrome.10 While the Rabbis knew nothing about the genetic underpinnings almost two millennia ago, they certainly recognised that there were people who were intersexed.
The assertion on the basis of Isaiah 51:1-2 that both Abraham and Sarah was each a (tumtumt) is apparently obscure, but the logic is roughly as follows. Verse 51:1 suggests that Israel owes its existence to the intervention of God, who hewed Israel out from a metaphorical rock, and dug Israel out of a metaphorical quarry. The references to the rock and to the quarry in 51:1 clearly stand in apposition to the references to Abraham and to Sarah in 51:2. Abraham is therefore to be identified with the rock, and Sarah with the quarry. This raises a question, however: why should God be said to have intervened, and why was the intervention compared to the hewing of something out of a rock (a stone cube, for example, does not emerge spontaneously from a piece of granite, and the nature of the rock has to be overcome in the hewing) or to digging something out of a quarry (where again, the nature of the rock of the quarry has to be overcome in the digging)? Hewing and digging are actions which involve substantial effort. The suggestion thus seems to be that the birth to Abraham and Sarah of Isaac, from whom Israel is descended, somehow required that God miraculously overcome an impediment in the natures of Abraham and Sarah which was considerably more of a challenge than the passage of anno Domini. The gloss therefore reads into this a hint that Abraham and Sarah were congenitally incapable of procreation by nature. This is why one gloss states that each of them was a tumtum, and the second gloss in the passage holds that Sarah was affected by complete androgen insensitivity syndrome or by some other intersex condition with a similar bodily upshot.
These two glosses about Abraham and Sarah, like many Rabbinical exegetical glosses of an anecdotal rather than of a legal character, are perhaps a trifle far-fetched and quaint; but they do make it abundantly clear that those who, more than any others, cherished and preserved the Hebrew text of scripture and sought faithfully to ensure that no scriptural “jot and tittle” was changed, did not see intersex conditions as falling under the condemnation of the canon of Hebrew scripture. Quite to the contrary, they contemplated with equanimity the possibility that leading and revered scriptural characters were intersexed.
Let us return to the main proof-text used by fundamentalists who wish to argue that intersexuality is condemned by scripture. I noted earlier that there is a syntactic ambiguity in Genesis 1:27 which led Jewish commentators to suggest that our species was originally created androgynous. The syntactic ambiguity and this particular Rabbinical gloss were taken up by some of the philosophers of the Renaissance, who viewed hermaphroditism as a mark of an original wholeness which had subsequently been lost. Far from being seen as the result and mark of sin, the original hermaphroditism of our species was viewed by these philosophers as a mark of perfection which was subsequently lost, perhaps in consequence of sin. There is also a gloss on Genesis 1:27 attributed to a Rabbi Shmuel bar Nahman, again in Midrash Bereshit Rabbah 8,11 which suggests on the basis of the syntactic ambiguity that the primal Adam was created Janus-faced – presumably male on one side and female on the other – and that the two halves were subsequently severed. The story of the formation of Eve from “Adam’s rib” does not tell against this, because the word (tsela‘), translated here as “rib”, is used elsewhere to refer to a section, wing (as in “the west wing of the building”) or half of a structure. It should be noted that this construal of these verses depends on the literal sense of the verses: they draw directly upon the lexical sense of the Hebrew words which are used in the passage.
The gloss about the original hermaphroditism of the primal “Adam” suggests that fundamentalists ought perhaps to consider it a grave sin against revelation to view intersexuality as “unnatural” or as “the consequence of Adam’s sin” for, as the gloss suggests, hermaphroditism predated Adam’s sin. It would seem to follow that it is the birth of people who are not hermaphrodites which might be “the consequence of Adam’s sin”. Hermaphroditism should perhaps be seen as a reminder of the “original innocence” and perfection before sin distorted it. Many scriptural fundamentalists read scripture very selectively, treating all-too-fallible translations as infallible, belittling the original text of scripture in practice, and ignoring implications of particular passages which, unpalatable though they might be from their point of view, can nevertheless legitimately be teased out of the original texts.
It might also be noted that, rather than supporting the imposition of surgery, Biblical literalists should be persuaded by the letter of Scripture to be very suspicious indeed of genital surgery imposed upon intersexed infants when no intrinsic risk to life and physical health is demands it. The removal of gonads and other such surgery is explicitly forbidden by Scripture (see Deuteronomy 23:1, for example), at least where there is no intrinsic risk to life. The burden of scripture is in fact such that those who take its exhortations seriously should positively welcome the notion of a spectrum which includes people who are intersexed. Biblical literalists are indeed arguably bound by Scripture to respect the sense of many people who are intersexed that violence was done to them in infancy by the imposition of what was in effect cosmetic surgery, and to accept that it is right and proper that those who are born intersexed be enabled to remain physically as they are and to identify as intersexed.12

End Notes
1. In the context of this article, I use both the term “intersexuality” and the term “hermaphroditism” as roughly co-referring terms. “Intersexuality” is the more contemporary and descriptively accurate of the two terms. Many people who are intersexed find the term “hermaphroditism” objectionable because its mythical connotations the not uncommon denial of the brute fact that there are indeed people who are intersexed, and that they are real people and not mythical creatures. The terms “hermaphroditism” and “hermaphrodite” are better known to lay-people than “intersexuality” and “intersexual”, and are used in some of the literature which moved me write this article. It is for this reason, and because this article has been written for people who cannot be assumed to be familiar with medical terms of art, that I have sometimes used the “h-words” which I tend to eschew in other contexts.
2. It was once commonly called “Testicular Feminisation” in the medical literature.
3. In general, the body-type which results seems to be more-or-less male, though it is not at all uncommon for large breasts to develop in adolescence. Many people affected by Klinefelter’s Syndrome undergo bilateral mastectomies in adolescence. Nancy Roper, ed., Pocket Medical Dictionary, Edinburgh, London and New York, 1978, characterises those affected by the syndrome as “genetic female, pragmatic male”, construing the chromosomal pattern as the ”female“ XX with an extra ”Y“ chromosome.
4. What cannot occur in nature is the hermaphrodite of myth, a human being who has two sets of external genitals, one male and the other female.
5. See Alice Domurat Dreger, Hermaphrodites and the Medical Invention of Sex (Cambridge, Mass, & London: Harvard University Press, 1998), for a meticulously documented study of the way in which modern Western medicine from the late nineteenth century onwards has been at pains to protect the putative immutability of the male/female dichotomy in the face of the challenge posed by the occurrence of hermaphroditism. Also see Suzanne J. Kessler, Lessons from the Intersexed (New Brunswick, New Jersey, and London: Rutgers University Press, 1998) for an account of the way in which, from the moment intersexuality is suspected and diagnosed, contemporary medical and social institutions are mobilised to maintain the dichotomy. An official statement made by the Catholic League for Civil and Religious Rights in a paid announcement published in the New York Times on the 3rd September 1995 in response to a challenge to the immutability of the dichotomy at the Fourth United Nations Conference on Women, is an example of depth of commitment to the dichotomy in the religious domain in the face of empirical evidence. Questioning the dichotomy was characterised as “maddening”, on the grounds that “every sane person knows there are but two sexes, both of which are rooted in nature”. “Roma locuta, causa finita est”, it would seem.
6. See Dreger, pp. 170 – 180, and Kessler, chapter 4. Dreger gives summary accounts of four contemporary life-stories of people who are intersexed, in all of which the imposition of what was objectively medically unnecessary surgery during infancy or childhood loomed large. Two of these stories bring out the fact that in many such cases, there are physical sequelae in direct consequence of the surgery which necessitate a number of subsequent surgical operations which would otherwise have been unnecessary. All the stories bring out the malign psychological consequences of the interventions, which have loomed very large indeed later in these representative lives. Chapter 4 of Kessler’s study draws on a variety of sources in order to interrogate the success of the surgery imposed upon intersexed infants and children. The tenor of her evaluation of these can be summarised by quoting from an extract from a letter set by a highly respected surgeon to an intersexed woman who urged her to be extreme cautious about subjecting herself to further “reconstructive” surgery, presumably to repair damage caused by the imposition of surgery in childhood: “I have no doubt that, twenty years from now, the next generation of medical intersex specialists will be shaking their heads over the ‘terrible’ price that was exacted on intersexed children by the surgeries of the early 1990s” (See Kessler, p. 75). Earlier in her study, Kessler perspicuously implies that for the most part “surgical ambiguity is ‘corrected,’ not because it is threatening to the infant’s life but because it is threatening to the infant’s culture” (Kessler, p. 32). See John Colapinto, “The True Story of John/Joan”, Rolling Stone, 11th December 1997, pp. 54-73 and 92-97, for a popular account of the way in which the actual outcome in a famous case which has been cited frequently in support of early surgical intervention tells strongly against surgical intervention. The empirical respectability of surgery in such cases was shaken by a paper later published as Milton Diamond and H.K. Sigmundson, “Sex Reassignment at Birth: A Long Term Review and Clinical Implications”, Archives of Pediatric and Adolescent Medicine 150 (1997), pp. 298-304, which gives an account of the John/Joan case and shows how systematically false claims, favouring surgery in infancy, were made about outcome which does not favour such surgery at all. In the light of the questions this raised about the standard protocol for the treatment of intersexed infants, Milton Diamond and H. Keith Sigmundson, “Management of Intersexuality: Guidelines for dealing with persons with ambiguous genitals”, Archives of Pediatrics and Adolescent Medicine 151 (1997), pp. 1046-1050 argues strongly against the imposition of surgery on such infants and puts forward suggestions for a radically different protocol of treatment.
7. The argument, which was put to me by conspicuously pious, intelligent, theologically sophisticated but fundamentalistic Christians of my acquaintance, is roughly as follows. Genesis 1:27 states that from the beginning of creation, God made each given member of the human species either male or female, and not both or neither. Thus, determinate maleness or determinate femaleness is the mark, above all else, of what it is to be created human. Validity of baptism is reserved for those who are human: one could immerse or sprinkle a dog, cat or tin of tuna, sincerely intending to baptise these, while uttering the formula of baptism, but no attempt to baptise these could ever be valid because dogs, cats and tins of tuna are not the kinds of thing which can be baptised and only human beings can be baptised. Since I am intersexed and my congenital physical sex has been found to be as ambiguous as it could be, I do not satisfy the divine criterion for humanness, which requires that one objectively be either determinately male or determinately female. It follows that, like dogs, cats and tins of tuna, I am not the kind of thing which could have been baptised validly. I presume that this is not the official view of the Church into which I was baptised as a young adult almost twenty years before either the Church or I realised that my anatomy was way beyond the tolerances of “industry-standard”.
8. Bereshit Rabbah, 8. The tradition that the primal Adam was created two-sided is also found in Talmudic passages: see b Berakhot 61a and b ’Eruvin 18a. Although the Talmudic forms of the tradition do not explicitly note that the pre-divided primal Adam was an androgyne, this is implicit. Those familiar with the dialogues of Plato will recognise the similarity between this Rabbinical tradition and the aetiological myth, which Plato attributes to Aristophanes, in the Symposium 189e – 191a.
9. The term “tumtum”, an Aramaic loanword, is probably a derivative of the term tam , which means “to stop up” or “to close”. It seems to me to be related to the Biblical Hebrew word (tamun), “stored up” or “hidden”. It has been suggested to me that it is in fact a loanword from Greek derived from tmn- as in “temno”, but this seems highly unlikely given the availability of Semitic roots.
10. The Rabbinical legal type which was said sometimes to be explicable in terms of Klinefelter’s Syndrome is the (saris amah), a person who is congenitally a “eunuch”, as distinct from the (saris ’adam), a person who is a eunuch in consequence of a human action or accident. In a saying attributed to Jesus in Matthew 19:12, there is an explicit reference to these Rabbinical legal categories.
11. As well as in the Talmudic references in footnote 1.
12. I would like to thank Cheryl Chase of ISNA, Kiira Triea and other members of the “Queer Little Tribe” of the openly intersexed to which I belong who, more than any others, helped me to come to grips with my own intersexuality and with the issues and concerns expressed here. I also owe a debt of gratitude to Rt Revd Dr Rowan Williams for encouraging me to submit it for publication, to Pam Lunn of Woodbrooke Quaker Study Centre, whose perceptive comments on an earlier draft of this article helped me to improve it and to make it more accessible, and to participants in Pam Lunn’s Woodbrooke Module, “Male and Female They Were Created”, to which I was invited to contribute in the Autumn Term of 1998.