Showing posts with label information. Show all posts
Showing posts with label information. Show all posts

Tuesday, August 7, 2018

False Dichotomies and Binary Thinking

 
(Originally published on LinkedIn)

The false dilemma is a logical fallacy that presents two options as the only available choices in a matter when at least one other option exists. When parents have toddlers, they're told to give them two choices for simplicity, so that they feel they have some control over their life, some power, but they aren't overwhelmed with options.

This is also how sex and gender are presented to us: you're either male or you're female. For most people, that isn't a problem. They readily agree with the sex they were assigned at birth, and they take pride in either conforming or not conforming to their gender roles. Not conforming is really only a pride point for those assigned female at birth because aspiring to be male is socially acceptable, but the feminine is seen as weak, "silly," and undesirable. Anything attached to the feminine is immediately considered only for those with a vulva. When something is attached to the masculine, it is considered a sign of strength and power, and thus, all are invited to participate--most of the time.

From before birth, from the moment parents get a glimpse of their offspring's genitals, they begin socializing them to either the feminine or the masculine. Expectations are lain in the moment that genitals are announced. "It's a girl!" is followed by per-condemnation of her sexual agency, sympathy expressed to the father as though a girl is a disappointment that can only bring stress. This is, of course, a self-fulfilling prophesy if the parents so choose. "It's a boy!" is followed by dinosaurs and sports and dreams that he'll be a doctor or lawyer or something big and important.

But there's a third occurrence that brings silence. No joyful declaration of the genitals unless the doctor has already decided how they are going to alter them without consent. "Intersex." Neither male nor female. Perhaps more one or the other. Many intersex individuals are missexed as male or female because their external genitalia is all that is used to determine how they will be socialized.

A growing body of support for intersex people condoning the non-consensual body modification is also attempting to bring light to the existence of intersex people, often offensively and inaccurately termed "hermaphrodite," as though they are an insect. Few people would deny the legitimacy of red-haired individuals, but they are only 2% of the population--the same percentage as intersex people. But intersex people force a reminder on society that their aggressive sexing and gendering of each other is often inaccurate. If not, then there would be a name all people know for the third sex, and a third gender, and the same joy (with maybe a little trepidation for possible medical complications) would be present in the announcement, "It's an [intersex baby]!"

Still, some acknowledgement that intersex people exist is present in the collective consciousness. But rather than see them as valid and natural, they are treated as an aberration, something to apologize for. A neutral pronoun identifier is rejected, and they are expected to conform to whatever sex they were ultimately assigned and blend in as one of the two dominant genders. Their own sex may even be hidden from them deliberately by their parents or the doctor that incorrectly sexed them at birth. They are an affront to the false dichotomy of sex.

Worse, there are those whose genital expression and reproductive systems match a chromosomal pattern that has been deemed male or female who know that they are not the gender they were told to conform to. Transgender.

There is an interesting story out there of a little boy whose mother decided that she wanted a girl so badly that she gave birth unassisted, assigned him female at birth, dressed him in girl's clothing and told everyone he was a girl, sent him to an all-girls' school, and he grew up believing that he was one. He said the he thought that maybe his penis would fall off when he reached puberty so that he would look like other girls. He socialized female.  But then one day, it was all blown open when a teacher removed his dress to protect him from a hot liquid spill and saw that he was male. Immediately, he was removed from his home, and everyone was in an uproar, calling it abuse. What he called abuse was what followed: having his hair cut against his will, being told to behave as a boy and develop masculine interests that he simply did not have, until he was finally placed with a family that allowed him to be himself. He concluded that he was definitely male, but his interests were still considered feminine--and he was still happy with himself.

Transgender children grow up in the same situation, only their genitals cannot announce to someone that they are being forced into an unnatural situation for themselves. Instead, a conspiracy forms around them to ignore that they are being harmed even more than that little boy was because no one will rescue them from the situation. In more and more cases now, parents are realizing that their children's genital configuration is not more important than their health and well-being. Children whose expressed gender identity is honored grow up happier and healthier, even if they end up being cisgender.

However, this is still primarily granted to female to male and male to female individuals. Female to third gender and male to third gender children are lost. They are given a false dilemma: are you male or are you female? Neither is a valid answer that is not being acknowledged enough. There are many nonbinary identities, from fluid (going from male to female and back) to agender (lacking gender) to bigender (simultaneously both), and more. Growing up, some of these children may present as fully transgender, or they may present as gender nonconforming within their assigned sex. "Tomboy" is a false identifier that some trans boys and nonbinary individuals assigned female at birth (AFAB) can cling to for a better way to tolerate or escape the pain and/or confusion of being misgendered.

Cisgender girls will use their own identification as a tomboy to de-legitimize the experiences of trans AFAB people, claiming that because their gender confusion vanished, it must do the same for anyone else who experiences it. This is an aggressive form of transphobia that is used to prevent medical care of trans boys and nonbinary AFAB children rather than acknowledge that there is no harm at all in giving children the safety and support to explore their genders until they are able to give words to their own identity. If a third gender were automatically acknowledged, yes, there would be more third gender children because they already exist, and they would then have the words to say so. Just as naming anything leads to discovery of more of that thing.

This isn't some new experiment, either. Third genders have existed in many cultures throughout history with no cultural pain. It is confusing why ours is so insistent on denying something that has existed as long as humans have had a sense of gender identity. The best explanation seems to be that dominant groups simply will not tolerate outsiders. Once schema is formed, it wants to be defended. The only cure for this is to establish societal change that adds third gender into the schema children are programmed with, but it is the adults that resist this, that reinforce the myth that there are only two sexes, only two genders, and that there is no difference between what is between one's legs and what is in one's heart and soul.

Cisgender people may be under the mistaken belief that transgender girls (assigned male at birth--AMAB) exist because they are told that dolls and dresses are for girls, and those "boys" are interested in such things and therefore confused that they are girls. That simply isn't true. Many boys, both cis boys and trans (AFAB) boys enjoy dolls and dresses, but they avoid them in their attempt to conform to stereotypical gender roles. Trans boys may be socialized female, but many recognize that males are supposed to behave in a certain way, and they internalize it. Trans (AMAB) girls do the same. They may show more interest in feminine iconography--dolls, dresses, makeup--simply because they want to be seen as what they are: girls. For quite some time, in order to transition, one had to prove that they were female enough to be acknowledged medically. Preferring pants and sports might get a sporty trans girl denied legitimacy. The lack of connection with gendered objects and clothes exists in trans people just as it exists in cis people. Just as there are cis girls who love sports and wear "boyshort" underwear and hate makeup and dresses, there are trans girls who feel the same. That doesn't make either group male.

But what about the third gender? Why do they know that they are neither male nor female? It is the same way that cisgender and binary transgender people know that they are male or female. In the past, Western world third gender people did what they could with what they had, just as all trans people had to. It may have been easier to be "eccentric" post-Humanism, in the Renaissance and beyond. For binary trans people, it was simpler to move somewhere that no one knew them and assume their true gender while hiding their assigned birth sex. Records of people who did this exist. This is how the medical establishment insisted trans people transitioned at one point, but that is no longer the case. With the growing body of evidence that nonbinary people have been erased via language rather than scarcity by establishing them into language, there is hope that in the future, this is a false dichotomy that will eventually be abandoned as unscientific, inaccurate, and antiquated, just as many sexist notions throughout history have been left behind.

Monday, August 30, 2010

Intact Penis Information

I have many friends who have intact sons, so I've been inundated with information about the proper care and expectations of intact penises, despite not having a son (yet?) of my own. However, despite the abundance of information available, many doctors in the US are poorly educated and give out bad information because they just haven't seen that many intact penises. The overall US circumcision rate is around 75%1 or so, though the latest statistic for new infants being circumcised is 33%2 (average--the south and midwest having the highest number, varying from 50% upward and the west having the lowest percentage) down from 57% in 1999. If these numbers are true, then doctors need to update their information for dealing with intact boys coming through their practices to properly answer the following questions.

So, let's start with the basics. How do you clean an intact penis?

Mis-educated doctors will answer with, "You gently retract the foreskin and wash with soap and water."

Except for the first part, that's right. You do NOT retract the foreskin--that is the boy's job when he is older, under his own initiative. However, simple soap and water, just like with a girl, is all it takes to clean it.

Next, is "ballooning" a cause for concern?

No. It's caused by the natural separation of the foreskin leaving pockets behind in which urine pools. It does come out eventually and in the meantime, urine is sterile. Apparently, some boys like to play a game that causes ballooning (which is messy but harmless). The biggest concern is that there is an obstruction to voiding, but under study, this was shown not to be so. 3 As long as there is no pain or infection, this is a normal process, particularly around the age of 3 and should go away as he gets older.

When should the skin retract?

This is the most common source of concern for parents of intact boys. The first study done on this subject only followed boys for 5 years who were forcibly retracted from infancy and thus, states that 90% of boys will retract by age 5. This study was refuted over and over and the current advice is that it will retract by puberty. Now, the misunderstanding comes with "by puberty." In fact, it is by late puberty that one should expect retraction (age 15-17, though 5% of men remain non-retractile until the early 20s when, anecdote suggests that most of the remaining men gain the ability to retract, but no studies have been done). At age 12-13 (early puberty), 40% of boys remain non-retractile.4

So, the answer is, it should retract by age 17, but a very small number of men don't retract until age 20 or later. Only the boy should retract his foreskin and he should be advised not to do so where he experiences pain. Forced retraction can cause iatrogenic phimosis,5 which causes the foreskin to be too tight to be retracted or scarring from torn adhesions that can cause the foreskin not to retract properly later and can cause severe pain when retraction occurs.

My son has been diagnosed with phimosis and I've heard that circumcision is the only treatment. Is this true?

First, there are two different kinds of phimosis. Phimosis is a condition where the foreskin either cannot retract or when it does, it chokes or creates a "waist" on the penile shaft, resulting in damage or pain. Pysiological phimosis is the natural period in which the foreskin is non-retractile. Pathological phimosis is problematic and typically caused by Lichen sclerosus, scarring caused by forcible retraction or Balanitis.

Pathological phimosis can be treated with steroid creams (4-6 weeks) 6 (note, in this study, it's stated that circumcision is mandatory following failure, but this is not so, three other, yet still surgical in two cases, options remain), balloon stretching7, dorsal slit8, preputioplasty9 and finally, circumcision, but pathological phimosis is an adult condition, typically. If the boy is experiencing issues with pain, inability to urinate or frequent infections and phimosis is diagnosed, it may be in his best interest to look begin non-surgical treatments first and if the condition persists, consider corrective surgery with circumcision as a last resort (unless he is mature enough to decide that circumcision is preferable).

So, those are the most common questions about care of the intact penis. You can do more reading here: http://www.cirp.org/library/normal/
and here: DAC faq sheet on intact penile care


In regards to circumcised penises, US doctors are well versed and are capable of answering parent's questions and concerns about penile care. Caution needs be exercised when cleaning until it's healed and then normal washing, the same as an intact penis, is all that's needed.10