Hermaphroditism

September 13, 2011

The term hermaphrodite derives from Greek mythology. Hermaphroditus was the son of Aphrodite and Hermes, endowed with the beauty of both deities. One day, he was walking by a lake when the nymph Samalcis instantly fell in love with him. She pleaded for his love, which he soundly rejected. When he later disrobed and jumped into the lake for a swim, Samalcis followed and embraced him, but he tried to escape. Samalcis prayed to the gods that the two would never be separated. The gods answered her prayer by fusing Samalcis and Hermaphroditus into one body.

The medical establishment throughout history has used the term hermaphrodite (or in some cases gynandromorphy) to describe a cluster of genetic and physiological departures from the typical gestational sex development pathway that result in individuals born with variations in the appearance of external genitalia and/or incongruence between internal sex organs and external genitalia. Hence, the analogy to Hermaphroditus is clear. The term has largely fallen out of usage due to the action of intersex activists who feel that it sensationalizes and dehumanizes individuals who have suffered extreme physiological and psychological trauma stemming from surgical interventions to correct these conditions, but that in actuality are more akin to genital mutilation.

For purposes of classification, the medical establishment historically has made distinctions between true hermaphrodites and pseudo-hermaphrodites. True hermaphrodites, also known as genetic mosaics, are rare in occurrence. Although most people think of sex at the individual (or organism) level, each cell in the body also can be viewed as having a chromosomal sex—XX (female) or XY (male). Thus, genetic mosaic refers to individuals born with cell patches throughout the body that are XX and other patches that are XY. When a patch crosses through gonadal tissue, the typical result is an individual born with at least one ovotestis (a hybrid of ovary and testicular tissues) accompanied by varying degrees of genital virilization.

Pseudo-hermaphrodite refers to all other variations resulting from an absence or insufficiency of certain enzymes that act at points along the human sex determination pathway. The prefix pseudo is applied because these individuals are not genetic mosaics. Because the overall ground state for human sex development is female—or put another way, male is a biological modification of an elemental female form—a majority of the departures affect developing fetuses with an XY chromosomal constitution. Generally, depending on when the enzyme acts in the sex development pathway, XY gonadal tissue will cease its differentiation away from the female ground state (i.e., male development) and will instead follow a female developmental path from that point forward.

The most common examples are genetic variations in the testosterone biosynthetic pathway. Like many hormones in the human body, testosterone is derived from a cholesterol precursor molecule through a complex pathway involving the action of many enzymes. Changes in the levels or alterations in the capacity of any of these enzymes can ultimately influence the amount of active testosterone produced. The availability of high titers of active testosterone, coupled with the ability of this hormone to enter into cells through a receptor molecule, are necessary for elaboration of the external genitalia in XY fetuses. Without active testosterone and capable receptor molecules, or if quantities of either are insufficient, development will return to the female ground state and the individual will be born with either female genitalia or varying degrees of hybridization of female and male external characteristics. However, because male differentiation has occurred up to this point, the vagina is a blind pouch without a cervix. Uterus, fallopian tubes, and ovaries are also absent; instead, testicles are present in the abdomen where the ovaries typically would be located.

Androgen insensitivity syndrome (AIS), which affects the transport of active testosterone into cells, and 5-alpha reductase deficiency (5ARD), which affects the activation of testosterone, are among the best known examples. Congenital adrenal hyperplasia (CAH) is a genetic variation in the cortisol biosynthetic pathway (a branch of the testosterone pathway) resulting in insufficient production of cortisol and overproduction of testosterone. Developing XX fetuses are thus born with hybridization of female and male external characteristics, but the internal sex organs are female. Sex assignment at birth in all three examples is usually female, at times with corrective surgery to normalize the genitals to an idealized feminine appearance. But this practice has been strongly criticized by intersex activists, many of which liken the genital mutilation to child abuse.

If the condition remains undiagnosed for Androgen insensitivity syndrome and 5-alpha reductase deficiency newborns, it will manifest itself at puberty. Menarche will not occur. Those with complete Androgen insensitivity syndrome will also fail to develop ancillary and pubic hair, a process under the action of testosterone in both females and males. Girls with 5-alpha reductase deficiency or partial Androgen insensitivity syndrome will begin to undergo virilization at puberty, an occurrence that in some instances is traumatic and in others is welcome. Virilization will continue unless the testicles are removed from the abdomen and estrogens are administered.

Compared to the general population, rates of lesbianism are very high among the intersexed (hermaphrodites), which challenges us to rethink strict interpretations of postmodern theories based on social learning or essentialist theories grounded in psychobiology and evolutionary psychology for either gender or sexual orientation development.

SEE ALSO: Femininity, Gender, Gender role, Homosexuality, Intersexuality, Lesbian, Masculinity, Queer, Transgenderism, Transsexuality

Suggested Reading

  • Barbin, H., Foucault, M., & McDougall, R. (1980). Herculine Barbin: Being the recently discovered memoirs of a nineteenth-century French hermaphrodite. New York: Random House.
  • Dreger, A. D. (2000). Hermaphrodites and the medical intervention of sex. Cambridge, MA: Harvard University Press.
  • Fausto-Sterling, A. (2000). Sexing the body: Gender politics and the construction of sexuality. New York: Basic Books.

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