The Murk Manual: How to Understand Medical Writing on Intersex

Raphael Carter

Raphael Carter lives in Minneapolis, Minnesota, and is the author of The Fortunate Fall, a science fiction novel published by Tor Books. The title is a pun on the Merck Manual, which is used by physicians to diagnose a variety of disorders.

ambiguous genitalia
Genitalia that refuse to declare their sex to doctors—no doubt on the principle that under interrogation by the enemy you should give only name, rank, and serial number.

androgen
Andro=male; gen=making. Androgens are administered to infants to prevent their becoming androgynes. See testosterone.

androgen insensitivity
The condition of infants who callously refuse to respond to testosterone treatment; the cause of many an endocrinologist’s hurt feelings.

circumcision
A mass-market edition of intersex surgery, priced for the common man. The reasons for circumcision are too numerous to treat here, but T.V.N. Persaud of the University of Manitoba recites one ingenious opinion: “Some conditions, such as phimosis, often lead to circumcision at a later age that could have been prevented if it had been performed earlier.” Physicians thus exhibit the same prescience as the Monopods in C. S. Lewis’ The Chronicles of Narnia, who boiled potatoes before planting them in order to save doing it when they were dug up.

clitoral recession
See female genital mutilation. Despite Webster’s false cognate, “recession” is derived from “rescission,” the noun form of the verb “rescind.” Endocrinologists, like certain Congressmen, like to rescind budgets they feel are too large, even when this means cutting off essential services.

clitoromegaly
Micropenis in the female. A longer definition would be superfluous, since this condition is apt to be cut off before the patient can pronounce it.

cryptorchidism
A condition in which the testes (-orchid) are hidden (crypto-). Hidden from whom? Obviously, from the doctors. Cryptorchidism is thus practiced by those discriminating infants who do not wish to put pearls before swine.

distress
A condition produced in parents when their intersexed children go unmutilated.

estrogen
1. A character in Samuel Beckett’s Waiting for Godot, who was just pining away for a doctor to come change his sex. 2. A character in Ursula Le Guin’s The Left Hand of Darkness, who bloody well wasn’t.

female
1. A male intersexual when the endocrinologist is through with him. 2. A female intersexual whom the urologist has not seen yet.

female genital mutilation (FGM)
The scarring or removal of the clitoris, performed by witch doctors and condemned by all right-thinking people. If the clitoris is a bit larger than average, however, the mutilation is performed by accredited surgeons and covered by all major insurance plans.

formerly intersexed
A term used by specialists to refer to any intersexual old enough to talk back. Such a person has no right to speak for intersexed infants; let the infants speak for themselves.

gynecomastia
Enlargement of the breasts in a patient whom we have decided to call male. In a patient whom we have decided to call female, the same trait is called “excellent breast development.”

hypertrophy
Literally, too much meat. How much is too much? More, madam, than your sister has; less, sir, than you will have when we are through.

hypogonadotropic hypogonadism
A condition in which the gonads are small owing to a lack of the chemical signals that activate them. To be distinguished from hypergonadotrophic hypogonadism, in which the gonads are small owing to an excess of the chemical signals that activate them. The progress of medical science makes possible these ingenious explanations of formerly murky phenomena.

hypospadias
A condition in which the meatus of the penis exits elsewhere than the tip. The etymology of this term is worthy of great meditation: hypo = “too little”; spadix is the Latin for sword. If only the infant’s sword were larger, he would be able to fight off the surgeon.

idiopathic
Found in solitude. A condition that boors never allow to persist in women or in symptoms. Contrary to previous report, idiopathy does not mean “stupid medicine,” there being no need of a special term to identify that thriving Science.

Klinefelter’s Syndrome
One of that large class of syndromes named for people who did not have the syndromes. Even Lou Gehrig’s Disease has been renamed for some doctor who probably couldn’t even hold a bat.

lusus naturae
A freak of nature. It may at first surprise the reader that this term is not applied to people who cut up perfectly healthy genitals; but while that behavior is certainly freakish, nature has nothing to do with it. male: See female. Whatever you may say of medical Fascism, it does make the males run on time.

micropenis
Clitoromegaly in the male. Cutting off the micropenis and rearing the child as female is a common way of producing a satisfactory psychological adjustment; “For it’s a fact the whole world knows, that Pobbles are happier without their toes” (Edward Lear).

presenting
Having. As in, “The infant presented a hypospadiac micropenis” (said by doctors) or “The jogger presented a large wallet” (said by muggers).

primary hypogonadism
Primary hypogonadism reduces the body’s sex hormones due to undeveloped testes or ovaries; see micropenis, which it sometimes causes. It is not clear to the compiler of this Manual why some doctors feel that primary hypogonadism should be followed by a genital election.

post-operative transsexual
A person who has decided for him- or herself to get surgical sex reassignment. A therapist’s certificate is necessary. Those who decide on SRS for others are called specialists; surprisingly, no psychological examination is required.

pseudohermaphrodite
Pseudo means “false”; a pseudohermaphrodite is one whose falsely ambiguous genitals cruelly mislead the doctor into hopes of publication. So, at least, says pseudoscience.

res ipsa loquitur
Legal, not medical, Latin: “the thing speaks for itself.” A sponge left in a patient’s body speaks for itself, and is well paid to do so; but for the sex organ removed from the body, nobody will speak.

rights
Wrongs. In medical literature, the “rights” of the intersexed refer exclusively to their right to be modified, never to any right to remain as they are. For example, one text calls for hypospadias to be “corrected” even when it is purely cosmetic, on the grounds that “by the age of five every boy has the right to be a ‘pointer’ and not a ‘setter’.”

sex determination
1. (when used by intersexuals and their parents) Divining which sex a child is. Determine: to find out by investigation. 2. (when used in medical journals) Deciding which sex a child shall be. Terminate: to put an end to the matter.

stenosis
Narrowness. A condition of meatuses and minds.

surgical sex reassignment (infant)
Making a sow’s ear out of a silk purse. Known to cause deafness.

testosterone
An androgen taking its name from the test in which it is applied to a micropenis. Micropenises that do not grow must be cut off; if they do grow then no further treatment is needed. Compare the water ordeal, beloved of witchhunters, in which witches that float must be drowned, while those that sink may remain as they are. We Americans may be justly proud at the advances in our enlightened Society.

urologists
Those benefactors of humanity who, with considerable difficulty, distinguish intersexed infant boys from intersexed infant girls. These infants, when grown, may with equal difficulty distinguish urologists from butchers.

I pray that some day I will have the means to repay, in some measure, the American Urological Association for all they have done for my benefit. I am having some trouble, though, in connecting the timing mechanism to the fuse.

From a letter to ISNA, reprinted in Hermaphrodites with Attitude