Sexing the Body: Gender Politics and the Construction of Sexuality
By Anne Fausto-Sterling. 485 pp., illustrated. New York, Basic Books, 2000. $35.
ISBN 0-465-07713-7

Poised to cast the deciding vote in a Salisbury, Connecticut, election in 1843, "Levi S." was charged with being a woman and therefore ineligible. A doctor found that Levi also had a vagina and menstruated regularly. What to do? Today we may be amused at 19th century conundrums concerning an intersexual person in a society in which only men held the right to vote. But modern America still requires citizens to be either male or female, and the institution that enforces this dichotomy with respect to babies is medicine, with the use of scalpels, sutures, and until very recently, sublime confidence. Physicians measure the intersexual newborn's phallus, an unless it is longer than 3 cm, shorten it to a more demure, clitoral length and perform whatever additional surgeries are needed to declare "it's a girl".

The primary attack on these decisions has come from intersexual adults who express dissatisfaction with the surgeries that were performed on them as children and who ask whether children's welfare is truly the goal of this sex policing. Physicians, on the other hand, may well feel that society demands that children be either boys or girls and that the schoolyard will brutally punish any deviance from these categories.

In this fascinating new book, Anne Fausto-Sterling describes these and many other troublesome issues that face our society when people refuse to fit the category of heterosexual man or heterosexual woman. A scholarly book with more than 120 pages of notes, its 255 pages of text nevertheless read like a bestseller. Fausto-Sterling reviews the history of ideas about sex and sex roles in the 20th century with authority and balance. She relates John Hopkins urologist Hugh Young's 1937 descriptions of intersexual people who grew up before the advent of corrective surgery. Young found these people, even the person working as a sideshow freak ("male and female in one"), to be well-adjusted and reasonable happy adults, many with active sex lives.
Fausto-Sterling also reviews the case of John/Joan, a child who gravitated later to John Hopkins with widely reported, disastrous results. She points out that intersexual newborns are not rare (they may account for 1.7 percent of live births), so a review of our attitudes about these children is overdue, and her book provides an excellent framework for the ongoing debates.

Fausto-Sterling digs deeper than current medical practice to investigate the basic sciences that guide and inform medicine. The scientists searching for steroid hormones had such abiding faith that male and female are antithetical conditions that they stumbled repeatedly. First, they refused to see that each steroid hormone naturally occurs and functions in both sexes. Next, they insisted that "male" hormones (androgens) must act antagonistically to "female" hormones (estrogens), when in fact they often work in a coordinated fashion.

The author also scrutinizes the work of early behavioral endocrinologists. How much of the famous 1959 report from William C. Young's laboratory, declaring that androgens "organize" the developing brain into a masculine configuration, was shaped by prevailing attitudes that men and women have fundamentally different roles in society? Even if the report itself was untainted by such attitudes, what about the audience that accepted this idea so enthusiastically? Why did the founder of behavioral endocrinology, frank Beach, who performed many similar experiments before the 1959 report appeared, never formulate this principle explicitly, despite its apparently tremendous explanatory power? For Fausto-Sterling, Beach was a hero, untempted by the simple formulation because he was so familiar with the simple formulation because he was so familiar with the data, which were replete with the exceptions that investigators still grapple with today. She sees Beach as open to the idea of sexual behavior as a continuum in which normal males might occasionally behave like females, and vice versa. For her, Beach had the independent, clear vision to see diversity when society sought dichotomy.

Fausto-Sterling is not a radical social constructionist. She repeatedly insists that nature has a say in the outcome of experiments - - as one might expect of a geneticist and professor of biology. But she is persuasive in showing how scientists' social background often affects their conceptualization of results, their naming of discoveries, and their decisions about which experiments to perform. Fausto-Sterling is not above rhetoric. It is a plain that she disagrees with certain writers, and she unabashedly declares her hopes for our political future. In discussing sex differences in relation to the human brain, she picks on the bedraggled corpus callosum. In 1982, the corpus callosum was reported to differ beween men and women, but a flurry of subsequent studies convinced investigators in the field that there is either no sex-based difference in this brain structure or only a very subtle, hard-to-pinpoint difference. What for Fausto-Sterling is matter for condemnation of research in human sex differences could as easily be seen as a validation of the scientific process.

However, Fausto-Sterling also takes pains to present at least two sides of every story, and she never fails to credit the intelligence and good intentions of others, even if, in hindsight, they have made dreadful mistakes. As physicians, scientists, and other citizens continue to take stock of ideas about men and women, and boys and girls, in this new century, Fausto-Sterling's careful and insightful book offers us the chance to question past assumptions and to dream of new formulations nearly as radical as allowing women to vote.