A Classic Case of Mistaken Identity: Failed Surgery Demonstrates That Sexual Identity is More Than Anatomy

A classic case of a surgical accident and its consequences that was long used as evidence of the pliability of sexual identity turns out, in follow-up, to suggest the opposite: that a sense of being male or female is innate, immune to the interventions of doctors, therapists and parents," reports New York Times columnist Natalie Angier in a March 1997 article entitled "Study suggests gender identification cannot be taught."

In 1973, the story became known of an infant boy whose penis had been irreparably damaged during circumcision ten years earlier. His parents, after consultaion with medical experts at Johns Hopkins Medical School, determined that it was in the boy's best interests to be reared as a girl. But even with hormone treatments and surgically created female genitals, he hated to wear girls' clothing, played with guns and insisted on using the toilet while standing. In spite of these contradictory behaviors, the case was cited in research texts and journals on sexuality as proof that sexual identity is not fixed at birth, but more fluid and dependent on environmental or social factors. In fact, 20 years ago his case was used widely in professional and popular media to support sex reassignment as appropriate for males with deformed, ambiguous or injured genitals.

The doctors know now that this textbook case was in fact a complete flop. Nevertheless, it will take a long time to remove the impact of such "proof " from the public consciousness. This spring the New York Times, along with articles in Time (March 24, 1997 p. 49) and The Washing- ton Post (March 18, 1997, section Z, page 7) summarized the full story which appeared in the Archives of Pediatric and Adolescent Medicine. In that journal, Drs. Milton Diamond and H. Keith Sigmundson presented an indepth follow-up report that flatly contradicts earlier conclusions in the case. Far from being satisfied with being reassigned to a female identity, the boy went through the struggles in childhood and adolescence, and ultimately renounced this imposed female identity at age fourteen choosing then to live as a man. He is now in his thirties, married and as well-adjusted as can be expected for someone who has undergone such an unusual ordeal.

Drs. Diamond and Sigmundson wrote that, "despite everyone telling him constantly that he was a girl, and despite his being treated with female hormones, his brain knew he was a male. It refused to take on what it was being told." In addition, Diamond said in an interview, "It's easy for us to modify genitals. But we can't modify the brain. That's what this kid proves."

As it turns out, the boy's parents did their everything they could to raise their child as a daughter, choosing feminine clothes, toys, and activities, but to no avail. "Joan" would tear off her dresses, refuse to play with dolls, and seek out male playmates. "Joan's" mother would try to get her to imitate her makeup routine; instead, "she" mimicked her father shaving. In second grade, "she" suspected that she would fit in better as a boy, but doctors insisted that she act feminine, preferring to suggest to her that she was just a tomboy. In 1977, at age fourteen, still unaware of her past or her Y chromosome, "Joan" finally refused to live as a girl. When "she" finally confronted her father, he told her of her true sexual identity. Rather than being devastated, "Joan" felt relieved. John later comments, "For the first time everything made sense, and I understood who and what I was."

John also displayed unusual insight into medical and social pressures when he recalled how one doctor warned him that "it's gonna be tough...you're going to be very alone" unless he underwent vaginal surgery and lived as a female. He noted, "And I thought to myself, you know I wasn't very old at the time, but it dawned on me that these people gotta be pretty shallow if that's the only thing they think I've got going for me, that the only reason why people get married and have children and have a productive life is because of what they have between their legs."

This case provides striking evidence that sexual identity lies far deeper than gender identity, that is, sociologically taught male-female differences. Sexual identity involves much more than external genitalia-it involves who we are as males and females. As believers, we know that manhood or womanhood is built into us by our Creator who created man as male and female. And, as Scripture tells us, this Creator has also ordained certain roles for men and women that are commensurate with his creative design and purposes. This case warns us again of the folly of resisting or seeking to overturn his creative design.