Fixing Sex: Intersex, Medical Authority, and Lived Experience by Katrina Karkazis

Fixing Sex: Intersex, Medical Authority, and Lived Experience Reviews

• 
  Alok Vaid-Menon

  This is such a helpful resource: a great introduction to the history of intersex people and the diagnosis of "hermaphroditism." Karkazis shows how intersex people have been foundational to the consolidation of the gender-sex binary, what markers became configured as the "true meaning" of sex, and how definitions and understandings of biological sex shift over time. She shows how doctors justify non-consensual medical surgeries on intersex patients because of aesthetic/social concerns and normative ideas of what "males" and "females" should look like. She shows that it was only in the mid-20th century that intersex became a medical issue because of heightened concern in the Western world with the relationship among bodies, gender, and desire and the fear of collapse of the racialized gender/sex binary. Besides the theoretical and historical contribution, I appreciate how Karkazis interviews a host of stakeholders -- showing how these issues map onto actual lives. While this book has become a staple, I'd love to read more academic writing by intersex scholars in the future.
  
• 
  Stacie

  Only read this if you want to get really angry.
• 
  Myth

  This wasn't in my list of books to read, but it came up when searching for other in regards to Intersex. I was surprise to find that this within the range of topics I was looking for. Fixing Sex takes a critical look at how we treat Intersex individuals and what influence our culture and society has on the medical arena.
  
  Karkazis did a great deal of research. Despite the side Karkazis takes, she provides a lot of details and research in her book. She focuses on the medical treatment of intersexed individuals and the response from doctors, parent and patients.
  
  What it comes down to, is what could be considered cosmetic surgery takes places on infants as if it's necessary. Is this ethical? Well Karkazis doesn't simply come out and say "No", but rather asks readers to consider all that goes into the making of gender and the decision for it. It becomes quite clear in her book that is not a simple matter.
  
  No one institution or people are made out to be the evil. There's conflict within every community.
  
  We are a culture that doesn't allow for there to be people who are not female or male. As we aim to be less restricted we still expect certain norms. It's quite bizarre to think tiny babies are having operations done to their genitalia for cosmetic appeal. It doesn't seem like such a drastic measure should be taken until the child has grown.
  
  When will relief come to this area of gender? In Karkazis book, as well as others I've read, it's clear that several gender movements have taken place and work off each other's steam. In more than one books it is pointed out that the feminist movement and the gay/lesbian movement has opened doors for other gender and sex issues.
  
  I've held the opinion that gender is mistaken and makes way too many unrelated connections between behavior, personality, socializing and norms. In my opinion, I suppose I would agree with those in the social sciences about this being a construct greatly determined by culture and history. In a somewhat crude comment a social scientist points out that the old will simply have to "die" for us to get anything done in this area.
  
  I agree that intersex conditions that pose no threat to a child's health shouldn't be "treated" until the child has a say in the treatment. It's a matter of being open minded and more honest with the children who are different. The biggest issue that stuck out to me was the fact that the children were so young when undergoing this surgery. It doesn't seem safe or right to make an infant undergo unnecessary surgery.
  
  I ended up thinking that the parents were the most... problematic. They were blamed as the people who made the decisions for their child, being uneducated and not protecting their children. At the same time, the doctors were noted as not always treating the intersex individuals as people and were the source for traumatic memories. As I said though, there isn't a bad guy in this book, there isn't someone to put all the blame on. If the blame is to go anywhere it is on society.
  
  The book itself seemed a little tedious in details. There was redundant information and some stuff was mentioned over and over. I understand that with a book with so much information that it's somewhat helpful to have the information re-addressed when it's talked about. I found myself needing that redundant information in a few instances.
  
  I kind of wonder if Karkazis covered too much, but then it wouldn't have been the same book or had the same amount of value if she hadn't taken if from many angles.
• 
  Elevate Difference

  For most parents, the first question asked after the birth of their child – “Is it a boy or a girl?" – is a straightforward one. For parents of children born with chromosomes, organs, and/or genitalia that do not fit neatly within the common conceptions of either maleness or femaleness, this seemingly simple question can become a source of extreme anxiety and mark the beginning of a long and complex journey filled with difficult decisions.
  
  In Fixing Sex, Katrina A. Karkazis draws on the experiences of doctors, intersex people, and parents of intersex people to take a critical look at the medical treatment of intersex infants - including sex assignment and genital surgery performed for cosmetic reasons – to match a child's outward appearance to that of a "normal" male or female. In incorporating the voices of not only medical professionals, but also the people whose lives have been affected in major ways by the results of medical decisions enacted on their or their children's bodies (and identities), Karkazis presents a more complete view of the topic than has been offered in the past.
  
  Karkazis draws attention to the staggering power of societal assumptions about sex, gender, and sexual identity. She discusses their influence on medical decisions, many of which have come to be seen as wrong (or at least deeply problematic) in retrospect. The sex/gender assignment of intersex infants is now understood to be a complex issue in which many factors (i.e., genetics, hormonal exposure in utero, and fertility) must be taken into account, but for years, the appearance and functionality of an individual's genitals was believed to be the most important factor. Therefore, sex assignments were determined by whether the infant's genitals appeared – or could most easily be surgically altered to appear – male or female. This practice, combined with the influential doctor John Money's assertion that nurture trumped nature, often led doctors to make surgically assign female genitals and to assume that in being raised as female, the individuals would come to fully identify as such. This turned out to not be the case.
  
  Doctors were making decisions based on the assumption that it would be far better for a child to grow up and be able to be "normal" (i.e., get married and have heterosexual intercourse) than to endure the psychological implications of having atypical genitals and not fitting squarely into the gender binary. In her interviews with intersex adults, Karkazis uncovers the psychological implications of having undergone genital surgery (which often includes several follow-up surgeries during childhood and even adolescence) and being treated as a medical oddity. In the end, decisions made in order to allow people to live "normal" lives created their own set of complications that have left many people feeling angry, violated, scarred, and anything but normal.
  
  Karkazis devotes a substantial portion of Fixing Sex to the intersex activist movement and the issues it has raised. These include critiques of the medical establishment's tendency to perform genital surgery on children (as opposed to waiting until the individual is old enough to decide), to treat intersex children as medical specimens in psychologically damaging ways, to deny families of intersex children the counseling and resources they need, and to adhere to rigid, heterosexist conceptions of male and female. Karkazis doesn't claim to offer any answers, but she brings the discussion up to date in a way no one else has yet, raising the difficult questions necessary to move the discourse on intersex issues forward.
  
  Review by Kiri Oliver
• 
  Alison

  If only all science books were this good. I picked this up because I so was impressed with Karkazis' recent (2019) collaboration with Rebecca Jordan-Young on testosterone. I don't usually read science books more than a decade old, but Fixing Sex holds up. It is a compelling mix of scientific analysis, and ethical examination of the application of medical 'treatments' by medical professionals, individuals not easily assigned gender at birth, and their parents.
  Bioethicist Karkazis's tone brims with empathy for all of these groups, as she weaves through the often tragic mix of medical norms, social expectation and identity. The book is populated by doctors who feel out of their depth ("I was trained how to make a male or a female: no-one trained me on how to make sex assignment decisions") or overly certain ("If you open the [girl's] diaper and see a phallic structure then clearly that's going to be objectionable"), parents beset by anxiety about what will be best, as well as what everyone will say, and children who have been, at worst, systematically abused, with little real redress and understanding. The book deals with big questions about gender norms, medicalisation, sexism and racism, but never loses sight of the people in the midst of it, which is where much of the power comes from.
  TW: This is a very upsetting book, with a lot of discussion about genitals. Karkazis discusses not only operations which impede sexual functioning, but also, most distressingly, the common practice of subjecting children to multiple genital exams per year for their lifetime, in some cases with entire classes of students present. It is hard to use any term other than abuse for this, and the confession of one parent that she did not know how to stop this without denying her child lifesaving medical treatment sits uneasily aside the blame many victims assign to their parents for colluding in it. Karkazis isn't interested in villains, however - what sharply comes through this book is the way these children are largely sacrificed at the altar of our need for two, cleanly distinguished, genders. There is, generally, no 'medical' reason for most surgical intervention. It is the belief of doctors that a life with ambiguous genitalia (or god forbid, a man with a small penis) will be unbearable that generates it. And is that the fault of the doctors or the society that makes this so hard? Rarely have I appreciated how much the LGBTI movement is doing for all of us, in broadening our appreciation for human diversity, and hopefully saving a new generation from medicalised abuse.
• 
  Alejandro Zuno

  Intersexuality is more common than we think. The percentage of intersex children is similar to those with red hair, so how come do we know so little about it?
  Reading this book will make us question why are we so incapable of accepting how diverse we are…
• 
  Aaron

  Thoroughly researched. Objectively critiqued. Well-written and highly (and properly) contextualized.
  
  Karkazis documents the competing structuring of identity politics of intersex-diagnosed individuals through multiple lenses, most significantly that of physicians. The voice of physicians/clinicians is easy to ignore or overlook, because many of them refuse to go on the record. However, Karkazis gives many of them a chance to voice their thoughts on past, current, and future reflections of sex diagnosis, gender identity politics, and the overall medicalization of human individuality.
  
  The book is highly academic and thoroughly researched. The author's approach digs into the cultural perceptions behind our supposed moral judgements at the core of treatment practices that may or may not be human, when properly interpreted. The conceit of the cure can be dangerous if there is nothing that truly needs to be cured.
  
  Many important topics are addressed, including: how sexual function is conceptualized by medicine; how technology gives clinicians more authority over the lived experience than the patient; the psycho-social care of an individual, and it's valuation, or lack thereof, in the midst of life-changing surgical practices; the routine medical decisions made to subvert female sexuality; social constructionist perspectives and how ambiguity predisposes or presumes difference; and the contradictions apparent, either by clinicians, parents of intersex children, or other individuals, who argue on the grounds of normative social policy, exaggerating social approval and ultimately regarding variation (somatic or otherwise) as an inadequate (and for some reason, dangerous) human existence.
  
  "Bodies are not only biological phenomena, but also complex social creations on to which meanings have been variously composed and imposed according to time and place."
• 
  Beth

  Interesting examination of clinical approaches to intersexed individuals, as well as the experiences of parents and patients. I wish she had included more individual stories, but given that her goal was to produce an overview, she has given future researchers a great foundation to build on.
• 
  Gaia

  Ce l'hai crocetti?
  
• 
  Chris Ma

  Informative, comprehensive and with a critical perspective that's well-argued.