About Intersex

Intersexuality and Scripture

"Is it a boy or is it a girl?" This is generally the first question asked after the birth of a baby, whether by the newly-born infant's mother, father, their relatives or their friends. As what is perhaps the earliest interrogation of a neonate's identity, it is treated as peculiarly fundamental, and clearly involves the assumption that any given person is indeed invariably either unequivocally and exclusively male or unequivocally and exclusively female in physical terms. This assumption is indeed borne out in the majority of cases and a straightforward answer to the question can be given. In a relatively small but significant minority of cases, however, this is not so. Something in the order of one in 2,000 infants is born intersexed [1], that is to say, with a body which is in some significant respect neither unequivocally and exclusively male nor unequivocally and exclusively female.

There does not appear to be any single canonical definition of intersexuality. The best one known to me is one put forward by Cheryl Chase, the Executive Director of the Intersex Society of North America (ISNA), in the course of a discussion in which I was involved. Cheryl Chase characterised intersexuality as atypical congenital physical sexual development, and this rough-and-ready definition manages to include all and only those who are liable to be identified and subjected to medical treatment as intersexed. In many (but not all) cases, the genitals of newly-born intersexed infants look ambiguous, and it is generally this which makes it difficult, if not impossible, truthfully and unequivocally to say whether the infant is a boy or a girl. It is important to note that "intersex" is an umbrella-term which covers a range of degrees and types of ambiguity which can come about in different ways.

At a genetic level, generally speaking, people have two sex-determining chromosomes, one of which is what is called an "X" chromosome because of its shape when examined under a microscope, and the second of which may be either another "X" chromosome or a "Y" chromosome - so-called because it is Y-shaped. As a rough rule-of-thumb, two "X" chromosomes in combination in each cell of a person's body yield a feminine bodily type, and an "X" and a "Y" chromosome in combination yield a masculine bodily type. In what follows, I shall refer to these combinations as the "XX" and "XY" chromosomal patterns respectively.

Intersexuality sometimes results from the breakdown of this rule-of-thumb in connexion with the "XX" and "XY" chromosomal patterns. There is a syndrome called "Androgen Insensitivity Syndrome" (AIS), for example [2], in which the sex-determining chromosomal pattern is XY, but in which people are born with either clearly female or ambiguous genitalia. While still in the womb, the gonads of people affected by AIS develop into testes rather than ovaries, and their testes produce the male hormone testosterone, but a peculiarity of their cells connected with the syndrome makes it impossible for testosterone to masculinise their bodies. In the absence of a masculinising hormonal trigger, or when the masculinising effect of such an hormonal trigger is blocked, any foetuses develop along feminine lines: developmentally, female bodiliness rather than male bodiliness is nature's "default". The genitalia of people with complete AIS are unequivocally female in form, as is the way in which the body develops with puberty, although the vagina is often short or rudimentary, and infants with the complete form of the syndrome are almost invariably classified as female at birth, raised as girls, and identify as female. Investigation (not infrequently initiated because of a failure to menstruate with the onset of puberty) reveals the absence of a womb and shows the gonads, which are in the abdominal cavity, to be testes. There are various degrees of partial forms of AIS, in which genital appearance ranges from predominantly masculine, through a range of "in-betweens" in which an infant could be described with equal justification as having a clitoris which is somewhat larger than usual or a smaller than usual penis, to predominantly feminine. There is a similar range of ambiguity running from fully developed vaginal labiae (the lips of the vagina) to fully-developed scrotal sacs, and these too are encountered  in many forms of intersexuality in general and in partial AIS in particular.

Congenital Adrenogenital Hyperplasia (CAH), in which the adrenal glands produce a hormone which has a masculinising effect on people with the XX chromosomal pattern from the time they are in the womb, sometimes results in virtually complete masculinisation of the genitalia and of the body from puberty onwards, and it too can produce a range of degrees of genital ambiguity. In what is called Klinefelter's Syndrome, the cluster of sex-determining chromosomes is XXY rather than XX or XY and, although the vast majority of people born with this syndrome are classified as male at birth and live and identify as male, it is a moot question as to whether the chromosomal pattern is to be construed as XX - notionally the "female" pattern - with an extra "Y" chromosome, or whether it is to be construed as XY - notionally the "male" pattern, with an extra "X" chromosome.[3] Many other forms of "gender-blending" at the chromosomal, gonadal, genital and hormonal levels, occur in nature and are manifested in intersexuality. There are cases of what is called "chromosomal mosaicisms", in which some of a persons's tissue consists of cells containing the "XX" chromosomal pattern, while other tissue consists of cells the "XY" pattern. The gonads are sometimes mixed, including both an ovary and a testis, what is called "an ovotestis" (a mixture of both ovarian and testicular tissue) or rudimentary ovarian and perhaps testicular streak-tissue which does not constitute a developed gonad or set of gonads.[4]

As a brute physical phenomenon, the bodiliness of people who are born intersexed challenges cherished assumptions about sex and gender made by many people within Western society.  A variety of social institutions, including the dominant canons of medical practice and conceptions, much of the domain of the law itself, and some of the religious teachings which have loomed so large in the history of the West, tend strongly to support the notion that sex and gender is a dichotomy, and that any given human being is either determinately and unequivocally male or determinately and unequivocally female.[5]   Congenitally intersexed physicality gives the lie to this dichotomous model of sex and gender.  It is scant wonder, therefore, that fundamentalist Christians, who could be expected strongly to support the dichotomy which looms so large in the idealised model of the family, should feel threatened by the phenomenon of intersexuality and should seek to find religious arguments against it.  It is not uncommon for Christian fundamentalists, faced with intersexuality as a brute fact, to adduce scriptural grounds for the condemnation of avowed intersexuality, at least, as "unnatural" and as something which is at odds with the will of God as expressed in the order of creation.  This theological condemnation of lived intersexual identities also finds expression in unconditional support for surgical interventions, as early as possible, aimed at making the unacceptably ambiguous bodies of intersexed infants and children conform to the dichotomous model in which there is no room whatsoever for ambiguity.  Such apparently religiously-motivated endorsement of surgery is insensitive to the fact that in most cases surgery is not necessitated by any real threat to the life or health of the infant, so that it is purely cosmetic in character.  It is also insensitive to the fact that such aesthetically-driven surgical interventions frequently give rise to medical problems later in life, and can therefore be directly detrimental to the health of an otherwise flourishing intersexed person.[6]

Two Biblical proof-texts in particular tend to be cited as part of this rejection of intersexual identities and to provide scriptural support for the argument that intersexed bodies must surgically be cut into conformity with the male/female dichotomy.  The first of these texts is Genesis 1:27:

 'So God created man [the Hebrew is "Adam"] in his own image, in the image of God he created him; male and female he created them.'

This is claimed to show that human beings are, by virtue of the divine ordering of creation itself, either male and not female or female and not male, and that nothing intermediate or ambiguous is sanctioned.  The second of these proof-texts is Numbers 5:3 which, in connexion with those who contract particular ritual defilements, commands that "you shall put out both male and female".  Those who brandish this verse argue that "both male and female" means everyone who is human, and that this implies that the scriptural criterion for being human excludes anyone who is not unambiguously male or unambiguously female.  Both proof-texts, but particularly Genesis 1:27, are cited in defence of an absolute division between the sexes which will not tolerate anything in between.  Let us therefore look at Genesis 1:27.

I am not personally a Biblical literalist, and doubt that the two Biblical stories of creation (a priestly account, in Genesis 1:1-2:3, and what is called the Yahwist's account, in Genesis 2:4-2:24) were even intended to be taken literally. For all that, it is interesting to note that Genesis 1:27, the proof-text for Biblical literalists who wish to argue that hermaphroditism is somehow unnatural or unscriptural, is perhaps more "herm-friendly" than many Biblical literalists realise or than translations suggest; and there are early Jewish exegetical traditions which undermine its use as a scriptural warrant for the rejection of intersex identity.>

Both Genesis 1:27 and Numbers 5:3 have sometimes been used, in discussion with me, to argue that God created all human beings determinately male or determinately female with nothing in-between. At a more personal level, they have also been used to argue that an intersexed person such as me does not satisfy the Biblical criterion of humanity, and indeed even that it follows that I am congenitally unbaptisable and must therefore be said not to have been baptised validly.[7] The use of either of these passages in this way is in fact odd and indeed rather comical, for there is a Rabbinical gloss on Genesis 1:27 which suggests that "Adam", at least, most certainly did not have a clear and unequivocal gender identity, and indeed that Adam was an hermaphrodite.

The verse states, in the original Hebrew: "va-yivra' 'elohim 'et ha-adam be-tzalmo, be-tzelem 'elohim bara' 'oto, zakhar u-neqevah bara' 'otam", 'and God created the man in his image, in the image of God he created him ['oto, masculine singular, matching the gender of the noun "'adam"], male and female he created them ['otam, masculine plural this time, which can also be used for sets of nouns which include masculine and feminine nouns]'. The shift from "'oto" (singular) to "'otam" (plural) with reference to "ha-'adam" ("the man") is odd, and it seemed clear to the Rabbis that it begged explanation. It is against this background that the following tradition is found:

'Rabbi Yirmiyah [Jeremiah] ben 'El'azar said:

When the Holy One Blessed be He created the primal man ["the primal Adam"], he created him an androgyne, and it is therefore said: "male and female he created them" (Genesis 1:27).'[8]

This is an anecdotal gloss, of course, but it responds to the undeniable oddness of the grammatical shift from singular to plural in the Hebrew. The very fact that the language of the verse gave rise to this gloss in a religious context which valued careful attention to the fine detail of the text is surely telling. It suggests that to use the verse in support of a razor-sharp division of humankind between male and female is perhaps misguided.

What, then, of Numbers 5:3? The phrase which tends translated as "male and female", and which is taken to imply that the division between male and female is an all-inclusive and immutable dichotomy  ratherthan a continuum, reads " mi-zakhar ve-'ad neqevah", "from male to female", in the original Hebrew. The form "from A to B" which is used here, however, surely suggests a continuum of some sort - precisely the kind of continuum which Biblical  fundamentalists allege to be unscriptural. The form itself points to the logical possibility that there are "in-betweens". It is thus clear that examination of the original Hebrew has again revealed that it is not the best verse to use if one wants a proof-text to "demonstrate" that physical intersexuality is an offence against the divine order of creation.

On the subject of Rabbinicaltraditions about intersexuality, Tractate Yevamot in the Babylonian Talmud (leaf 64a) contains a tradition to the effect that Abraham and Sarah were intersexed. It states:

'Abraham and Sarah were [each of them a] tumtum, as it is said: "Look to the rock from which you were hewn, and to the quarry from which you were digged" (Isaiah 51:1) and it is written: "Look to Abraham your father and to Sarah who bore you" (Isaiah 51:2). Rabbi >Nahman said in the name of Rabbahar >Abuha: Sarah our mother was an 'aylonith, as it is said: "Now Sarai was barren; she had no child" (Genesis 11:30) - she did not even have a womb.'

The terms "tumtum"  and"'aylonith" are intersex categories. A tumtum is a person whose physical sex is indeterminable because there are apparently no genitalia, although determinate natal sex can sometimes (but only sometimes) be revealed by means of the surgical removal of an occlusion.[9] An 'aylonith is a woman without a womb - clearly someone who might suffer from complete androgen insensitivity syndrome. The Talmudic Rabbis were observant and shrewd, and seldom "missed a trick". It is therefore not surprising that there are Talmudic references to other intersex conditions. A modern commentator speculates that  one type of condition in this category noted in the Mishnah and Talmud corresponds to  Klinefelter's Syndrome.[10] While the Rabbis knew nothing about the genetic underpinnings almost two millennia ago, they certainly recognised that there were people who were intersexed.

The assertion on the basis of Isaiah 51:1-2 that both Abraham and Sarah was each a tumtum is apparently obscure, but the logic is roughly as follows. Verse 51:1 suggests that Israel owes its existence to the intervention of God, who hewed out from a metaphorical rock, and dug out of a metaphorical quarry. The references to the rock and to the quarry in 51:1 clearly stand in apposition to the references to Abraham and to Sarah in 51:2. Abraham is therefore to be identified with the rock, and Sarah with the quarry. This raises a question, however: why should God be said to have intervened, and why was the intervention compared to the hewing of something out of a rock (a stone cube, for example, does not emerge spontaneously from a piece of granite, and the nature of the rock has to be overcome in the hewing) or to digging something out of a quarry (where again, the nature of the rock of the quarry has to be overcome in the digging)? Hewing and digging are actions which involve substantial effort. The suggestion thus seems to be that the birth to Abraham and Sarah of Isaac, from whom is descended, somehow required that God miraculously overcome an impediment in the natures of Abraham and Sarah which was considerably more of a challenge than the passage  of  anno Domini. The gloss therefore reads into this a hint that Abraham and Sarah were congenitally incapable of procreation by nature.  This is why one gloss states that each of them was a tumtum, and the second gloss in the passage holds that Sarah was affected by complete androgen insensitivity syndrome or by some other intersex condition with a similar bodily upshot.

These two glosses about Abraham and Sarah, like many Rabbinical exegetical glosses of an anecdotal rather than of a legal character, are perhaps a trifle far-fetched and quaint; but they do make it abundantly clear that those who, more than any others, cherished and preserved the Hebrew text of scripture and sought faithfully to ensure that no scriptural  "jot and tittle" was changed, did not see intersex conditions as falling under the condemnation of the canon of Hebrew scripture. Quite to the contrary, they contemplated with equanimity the possibility that leading and revered scriptural characters were intersexed.

Let us return to the main proof-text used by fundamentalists who wish to argue that intersexuality is condemned by scripture. I noted earlier that there is a syntactic ambiguity in Genesis 1:27 which led Jewish commentators to suggest that our species was originally created androgynous. The syntactic ambiguity and this particular Rabbinical gloss were taken up by some of the philosophers of the Renaissance, who viewed hermaphroditism as a mark of an original wholeness which had subsequently been lost. Far from being seen as the result and mark of sin, the original hermaphroditism of our species was viewed by these philosophers as a mark of  perfection which was subsequently lost, perhaps in consequence of sin. There is also a gloss on Genesis 1:27 attributed to a Rabbi Shmuel bar Nahman, again in Midrash Bereshit Rabbah 8,[11] which suggests on the basis of the syntactic ambiguity that the primal Adam was created Janus faced - presumably male on one side and female on the other - and that the two halves were subsequently severed. The story of the formation of Eve from "Adam's rib" does not tell against this, because the word ", translated here as "rib", is used elsewhere to refer to a section, wing (as in "the west wing of the building") or half of a structure. It should be noted that this construal of these verses depends on the literal sense of the verses: they draw directly upon the lexical sense of the Hebrew words which are used in the passage. 

The gloss about the original hermaphroditism of the primal "Adam" suggests that fundamentalists ought perhaps to consider it a grave sin against revelation to view intersexuality as "unnatural" or as "the consequence of Adam's sin" for, as the gloss suggests, hermaphroditism predated Adam's sin. It would seem to follow that it is the birth of people who are not hermaphrodites which might be "the consequence of Adam's sin".  Hermaphroditism should perhaps be seen as a reminder of the "original innocence" and perfection before sin distorted it.  Many scriptural fundamentalists read scripture very selectively, treating all-too-fallible translations as infallible, belittling the original text of scripture in practice, and ignoring implications of particular passages which, unpalatable though they might be from their point of view, can nevertheless legitimately be teased out of the original texts.

It might also be noted that, rather than supporting the imposition of surgery, Biblical literalists should be persuaded by the letter of Scripture to be very suspicious indeed of genital surgery imposed upon intersexed infants when no intrinsic risk to life and physical health is demands it. The removal of gonads and other such surgery is explicitly forbidden by Scripture (see Deuteronomy 23:1, for example), at least where there is no intrinsic risk to life.  The burden of scripture is in fact such that those who take its exhortations seriously should positively welcome the notion of a spectrum which includes people who are intersexed.  Biblical literalists are indeed arguably bound by Scripture to respect the sense of many people who are intersexed that violence was done to them in infancy by the imposition of what was in effect cosmetic surgery, and to accept that it is right and proper that those who are born intersexed be enabled to remain physically as they are and to identify as intersexed.[12]