Against the quiet revolution: The rhetorical construction of intersex individuals as disordered

What is intersex?

An intersex individual is generally understood to have biological characteristics that are not easily classifiable as either male or female. Formerly known as Hermaphroditism, intersexuality may physically manifest as atypical sex organs, which have historically been referred to as ambiguous genitalia. However, not all intersex variations result in external physical differences; in some cases, the divergence from typical development manifests in one’s internal gonads or as chromosomal anomalies. As such, many identify intersexuality as an umbrella term for a host of ‘congenital conditions in which the development of chromosomal, gonadal, or anatomical sex is atypical’ (Lee, et al., 2006: 488).

Although conservative estimates suggest that intersex may exist in one in every 4500 births (e.g., Vilain, 2006), it is more likely, after accounting for underreporting and including all of the major variations, that it is actually closer to one in every 1500 births (Blackless et al., 2000; ISNA, 2005a). Gurney (2007) points to even higher frequency. She writes, ‘Some researchers now suggest a frequency of 1.7 intersexed births per 100, with surgical rehabilitation required in one in 2000 births’ (Gurney, 2007: 626). Diamond (2007: 37), one of the leading experts of intersexuality, says that the best data suggest and consensus is increasingly growing that ‘more than one in every hundred newborns has an intersexed condition.’ Of course, certain intersex variations have a higher incidence than others and depending on the specific hormone levels or genetic configuration, a variety of atypical variations may result. The most common of such variations are Klinefelters, Congenital Adrenal Hyperplasia, complete and partial Androgen Insensitivity Syndrome, gonadal dysgenesis, (Blackless) and hypospadias (Accord Alliance, 2011).

Cut now, ask later: The medical mismanagement of intersex

Although treatment differs according to the specific variation, several themes recur in discussions of historical medical handling of intersexuality. Theorized in and supported by the work of John Money and Anke Ehrhardt, the predominant 20th-century treatment of intersexuality rested on several assumptions: First, individuals are psychosexually neutral at birth; and, second, healthy psychosexual development is dependent on the appearance of normal genitals (Diamond and Sigmundson, 1997). Money and his supporters held that:

Gender identity arises primarily from psychosocial rearing (nurture), and not directly from biology (nature); that all children must have their gender identity fixed very early in life for a consistent, ‘successful’ gender identity to form; that from very early in life the child's anatomy must match the ‘standard anatomy for her or his gender; and that for gender identity to form psychosocially boys primarily require ‘adequate’ penises with no vagina, and girls primarily require a vagina with no easily noticeable phallus. (Dreger, 1998: 27)

As a result of such an ideology, 20th-century management of intersexed infants relied on medical interventions to create the appearance of a ‘normal’ child. Practitioners turned to cosmetic genital surgeries on infants and administered hormone therapy to adolescent youth (Haas, 2004). Doctors often concealed necessary information from parents in fears that parents would feel guilt or shame about their child or because they were worried parents would stray from interacting with their child in accordance with the selected gender. Parents, in turn, would keep the information from their child, either out of ignorance or in hopes of ensuring proper gender role development. Unfortunately, lack of information and repeated doctors visits often left children feeling humiliated and stigmatized (Dreger, 1998; Preves, 2003). Further, confidentiality was often forgone for the sake of medical understanding. Colapinto (2006) describes that doctors commonly used the bodies and genitals of intersex children as learning and teaching tools for themselves and young medical residents. Labeled by some as the ‘concealment-centered paradigm of intersex treatment’ (Dreger) and by others as the ‘cut now, maybe ask about quality of life later’ (ISNA, 2005b: para. 2), this approach maintained its position as preferred treatment regimen for over 60 years.

Worried about the dangerous effects of the surgical model of treatment, members of the Intersex Society of North America (ISNA) and its supporters started a crusade in 1993 aimed at ending what they saw as the medical mismanagement of intersexed individuals. Although frustrated for over a decade by the lack of knowledge on the subject, doctors’ stubbornness, and a host of other constraints, they continued to push hard for alternative treatment regimes and more sympathetic perspectives. Their calls were partially heeded in 2005 when the Chicago conference occurred and produced its consensus document.

The report, published in 2006, suggested that, in addition to adopting a new nomenclature for describing intersexuality, doctors should adhere to the following guidelines for appropriate medical management:

(1) Gender assignment must be avoided before expert evaluation in newborns; (2) evaluation and long-term management must be performed at a center with an experienced multidisciplinary team; (3) all individuals should receive a gender assignment; (4) open communication with patients and families is essential, and participation in decision-making is encouraged; and (5) patient and family concerns should be respected and addressed in strict confidence. (Lee, et al., 2006: e490)

Many intersex advocates hailed the new recommendations an enormous success. As Weil (2006: 2) argues, ‘Where the consensus departs from tradition is that it also instructs doctors to discourage families from rushing into surgery.’ Further, the report stated that ‘no good scientific studies prove infant cosmetic genital surgery improves quality of life’ (Weil, 2006: 2). It also satisfied many because the report asked for open communication between patients, parents, and the multidisciplinary medical team, including endocrinologists, geneticists, urologists, gynecologists, sexual-medicine specialists, and mental-health professionals. Cheryl Chase (2002: 3), the founder of the ISNA, writes, ‘Families and patients need complete and honest medical information, presented in a comprehensible way’ and the report takes a step toward accomplishing this. Finally, while the report does not end all traumas surrounding an intersex diagnosis, it does promise confidential management of the intersex child’s records and treatment.

The procedural changes related to medical treatment deserve praise; however, the change in nomenclature needs to be questioned and challenged. Postponing, if not avoiding, surgery, fully communicating health information, maintaining confidentiality, and striving for multidisciplinary teams are notable reforms. However, labeling someone as Disordered works against the revolution toward productive care and the end of stigma. Of course, those who pushed for the change in nomenclature offer a robust defense of their change.

Overcoming imprecision and positively normalizing: In defense of disorders

Since the publication of the consensus document, conference participants and many others have expanded the case in favor of change. They offer several arguments in favor of their position. First, they attempt to legitimize Disorder by discrediting intersex terminology. They say the language of intersex functions incorrectly and dangerously as an identity category rather than a condition with which someone must deal. For example, the Accord Alliance (2008), an advocacy organization founded in 2008 to help carry out the objectives of the consensus statement, writes in their Glossary of Terms:

The definitions of such older terms such as ‘hermaphrodite’ and ‘intersex’ were considered problematic because of a lack of consensus on definitions and because they labeled persons (rather than conditions). Further, they implicitly labeled patients with a gender, and one that was frequently inappropriate because incongruent with the patient’s assigned or experienced gender. (‘Disorders of Sex Development’, Accord Alliance, 2008)

They recognize that the term intersex ‘is often used by adults with DSD to talk about their bodies and their experiences’ (Accord Alliance, 2008); however, they fear it is not representative of most people’s experiences. Karkazis and Feder (2008) found that some individuals frown upon the term because they are not intersexed; rather they are someone with an intersex condition. In other words, they see intersex as referring to something ‘one essentially was’ (Karkazis and Feder, 2008: 2016) and find this to be an oversimplification of their life. They worry that an unintended consequence of this is that the medical needs of those with intersex conditions can be obscured (Feder, 2009). The reasoning is that if intersex is an identity then the role of medicine is minimized, which may be a problem for those who need or desire medical intervention.

The second major argument they make against intersex is that it is imprecise and misused. Simmonds (2007), of the Androgen Insensitivity Syndrome Support Group (AISSG) in London, contends that empirical evidence suggests the term is applied by clinicians to mean only ambiguous genitalia and thus is too narrowly applied to service all interested parties. Others argue that the media and general public have historically conflated intersex with problems of sexual identity, demonstrating further lack of precision and misunderstanding of the language. Some parents also worry that having a child labeled as intersexed is ‘frightening, off-putting, and freakish’ (Reis, 2007: 537) because it implies that their child is neither boy nor girl, but rather something else entirely.

Consensus advocates argue that Disorders of Sex Development can overcome the shortcomings they perceive in the label intersex. To them, it removes any connotation of constructing an all-encompassing identity because DSD is, by definition, a condition with which one must deal rather than a truth about one’s whole existence (Reis, 2007). DSD also has the potential to appease parents because the ambiguity surrounding their child’s existence can be remedied through medical intervention. Further, they argue that it may even help to alter some of the public’s misconceptions because people are less likely to sensationalize health conditions than they are issues of sexual identity (Vilain et al., 2007).

They point out other advantages they perceive as well. First, clinicians and medical practitioners use it and understand it (Simmonds, 2007). If one accepts that intersex is primarily a medical condition and not an identity this advantage takes on more importance. Second, conceding the normalizing potential inherent in the label DSD, Feder (2009) argues that this is not necessarily dangerous: DSD can normalize in a positive sense by directing attention to appropriate and ethical treatment of various conditions. She asserts that considering the long history of medical mismanagement of intersex individuals some amount of medicalization may be allowed if it leads to better medical treatment.

On its face, the arguments made by supporters of the new nomenclature may seem sensible, and some of the arguments may truly have merit. However, the relative advantages of using Disorder of Sex Development are far outweighed by the host of problems produced by the codification of this change by some intersex advocates and the medical community. Some of their arguments display a fundamental misunderstanding of the nature of language, while others of their arguments downplay the detrimental effects of discursively pathologizing an entire population of people.

Medicalizing and coercive: Problems with Disorders of Sex Development

In the consensus statement, conference participants offered their criteria for determining preferred nomenclature:

A modern lexicon is needed to integrate progress in molecular genetic aspects of sex development. Because outcome data in individuals with DSD are limited, it is essential to use precision when applying definitions and diagnostic labels.^{3, 4}It is also appropriate to use terminology that is sensitive to the concerns of patients. The ideal nomenclature should be sufficiently flexible to incorporate new information yet robust enough to maintain a consistent framework. Terms should be descriptive and reflect genetic etiology when available and accommodate the spectrum of phenotypic variation. Clinicians and scientists must value the nomenclature’s use, and it must be understandable to patients and their families. (Lee et al., 2006: e488–e489)

Characteristic of consensus supporters’ theory of language, their call for new nomenclature asked for appropriate terms to be descriptive, classificatory, and useful for medical etiology. They applauded terms that were precise, limiting, and, most importantly for them, supported by the medical community. They found that Disorders of Sex Development was properly taxonomic (Dreger, 2007), that it fulfilled their demands for properly ‘descriptive terminology’ (Hughes, 2008: 121), and that adoption of the a new nomenclature ‘spawned a radical change in the classification of disorders of sex development’ (Hughes, 2008: 120).

Although language can be classificatory, attending only to the semantic or ‘strictly scientific vocabularies of description’ (Burke, 1969: 42) is a partial and bankrupt view. Scientists and medical personnel should ‘recognize the factor of rhetoric in their field’ (Burke, 1969: 43). It is no mystery that names have tremendous creative power. This formative potential is inherent in language. Burke (1974: 3–4) argues, ‘The magical decree is implicit in all language; for the mere act of naming a specific object … decrees that it is not to be singled out as such and such rather than as something other  … What we need is correct magic … whose decrees about the naming of real situations is the closest possible approximation to the situation named.’ Cameron (1999: 10) adds, ‘Names are a culture’s way of fixing what will actually count as reality in a universe of overwhelming, chaotic sensations, all pregnant with a multitude of possible meanings.’ Thus, once a name has been chosen it functions ontologically to bring into being a particular, singular subject.

Language also plays an important epistemological function in society. In a general sense, ‘Language mediates reality to the individual. It makes it possible for one to find one’s bearings in the world as a person’ (Luckmann, 1975: 50–51). In particular, names shape one’s orientation toward the world. A name is an ‘identifying tag that follows its referent wherever she goes’ (Margolin, 2002: para. 3). It is not something easily changed or reformed. Instead, once a name is selected, the individual receiving the name will find it difficult to detach himself from the implications of that label. This is because, as Vacarescu (2004: 3) argues, ‘There is an intimate relationship between language and knowledge, between the act of naming and that of knowledge production, a relationship in which the former influences, structures and constructs the latter.’ Thus a name is not simply an empty label; rather it plays an integral part in shaping the ‘details of everyday life’ (Vittoria, 1999: 370) and in constructing one’s reality. This is possible because of language’s ability to select certain aspects of reality while deflecting others (Burke, 1966).

The axiological implications of language cannot be divorced from a discussion of naming either. The act of naming and accepting a name conveys ‘powerful imagery’ and ‘can be a political exercise’ (Martin, 1991: 83). The ethical implications of choosing a name are an important concern and the ‘belief that some labels are more stigmatizing than others may lead to a search for an alternative label that is regarded by the person as less stigmatizing’ (Gillman et al., 2000: 395). The potential for some names to empower and for others to harm is especially evident when contextualized in a medical setting.

The language of illness, disease, diagnoses and medicine can be particularly powerful for individual understandings of self. Karkazis and Feder (2008: 2016) argue, ‘The ways we identify medical conditions—together with their permutations in labels, identities, or diagnoses attributed to (and sometimes embraced by) individuals thereafter—are freighted with meaning that is tied to a sense of self.’ Gergen, Hoffman, and Anderson (1996: 5) add, ‘Diagnoses, official and unofficial, often concretise identities that limit people; they create black boxes with few, obscure exits, and they form obstacles to more viable and liberating self definitions.’ Gillman, et al., (2000: 403) take this further and argue that diagnoses can be a form of social control that possibly ‘“bring forth” pathology, create problem saturated identities, and construct careers as patients and cases.’ Of course, the individual alone does not complete the process of diagnosis; a medical expert is an integral player in this process.

Medicine and its attendant ‘discursive practices, such as diagnosis, have been central to the construction of the subjectivity and the objectification of people’ (Gillman et al., 2000: 391). This is because the choice of terminology and the way it is presented to an individual ‘may have a profound effect’ (Wood, 1991: 534). Unfortunately, medical practitioners often are untrained in the use of ‘illness language to negotiate the relief of the sufferer’ (Good, 1977: 27). This is especially problematic because, as Mendez, Coddou, and Maturana (1988: 145) suggest, ‘society empowers certain groups of people to make definitions … of health or sickness, and in consequence, the right to be heard and be obeyed in those domains.’ Thus, if doctors are applying certain diagnoses to some patients they are not applying neutral labels for a condition; instead, they are ‘actively involved in the very production of the phenomena they represent’ (Lachmund, 1998: 780). Further, research in a medical setting suggests that social meanings attached to illness and disease have a powerful effect on standards of care and treatment options (Cottrell and Schulz, 1993; Mishler et al., 1981). Thus, the names that doctors themselves apply change their understandings of situations and people.

The implications of naming stretch beyond the medical realm; ‘the voice of medicine’ implicates the ‘voice of the life-world’ (Mishler, 1984). In other words, diagnosis ‘is often enough the legal basis for provision of health services, welfare benefits, unemployment certification, workers’ compensation claims, and legal testimony’ (Brown, 1995: 39). Additionally, the choice of language ‘influences … how parents view their affected children, how intersex people understand themselves, and how others not directly involved in medical settings—such as gender and legal scholars, historians, and media commentators—conceive of and theorize about gender, sex, and the body’ (Reis, 2007: 536). It should be clear that the choice of naming, especially in relationship to something labeled as a medical condition, has severe implications for how a person perceives him or herself and how others treat them and sets limits on the possibilities open to that individual.

In the case of intersexuality, a consortium of doctors met in Chicago in hopes of reshaping the life situation of individuals with intersex variations. They instead chose terminology that served their interests rather than those whom they were trying to serve. The Organisation Intersex International (OII, 2011: para. 2) points out, ‘The DSD Consortium consulted almost no intersexed people before making the decision to change “intersex” to “disorders of sex development”.’ In fact, only two individuals with intersex conditions in the USA were asked to participate in the conference and there was no consultation with those outside of the USA (AISSG, 2011: Against DSD c). Further, those who have since touted its success are the same people who attended the conference (e.g., Ieuan Hughes, Cheryl Chase, members of the Accord Alliance). The process has been insular and the praise, self-congratulatory.

Notably, the discussion about changing terminology was an ad hoc addition to the agenda. The initial schedule included no indication that naming or nomenclature would even be mentioned. The Androgen Insensitivity Syndrome Support Group, a predominant, international consortium of support groups for individuals and families affected by complete and partial Androgen Insensitivity Syndrome, reports, ‘The “consensus” element of the conference refers, or should [emphasis in original] refer (only) to the clinical treatment guidelines that were on the official agenda and were the main focus of discussions, and not to terminology issues (which weren’t on the agenda)’ (AISSG,2011: Against DSD). Thus, while they may have made some substantive progress in terms of minimizing or delaying medical procedures, they were not responding to the concerns or wishes of the intersex community. The decision to change terminology limited the possibilities of those they were trying to serve. Rather than empowering or helping a long stigmatized group, the doctors codified a nomenclature that works against the interests of intersex individuals and their families.

By selecting a term that served their interests as doctors, they foreclosed the possibility of denying medical treatment. By labeling intersexuality as a disorder, the medical community discursively coerced parents into selecting medical options for their newborn children. This is because the language of disorder is pathologizing; it marks the body as impaired and in need of fixing (Holmes, 2002). ‘The word “disorder” implies there is something wrong, pathological, stigmatising. Intersex, in most cases, is not life-threatening, and is only life-limiting [emphasis in original] because society, and medicine, treat [emphasis in original] it as a disorder’ (AISSG, 2011: Against DSD a). Such an understanding contradicts one of intersex advocates’ central tenets: ‘that unusual sex anatomy does not inevitably require surgical or hormonal correction’ (Reis, 2007: 538) and is dangerous because it functions to legitimate invasive medical interventions.

Further, although speaking the language of doctors might mean more recognition of different conditions by the medical establishment and even some changes in care standards, there are latent consequences to this move. Ceding control of the issue to doctors grants them a level of authority to decide the fate of a large population of people. This seems counterproductive when one thinks about the manipulation and deceit inherent in the traditional concealment model of treatment. Habermas (1984: 19) affirms this concern by arguing, ‘Instrumental categories of professional ideology come to dominate all forms of human experience.’ Further, Reis (2007: 541) queries, ‘By adopting the term disorders of sex development, and granting doctors the power to do the naming, do we, in fact, give disproportionate control to the medical establishment? I think we do.’ With the history of medical mismanagement and manipulation in mind, it is wise to keep these concerns in mind.

The choice of DSD also limits individuals who may choose to identify outside of the traditional gender binary. The Organisation Intersex International (OII), the world’s largest intersex advocacy organization, argues that there are more than two sexes. ‘There is a third, a fourth, even a fifth sex, etc. within a continuum from very female to very male’ (OII, n.d.: Q3). As such, some intersex individuals may identify as existing outside of traditional categories of ‘male’ and ‘female.’ Disorder of Sex Development is essentialist at its core because it perpetuates reliance on the binary two-sex system by assuming that there are only two naturally occurring groups—men and women—and those outside are disordered. Reliance on gender essentialism necessarily erases the experiences and even bodies of those who do not easily fit into either category. Imposition of the DSD label thus makes selection of an alternative sex category shameful and wrong and results in a definitional foreclosure that precludes viewing gender as varied.

Further, although not a concern for doctors who participated in the conference, the move away from intersex may limit the potential for building coalition. Some worry DSD is not recognized internationally or even by several domestic advocacy groups (Simmonds, 2007), which makes forming alliances more difficult. Indeed, even if the terms are seen by some as interchangeable, choosing the label Disorder of Sex Development puts one at odds with many advocacy groups who see intersexuality primarily as a problem of acquiring human rights and gaining self-determination and not a medical problem (OII, 2010). The new nomenclature is also troubling because ‘The word ‘disorder’ has a particularly nasty German equivalent (Störung) and ‘sex development’ can, in French-speaking countries, mean something entirely different and offensive’ (AISSG, 2011: Against DSD b). Fostering growth in advocacy and expanding awareness about intersexuality will require more than changes in medical procedures; thus, the detrimental implications of fracturing coalitions cannot be downplayed.

Beyond overlooking the problems that result from acceptance of Disorders of Sex Development consensus supporters inaccurately indict intersex. If one were to eschew the language of intersex one would be ignoring that many intersex people have benefited from its use. Reis (2007) argues that because intersex complicates understandings of natural sex categories and the relationship between sex and gender it has helped many whose anatomies do not fit easily into these socially constructed categories. Cameron (2006) adds that some have felt more comfortable identifying as intersexed because they are not solely female or male. For them, intersex is an accurate and accommodating concept.

Further, while there may be confusion about the term in society at large it is clear that for many the term intersex has been usefully appropriated for political purposes. Because all successes related to intersex advocacy have been achieved while using the language of intersex, it is difficult to argue that intersex cannot be successfully deployed publicly. Additionally, it is unclear that public disagreement or ignorance about the meaning of intersex is a reason to stop using it. Instead, better education efforts and public awareness campaigns may be helpful, especially since it is likely that misinformation and lack of understanding will be a preeminent concern regardless of which label is selected. As Disorder of Sex Development becomes the dominant nomenclature within the medical community, there is no evidence that the public would suddenly understand the issue any more fully.

At the same time, there is also no proof that doctors or others who currently support the new nomenclature would be convinced to abandon Disorders of Sex Development and return to intersex. It is clear that doctors have concluded that intersex is an imprecise term, ill suited for medical use. It is also clear, however, that the dangers inherent in the language of disorders must be avoided. As a response to this dilemma, some have sought an alternative to both terms.

A third way: Differences of Sex Development

Since the publication of the 2006 consensus document, several groups and a small number of doctors have started endorsing a different terminology. Advocates for Informed Choice (AIC) offers a prime example of the new approach. Dedicated to ‘promoting the civil rights of children born with variations of sex anatomy’ (AIC Homepage, 2009), the AIC uses both DSD and intersex to ‘reflect our commitment to listening with compassion and respect to all of these different groups as we work to promote the rights of affected children’ (AIC Homepage, 2009). Importantly, for the AIC and a small group of others, the acronym DSD means Differences of Sex Development, rather than Disorders of Sex Development. Medical ethicists in the UK explain:

[W]e use the terms ‘differences in sex development’ or ‘intersex’ to avoid a biased opinion. The field of intersex shows a wide range of variations from the statistically normal … Normality in medicine is a biological as well as a social criterion, and its meaning is changing over time. The notion ‘disease’ or ‘disorder’ implies that something is a relevant abnormality and that medicine is in charge of it. We want to avoid this reflex. (Wiesemann et al., 2010: fn. 1)

In further defense of Differences of Sex Development, a taskforce of UK experts in the field explain, ‘The use of phrases such as ‘differences’ or ‘variations’ in sex development may help to introduce the concept of the range of variation that may occur in sex development’ (Ahmed et al., 2011: 14). Dr Milton Diamond, medical expert on sexology and long-term intersex advocate, and University of Hawaii Law Professor Hazel Beh (2008: 5) argue that Differences of Sex Development acknowledges ‘the variations inherent in intersex conditions’ and respects the ‘notion that people are being portrayed rather than just medical disorders.’

It is unclear yet whether Differences of Sex Development will be as readily accepted at the ‘high alter of medical practice’ (Hughes, 2010: 161) as Disorders was after the 2005 conference. The fact that several European consortiums have begun to embrace Differences (e.g., Ahmed and colleagues, noted earlier) is a promising start, but more needs to happen. Hopefully, just as a ‘quiet revolution’ (Hughes, 2010: 160) swept the medical community when the initial modification of nomenclature took place, another fast reform will occur ushering in a less pathologizing term.

Conclusion

Although appropriately descriptive language is important for clarity and understanding, there is more to language. In addition to its classificatory nature, language is also rhetorical; it shapes people’s understandings of themselves, frames their understandings of their life situations, and affects human interactions. When placed in the context of medicine, the rhetorical effects of language are further multiplied. When applied to the case of intersex, it is seen that the narrow view of language adopted by consensus participants and supporters has led to the adoption of a debilitating terminology that characterizes an entire group as disordered, defective, and in need of medical intervention.

The ability of a single group to dictate nomenclature and reforms should give us pause. Although building scientific consensus is extremely important, consensus should not be taken as unanimity. Despite great intentions, the 50 participants at the Chicago conference may not have acted in the best interest of those they were trying to serve. By focusing on the interests of doctors and other medical professionals, the consensus neglected the needs of individuals with intersex variations, thus foreclosing the possibility of denying medical treatment and limiting agency in making important life decisions.

It is clear that maintaining the language of intersex is a preferable alternative to Disorders of Sex Development. By avoiding negative pathologization and allowing international coalition building, intersex can be used effectively by advocates, allies, and doctors. However, for those worried about its imprecision, a third option exists. Differences of Sex Development recognizes that biological variations occur and can be classified scientifically, but avoids the negative medicalization that results from using the term Disorder. Already accepted by some practitioners in the EU and even in the USA, it is possible a second linguistic revolution may occur in the field. Adoption of the new DSD, or Differences of Sex Development, could aid in unifying all advocates by finding a shared common ground that is void of the limitations of intersex and Disorders.

It is clear that the ‘sea change’ (Levine, 2007: 113) that resulted from the Chicago conference should not be immediately praised. Although material reforms in treatment guidelines were necessary, adoption of the new nomenclature should be slowed. Hughes (2010) might be correct that a quiet revolution occurred faster than most other medical changes; however, rapidity of reform or the speed at which doctors accepted the language should not be the standard by which we measure the consensus’s effect. The decision to adopt Disorders of Sex Development has threatened to pathologize an entire population and it did so without the group’s consent. It is clear that the consensus group prioritized precision and description as their key objectives. In doing so, they selected a term that labeled a group as defective and in need of medical correction. Only returning to the language of intersex or adopting the newly suggested Differences of Sex Development will help remedy their shortcoming.