Ryerson Midwifery 101

Disclaimer: This description consists only of my observations and personal experiences of the MEP and by no means should it take precedence over the current or listed practices that are currently happening through the MEP. 

So, with the beginning of first year coming in, I've been inundated with questions lately about "What its going to be like" - both by students who will be starting in the fall, and by others contemplating the journey.  Of course, since I'm only beginning second year, many of these questions I can only speculate on myself, and I often find myself asking students further along in placements the very same questions.  That being said, I can speak for what first year is like, and explain some of what we understand the rest of the program to be like. 

Beginning the program is a difficult process.  Once you've been accepted, you get very little communication directly from the program.  You're left with a million questions and nobody to ask until you make contact with administration and receive your second package with some more details.  Still, none of that tells you what your schedule will be like, who your teachers will be, how much tuition and books will cost, etc.  Its a time of lots of questions.  What is the point of the courses we're taking?  Whats the content?  What's the schedule?

I won't speak to the schedules, because they will inevitably change over time.  What won't change, though, is that they're all 3-hour blocks, with the exception of Working Across Difference, which I will describe below, along (briefly) with the other core first-year courses and some FAQ's I've been getting lately.

So, the courses:
Anatomy and Physiology (full year):  This course is usually shared with the nursing students in a large auditorium.   Its a two-credit course, and goes all year.  The textbook that we used last year was Marieb's Anatomy and Physiology.  This course can get transfer credits through various means.  Some people thinking about entering the program take this course to get it out of the way.  This is a pretty good idea, although I found some strengths in taking this in combination with some of the other courses and personally think getting rid of your electives to be more important before entering the program (if you can!).  This course has two sets of concept maps for assignments, one in each semester, and a midterm and final exam in each semester.  Beware: the concept maps *will* become your worst nightmare and you will probably hate them, but you will also learn the material so well you might not need to study it later!

With Woman (first semester): A favourite of mine.  As a doula, getting to sit down and talk about birth with a midwife is just about the greatest thing in the world to do.  In this course, we learned about labor support, the *basic* physiology of birth, professional behavior, and lots of fun introductory issues in midwifery including legislation.  There's no exam for this course, but lots of other commitments.  We're assigned at least one woman to follow through the end of her pregnancy and birth (some of us were assigned 3 or 4); and we attend a midwifery clinic for a half day to sit in on prenatal appointments and observe.  These are great opportunities, especially for those less experienced with birth, but I gained a lot from them as well.  There's no exam for the course, however there are I think 3x500 word reflections throughout the semester, a With Woman paper (I think that was about 2000 words) and a final literature review that was 1500 words (but dont be fooled - that paper took a lot more than your typical 1500 word paper).  As far as I know, nobody can get transfer credits for this course.

Working Across Differences (full year): Hands down, my favourite course in first year. Nadya Burton is a blessing to midwives everywhere. This course is also mandatory - nobody can get transfer credits, no matter how many anthro/sosc/psych/womens studies credits you've got under your belt, and you'll understand why after a while.  Although its introducing new concepts to many of the students, everything is presented in the context of midwifery - what do you do as a midwife when you are faced with differences?  This covers a really broad spectrum of different issues that face women but to gloss over it, important focuses are issues concerning poverty, abuse, genital cutting, immigrants, different sexualities and gender identities, aboriginals, and differing views and facts about breastfeeding.  I benefitted so much from this course.  It really transformed the way I look at the world.  Also, since this is the only first year course that every first year takes, this is your opportunity to get to know the classmates that you started with.  You'll be seeing them every Thursday (or whatever day) for both semesters of the school year.  You'll love them; midwifery students are swell!  And so are you!  The assignment portion of the course is challenging but interesting.  Six critical reflections, three per semester.  Readings are pretty heavy sometimes - the 1000pg + text is compiled by Nadya and sold through McMaster University bookstore.  The final assignment is a 20 page paper on whatever issue about difference that you'd like to write about.  This is HUGE!  And an incredible opportunity to become an expert on whatever difference you decide to work on.  For an example of what this paper looks like, check out my own, which I wrote on the intersections between Unassisted Childbirth and midwives.  You will love this course, and it will probably, at some point,  also make you cry.  Its okay.  I think it's supposed to.   :) 

Life Sciences (second semester):  This course deals with some physiological processes that are also covered in A&P, and then the second half of the course is devoted to infectious disease (particularly those affecting pregnancy, such as STDs), bacterial and viral structure, modes of transmission, vaccines, etc etc. The last few classes were devoted to various prenatal tests - both how they're done in the lab and how midwives read them and what they do with the information.   I did learn the material from this course, really I did.  But I didn't like it. As for assignments, I"ve put it all out of my head.  You'll have to find out when you get there! There was no assigned text that we had to buy but I suspect that might be changing, as I gather they are still tweaking the finer points of this course. 

Critical Appraisal of Research Literature (first semester): This course was an interesting learning experience.  We got to learn about different research methods and how they're done - and no, we didn't have to do statistics!  Yay!  The textbook is based, again, on midwifery research so at the same time as you're learning research approaches, you're also learning about studies relevant to midwives.  This course is very important, even though the name of the course sounds really bland, and the teacher (that we had) is very enthusiastic about research and can teach you a lot.  Assignments are a bit blurry in my head, but I'm pretty sure there was a midterm and a final, as well as a group project where you critique a piece of research, and a question/answer assignment.

OK!  So there's your first year (except for electives).  I can't speak for electives because there are so many.  Just know that the above should be your focus for the year!

Once I understand the second year courses a little more fully, I'll be able to speak to them more.  Just know that Clinical Skills is actually a three-credit course that involves lots of testing and 1.5 full days per week of instruction (as well as some other engagements).  Reproduction and Physiology and Pharmacotherapy have been graciously scheduled on the same day (at least for us, and last year) for those commuting and concerned about it.  But that's about all I know now, until I'm actually doing them!

SO - the FAQ's I've been getting lately...

Can you work and do the program?
Yes - but only to a certain extent.  Ryerson offers 4, 5, or 6 year programming.  This means, essentially, that the first portion of the program is either condensed or spread out, but the second portion will be the same no matter what.  When you're accepted, you are TOLD which stream you get into (and, like me, it might not be the one you applied for!).   There is flexibility though if you want to slow down or speed up.  The courses described above are what someone in a 4 year stream will be doing.  Those in the part time streams probably wont take all of those at once.  If you are doing the 4 year stream, the academic portion of the program is condensed into 3 semesters - whereby you need to obtain (with or without transfer credits) 16 credits.  This is very very full time!  5 year part-timers get an extra year to do the same number of courses; 6 years get another year.  There's no way I could have combined commuting 5 hrs/day, 4-6 courses a week, and parenting with any kind of work (especially since my "work" is unpredictable doula work!).  Many many can do it with a lighter course load, though, including doulas and many who continued working full time.  We are allowed one absence per term per core course without it affecting our grades, and we must be present for exams - so you'll need backup if you're working as a doula, but it can be done!    When it comes to placement, which is full time and lasts 2.5 years for people in all streams - no, you can't work.  See below.

What is placement like?
As I mentioned earlier, I am not yet in placement.  However, there has been enough talk to us about it (it, being second year placement - third year is much different but I dont understand it at all yet!) that I have a general understanding of the process. Basically, we are given a list of regions in Octoberish, with which we have to choose our top three preferences.  All of the students from all three university locations in Ontario are then put into a computer system and the computer attempts to randomize as many first, second, and third choices as possible.  No priority is made for any particular circumstances that I am aware of, aside from francophones (to the best of my understanding).  This has been explained to us as an attempt to equalize students, since nobody can really say whose reasons for wanting "x" placement are more important.  Inevitably, some people won't get any of their choices.  These people will be contacted before the final results are posted so they can choose from the remaining locations.  The end results, to the best of my knowledge, are given to us mid-to-late November.  This is an extreme source of stress for me.  I don't live in Toronto, and am thus quite a distance from most midwifery practices in the province aside from 2 or 3!  The threat of moving is great.
While we are in placement, we are on call 24/7.  We follow our preceptor in clinic and to births and home visits, as well as attend weekly virtual classes online and write exams and do assignments.  I believe the amount of time we are given off call is something like 4 days per month.  So, basically, its really intense.

Can I get transfer credits?
By far, the majority of the people in the program already have some university education and can get some transfer credits.  I think in our starting year there were only three of us (out of 32) that didn't have at least some. As I mentioned above, you can't get transfer credits for With Woman and Working Across Difference.  It's also very hard to get transfer credits for Life Sciences.  Many have gotten them for Critical Appraisal of Research Literature and A&P, and many more have gotten them for the electives.  Remember, you've got 2 professionally related (anything goes basically) electives, 2 Social science electives (which must involve a major paper and discuss women's issues), and 2 women's studies electives.  I only wound up doing two of my electives through Ryerson.  Everything else, I took this past summer through Athabasca and will be transferring them over in the fall.  This makes the rest of the academic portion much more liveable! 

Please let me know if you've got other questions (that I can answer!) and I'll update as needed.

Gender, sex and anatomy: Sexuality and the Intersexed Individual

Aaah, the wonderful feeling of the last essay of the summer (even if the summer is almost over and the "crazyness" of second year just upon its heels).  It feels good to see something to completion.  I gave up on this essay more than once in frustration for the lack of sources available.  I find that I follow a pattern similar to labour with my essays - the easy "I can do this" part of early labor (akin for me to researching the paper), the active labor (structuring the essay), transition (No!  I hate this paper!  I can't do it!) and pushing - that magical time when all of a sudden the paper that I hate has turned into something pretty good!  Or at least, hopefully good!  : ) 

Here is the most recent one, the final essay in my Human Sexualities course that I've enjoyed so very much (look out, again, its a bit long).  Also, please note the essay also contains some sexually explicit commentary, so read at your own risk. 

Gender, sex, and anatomy:

Sexuality and the intersexed individual

Melissa J. Nowell

Introduction

            Parents often hold specific expectations for the birth of their babies, which vary dependending on the sex of the baby.  When a child is born with genitalia that are indistinguishable as either male or female, a parent is often left with a sense of misunderstanding, confusion, and upset about the future of their child.  These feelings lead to a myriad of expressions and events that alter the course of the child’s life.  This essay attempts to explore the experience of the intersexed individual, and some of the medical interventions that their parents may be faced with.  Most importantly is a particular focus on their sexuality as they reach adulthood; both those who face medical intervention and those who do not.

Description and prevalence of intersex conditions

            The term intersex is a catchall term that includes those who are considered to be true or partial hermaphrodites, or those with ambiguous genitals despite a clear genetic or internal sex (Fausto-Sterling 2003:167). There are several other terms that are used to describe these people; one of the most well-known is the label hermaphrodite.  Reis (2007:535-543) explains that intersex conditions may also be called “disorders of sexual development” (DSD), which she would prefer to rename to “divergence” of sexual development.  The term intersex is used in this paper to the exclusion of others due to its prevalence in the literature.  Intersex conditions can come about in a number of different ways.  During early fetal development, male and female sexual organs begin in the same form, and several factors can potentially influence their development toward the typical male or female expressions that are expected at birth.  Despite having the chromosomes for one sex, a child may develop genitalia that resembles the other, or may have genitals or gonads that incorporate aspects of both sexes.  This may be due to hormonal conditions, a defect in the sex chromosome, or otherwise unknown reasons (Preves 2003, in Gough et al. 2008:494).  Although the most discussed cases of intersex are discovered at birth, many who have hormonal conditions may not show intersex characteristics until, or beyond, puberty (Gough et al. 2008:494).

            Because of the variation in the point in life that the condition might be discovered, and the widespread disagreement about what constitutes a true intersex condition, experts are not in agreement about the prevalence of intersexed births.  Estimates of the prevalence are as high as 2% (Preves 2003 in Gough et al. 2008:494) and as low as 0.018% (Sax 2002:174). Despite its potential prevalence, however, the condition is one that is not generally understood outside of specialized medical fields, because the majority of intersexed children are assigned a sex at birth and are surgically reconstructed to resemble that sex as much as possible (Chase 2003:173). While some intersexed individuals may present genuine health conditions, such as metabolic disorders or higher risk of cancers, this is not the rule, and most intersexed people find themselves to be in good health (Dreger 1998:30).   Chase (2003:174) explains that surgical reconstruction is done not because of a medical risk but due to the fact that the birth of an intersexed child constitutes a “psychosocial emergency” – or rather, an emergency of social and psychological nature whereby the family and others feel the strong need to identify the child as one sex or the other for the sake of his/her upbringing and socialization in the binary sexed world that s/he has been born into. Thus, the surgical reconstruction of a baby’s genitals is generally done for social or cosmetic reasons, and is strongly encouraged within the medical literature (Holmes 2008:169). 

Justification for medical treatment

Those born with ambiguous genitals are met with an intense array of social and psychological challenges not met by the majority of the population.  From the moment of their births, their parents are often found questioning “what” they are.  Indeed, Gough et al.( 2008:499) discovered in their study of parent’s attitudes about their intersexed babies that they were unable to identify their child as being fully human until they could identify the sex, referring to their child as one without status, or like a “no-thing.”  Holmes (2008:173) explains that parents of “non-responsive infants with severe neurological impairments” relate more to their babies as real people than those of intersexed infants. Because of the fundamental affects this attitude can have on a young child, this is often touted as one of the primary reasons that intersexed children are assigned a sex and treated as soon after birth as possible (Gough et al. 2008:494).  These people are thus subject to much medical exploration and treatment in the course of determining and enforcing their assigned sex.  Gough et al. (2008:494) explain that this is due to the widespread belief in the literature that a child should have normal-looking male or female genitals in order to adjust well in the social world.   As a result, much of the treatment these children receive occurs in their first two years of life, before a solid memory of early childhood has formed (Gough et al. 2008:494).  Perhaps to prevent an identity crisis, parents are then generally encouraged to hold silence about their children’s sex change from others and from the child him/herself, despite the frequent necessity of follow-up procedures, surgeries, and hormonal treatments.

Social consequences of treatment

            There is a great deal of counter-culture rising up against this blanket approach to intersexed children, for a variety of reasons which will be explored here. Most assuredly, this medical reconstruction is done with positive intentions to improve the relationship between parents and child, and preserve the child’s integrity and personal identification.  It is widely assumed that a child who cannot relate exclusively with one sex will inevitably become unhappy and stigmatized (Holmes 2008:170; Gough et al. 2008:494).  Yet the stories of many intersexed people who have been altered paint a different picture than this.  Most intersexed children who were surgically assigned sex at or near birth were kept from the knowledge of what was done to them; thus, most of them grow up in silence, not understanding or even being aware of their differences.  Many of the surgeries these children underwent required invasive follow-up care, which is often reported to have gone unexplained to the children being treated (MacKenzie et al. 2009:1778). In the case of a vaginal reconstruction, the follow-up procedures are described as involving a daily dilation of the newly constructed or reconstructed vagina with a prosthetic by parents until the child is old enough to do it herself (Hird 2003:106).   MacKenzie et al.( 2009:1780) summarize that their study did not determine that these practices had the effect of creating “normalcy” that they were intended to have. 

            Despite normalizing surgery, intersexed children are still treated differently by medical professionals and their parents than “normal” children, and thus often find themselves “experiencing a childhood of uncertainty and a sense of being imperfect” (MacKenzie et al. 2009:1778), even when they are unaware of why they are different.  Dreger( 1998:31) takes issue to the fact that nature of the surgeries and follow-up procedures serves to increase a child’s feelings of “freakishness” rather than reduce them.  This is due to the non-consensual and secretive way that they are brought about upon a child unable to decide for him/herself. 

“In cases of intersex, it is the parents who demand or consume treatment; however, it is the children who have to live not only with medicine’s technical shortcomings, but also with the awareness of the message conveyed through intervention, namely, that in their intersexed bodies they were unacceptable, perhaps unlovable, and certainly unrecognizable as persons.” (Holmes 2008:170)

            Clearly, the answer medicine has found is not black and white.  Reis (2007:537) explains that the consensus statement on intersexuality concludes that “there is little evidence” that normalizing surgery improves relations between parents and child or ensures proper gender identity development as it had been expected to.  Far from just affecting parental bonding and gender identity, however, are deeper psychological issues.  Hird (2003:1069) discusses many issues which come up for therapists working with intersexuals, namely trauma from above mentioned surgeries and follow-up procedures and trauma due to loss of erotic sensation. 

Medical/sexual consequences of treatment

Yet, as we have seen, surgical sex assignment is the norm for intersexed children.  Interestingly, Turner (1999:461) explains that 90% of children diagnosed as intersexed - whether they possess the gonads of a male, female, or both – are assigned a female sex.  The treatment that they undergo are a series of surgeries and procedures which remove or reduce an “enlarged clitoris”, and create a vaginal canal if there is not already one.  Dreger (1998:28) explains that this means that many children who are true males with a micropenis, potentially able to have sexual relations and children with women, are surgically reassigned a female gender.  Dreger also speculates that physicians appear to place much more emphasis on assigning female sex to intersexed children because their criteria for a “successful” penis are higher than for a vagina.  The penis is required to be capable of erection, able to urinate and ejaculate from the same hole which is expected to be located at the tip of the penis, and “’believably’ shaped and coloured” (p.29). Unfortunately for intersexed children assigned to the female sex, the vagina is only required to be a hole which permits the penetration of a penis – sensitivity, self-lubrication, and clitoral integrity are not considered as important as their male counterparts and are therefore missing in most surgical vaginal constructions (p.29).  Clearly, as Dreger (1998:29) and Turner (1999:461) have both noted, this not only devalues the body and sexual potential for the intersexed individual, but also that of females more generally.  This is particularly notable since it moves in line with more typical feminist critiques of the devaluation of women’s bodies and sexualities. 

            There are important reproductive consequences to reconstructive surgery as well.  Some intersexed people are born potentially fertile, and the removal of gonad tissue that does not match the assigned sex may render them permanently infertile.  One must speculate at what these babies would choose for themselves should they have understood the potential consequences.  MacKenzie et al. (2009:1780) noted in their small study that none of the participants would have chosen surgery had they been given the option. Kessler’s survey of non-intersexed men and women found they almost exclusively indicated they would wish not to have clitoral reducing surgery if their clitorises had been too large/penises had been too small; and in the case of the men, all but one indicated they would not wish to have their micropenis removed even if there were valid health reasons to do so (Dreger 1998:33).   This is in line with others who have found that a great many intersexed individuals who were unaltered through childhood do not wish to have reconstructive surgery on their genitals when approached with the possibility in adulthood (Gough et al. 2008:495; Chase 2003).  Indeed, many who discover their medical histories express a sense of loss for their former bodies and sexualities unexplored and may seek out gender reassignment  (MacKenzie et al. 2009:1780; Hird 2003:1083-1084). Chase (2003) and others have connected the acts done to intersexed people in much the same ways others in the West have condemned female genital cutting.  Much like female genital cutting, reconstructive genital surgery is “non-consensual and cosmetic” (Hird 2003:1083-1084).

            An ulterior motive may be subtly at work here as well, which plays its tune at altering the child’s genitals to match its perceived future sexuality so that it may grow up to become heterosexual.  Holmes (2008:170-171) explains that heteronormative frameworks assume that the appearance of the genitals will portray sexual preferences.  The “heterosexual matrix”, as Dreger (1998:29) describes it, “does not allow for other sexual practices or sexualities.”  Hird (2003:1083-1084) confirms that inducing “opposite gender desire” is a “major concern for clinicians”.  Real (2007:540) explains explicitly that sex assignment surgery has repeatedly been justified as a homosexual preventative. Thus, we see the cycle of heteronormativity reach its peak – the intersexed body challenges the ideas that males couple only with females to such a degree that anyone whose genitals at birth may suggest a potential for another type of sexuality is subject to alteration in order to conform with the principles of heterosexism (Fausto-Sterling 2003:170).

Sexuality

            There are many rumours and thoughts about what sexuality might look like in a person without a clear sex.  Reis (2007:537) notes that just the word intersex has been thought to be associated directly with sexuality, and explains that some parents have difficulty separating thoughts of their child’s sexuality from their “anatomical condition”.  Butler (1995, in Turner 1999:468) discusses how the heteronormative framework must rest upon the assumption that a hermaphroditic body, being neither male nor female and therefore incapable of “normal” heterosexual relations, is rendered “incapable of desire”.  The idea of a person who, as Fausto-Sterling (2003:170) describes it, possesses female organs and menstruates, but also has a clitoris large enough to penetrate a vagina, challenges “traditional beliefs about sexual difference”.  It will inevitably make many people squirm in their seats and question all that they understood about “normal” sexuality.  But what is normal for those who are born this way?  Is the removal of the enlarged clitoris an instigator of normal, or a stripping away of a “very special form of sexuality, arousal, and all of that which is uniquely hermaphroditic” (Intersex Society of North America 1996)?  Is the untouched hermaphrodite capable of satisfying intimate relationships?

            The answer, of course, is absolutely.  This is not to say that intersexed people are without challenges.  Their unique anatomies (used in plural to convey the wide variation between individuals) do leave them with challenges and opportunities for variation and creativity.  MacKenzie et al. (2009:1779) notes that concern over “body rejection” may cause some to avoid intimacy, but their participants have nonetheless participated in intimate relationships and found them to be positive. Intersexed people may also exhibit a tendency toward sexual dysfunction.  This is not to say that intersexed people are all sexually dysfunctional, but that they have higher likelihood of challenges.  Minto et al. (2003:1256) notes that, while the 7% of the general population reports never being able to reach orgasm ever, 39% of their sample of intersexed people who had received clitoral surgery made this same report.  Minto also noted that those who had undergone clitoral surgery had greater difficulties with “sensuality,” “communication difficulties,” and “avoidance” (p.1256).   Interestingly, their intersexed controls who had not received clitoral surgery did not report these same effects.  They were, however, sure to note that both groups still indicated overall difficulties reaching orgasm (p.1256).

 As one might have guessed by this point, sexuality is not a clear category in which one easily fits into.  This is true to the multiples with intersexed people.  There is a very wide variation in the preferences and practices of intersexed people.  It appears that males with a micropenis, whose parents were well informed and chose not to surgically alter them, are “more confident and better adjusted”, but do not generally practice ‘typical’ heterosexual contact (Shober and Woodhouse, in Dreger 1998:30).  Indeed,

“The group was characterized by an experimental attitude to sexual positions and methods....the group appears to form close and long-lasting relationships.  They often attribute partner sexual satisfaction and the stability of their relationships [with women partners] to their need to make extra effort including non-penetrating techniques” (Shober and Woodhouse, in Dreger 1998:30)

As noted, the concern to eliminate “homosexuality” in intersexed people may be one of the greatest motivators for clinicians to advise surgery.  Several sources have noted that intersexed people identify as lesbian or gay, particularly those who have undergone feminizing gender assignment surgery (Turner 1999:461; Hird 2003:1083-1084; MacKenzie et al. 2009:1780). The ability, then, to predict the future sexuality of the child has not been reached.  The varieties in practices, preferences, and the way intersexed people will identify sexually is practically limitless.  Turner (1999:474) describes an unaltered intersexed individual raised as a girl who identifies as heterosexual because she has relations with both males and females, and not other intersexuals.  Certainly the variety in ways of identifying sexually might be particularly dependent on the gender that the intersexed person relates to in adulthood, which may or may not align with the appearance of their genitals.

Conclusion

The challenges that intersexed people, their parents, and health care providers meet are clearly unique to their conditions and the social arenas which are affected by them.  The effective erasure of hermaphroditism from the wider spectrum of understanding has contributed to the stigma that intersexed people and their parents face when dealing with medical decisions and day to day life.  Although the surgical restoration of the genitals of intersexed people is the preferred norm of specialists today, a closer look at the lived experiences of these children in adulthood leads one to question whether or not this is the best course of action.  The current understanding of the psychological and sexual outcomes from genital reconstruction surgery that I have reduced here leads to the conclusion that other alternatives should be explored.  Further qualitative research and speculation into the outcomes of genital reconstruction surgery would contribute greatly to the understanding of clinicians and the parents of intersexed children who are faced a decision that no parent should have to make.  

References

Chase, C.
2003 Hermaphrodites with Attitude: Mapping the Emergence of Intersex Political Activism. In Constructing Sexualities: Readings in Sexuality, Gender, and Culture. S. Lafont, ed. Pp. 172-187. Upper Saddle River, NJ: Prentice Hall.

Dreger, A. D.
1998 "Ambiguous Sex" --- Or Ambivalent Medicine? The Hastings Center Report 28(3):24-35-http://www.isna.org/articles/ambivalent_medicine.

Fausto-Sterling, A.
2003 The Five Sexes: Why Male and Female are Not enough. In Constructing Sexualities: Readings in Sexuality, Gender, and Culture. S. Lafont, ed. Pp. 166-171. Upper Saddle River, NJ: Prentice Hall.

Gough, B., N. Weyman, J. Alderson, G. Butler, and M. Stoner
2008 "They did not have a Word": The Parental Quest to Locate a 'True Sex' for their Intersex Children. Psychology and Health 23(4):493-507.

Hird, M. J.
2003 Considerations for a Psychoanalytic Theory of Gender Identity and Sexual Desire: The Case of Intersex. Signs: Journal of Women in Culture and Society 28(4):1067-1092.

Holmes, M. M.
2008 Mind the Gaps: Intersex and (Re)Productive Spaces in Disability Studies and Bioethics. Bioethical Iniquiry 5:169-181.

Intersex Society of North America
1996 Hermaphrodites Speak (video). Intersex Society of North America Ann Arbor, MI.

MacKenzie, D., A. Huntington, and J. A. Gilmour
2009 The Experiences of People with an Intersex Condition: A Journey from Silence to Voice. Journal of Clinical Nursing 18:1775-1783.

Minto, C. L., L. M. Liao, C. R. J. Woodhouse, P. G. Ransley, and S. M. Creighton
2003 The Effect of Clitoral Surgery on Sexual Outcome in Individuals Who have Intersex Conditions with Ambiguous Genitalia: A Cross-Sectional Study. The Lancet 361:1252-1257.

Reis, E.
2007 Divergence Or Disorder? the Politics of Naming Intersex. Perspectives in Biology and Medicine 50(4):535-543.

Sax, L.
2002 How Common is Intersex? A Response to Anne Fausto-Sterling. The Journal of Sex Research 39(3):174-178.

Turner, S. S.
1999 Intersex Identities: Locating New Intersections of Sex and Gender. Gender and Society 13(4):457-479.