Intersexuality and sexual rights in southern Brazil

Abstract

This paper reports of the socio‐medical management of intersexuality in a teaching hospital in southern Brazil. Findings reveal that the ‘search for sex’ in the body treats sex as a medical‐diagnostic category constructed during decision‐making negotiations. In the course of the various bodily ‘regulations’ and ‘corrections’ imposed, the insufficiency of a model in which categories are based around a sexual dichotomy is revealed. By questioning this dichotomy, it is possible to examine theoretical and ethical limits circumscribing the field of bioethics and the notion of sexual rights as human rights. The paper also explores the tensions that can arise from the application of sexual rights to health issues in general, and the medical sphere in particular.

Résumé

Cet article rend compte de la gestion sociomédicale de l'intersexualité dans un hôpital universitaire du Sud du Brésil. Les résultats révèlent que la «détermination du sexe» dans le corps aborde le sexe comme une «catégorie médico‐diagnostique» qui se construit au cours des négociations menant aux prises de décision. Au travers des diverses «régulations» et «corrections» corporelles imposées, l'insuffisance d'un modèle dans lequel les catégories se fondent sur une dichotomie sexuelle est révélée. En remettant en cause cette dichotomie, il est possible d'examiner les limites théoriques et éthiques qui circonscrivent le champ de la bioéthique et la notion des droits sexuels en tant que droits humains. L'article explore aussi les tensions pouvant émerger de l'application des droits sexuels aux questions de santé en général, et en particulier à la sphère médicale.

Resumen

En este artículo describimos la gestión sociomédica de la intersexualidad en un hospital docente al sur de Brasil. Los resultados indican que en la ‘búsqueda de sexo’ en el cuerpo, el sexo se clasifica como una ‘categoría médico‐diagnóstica’ que se interpreta al negociar la toma de decisiones. En el curso de varias ‘regulaciones’ y ‘correcciones’ corporales que se imponen, se observa la deficiencia de un modelo en el que las categorías se basan en una dicotomía sexual. Al cuestionarnos la dicotomía, es posible analizar los límites teóricos y éticos que definen el campo de la bioética y la noción de derechos sexuales como derechos humanos. En este ensayo también evaluamos las tensiones que pueden surgir en la aplicación de los derechos sexuales en cuestiones sanitarias en general y especialmente en el entorno médico.

Keywords:

• intersexuality
• sexual rights
• human rights
• bioethics
• Brazil

Acknowledgements

My great thanks to Mauro Cabral for his valuable commentaries and our stimulating discussions and to Daniela Riva Knauth for her constant support and assistance in relation to this study.

Notes

To coincide with the 6th IASSCS Conference (27–29 June 2007) organized at Cayetano Heredia University in Lima, Peru, a competition was held for the best paper presented by a new researcher. In this issue of Culture, Health and Sexuality, we have the pleasure of publishing the paper awarded the first prize.

1. All names of people and places have been changed to preserve anonymity. Medical professionals are designated according to specialty, with genders assigned randomly.

2. August 2006 saw the publication of the Consensus Statement on Management of Intersex Disorders, also known as the ‘Chicago Consensus’, a medical consensus which suggests the use of the term ‘Disorders of Sex Development’ (DSD) in place of ‘intersex’ or ‘intersexual states’ (Lee et al. 2006).

3. In Brazil, interns are recently graduated doctors carrying out a period of specialisation at the hospital, in, for example, surgery, paediatrics, cardiology, and so on.

4. The karyotype is defined as the chromosomal set of a species. The expressions 46XX and 46XY are a biomedical convention, in which 46 indicates the total number of chromosomes of the individual and XX or XY refer to the so‐called ‘sex chromosomes’, being one of the pairs of that set.

5. This study is part of broader doctoral thesis research in social anthropology at the Universidade Federal do Rio Grande do Sul (Machado 2008).

6. It should be pointed out that the material used in this study is the result of field work undertaken before the publication of the Chicago Consensus, with its proposal for review of the ‘intersex/intersexual states’ terminology for DSDs (Lee et al. 2006).

7. The first intersex activist group, the Intersex Society of North America (ISNA), appeared in the USA in the 1990s. This group began to promote the use of the term DSD (without, however, abandoning the term intersex). In fact, ISNA founder Cheryl Chase was one of the 50 participants in the ‘International Consensus Conference on Intersex’ who produced the ‘Chicago Consensus’. Available from: http://www.isna.org [Accessed April 2007]. ISNA has recently closed its doors, but it has originated a new organization, called ‘Accord Alliance’. Available from http://www.isna.org [Accessed May 2008].

8. For example, certain samples had to be sent to the state of São Paulo or out of the country in order to be analysed, not because of a lack of human resources, but because of lack of relevant technology.

9. For the so‐called Principlist Bioethics, there are certain universal principles to be taken into account in reaching a good decision: autonomy, justice, beneficence and non‐maleficence. See Beauchamp and Childress (1979).

10. It is important to stress that there are, however, certain tendencies within bioethics that already incorporate a human rights perspective. See, for example, Diniz and Guilhem (2000) and Diniz (2001).

11. Personal communication.

12. The argument based on ‘the best interests of the child’ also appears in the data presented by Elizabeth Zambrano et al. (2006), when dealing with the discourses for or against ‘families with homosexual parents’.