The March 1996 issue of the Archives of Pediatric and Adolescent Medicine brought back into public view the landmark case of a twin boy, John, damaged beyond repair by a circumcision in 1963. The follow-up research affords a rare perspective on medical ideas and practices in the last third of the 20th Century.
Experts at Johns Hopkins Medical School advised the parents that the child's best chance to have a normal life was to become an anatomically correct woman. Consequently, the baby was castrated, and surgeons fashioned a kind of vagina out of the remaining tissue. When "she" grew older, hormone treatments would complete the transformation from boy to girl.
The case became a landmark in the annals of sex research proving a popular theory of the time that sexual identity exists in a kind of continuum and that nurture was more important than nature when it came to gender roles. An expert proclaimed that babies were born gender neutral and you could make them whatever you want. Authors of textbooks in social science and medicine were eager to cite this fascinating case.
What people never knew was that the celebrated sex-change success was actually a dismal failure. From the follow-up story published this Spring, we learned that "Joan" always felt "different," preferred to play with boys and with boys toys; she would rip off the frilly dresses her mother bought for her. Looking back, she said she felt like a freak. Public bathrooms presented a particular challenge. Joan usually insisted on urinating standing up, although this made such a mess in the girl's room that the girls put her out and she was forced to use the boy's room instead. Doctors said she was just a tomboy and pressed her to act more feminine.
By the time she was 14, she decided she had only two options: either commit suicide or live her life as a male. In a tearful confrontation, her father finally told her the truth about her birth and sex change operation. "For the first time," she said, "things made sense and I understood who and what I was."
With the help of a new set of surgeons, "Joan" had her penis reconstructed (although it lacked the sensitivity of a normal penis) and began life again as John. Fortunately, he made his social readjustments with the support of High School friends, and went on to become a happily married father of three adopted children.
This historic case is a sobering documentary of medical attitudes and practices over the last thirty-four years. Among the important lessons to be learned are these: (1) Doctors were naive about the hazards of routine circumcision, and had an enthusiasm, wholly unjustified, for a procedure that robs boys of a necessary and functional part of their sexual anatomy. (2) The view that sex was only skin deep and could be turned around by upbringing was an arrogant and superficial understanding. This arrogance was matched by their readiness to manipulate reality with surgery. (3) The conspiracy of secrecy and silence among parents and professionals spread like a pall over the first fourteen years of this boy's life and drove him to ponder suicide. During this same period, experts made the same mistake about adoptions. Are we clear yet that secrecy and silence is a failed policy which harms, not helps, children? (4) And, finally, what can we say about the gullibility of parents who were so quick to follow current medical opinion? In the intervening years, have parents become more critical in their thinking, less dependent on "experts," and more responsible for protecting their children?