Historical and cultural context
The social meanings attached to genital differences -- between men and women, and between those who are intersexed and those who are not -- have varied since ancient times in line with the prevailing knowledge-producing systems (religion, philosophy, science, medicine) and between geographical and cultural loci (anthropological, sociological). For several centuries so-called hermaphrodites were accepted as people in whom a combination of sex characteristics could be found, and who might therefore be allowed to choose what they wanted to be. But by the mid-1800s they had become people whose bodies deceptively hide their ‘real’ identities, their ‘true’ sex, which the expertise of doctors could uncover.
The year 1852 has been given as the date of the first published report of sex-‘corrective’ surgery in the US, alongside an increasing reference to homosexuality in medical journals. By the mid-20th century physicians understood the scientific importance of chromosomes and hormones in sex differentiation and development. However, the external genital morphology became the single most important criterion for the social act of assigning gender, and ‘corrective’ genital surgery became the gold standard that preserved our binary system.
“Accepting genital ambiguity as a natural option would require that physicians also acknowledge that genital ambiguity is ‘corrected’ not because it is threatening to the infant’s life but because it is threatening to the infant’s culture.”
Suzanne Kessler
“The goal of medical intervention in cases of atypical bodily appearance, then, is not to make bodies more natural, but to make them provide a cultural surface that coincides with larger cultural ideals and expectations. This is especially, though not exclusively, true with intersex, which medicine has recognized for several centuries as a natural variation, but for which law and culture have no room.”
Morgan Holmes
The now discredited 1950s advice of gynaecologist John Morris (that CAIS patients would not handle truthful disclosure) and psychologist John Money (that genital surgery, usually feminizing, would have a successful outcome if done early enough and if the medical history is withheld from the patient) held sway until challenged by intersex patient activism from the mid-1990s.
​
Social scientists and patient advocates question unhelpful cultural conceptions of intersex, and the way in which these have been upheld in medicine and psychology, with detrimental effects on the psychological well-being of people born differently sexed. Positive responses to atypical sex characteristics associated with intersex/dsd are at the heart of EuroPSI.
​
“The shift from ‘intersex’ to ‘DSD’ allows medical professionals to reassert their authority and reclaim jurisdiction over intersexuality in light of intersex activism that was successfully framing intersexuality as a social rather than biological problem.”
Georgiann Davis