Case Management of
SUZANNE J. KESSLER
The birth of intersexed infants, babies born with genitals that are neither clearly male nor clearly female, has been documented throughout recorded time.1 In the late twentieth century, medical technology has advanced to allow scientists to determine chromosomal and hormonal gender, which is typically taken to be the real, natural, biological gender, usually referred to as "sex."2 Nevertheless, physicians who handle the cases of intersexed infants consider several factors beside biological ones in determining, assigning, and announcing the gender of a particular infant. Indeed, biological factors are often preempted in their deliberations by such cultural factors as the "correct" length of the penis and capacity of the vagina.
In the literature of intersexuality, issues such as announcing a baby's gender at the time of delivery, postdelivery discussions with the parents, and consultations with patients in adolescence are considered only peripherally to the central medical issues—etiology, diagnosis, and surgical procedures.3 Yet members of medical teams have standard practices for managing intersexuality that rely ultimately on cultural understandings of gender. The process and guidelines by which decisions about gender (re)construction are made reveal the model for the social construction of gender generally. Moreover, in the face of apparently incontrovertible evidence—infants born with some combination of "female" and "male" reproductive and sexual features—physicians hold an incorrigible belief in and insistence upon female and male as the only "natural" options. This