Diagnosing (Inter)Sex: A Case of Social Diagnosis

For parents of intersex children, from the moment of birth, if not before, the announcement of sex is replaced with an announcement of a different kind: that of a medical and social emergency. A body that is not clearly male or female as a result of its chromosomal makeup, hormonal balance or external genitalia, is given the diagnosis of ‘indeterminate sex’ (ICD-9-CM code 752.7). But this diagnosis is only a first step; as with other diagnoses (such as cancer), further classification of the medical problem is necessary for deciding on management and prognosis.  In the case of intersex, medical professionals assess additional data to determine the intersex individuals’ ‘true sex,’ in effect explicitly diagnosing intersex while implicitly diagnosing sex en route to treatment recommendations.  In this paper, we examine the diagnosis of intersex as a site that renders visible the process of social diagnosis (Brown, Lyson, Jenkins 2011).  As argued in the framework, diagnosis is social because of both the variety of social actors involved in diagnosis and because it diagnoses social structures that contribute to health and illness. In this vein, we (1) show how multiple social actors (e.g. parents, doctors, technology, legal and cultural institutions) contribute to diagnosing the individual’s ‘true sex,’ which, once determined, can be ‘restored’ medically. We then (2) set out to diagnose the social structures that make intersex a medical and social problem. In line with other scholars (e.g. Fausto-Sterling), we view sex in a multi-dimensional space, with male and female representing only two points. It follows that a system that diagnoses intersex, in effect, also diagnoses sex. We argue that since most cases of intersex do not involve physical dysfunction, it is this social compulsion to categorize sex that make intersex individuals ‘sick’ – not their chromosomes or organs.