Amy Bloom - Normal

Almost everything Tri-Ess has said about its members is true: they are straight and traditional men who love their wives and wear dresses. Just as Tri-Ess says, its Christian, conservative, Republican men have a great deal more in common with other Christian, conservative, Republican men than with anyone else. Their wives are not professional women with their own substantial incomes and career paths, and they are not royalty or Hollywood types who expose their spouses’ peculiarities and let the muck cling to their kids. They try to make their marriages work, and if the price of a good provider and a decent man is not much sex and a certain amount of constant pain, it is not an unfamiliar bargain. The wives are not uniformly overweight, motherly, and devoid of self-esteem (as some mediocre research has suggested they are), or at least no more so than any other group of middle-class women married young to traditional and dominant men, devoted to home and family, and lacking in advanced education. Juggling the limited resources of time, money, and pleasure, balancing dominance and fear, self-deception and love, selfishness and generosity, crossdressers and their wives struggle with one big difference — his compulsion — and otherwise, just as they have told me all along, they are just like everyone else.

Beautiful, the doctor says. Ten fingers, ten toes, and the mother’s beautiful blond curls. Baby and parents crying with relief, three weary, joyful travelers. They place the baby on the mother’s stomach, clamp the cord, and hand the father a pair of slim scissors to cut it. The parents expect both these things — they’ve seen it done in the Lamaze video, they’ve seen it on the Lifetime channel. The OB nurse cleans and swaddles the baby quickly while the aide washes the mother’s face and changes the bloody sheet under her for a fresh one. They give the baby the Apgar test, a visual assessment taken minutes after birth — a nice experience in most cases, since a baby will get a gratifyingly high score, 8 or 9 out of 10, just by being his or her healthy baby self. It is a high score in this case too, but the doctor shakes his head, in such a small gesture that the father doesn’t even see it. The mother sees it, through the anesthetic, through the sweat, right past the sight of her beautiful baby held tight in the nurse’s arms.

Finally, the baby is in the mother’s arms. The doctor is thinking fast and trying to hide it. As Dr. Richard Hurwitz instructs in Surgical Reconstruction of Ambiguous Genitalia in Female Children , a 1990 training videotape produced by the American College of Surgeons, “The finding of ambiguous genitalia in the newborn is a medical and social emergency.” A hundred years ago, midwives examined babies and assigned gender in doubtful cases, or they brought the babies to priests or doctors and the team consulted and assigned gender, and little was made of it until the occasional married, childless woman went to her doctor for a hernia and discovered she had testes, or the married, childless farmer went to the doctor and discovered he had ovaries. Today many physicians regard “genital anomaly” as a dire matter. “After stillbirth, genital anomaly is the most serious problem with a baby, as it threatens the whole fabric of the personality and life of the person,” one doctor wrote in 1992; only slightly worse to be dead than intersexed.

The baby is taken to the nursery. The next day the doctor comes in and sits down, and speaks softly. “Your baby will be fine,” he says. The parents brace themselves: a faulty valve, a hole where there should be none, something invisible but terrible. “Somehow your baby’s genitals haven’t finished developing, so we don’t quite know right now what sex it is. We’re going to run a couple of tests and we’ll know very soon. Don’t worry. It may be that some cosmetic surgery is required, but don’t worry,” the doctor tells the parents, who are already well past worrying. “This will all be okay. We can solve this in just a few days. The sooner, the better.” As the doctor leaves, he is already calling a pediatric urologist for a consult, getting a pediatric endocrinologist to come over and take a look, getting a geneticist to come on board, to help assign sex and then do what is medically necessary to have the baby’s genitals resemble the standard form of that sex.

This scene occurs about two thousand times a year in hospitals all over America. Far from being an exceptionally rare problem, babies born with “genitals that are pretty confusing to all the adults in the room,” as medical historian and ethicist Alice Dreger puts it, are more common than babies born with cystic fibrosis. Or, to think of it differently, there are probably at least as many intersexed people in the United States as there are members of the American College of Surgeons. *

Imagine a baby born with an oddly shaped but functional arm. Would one choose an invasive, traumatizing pediatric surgery that almost inevitably produces scarring and loss of sensation, just to make the arm conform more closely to the standard shape? Yet parents believe there must be tests that will show their baby’s true sex, and surgery that will ensure and reinforce their baby’s true sex, and parents want it to happen, quickly. A few days, even a few hours, of having Baby X is too long. One cannot raise a nothing; when people say, “What a beautiful baby! Boy or girl?” one cannot say, “We don’t know.” In a culture that’s still getting used to children who are biracial and adults who are bisexual, the idea of a baby who is neither boy nor girl, or both boy and girl, is unbearable. How do you tell the grandparents? How do you deliver the happy news that you have a healthy It?

The parents hold the baby, still beautiful, still raw but shapely, and they peer at what is under the diaper. Let’s say that what they see is a tiny — even for a baby — tiny penis, technically, a microphallus, both misshapen and far smaller than the standard (less than about two centimeters when stretched out from the body). The prevailing approach for the last fifty years has been to declare that a baby boy with such a small and inadequate penis is better off as a girl. In the straightforward words of surgeons, “Easier to make a hole than build a pole,” and the collective medical wisdom has been that a boy without much of a pole, and even more, a man without much of a pole, is doomed to live ashamed, apart, and alone. In the face of the assumption that suicide is likely and profound depression inevitable, a physician with the best intentions and the support of his peers might well declare the boy a girl, remove the micropenis and the testes, fashion labia and a small vagina, and tell the parents as little as possible so as to spare the entire family further anxiety and troubling questions of gender (parents who don’t know that their little girl was born a boy are less likely to wring their hands over persistent play with trucks and a refusal to wear dresses). This approach owes a great deal to John Money, a psychologist and the founding director of the Psycho-hormonal Research Unit at Johns Hopkins, author of some forty books and four hundred articles, whose once-bright star has been dimmed by the case in which he turned little John into little Joan, and in which “John” insisted, heroically, that he was John all along, and resumed life as a male despite Money’s assertion that gender was all a matter of nurture, not nature.