Resolving an intersex condition

[HomeschoolDad]

Some people, who are visibly and apparently female, are found at a certain point in life (usually after puberty has begun) to be genetically male, having been born with AIS (androgen insensitivity syndrome) which suppressed their maleness and directed the embryo to begin taking on female physical characteristics as the “default choice”. Put more simply, the androgen doesn’t “kick in”, and the boy embryo becomes feminized. Such girls and young women think they are female until they have a DNA test that indicates otherwise, and they may have unknown internal testes, as well as other ambiguous physical traits. Strangely enough, they are often very beautiful, tall and graceful with very attractive skin and features.

Would these “genetic males who appear female”, have always thought of themselves as female, never identified as male in any way — they had no reason to — be justified in having surgery, if desired, to make themselves “totally female”? (Removal of the internal testes is often indicated to prevent future health problems, and that part is unproblematical.) Would female hormonal therapy be acceptable? Would they then be able to marry a man in the Church, if they are capable (either naturally or through restorative surgery, if needed) of consummating? (Obviously they could never bear children.)

 

[Thorolfr]

Would these “genetic males who appear female”, have always thought of themselves as female, never identified as male in any way — they had no reason to — be justified in having surgery, if desired, to make themselves “totally female”? (Removal of the internal testes is often indicated to prevent future health problems, and that part is unproblematical.) Would female hormonal therapy be acceptable? Would they then be able to marry a man in the Church, if they are capable (either naturally or through restorative surgery, if needed) of consummating? (Obviously they could never bear children.)

Another interesting question would be whether it would ever be appropriate for someone with AIS to have surgery to remove their breasts (i.e. have a mastectomy) and change other body parts so that they look more male since they are genetically male, even though they were born looking female? Or should they accept themselves as they are with an outwardly female body?

 

[0Scarlett_nidiyilii]

The National Catholic Bioethics Center website is a good resource.

 

[HomeschoolDad]

Another interesting question would be whether it would ever be appropriate for someone with AIS to have surgery to remove their breasts (i.e. have a mastectomy) and change other body parts so that they look more male since they are genetically male, even though they were born looking female? Or should they accept themselves as they are with an outwardly female body?

That is a very interesting take on the situation, and a question I’ve entertained as well.

I was thinking of people who look female, think of themselves as female, don’t have anything obviously “mannish” about them, and might only need continuous female hormone therapy, and possibly surgery to make it easier for them to consummate marital relations as the female partner. None of this, of course, would change their chromosomes from XY to XX.

The question might then be “are chromosomes the ‘bottom line’ when it comes to questions of sexual identity?”. If such people are to be considered female (and I think they should be), clearly not.

As you point out, though, some of these “XY females” might, for whatever reason, wish to be males. Even though they look female to one extent or another, they feel male, they’d prefer to be males, they are attracted to other females, they’d like to have surgery to make the situation unambiguous and possibly even be able to consummate as a male. Would they act licitly if they chose this route?

 

[OraLabora]

Usually AIS women are happy as women, because their brains were never exposed to androgens and thus developed female structures. Perhaps there’s a minority not happy about it. In either case, in intersex conditions the current thinking is to not alter anything until the person has clearly demonstrated which gender they identify with.

For AIS women, surgery to remove testes, or to correct structural deficiencies to permit natural intercourse, and hormones to develop normal female secondary sexual characteristics are pretty much the norm. I don’t see why the Church would or should want to stick her nose into such a delicate intimate situation. It’s a medical issue calling for a medical solution.

 

[HomeschoolDad]

Usually AIS women are happy as women, because their brains were never exposed to androgens and thus developed female structures. Perhaps there’s a minority not happy about it. In either case, in intersex conditions the current thinking is to not alter anything until the person has clearly demonstrated which gender they identify with.

For AIS women, surgery to remove testes, or to correct structural deficiencies to permit natural intercourse, and hormones to develop normal female secondary sexual characteristics are pretty much the norm. I don’t see why the Church would or should want to stick her nose into such a delicate intimate situation. It’s a medical issue calling for a medical solution.

This very well sums up the situation of most XY women. The chromosomes may say male, but aside from that, they are females. As you point out, a pharmaceutical and possibly even a surgical intervention might be called for. Internal testes are normally removed both to eliminate male hormone production and for health reasons — they could grow malignant. I would be very surprised, and even a bit disappointed, if the Church were to maintain “the person is really a male, and medical intervention or no medical intervention, ‘male and female He created them’, maleness is written into their DNA, and they cannot be females”.

There are also some intersex people, who choose to remain the way they are, even though removal of the internal testes is called for medically (just as a normal male might have cancerous external testes removed). They might be neither predominantly male nor predominantly female — “a little of each”. If they are not capable of consummation either as a male or a female unless they are surgically altered, then they cannot marry in the Church. Even given this scenario, I would like to see our society matured, or evolved, or whatever the best word is, to recognize that they, too, are people created in the image and likeness of God, their bodies the temple of the Holy Spirit, and even if they choose not to have their ambiguities addressed medically or surgically, they are “fine the way they are”, and this is nothing to be ashamed of. I’m sure many of us are familiar with the South African athlete, always assumed to be female, epicene in appearance (and a very handsome person), forced to have her gender determined — how humiliating would this be? — and found to be intersex. I deeply admire the way she handled this situation with grace and dignity, asserting her pride that God made her precisely the way she is. Total class act all the way.

I wouldn’t know how to address questions of sexual orientation among these people. A case could be made either way.

 

[OraLabora]

I wouldn’t know how to address questions of sexual orientation among these people. A case could be made either way.

I think the Church would argue that if physical deformities prevent the consummation of the relationship in a normal manner, they would have to stay single and sexually inactive.

And I would say that response robs these folks of their dignity by denying that their entitled to their sexuality and ability to enjoy intimacy, assuming they can find a partner that accepts their limitations.

I hope I am wrong, but on sexual matters, the Church has lost a lot of credibility in my eyes by being unable to protect the faithful from the predators in the clergy, including predators at the highest levels of the hierarchy who would preach the exact opposite of their behaviour.

 

[HomeschoolDad]

I wouldn’t know how to address questions of sexual orientation among these people. A case could be made either way.

I, too, find these circumstances regrettable, but Catholic teaching does not allow anyone to marry, who is physically incapable of performing the marital act. This is not only confined to intersex people with deformities incompatible with consummation — just to cite one example, a man who is absolutely, utterly, irreversibly impotent, or who has had his genitals destroyed, cannot validly marry. If a remedy, or reconstruction, is not possible, that means lifelong celibacy. I don’t think that robs anyone of their dignity, it is just the cross Our Lord has called them to bear.

I hope I am wrong, but on sexual matters, the Church has lost a lot of credibility in my eyes by being unable to protect the faithful from the predators in the clergy, including predators at the highest levels of the hierarchy who would preach the exact opposite of their behaviour.

I don’t think you’re wrong at all. Especially where people are concerned who don’t want to accept or follow her teachings in the first place, and want to find a moral pretext for not accepting or following them (I am not saying you are among these, so don’t take it that way), the Church has lost a lot of credibility for the reasons you cite. It may be that faithful laypeople are being called upon to “step into the breach” and affirm these teachings as true, not because they are taught by fallible clergy who have lost credibility, but simply because these teachings are true.

 

[Thorolfr]

I, too, find these circumstances regrettable, but Catholic teaching does not allow anyone to marry, who is physically incapable of performing the marital act. This is not only confined to intersex people with deformities incompatible with consummation — just to cite one example, a man who is absolutely, utterly, irreversibly impotent, or who has had his genitals destroyed, cannot validly marry. If a remedy, or reconstruction, is not possible, that means lifelong celibacy. I don’t think that robs anyone of their dignity, it is just the cross Our Lord has called them to bear.

In some ways it’s a little unfair that if a man is impotent, i.e. is unable to achieve a sexual erection, he can’t get married and must live a life of lifelong celibacy whereas a woman doesn’t have to worry about this kind of issue. As Queen Victoria supposedly said to one of her newly married daughters when asked about carnal activities in the marriage bed, “Just close your eyes and think of England.” A woman doesn’t have to worry about being impotent and even if infertile can still enjoy a married life.

 

[HomeschoolDad]

I, too, find these circumstances regrettable, but Catholic teaching does not allow anyone to marry, who is physically incapable of performing the marital act. This is not only confined to intersex people with deformities incompatible with consummation — just to cite one example, a man who is absolutely, utterly, irreversibly impotent, or who has had his genitals destroyed, cannot validly marry. If a remedy, or reconstruction, is not possible, that means lifelong celibacy. I don’t think that robs anyone of their dignity, it is just the cross Our Lord has called them to bear.

Yes, but life itself is unfair, and some people just have burdens that others don’t — and people who don’t have my burdens, have burdens that I don’t have, and vice versa. Men have burdens and limitations that women do not have, and women have burdens and limitations that men don’t have.

As a practical matter, if a person were physically incapable of fulfilling the obligations of marriage, they could always find a like-minded partner, who does not mind living in a sexless relationship, and live as brother and sister. This happens quite often. If I were a bishop, I would have no problem whatsoever granting a couple in these circumstances a dispensation, and allowing them discreetly to marry before a civil official, for the very good reasons of property rights, inheritance, next-of-kin designation, insurance, possibly child custody, and so on.

(Just for the record, I am neither intersex, nor impotent, nor deformed in that way. My only impediment to marriage is that I do not have an annulment, and that may be easily remedied one day — or not. It’s not a priority with me. And no, I’m not gay. Nothing to look at, and poor as a churchmouse, but not gay. I’d be a precious child of God even if I were. To paraphrase Janet Reno, I’m just an awkward old guy who admires women.)

 

[Lea101]

This is the difficult part about defining what is a man and a woman.

If it’s strictly biology, intersex people are suddenly expected to live their lives as the opposite gender they’ve known. If it’s not biology, well let’s say that we already know the implications.

A woman doesn’t have to worry about being impotent and even if infertile can still enjoy a married life.

I wanted to say that there’s a condition that makes women feel a great amount of pain during sex, but i realised that you wouldn’t know before marriage and there are treatments for it.

Besides birth defects, I think you’re right. We have our other crosses though.

 

[Rau]

I’m sure many of us are familiar with the South African athlete, always assumed to be female, epicene in appearance (and a very handsome person), forced to have her gender determined — how humiliating would this be?

What are the sporting bodies to do? If participation in particular sports is to be divided according to sex, sex must be known. There is a spectrum of cases from the very challenging to the absurd.

 

[Rau]

A woman doesn’t have to worry about being impotent and even if infertile can still enjoy a married life.

True, though note infertility is itself no impediment for either.

 

[Thorolfr]

Thorolfr:

A woman doesn’t have to worry about being impotent and even if infertile can still enjoy a married life.

True, though note infertility is itself no impediment for either.

The requirement that a man not be impotent to marry seems unreasonable to me. Say, for example that a 65 year old widower wants to marry a 65 year old widow but he’s impotent because he has high blood pressure. Everyone knows that such a couple will not be having any children because the woman is beyond her child bearing years. So, it doesn’t make any sense to me that they shouldn’t be able to get married and that the man must remain single for the rest of his life while the 65 year old woman who cannot have any children could marry another man who isn’t impotent. And if this 65 year old couple had been married when they were younger, they wouldn’t be expected to get divorced now that the man is impotent.

 

[Rau]

So, it doesn’t make any sense to me that they shouldn’t be able to get married and that the man must remain single for the rest of his life while the 65 year old woman who cannot have any children could marry another man who isn’t impotent.

It’s a challenging idea. But it rests on the understanding of the meaning of marriage. Some make equally reasonable sounding arguments about why it’s unreasonable that two women can’t marry

But the point of my post was to make clear that infertility is not a factor in the eligibility for marriage.

 

[OraLabora]

The requirement that a man not be impotent to marry seems unreasonable to me. Say, for example that a 65 year old widower wants to marry a 65 year old widow but he’s impotent because he has high blood pressure.

When undergoing the questioning for convalidating our marriage, the priest said that for older couples, he generally gives them the benefit of the doubt.

With modern medicine (oral drugs, injections, surgery) it is the very rare man who wouldn’t be able to achieve an erection at least once to consummate the marriage, which is all that is technically required.

Even if the couple elects to not engage in intercourse due to age, lack of interest or whatever, the possibility remains should they change their minds, with various forms of medical assistance. And that’s all the law requires before marring a couple: that the possibility for intercourse should exist. It doesn’t have to take place, a couple for instance can mutually elect to have a Josephite marriage. Even a young couple, though that would surprise me these days!

The situation for the intersexed is a bit more complex because they may have serious genital malformations that make intercourse impossible. More and more though, medical advice is to leave well enough alone as the surgery is difficult, with no guarantee of functional results.

 

[thistle]

If it’s strictly biology

Yes it is strictly biology.

 

[HomeschoolDad]

This is the difficult part about defining what is a man and a woman.

If it’s strictly biology, intersex people are suddenly expected to live their lives as the opposite gender they’ve known. If it’s not biology, well let’s say that we already know the implications.

I don’t think it’s strictly biology, and I don’t think the Church says that either. “Strictly biology” would say to a person, for instance, “you have XY chromosomes, even though your body didn’t respond to androgen, and in spite of your female appearance and bodily parts, you are a man, because your DNA is that of a man — you can either have surgery, if you wish, and be made visibly into a man, or you can stay the way you are, and realize that you are a man, even though you don’t feel like one or look like one”.

I was thinking just today of how I would react if, for the sake of argument, I discovered that I had XX chromosomes, and that I actually had ovaries that I had always just assumed… you get the idea. (I’m not sure that is even scientifically possible, but let’s say it were.) I don’t — I have fathered at least two children (one living, one known to be miscarried) — but let’s say I did. There is absolutely nothing feminine about my appearance. I like women and only women. I am the quintessential “man’s man” — I like beer, I even brew my own beer sometimes, I like guns, I have a mancave (or rather, I had a mancave until my son decided he needed it worse than I did ), I like action-adventure movies, the whole nine yards. Someone tells me “you are really a woman — you have female DNA. You can either have hormone therapy and an operation to make you into a woman, or you can stay the way you are. And on top of all that, you like women, so you’re a lesbian”… and so on.

I’d politely tell them they were crazy.

I’m sure many of us are familiar with the South African athlete, always assumed to be female, epicene in appearance (and a very handsome person), forced to have her gender determined — how humiliating would this be?

I think the complaint was that “she’s really a guy”. She regards herself as a woman, she didn’t know about the internal testes until she was examined, and she is physically a woman even though she does, admittedly, look pretty mannish. FWIW, she is a lesbian, but so are many women with XX chromosomes.

 

[HomeschoolDad]

The requirement that a man not be impotent to marry seems unreasonable to me. Say, for example that a 65 year old widower wants to marry a 65 year old widow but he’s impotent because he has high blood pressure. Everyone knows that such a couple will not be having any children because the woman is beyond her child bearing years. So, it doesn’t make any sense to me that they shouldn’t be able to get married and that the man must remain single for the rest of his life while the 65 year old woman who cannot have any children could marry another man who isn’t impotent. And if this 65 year old couple had been married when they were younger, they wouldn’t be expected to get divorced now that the man is impotent.

It does seem unfair, but fact is, a man has to be able to consummate a marriage, to marry validly in the first place. As I said above, if a man were absolutely incapable of ever consummating, it seems to me that he and his intended spouse could simply marry civilly, if they so desired, and live as brother and sister. I noted above that I would dispense them if I were their bishop.

Impotence that occurs after marriage does not invalidate the marriage, and sterility is not an impediment to marriage in the first place.

When undergoing the questioning for convalidating our marriage, the priest said that for older couples, he generally gives them the benefit of the doubt.

With modern medicine (oral drugs, injections, surgery) it is the very rare man who wouldn’t be able to achieve an erection at least once to consummate the marriage, which is all that is technically required.

It is my understanding that the Church rarely enforces the impotency prohibition, for as you say, impotence is hardly ever a case of “we know for a fact that you will always be impotent under all circumstances”, and as you note, there are many medical remedies for impotence.

The situation for the intersexed is a bit more complex because they may have serious genital malformations that make intercourse impossible. More and more though, medical advice is to leave well enough alone as the surgery is difficult, with no guarantee of functional results.

I am all in favor of “leaving well enough alone” — these surgeries can go horribly wrong — and I would like to see a society that is so understanding that an intersex person could, if they so choose, be entirely open about their circumstances and have no one think the worse of them for it. Bullying of an intersex child in school should be unthinkable. (Actually, all bullying should be unthinkable!) This said, though, if an intersex person cannot consummate in a normal manner, sadly, they could not marry in the Church.

 

[Thorolfr]

This said, though, if an intersex person cannot consummate in a normal manner, sadly, they could not marry in the Church.

If someone with AIS could consumate, would the Catholic Church consider this person to be a woman when it comes to marrying in the Church even though that person is genetically male?