Penile ablation and Gender Orientation

Inspired by recent development on Section 377A, i have decided to link it back to what i learnt at University. To me, it seems that the bloggers have been ranting on about the pro- and against- 377a views, on and on. These issues revolve about gender orientation. Most of the time, bloggers focused on the typically developing individuals. Today, i would like to present something a lil’ atypical. (reference)

Also, treat yourself to a beautiful soundtrack from Forrest Gump.

Intersex conditions

These are a set of medical conditions that feature congenital anomaly of the reproductive and sexual system that are not standard for either male or female. For example:

• Androgen insensitivity syndrome (AIS)
• Progestin induced virilisation
• Klinefelter syndrome (XXY)
• Congenital Adrenal Hyperplasia (CAH)
• Ablatio Penis (trauma)

Before we go into penile ablation and the investigations surrounding it, let us consider some theories about gender identity.

Cognitive theory of Gender Identity (Kohlberg, late 1960’s – early 1970’s)

• Focus is on the construction of cognitive (mental) representations of gender.

1. Stage 1: Gender Labeling: 0-30 mths. Self-recognition as a boy or a girl.
2. Stage 2: Gender Stability: By 3-4 years, development of awareness that gender does not change over time.
3. Stage 3: Gender Consistency: By 4-5 years, development of an understanding that gender does not change, despite changes in appearance or activity.

• Stage 2+3 = Gender Constancy: understanding that gender is both stable and consistent.
• Gender Identity complete by 6 or 7 years of age.

Biological theories

• Physiological or biochemical process that effect gender development (hormones)
• Androgens masculinise the brain as it develops, making it more sensitive to some types of environmental stimulation and less sensitive to others.
  • As a result, males and females are predisposed to develop different skills, abilities and personalities
• Accounts for gender differences across a range of aspects (e.g., male aggression, female nurturing)

John Money and his proposition

• Gender identity is not established before 2 years of age.
• Gender identity is established through socialisation and learning from age 2 to age 7.
• Gender identity is mostly determined by nurture.
• Therefore, gender can be surgically determined or re-assigned prior to age 2 years.

David Reimer

Bruce was a biologically normal 46XY male born 1965. He is a monozygotic twin to Brian. His penis was accidentally ablated during circumcision by electrocautery at 7 months (subsequently it was necrosed and sloughed off)

The plot thickens. He was referred to Prof. Money, who decided to reassign infant male to female gender. This involved surgical castration and initial genital reconstruction performed at 21 months

Bruce –> Brenda

Money evaluated Brenda at 9 and found that she displayed ‘tomboyish’ traits such as abundant physical energy, high level of activity, dominant among a group of girls.

Money wrote..

“Her behaviour is so normally that of an active little girl, and so clearly different by contrast from the boyish ways of her twin brother…”

Hence it was concluded

“..gender identity is sufficiently incompletely differentiated at birth to permit successful assignment of a genetic male as a girl… and differentiates in keeping with the experiences of rearing.”

Reported ‘success’ of this case received widespread exposure in professional journals and the media. This case was used as proof of the importance of environmental influences on gender identity formation. It served as a precedent for many
others.

Milton Diamond was not convinced

Prof Milton was a Professor of Anatomy & Reproductive Biology, University of Hawaii. In 1994, he contacted the treating psychiatrist at Johns Hopkins University (Dr Keith Sigmundson) and discovered that Brenda had been living as a male since age 14. At age 25 was married.

The recollections reveal …

David’s recollection of ‘her’ childhood was that he never felt comfortable as a girl (mother reported similar recollections). There was also recollections of refusal to wear dresses, hate for make-up, strong preference of ‘boy’ type behaviours, fought like a boy, incidents of bans from girl’s toilets for standing to urinate. Also he often had thoughts of suicide.

How ’she’ was managed to be a ‘he’

Brenda was placed on an estrogen regime at age 12. Breast development resulted.

However, the truth of gender reassignment was revealed at age 14. And Brenda immediately return to living as a male. Testosterone replacement regime commenced to induce masculisation at age 14. Mastectomy followed, and surgery for phallus construction at age 15 and 16 was scheduled.

Conclusions of Brenda/Bruce

Female gender identity was not established, despite surgical gender reassignment, feminising hormonal therapy and socialisation as a female. It provides evidence for a biological etiology for gender identity (i.e.,Nature) This has been further backed in recent research.

Concluding thoughts

Hence, ladies and gentlemen, gender identity is due to nature. Or so we are inclined to think. If we are born a male, we remain a male. Likewise for a female. There are no shades of grey in this. I beg to differ when claims are so adamant that some are born homosexual and that is just the way it is. I am inclined to believe the issue of homosexuality has more to do with nurture or the effects of the environment. Now please do not understand here that i’m trying to put them down. I believe they are as human as anyone else is and have their roles in society as everyone else has. I’m just suggesting that maybe its not true that they are born like that. As the above has suggested. It’s perhaps a matter of choice.

As nature made us. As nature made him, David Reimer. Surely there is something for us to learn here. (photo credit)

And that’s only my opinion. Thanks for listening.