The plight of South African athlete Caster Semenya, whose female sex was questioned a few years ago by the sporting authorities, has brought the phenomenon of intersex into public consciousness. This naturally occurring bodily state has been subject to much medicalisation, secrecy, and surgical ‘normalisation’, leading to stigma and feelings of abjection and freakishness in those affected.

My PhD thesis looks at the experience of 114 intersexed individuals who are at the female end of the continuum of male-female body forms. They are termed XY-women, that is, they have XY sex chromosomes, intra-abdominal testes in place of ovaries, have no uterus, but have a completely female external genital appearance. One such diagnosis is Androgen Insensitivity Syndrome (AIS). A male (XY) foetus cannot respond to its own masculinising hormones, and in the onward development of its external body form it follows what medicine classes as the default female path.

Such conditions are conceptualised by medicine as a failure to masculinise, whereas affected individuals who are at the female end of the spectrum view themselves as under-feminised, infertile females. Many have no idea of their difference until they fail to menstruate at puberty.

Most will have their internal (intra-abdominal) testicular tissue removed, ostensibly to avoid a risk of cancer, but possibly also to rid female bodies of so-called ‘male’ tissue. The cancer risk is currently estimated to be 0.8% in the ‘complete’ form of AIS (CAIS). Compare this to a 12% risk of breast cancer in the female population as a whole. Breasts are not removed prophylactically from young women.

Mine is a mixed methods study, spanning medicine, clinical psychology, sociology and gender theory. It looks at how these individuals discovered their diagnosis and how they negotiated a path through eight notional subject positions based on medical paradigms and sociological labels.

My study examines whether feminist gender theory has a part to play in rescuing these individuals from the essentialist medical view of their bodily status, and offering a more holistic alternative to the standard androcentric medical discourse. Patients are usually left to their own devices to cope with such a diagnosis and I advocate more specialist clinical psychology, and specifically psychology that is informed by feminist gender theory, such that additional possibilities are opened up beyond the standard ‘male’, ‘female’ or ‘abnormal’ offered by medicine.

I hypothesise a four-stage process that these individuals might go through, with the help of psychological support, in some ways similar to Elizabeth Kubler Ross’s stages of grief:

• Biological essentialism – “I have a Y chromosome and have/once had internal testes, this must make me male. How can this be, because I look and feel like a woman? I must be a one-off freak.” This is the stage that some are stuck in, especially just after learning their diagnosis.
• Discursive production – “I have a Y chromosome and have/once had internal testes, but these male elements are abjected/irrelevant. My female gender precedes, and determines my sex. My sex is female.” This is a stage that many come to adopt.
• Corpo-real(ity) acceptance – “I have a Y chromosome and have/once had internal testes, I embrace the language of intersex. My sex is intersex (or male). My female gender thus makes me an intersexed woman.” This is a stage that some attain, but many reject.
• Different ‘sexual difference’ – “I have a Y chromosome and have/once had internal testes. I am a different sort of woman/female, which may not be defined in standard male/female terms.” This is a stage that I think could be worth aiming for.

French poststructuralist feminist writers such as Luce Irigaray and Helene Cixous advocate a more fluid notion of female embodiment. They argue against spatialised (masculine) models of corporeal containment, based on ‘optics’, ‘straight lines’, ‘self-contained unity’ and ‘solids’, in favour of one modelled on a conceptualisation of feminine desire as rich and plural. Irigaray’s conception is expressed as “this sex which is not one”, (Luce Irigaray, This Sex Which is Not One, Cornell University Press, Ithaca, N.Y., 1985) that is, men having one organ (penis/phallus) and women having several (clitoris, labia, vagina). It is based also on touching (including the notion of the two vaginal lips always being in contact) rather than looking, and a self that exists not by repulsion/exclusion, but via interpenetration of self with otherness. Cixous argues for the possibility of a ‘bisexuality’ (not, I think, referring to orientation, but to sex) rather than a denial of sexual difference; one that involves a lived recognition of plurality and the simultaneous presence of masculinity and femininity within an individual subject (M. Sarup, An Introductory Guide to Post-structuralism and Postmodernism, Harvester Wheatsheaf, 1993).

Professor Irigaray’s early work suggests that women in general should seek a more self-referential identity situated directly in their ‘otherness’ not only from men, but from women also, in order to break away from the single restrictive category of ‘woman’ (Luce Irigaray, op. cit.). Irigaray’s early form of sexual difference feminism, although it pays attention to nature and to autonomy in a way that seems useful to XY-women (but which possibly met with some resistance within feminism in the 1980s) focuses on the symbolic constitution of sexual difference, i.e. ‘male’ and ‘female’ as identities or positions made available within the symbolic order (broadly, the linguistically articulated realm of culture and meaning) and in opening up the project of transforming received patterns of symbolism by reconceiving female identity positively (A. Stone, Luce Irigaray and the Philosophy of Sexual Difference, Cambridge, Cambridge University Press, 2006, pp, 4-5).

Irigaray’s later thought, it seems, is one that ascribes greater value to nature and matter, relative to culture and meaning, and is an area that I didn’t explore in my thesis but would like to understand better. My understanding of Irigaray’s later conception of sexual difference, from reading Stone’s account, is that she returns to nature, but not as a static realm of fixed forms, but, thater, as a process (or set of processes) of open-ended growth and unfolding, such that sexual difference is based on the different rhythms of male and female bodies rather than on bodily forms or capacities such as menstruation or child-bearing,  and on men and women experiencing different “worlds” or “relational identities”.

I have found Professor Irigaray’s notion of sexuate difference with its emphasis on an ontological difference between the sexes – but one which pays respect to nature and the body, and to differences between women – to be particularly useful.