‘A woman and now a man’: The legitimation of sex-assignment surgery in the United States (1849–1886)

Throughout much of recorded history, societies that assigned rights and duties based on sex were confounded by people with unclear sex. For the sake of maintaining social and legal order in those contexts, legal systems assigned these people to what they figured was the ‘most dominant’ sex. Then, in mid-19th century United States, a new classification mechanism emerged: sex-assignment surgery, which was imagined by some surgeons to ‘fix’ one’s physical and legal sex status permanently. Other surgeons, however, fiercely opposed the new practice. This article traces the controversy around sex-assignment surgery through three high-profile cases published in US medical journals from 1849 to 1886. Its central argument is that the more general effort to transform surgery into a scientific field helped legitimate the practice of sex-assignment surgery. Although such surgery was subject to intense moral criticism because it was thought to breach the laws of men and nature, over time, these concerns were abandoned or transformed into technical or professional disagreements. In a secondary argument, which helps explain that transformation, this article shows that surgeons gradually became comfortable occupying the epistemic role of sex-classifiers and even sex-makers. That is, whereas sex classification was traditionally a legal task, the new ability to surgically construct one’s genitals engendered the notion that sex could be determined and fixed in the clinic in a legally binding manner. Accordingly, I suggest that surgery became an epistemic act of fact-making. This evolution of the consensus around sex-assignment surgery also provides an early origin story for the idea of sex as plastic and malleable by surgeons, thus offering another aspect to the history of plastic sex.

Case Report: Prenatal Genetic Counseling to Parents of Fetuses Suspected of Having Ambiguous Genitalia

The occurrence of fetuses suspected of having ambiguous genitalia will likely increase in the future. Currently, the impact of prenatal genetic counseling on parents' understanding and psychological preparedness has not been addressed. We provided prenatal genetic counseling to parents of two fetuses suspected of ambiguous genitalia. Case 1: At 22 weeks of gestation, swelling of the labia majora, and a clitoris-like structure were noted despite 46,XY detected in amniotic fluid cells. Case 2: At 28 weeks of gestation, bladder exstrophy and a scrotum-like structure were noted. At 32 weeks (Case 1) and 37 weeks (Case 2) of gestation, we shared information with parents regarding the possible difficulty of legal sex assignment at birth, and a scenario for registration of the birth certificate. At birth, both babies presented with ambiguous genitalia. For both cases, the parents remained calm on seeing their baby's genitalia for the first time. After a month, we shared medical information with parents, including karyotype, testosterone production capacity, and surgical schedule. In both cases parents assigned their respective baby's legal sex as male. Several months later, parents were questioned on prenatal genetic counseling. Case 1: Mother, “I was prepared to address our baby's genitalia calmly.” Father, “I understood the procedure of legal sex assignment.” Case 2: Mother, “Without counseling, I would have been more upset and worried.” Father, “We were assured that multidisciplinary experts would support us.” Prenatal genetic counseling provides reassurance to parents, who remain informed and emotionally secure throughout the legal sex assignment of their child.

Sex and Gender Diversity in Southeast Asia

The United Nations human rights system has recognized rights of lesbian, gay, bisexual, transgender and intersex individuals (LGBTI), with key decisions in 2011 and 2016. To what extent are the rights of these groupings respected in Southeast Asia? The visibility of LGBTI is low in Southeast Asia and government attitudes vary. Criminal laws, both secular and Sharia, in some jurisdictions, have prohibitions, but active enforcement is rare. Discrimination in employment is prohibited by law in Thailand and in local laws in the Philippines. Change of legal ‘sex’ for transgender individuals is sometimes possible. Legal recognition of same-sex relationships has been proposed in Thailand and the Philippines, but not yet enacted. Marriage has been opened to same-sex couples in neighboring Taiwan. Laws on adoption and surrogacy generally exclude same-sex couples. So-called ‘normalizing surgery’ on intersex babies needs to be deferred to the child’s maturity, to protect their health and rights.

The Transition from Sex to Gender in English Prisons: Human Rights and Queer Theory

This paper analyses how the prison system in England and Wales transitioned from sex to gender, from the 1990s to the 2010s. It traces the succession of criteria for allocating males to women’s prisons: first genital surgery, then legal sex, and finally gender identity. These changes can be explained by two distinct forces. The first was the expansion of human rights in the spheres of imprisonment and healthcare, largely through legal decisions. The second force can be called queer theory, which inspired activists and eventually shaped media coverage. Sustained pressure on the government led in 2016 to regulations which facilitated the transfer of males to the women’s estate. Predictably, one sexually assaulted female inmates. The paper concludes with this case, which illuminates the consequences of putting queer theory in to practice.

Prevalence of antibodies against a cyclic peptide mimicking the FG loop of the human papillomavirus type 16 capsid among Tunisian women

Background In the past decades, several studies have identified cervical cancer is the second most common cancer in women worldwide and leading causes of death in developing countries. High-risk types of human papillomavirus (HR-HPV), mainly type 16, are the sexually transmitted agents etiologically linked to cervical cancer. The present epidemiological study aimed to investigate the efficacy of enzyme linked immunosorbent assay (ELISA) and assessed host humoral immune response against the oncogenic HPV-16 infection using the cyclic synthetic peptide mimicking the FG loop of the major L1 capsid protein of the HPV-16 among Tunisian women. Methods The antibody responses against synthetic peptides mimicking the FG loop of the HPV l6 major capsid protein L1 in sera and cervical secretions among 179 Tunisian women were assessed by ELISA. HPV infection was examined by a polymerase chain reaction-based method. Results The frequency of systemic antibodies, in contrast to HPV-16 DNA prevalence, was higher in women with low-grade squamous intraepithelial lesions (LGSIL) than in women with high-grade squamous intraepithelial lesions (HGSIL) (43.7% versus 14.8%; P=0.04). Compared to women from the general population, systemic IgG response frequency was significantly higher among legal sex workers (25.5%; P=0.002) and women with LGSIL (43.7%; P=0.001). In addition, systemic IgA and local IgG responses were higher, only among legal sex workers (P=0.002 and P=0.001 respectively). Conclusions Overall, the frequency of HPV DNA detection was significantly higher among women with HGSIL. We did not observe a positive IgG response in women with a positive HPV-16 infection, suggesting that the anti-peptide antibodies are protective and confirm that the FG loop contains neutralizing epitopes. This could have implications for future monitoring of women to predict clinical outcome and for the design of synthetic peptide-based vaccine.

Introduction to Camming

This chapter provides an in-depth analysis of the historical development of the erotic webcam industry. The camming industry emerged in 1996 because of two converging social phenomena: the introduction of the Internet and the popularity of non-erotic camgirls in the United States. Additionally, the explosion of amateur pornography on the Internet has led to the demystification of porn. As a result, clients, who are disproportionately cis men, have come to value embodied authenticity and realness. The chapter examines the emergence of erotic cam sites and various technological developments that furthered the growth of the industry such as Skype, social media, smartphones, and teledildonics. The inequality generated by global capitalism means that for many people around the world, the costs associated with becoming a cam model are prohibitive and access to the technologies described in this chapter are not available. While the camming industry can thus be lauded for creating an opportunity for safe and legal sex work, this opportunity is not open to the most economically vulnerable people around the world.

When Transferable Skills Can’t Transfer

In Chapter 7 the authors explore the difficulties legal prostitutes experience transitioning out of sex work. Employers often seek universal or “transferrable” skills when hiring, and are less concerned about industry or occupational experience, as long as core skills are visible on applicants’ resumes. However, legal sex workers, like other people in stigmatized occupations or industries, must often hide their work history, which creates challenges for advertising their transferrable skills. This presents a problem of mobility. In this chapter, we argue that employers’ reliance on work history transparency and their desire for transferrable skills creates a paradox for workers in stigmatized fields. These workers must disclose their work history to reveal their transferrable skills. At the same time, they often cannot disclose their work history and the valuable skills gained in their stigmatized occupations. This prevents the transfer of skills, and ultimately, mobility out of stigmatized occupations.

Life after the Brothel

This chapter focuses on the voices of ex-legal sex workers and their narratives about their time in brothels, why they decided to leave, and how they view their past lives. The perspectives of former sex workers are often different from the women currently working in the brothels, and thus these reflections present an even more nuanced understanding of life in and out of the brothels. This is a particularly vulnerable population; some of the women have moved on to illegal prostitution while others are currently in non sex-work jobs, trying to conceal their past. The women share detailed stories and perspectives about their lives in the brothels and their current realities after leaving legal prostitution. Rather than presenting their words broken apart into themes, we present each woman, her story and her experiences together so that readers can begin to see what life is like for a few women as holistic beings.