Medical Ethics and Practice

The Phallometer

When a baby is born, the customary first question everyone wants answered is whether the newborn is a boy or a girl. The answer to this question is generally sought by looking between the baby’s legs and seeing whether a phallus is discernible, and at the prominence of the phallus. On the face of it, this is straight-forward. In practice, however, far more people than is generally realised are born with genitals which are ambiguous. Such people are the majority of the intersexed, people whose physical sexual differentiation from development in the womb onwards is not typical. In such cases, there is no really straight-forward answer to the “is it a boy or is it a girl” question.

It is estimated that around one in fifty people is born with some degree of non-typical sexual differentiation. In South Africa, which is said by experts to have among the highest prevalences of intersex in the world, it is reasonable to assume that the variance from the typical is major in around one in five hundred if not more. Given a total South African population of around 48 million, this suggests that some 96 000 people or more South Africans are intersexed to a marked degree, mostly born with ambiguous genitals, and that 960 000 or more South Africans are in fact intersexed, though the degree of variance from what is typical is relatively small in most of these cases.

The use of possession as a phallus as the common-sense criterion for classifying the sex of a new-born baby is not in fact straight-forward. This is because of the way in which sexual differentiation takes place in the womb. The very same body of tissue in the embryo develops into a penis in undisputed and typical male infants, and into a clitoris in typical and undisputed female infants, and whether a phallus is deemed to be a penis or a clitoris is largely a matter of size. In the case of infants with ambiguous genitalia, it is the length of the phallus which, in the context of the standard protocol of treatment, determines whether surgery is imposed without the option to cut a culturally unacceptable phallus into conformity with the standards required by society, or whether the infant’s is left to develop without the imposition of what is in effect cosmetic surgery which does damage and is not required for the preservation of the physical health and life of the baby.

The Phall-O-Meter shown above, designed and produced in around 1997 by Kiira Triea, an intersexed activist in the USA, illustrates the way in which standard practice classifies sex and decides whether or not to impose genital surgery on infants born with ambiguous genitals. It is basically a measuring-rule (which, having been produced in the USA, is in inches). What is measures is the stretched length of a baby’s phallus. Should the stretched length of the phallus be no more than 0.9 cm, it is considered to be an acceptable clitoris and baby is classified as a girl. Where the stretched length is greater than 2.5 cm (about the size of one digit of an adult’s thumb), the phallus is deemed to be an acceptable penis, and the baby is classified as a boy. However, when the stretched length of the phallus is between 0.9 and 2.5 cm, panic spreads, alarm bells ring, medical staff run around on a state of panic, a socio-cultural state of emergency is declared, scalpels are sharpened and used, the unacceptably ambiguous phallus is cut off or cut down to an acceptable size, and baby is classified as a girl. It is not that the little body or the little phallus constitutes a danger to the baby’s health or life. Quite to the contrary, the surgical intervention typically leads to years of further surgery to seek to repair damage done by the scalpel and made worse by growth. Typically, the long-term psychological impact of all of this on the non-consenting patient is major and highly negative. As the American sociologist Susan Kessler observes, the imposition of surgery in this way is not for the preservation of the infant’s health, but rather to protect the surrounding culture from the infant’s subversive little intersexed body.

A recent article posted on Health24:
Sexual Diversity & Intersex on Health24