Abstract

Metadata-driven static site generators — CollectionBuilder, Wax, and the broader Lib-Static and minimal-computing tradition — have made it possible for one person to publish a rigorous digital collection with no server, no database, and no institutional infrastructure. But they share a founding assumption: that everything described in the metadata is destined to be public. For institutional collections of already-cleared objects, that assumption holds. For personal papers, community archives, and oral history — corpora dominated by living third parties, private correspondence, and identifications that cannot be surfaced without review — it fails. In these collections the consent decision is not a preliminary step; it is the central and recurring editorial act.

This article describes a consent firewall built onto a minimal-computing stack for The Bo Laurent Papers, an archive of the founding years of the intersex movement. The design makes non-publication the default and enforces it in the data layer rather than through editorial discipline. A relational catalog (SQLite) carries review status, a reviewer’s note, and a published flag as first-class fields; a two-repository architecture structurally separates a private working tier from the public site, so a dark item never enters the build at all; and a publish step copies only rows that have been explicitly cleared. Supporting patterns — an intake bench that surfaces the firewall’s state at the moment of description, reversible per-identification redaction, and provenance sidecars with fixity — carry the same principle through the workflow. The approach borrows the access-state logic of heavyweight repository frameworks such as Samvera and Islandora, but keeps it inside a stack that a non-technical steward can inherit, host at no cost, and eventually transfer to an institution intact.

Is early vaginal construction wrong for some intersex girls?

Anne Scheck, Urology Times, February 1997.

Written after intersex demonstrators picketed a pediatric urology meeting, this first piece put the dissent on the record for a surgical readership. Against the American Academy of Pediatrics’ position that early surgery is beneficial and best done between six weeks and fifteen months, Scheck profiles British pediatric urologist David Thomas, who tells colleagues the protesters “do have a point.” Thomas’s review of about a dozen girls with congenital adrenal hyperplasia who had undergone early feminizing surgery found poor long-term results — persistent urogenital sinus, unsatisfactory clitoroplasty, and every girl needing further surgery — even though most operations had been done by specialists, and he argues for deferring definitive vaginoplasty until after puberty. Antoine Khoury of Toronto’s Hospital for Sick Children counters that the reviewed cases predate modern nerve-sparing technique. The article closes on a point both surgeons share: the near-total absence of long-term follow-up.

Attitudes changing toward intersex surgery, but for the better?

Anne Scheck, Urology Times, August 1997, pp. 44–45.

A follow-up written once the controversy had reached the New York Times and Newsweek. Scheck centers Khoury’s argument that the media debate leans on decades-old outcomes and ignores refined microsurgical technique, endocrine assays, and imaging now available, and sets it against ISNA’s position — voiced by Cheryl Chase — that surgical success should be judged by preserved organ function and sexual identity rather than cosmetic appearance, and that ISNA opposes only function-damaging surgery, not all intervention. Khoury endorses a cautious, multi-factor assessment before any sex assignment; Thomas again supplies the dissent. The piece ends by noting that outcome studies over the next fifteen years may finally supply science-based answers.

Intersexuality takes a conservative turn

Anne Scheck, Urology Times, February 1998, p. 1.

A front-page report on a perceptible shift toward caution, prompted by two October 1997 papers in the Archives of Pediatric and Adolescent Medicine. Scheck summarizes William Reiner of Johns Hopkins, a pediatric-urologist-turned-psychiatrist, who weights chromosomes and fertility over genital appearance and argues “the brain is the most important sex organ,” alongside the guidelines of Milton Diamond and H. Keith Sigmundson, which ISNA favored and which press for changed terminology and patient involvement. Patrick McKenna welcomes the papers as commonsensical; Barry Belman calls ISNA’s push to postpone all surgery “extreme.” Cheryl Chase, ISNA’s executive director, warns that even the new language of “waiting” still presumes a surgical decision-maker with a vested interest. The article surveys the wider climate — the 1996 AAP picket, the December 1997 Rolling Stone account of the “John/Joan” case, and new psychosocial-outcome research — and notes that the AAP and AUA had not, at press time, changed their positions.

A note on availability

None of the three articles appears on the Urology Times website, whose archive does not reach the 1990s, nor in the Intersex Society of North America’s bibliography of online-accessible articles; the coverage is effectively offline. Anne Scheck’s reporting is cited, and the February 1997 piece quoted, in ISNA’s amicus brief on intersex genital surgery.

The citations here are drawn from the publication footers preserved inside the source files. Volume and issue numbers, and the page number of the February 1997 article, remain to be confirmed against the original clippings.

Transcription

American Academy of Pediatrics
141 Northwest Point Blvd
Elk Grove Village, IL 60009-0927

News Release

American Academy of Pediatrics Position on Intersexuality

The American Academy of Pediatrics, a voice for children for over 60 years, is aware of the concerns and sensitive to the needs of intersexuals.

• Intersexuals are individuals who are born with anatomical characteristics of both males and females.
• The Academy is deeply concerned about the emotional, cognitive, and body image development of intersexuals, and believes that successful early genital surgery minimizes these issues.
• Research on children with ambiguous genitalia has shown that a person’s sexual body image is largely a function of socialization, and children whose genetic sexes are not clearly reflected in external genitalia can be raised successfully as members of either sexes if the process begins before 2 1/2 years.
• Management and understanding of intersex conditions has significantly improved, particularly over the last several decades.
• From the viewpoint of emotional development, 6 weeks to 15 months seems the optimal period for genital surgery.

The American Academy of Pediatrics is an organization of 51,000 pediatricians dedicated to the health, safety and well-being of infants, children and young adults.

Textual notes

The text here is the Academy’s. It survives through a Microsoft Word file prepared for redistribution in April 1997 by Riki Anne Wilchins; that file added a bracketed headnote and set two passages in bold (“emotional, cognitive, and body image” and “6 weeks to 15 months seems the optimal”). Both are the distributor’s additions, not the Academy’s, and are omitted so the release reads as issued. The distributed file reads “extemal genitalia”; corrected to “external.”

The Academy did not publish this release through its own channels; it was handed to reporters at the convention. The wording above agrees verbatim with the copies preserved by the Intersex Society of North America and the Intersex Day project. The Academy’s own later, formally published statements on intersex are separate documents: the 2006 Consensus Statement on Management of Intersex Disorders and the 2017 Bringing Back the Term Intersex.

Further reading

ISNA’s side of the same event — the cover letter to Dr. Robert Kay and the statement handed out at the picket — is transcribed in Letter to Dr. Robert Kay, with “Why We Are Picketing the AAP”. The debate the picket opened was then followed in the surgical trade press; see Press coverage in Urology Times, 1997–1998.

Source

An access copy: a born-digital Word document (1997 redistribution copy) held in the private archive. See the source sidecar for fixity, provenance, and the three-witness corroboration of the text.

Citation

Transcription

Dr. Robert Kay¹ Chairman, AAP Section on Urology

Dear Dr. Kay,

Members of the Intersex Society of North America, a peer support and advocacy group for persons born with mixed sexual anatomy, will picket this week’s AAP meeting in Boston².

We would welcome an opportunity to meet with you, during the demonstration or in private before or after, to discuss who we are and the sort of changes we want to effect in treatment of intersex. We have heard that you are a compassionate man and likely to listen with an open mind to our concerns. We are very serious, and a growing list of professionals and academics, including doctors, support our work. ISNA’s Board of Directors includes an MD and two licensed therapists.

We plan to peacefully exercise our First Amendment rights by distributing literature and speaking with media. We will use no amplification, and we will inform the local police of our plans.

When:    Saturday October 26: demo at noon; press conference 11:45 AM
Where:   Hynes Auditorium, Boston
Who:     Intersex Society of North America
What:    Picket of the 1996 annual meeting of AAP
Why:     A detailed explanation follows

Contact:      Cheryl Chase
              Intersex Society of North America
              cchase@isna.org email

Why We are Picketing the AAP

The shame and secrecy surrounding intersexuality have allowed a disastrous model of treatment to continue for 40 years. Follow up has been notable for its absence. Physicians treating intersexed children have rejected the testimony of those of us who have recently broken free of shame and begun to speak out. It is unethical to continue to impose on intersexed children and their families an experimental treatment with no demonstrated benefit and which a large and vocal population of patients has experienced as terribly harmful.

To enlist the help of those who agree with us that [genital?] difference should not be treated with horror, weighed down with shame, or eliminated with cosmetic surgery that damages sexual function. We believe that support will come from some AAP physicians if we can communicate our concerns to them.

To gainsay those who say that intersexuality is so rare that it is not worth thinking about.

Medical ethicists we have appealed to have told us that no one would help us, because “it’s so rare”. Based on credible statistics in medical publications, we believe that 1/2000 births³ exhibit intersexual characteristics which may be targeted for medical treatment. Further, our personal experience is that, once we break out of shame enough to begin speaking, we find that intersex is all around us. During the first year after I began to speak about myself (to friends and acquaintances; not using media) I came upon six others.

One of the ways that the “It’s so rare” myth is maintained is by separating us according to narrow etiological categories. But those of us whose birth emotionally traumatized our parents; early treatment destroyed our genital sensation; childhoods were filled with silence, taboo, and outright lies share a common experience. When the third person this week comes to ISNA with this story, should we inquire about karyotype or adrenal function?

After AAP, we will schedule picketing of hospitals specializing in “managing” intersexed children. Bringing attention to these hospitals will help people realize that it cannot be so rare.

To gainsay the assertion of specialists that their patients are satisfied, that those of us who are now speaking out are “bad apples.”

To increase our visibility so that intersexuals in desperate need can find us. Meeting others who share our experience has been a life-changing, even life-saving, experience for most of us. We want to give that to others who continue to suffer in silence, as we did until so recently.

To let parents know, before their intersexed child is born, that surgery and secrecy will harm rather than help their child. What the child and family need is peer support and qualified mental health care. Our specific recommendations are presented on our web site, http://www.isna.org

To demonstrate that we can take a stand as openly intersexed people without being crushed by shame. Doctors and parents believe that genital difference would be so horrifying that no one could live with it. Thus the surgery. The surgery does not leave us with bodies that “pass”–our genitals are obviously mutilated, and our sexual response damaged. We will no longer live in silence, shame and secrecy. And we are determined to save children from being treated as we were.

Textual notes

The original is a typewritten (monospaced) document reproduced as a photographic scan. Wide inter-word gaps in the original are artifacts of full justification and have been normalized to single spaces; they do not mark missing text.

[genital?] in the second paragraph of the statement is a conjectural reading. A word appears to have dropped out of the phrase “agree with us that ___ difference should not be treated with horror,” and no text is legible in the gap. genital is a guess, consistent with the statement’s later “genital difference would be so horrifying”; it is not legible in the source and should not be treated as established.

Two manuscript annotations on the scan are not part of the typed text: a circled “4” in the right margin beside the contact block, and a pencilled “Add’l NEW 4” in the right margin beside the paragraph beginning “Medical ethicists we have appealed to.” Both appear to be later filing or enumeration marks.

Further reading

The Academy’s answer to the picket — the news release it handed to reporters at the demonstration — is transcribed in American Academy of Pediatrics Position on Intersexuality.

The picket and the debate it opened were followed in the surgical trade press. See Press coverage in Urology Times, 1997–1998 — three articles by Anne Scheck, written between February 1997 and February 1998, in which Cheryl Chase and ISNA are quoted.

Source

An access copy: a single-page scan held in the Suzanne Kessler Papers at the University of Michigan’s Labadie Collection, burst from the larger Kessler correspondence scan set. See the source sidecar for fixity and a note on the item’s placement within that collection.

Citation

The evidence

Domain registration. The isna.org domain was registered on 1994-10-31 (31 October 1994, 05:00:00 UTC), per the domain registry’s record (Registered On: 1994-10-31T05:00:00.691Z).

Earliest known capture. The earliest snapshot of the site held by the Internet Archive’s Wayback Machine was captured on 1998-12-12 (12 December 1998, 03:00:50 UTC):

https://web.archive.org/web/19981212030050/http://www.isna.org/

Source & citation

This page is generated to mirror the catalog record, so the two never drift.

Suggested citation. Cheryl Chase, isna.org: the movement moves online. The Bo Laurent Papers, catalog isna-org-website. Earliest capture: Internet Archive Wayback Machine, https://web.archive.org/web/19981212030050/http://www.isna.org/, captured 12 December 1998. Domain registered 31 October 1994.

The letter

6 September 1994

Ms Natalie Angier
c/o New York Times
229 West 43d¹ Street
New York NY 10036

Cheryl Chase
Intersex Society of North America
PO Box 31791
San Francisco CA 94131
Tel 415-695-0975
Fax 415-695-1454
email cchase@ptechwest.com

Dear Ms Angier,

I  have² appreciated your articles in the Times about many aspects of sexual differentiation and,³ biology and gender, and the action of sex hormones. I hope that I can persuade you to write about the human consequences of gender ambiguity.

The Intersex Society is a peer support and activist group for individuals born with unusual genitals or some discordance between genitals and reproductive organs or chromosomes. I know from your writing that you must be familiar with the phenomenon.

However, because the topic is highly taboo, it is little known outside the circle of medical intersex specialists and geneticists. Intersexuals are not at all rare, but are typically so shamed by social stigma and so emotionally damaged by medical objectification and surgical mutilation, that few of us have dared to speak.

There are a few of us at ISNA who are determined to change that. We have found that the path to healing ourselves is to accept our intersexual bodies and to make political identity as intersexuals. We reject the medical model of intersex-as-disease. This model is as culturally biased and unscientific as that of homosexuality-as-disease.

The current climate of discourse about gender and the media fervor over African female genital mutilation, makes the topic of medical oppression of intersexuals a timely one. Intersex specialists claim that their ministrations allow us to live as nearly normal males and females, but they have consistently refused to do long term follow up studies. Based on my interviews with dozens of adult intersexuals, medical intervention allows parents to deny the fact and consequences of their child’s intersexuality. Parental distress is replaced with a “time bomb” for the intersexual patient, who will have to overcome great obstacles without help in order to learn the truth about his/her own nature and history, and live with sexual dysfunction consequent to surgical destruction of genital sensitivity.

If you will write about the “other side” of the story of medical erasure⁴ of intersexuality, I will be happy to act as a resource. In addition to being extremely knowledgeable about the technical issues involved, I am willing to relate my own experience, and can introduce you to others who will also do so.

I have enclosed copies of two recent letters to the editor of the Times, and the ISNA’s Annotated Bibliography. I hope to hear from you soon.

Yours Truly,

enc:

Annotated Bibliography

NYT letter Sept 6

NYT letter Sept 15

sample correspondence

Note on the source

The letter survives as one Microsoft Word for Macintosh 5.0 document (6,144 bytes, Mac OS Roman). The file had been fast-saved, so its current text was stored as scattered fragments with a piece table recording their order; read straight through, the bytes yield a truncated, garbled letter. The transcription above is reassembled according to that piece table.

Because fast-save appends revisions rather than rewriting, the file also preserved a trace of the author’s editing. An earlier draft of one sentence read “the story of medical treatment of intersexuality”; it was revised, before the final save, to “medical erasure of intersexuality.” The discarded word remains recoverable in the file and is recorded in the textual notes.

The sender’s 1994 telephone, fax, and email address (at a long-defunct domain) are transcribed as part of the historical document.

Source & citation

Generated to mirror the catalog record, so the two never drift.

Suggested citation. Bo Laurent [as Cheryl Chase], letter to Natalie Angier, 6 September 1994. Intersex Movement Archive, catalog letter-angier. Born-digital; recovered from a Word for Macintosh 5.0 file.

Read the original issue

Download the original PDF · 6 pages, US letter, born-digital (Adobe FrameMaker → Acrobat Distiller, 2000), ~550 KB.

Contents

The issue as it was laid out, in reading order. Each title links to its transcription below.

• Welcome, readers! — the editor, on why “Hermaphrodites with Attitudes”
• Case report — Will B. Dunn, M.D., FACS — a satire on cosmetic genital surgery
• The Awakening — Kira Triea
• Whose sex errors? — a reply to John Money’s Sex Errors of the Body
• Hermaphrodites on the infobahn — ISNA’s new email list
• Going home — Anne Ogborn — among the Hijra in New Delhi
• Thirty seconds over Penn Station — Kira Triea (poem)
• Hijras and intersexuals — Anne Ogborn
• Winged labia: Deformity or gift? — Cheryl Chase
• Morgan awarded M.A.! — Morgan Holmes defends her thesis
• San Francisco chapter meets!
• I am not alone! — from David’s personal journal
• Dr. Money and The Five Sexes — Cheryl Chase
• I’m still intersexual — Morgan Holmes
• Send Money! — an appeal
• Colophon

Full transcription

Case report

Will B. Dunn, M.D., FACS

The patient was a 2 year old reindeer (Rangifer tarandus) who was brought to the clinic by guardians for diagnosis of a disfiguringly prominent nose. Some even said it glowed. (fig. 1, left) Although no objective standards have been published for proboscal length in reindeer, it is a simple matter for the surgeon to judge.

Under general anesthetic, the offending tissue was excised and sent for frozen section microscopy. While awaiting the pathology results, an incidental tonsillecto-adenoidectomy was performed, as a prophylactic measure against the known possibility of sore throats. No pathology was detected in the frozen nose sections, and no etiology is apparent for the rumored “glowing.”

Follow-up at three weeks post-surgery revealed an excellent cosmetic result, the proboscis now displaying an appropriately diminished contour. Patient was discharged to guardian’s care.

(In the original, this piece began on page 1 and concluded on page 6.)

Going home

Anne Ogborn

It’s March, but already the sun is beating down on this little open footpath, sandwiched between two single room houses in the Nehru Stadium basti. The light stanchions of the stadium frame the sky. I’m in New Delhi, working. My job? Sacred dancing eunuch.

I peek into the dark interior of the house. Sonna is arguing with a woman in Bangla. The woman keeps pulling the end of her cotton sari over her head with one hand, while holding a baby wrapped in a blanket in the other. Finally she capitulates and hands the infant to Sonna.

I can understand her reluctance. Sonna isn’t exactly a person whose appearance inspires trust. She says she’s fifty. She looks much older. By looking at her, she’s half monkey and half child.

Actually, she’s one of the most delightful people I know. Sometimes she shows me how to play traditional Indian children’s games. I’m getting pretty good at playing jacks with chips of broken concrete. Always dressed in an androgynous kurta styled salwar-kameez, she looks like neither a man nor a woman.

And in truth she isn’t. We’re all Hijras—members of a religious order that is closed to men and women. For the last 2,400 years we’ve maintained the customs and beliefs of one of the oldest spiritual orders on earth, an order whose truths are inscribed not in words, but on our bodies.

Sonna, like most of my sisters, has no genitals. She has a urinary meatus with a faint ridge below it. I’m different. I have roughly female-looking genitals, courtesy of western sex change doctors. They love me anyway.

I’ve seen her genitals often. We curse people when they won’t let us dance by showing them our genitals. This makes people infertile. No, really—hey, reading about Renee Richards eventually made me infertile.

Everybody in my dance troupe joined later, but I met people who were raised from infancy as Hijras. Because non-transgendered people don’t understand us, we always say, “We were born this way,” when they ask us if we have been castrated and penotomized.

Anyway, Sonna takes the infant and holds it, puts a mark of vermilion and oil on it’s head, and looks at its genitals. Boys get one blessing. Girls get another. Everybody else we take with us to raise. This one’s a boy, she decides.

Look down and be proud.

Winged labia: Deformity or gift?

Cheryl Chase

One of the many genitally mutilated people who has corresponded with ISNA is a woman named Jean. Although Jean is not intersexual, she did undergo a clitoral recession as an adult. Here is her story.

At puberty, like other women, Jean’s inner labia grew larger. However, unlike most other American women, Jean’s labia grew very large—she characterizes them as five inches long, when stretched. One term that is used to describe such labia is “winged labia.” As most readers are painfully aware, genital diversity is not widely appreciated in our culture, and the adolescent Jean was confused and shamed. She investigated pornography to find pictures of someone else “like me,” but to no avail. Every image of female genitals that she could find had petite, ladylike labia. As many intersexuals have done, she took herself to the library to try to understand her body.

She found photographs of genitals like hers in older anthropological writings. In such tomes as “Woman: An Historical Gynaecological and Anthropological Compendium” (Ploss, Bartels and Bartels, 1935) she read that the form of her genitals was a “malformation” called the “Hottentot Apron,” that it was characteristic of “primitive Bushmen,” and that it was an atavistic throwback. Racist anthropologists characterized the “Bushmen” as similar to chimpanzees. (In fact, female chimpanzees have nearly absent labia minora.) Finally, most writings agreed that the Hottentot Apron was attributable to masturbation, and was deliberately produced.

She next turned to contemporary (mid-1970s) medical literature. Here she found a number of articles by plastic surgeons which addressed “labial hypertrophy” as a “developmental disorder” or “congenital anomaly” requiring surgical correction, by reducing the labial tissue under general anesthetic. There were citations of the racist literature which attributed winged labia in southern African populations to masturbation. Winged labia in Asian women were attributed to “prostitution or excessive intercourse” and “lack of cleanliness.”

Jean found a surgeon who said he could make her labia “normal.” She went under his knife, but when she woke she was left with absurdly small inner labia. She was still deeply distressed about the appearance of her genitals because her clitoral hood, which had been in proportion to her inner labia, now seemed too prominent. She submitted to a second surgery, and this time so much of her hood was removed that her clitoris was exposed, an excruciatingly painful condition.

Jean tolerated this pain for a couple of years before she located another surgeon who said he could help. His solution: a clitoral recession, just like what is done to intersexual infants whose clitoris is labeled “too big.” Jean’s clitoris was normal size, so the surgeon didn’t remove parts of the glans and shaft, as he would have done to an intersexual baby girl. He merely dissected the clitoris from the surrounding tissue, cut the suspensory ligament, and buried the clitoris beneath the subcutaneous tissue.

Jean feels that she was helped by this final surgery. It alleviated the excruciating pain, but it was “terribly desensitizing.” While she is still orgasmic, she says “if orgasms before the recession were a deep purple, now they are a pale, watery pink.” She regrets ever having considered surgery to “normalize” her genitals.

It wasn’t until after the surgeries that Jean learned that her mother and grandmother’s genitals were similar to hers. It is a family trait. Jean, who is African American, speculates that her ancestors may have been transported to the U.S. from parts of southern Africa where winged labia are prevalent.

The illustration on the previous page is an erotic woodblock print from Nineteenth century Japan. This illustration celebrates winged labia as a beautiful gift called the “long-tailed butterfly.”

Further Reading: See Anne Fausto-Sterling’s “Gender, Race and Nation: the Comparative Anatomy of ‘Hottentot’ Women in Europe, 1815–1817” (in Deviant Bodies, eds. Jennifer Terry and Jacqueline [Urla], 1993) to read about anthropological “rational investigation” of African women’s genitals.

Source & citation

This page mirrors the catalog record so the two never drift.

Suggested citation. Hermaphrodites with Attitudes, Vol. 1, No. 1 (Winter 1994), ed. Cheryl Chase. Intersex Society of North America. Born-digital; [Archive name], catalog hwa-01.

Transcription

Textual note

Copytext is the printed letter in The Sciences (July/August 1993, p. 3). A lightly revised version later circulated on ISNA’s own website (isna.org), and constitutes a distinct variant witness. Representative substantive variants in the web text include: “opportunity to meet” for the print’s chance to meet; “I believe that I can provide” for I think I can provide; “parents and doctors” for parents and physicians; “Some are transexual” for Some former intersexuals become transsexual; and a closing that names ISNA but drops the explicit postal address. A full collation is deferred; the print copytext is authoritative here.

Transcription is diplomatic: original spelling, capitalization, hyphenation of compounds, the spelled figure “4 percent,” and the em dash at “medicine—and” are preserved. The three Latinate terms are italicized as in the printed original; the magazine set the headline in full capitals.

Source and citation

Chase, Cheryl. “Intersexual Rights.” The Sciences, July/August 1993, p. 3. Intersex history archive, item letter-sciences-1993.

References

Headnote

These four letters, exchanged over about four months in 1992–1993, document a hinge moment — both personal and historical. The first letter is faxed from Kamakura, Japan, in September 1992; by the December follow-up the writer has relocated to San Francisco “to work on healing myself”; Judson Randolph replies by hand in January 1993; and the final letter, dated 31 January 1993, turns from the search for a surgical “repair” toward a wholly different idea — a support group of women who had undergone the same surgery. That reframing, from an individual medical problem to a collective one, is the founding logic of the intersex movement, and it appears here in real time, on the page, months before the Intersex Society of North America was established later that same year.

The letters are signed “Bonnie Sullivan,” the writer’s legal name until 1995, when it was changed to Bo Laurent. They are addressed to Judson G. Randolph (1927–2015), for nearly thirty years Surgeon-in-Chief at Children’s National Medical Center in Washington, D.C., and co-author of “Clitorectomy for Sexual Abnormalities: Indications and Technique” (Surgery, 1966) (which he mistakenly dated to 1964 in his reply).

Read together, the four documents trace an arc: a survivor approaches the surgeon-author of the technique used on people like her, not as an adversary but as a self-taught peer armed with his own literature; she asks the question underneath the whole inquiry — whether the profession ever actually knew the sexual outcomes of what it did; the surgeon answers with unusual candor, describing his own change of practice and conceding that the operation “improved your feminine appearance but removed much of your potential for orgasm”; and the correspondence closes not in resignation but in the decision to find, and speak with, others.

1. Bonnie Sullivan to Judson Randolph, 24 September 1992

Metadata

• Date: 24 September 1992
• Sender: Bonnie Sullivan, Kamakura, Japan
• Recipient: Dr. Judson Randolph, Department of Surgery, Children’s National Medical Center, Washington, D.C.
• Medium: Typed letter, transmitted by fax
• Extent: 1 letter (2 pp. as scanned)
• Signature: “Yours Truly” (typed); signed Bonnie Sullivan
• Provenance: Author’s retained copy
• Related: Followed up by the letter of 5 December 1992 (item 2) after no reply
• Redaction flags: third-party name on the fax cover line — masked. Sender’s own Kamakura street address, postal code, telephone, and fax — masked; email local part masked, domain retained (city and country retained).
• Rights: Author’s own; publishable in full

Transcription

24 September 1992

Dr. Judson Randolph Department of Surgery Children’s National Medical Center 111 Michigan Ave NW Washington DC 20010 USA Tel: 202-745-5000 Fax: 202-939-4492

Bonnie Sullivan [street address redacted] Kamakura, Japan [telephone redacted] [fax redacted] Internet email: [redacted]@mit.edu

Dear Dr. Randolph,

Your name is familiar to me from your papers on clitoral reconstruction and older ones on clitorectomy. I am writing to ask you for some information about clitorectomy, which is of very personal interest to me, as I will describe below. In exchange, I can offer to share any aspects of my personal experience that may be of interest.

I was born in 1956 with an enlarged clitoris and bilateral ovo-testes. Everything else was female normal, I chromatin test positive, and my karyotype is 46,XX. However, I was raised as a boy until age 18 months, at which time I was diagnosed as a true hermaphrodite, my clitoris was removed as far as the division of the corpora, and my parents were told to rename me and raise me as a girl. At age 8, the testicular part of my gonads was removed, and sufficient ovarian tissue remained to allow me to experience natural feminizing puberty without exogenous hormones. My emotional development was considerably more hazardous. I discovered these facts at age 22, after no small battle with hospital bureaucracy and with obstructive physicians. By the way, I was not seen or operated on by you or your colleagues.

I am now 36 years old, and my sex life has always been quite miserable. Sex therapy has not been helpful. In trying to understand what was done to me, and why, I have obtained most of my medical records, and have done a fairly extensive review of the historical literature. According to my reading of the surgeon’s notes, the crura should be intact. (“External genitalia were then exposed and incision was made around the base of the clitoris. This was dissected free from the surrounding tissue as far back as the division of the corpora where it was clamped, divided and stump ligated”). The pre-surgery photo is missing, but the pathology report states that the tissue removed was 3 cm long. I interpret this as a clitoris which protrudes about 1 cm (Does that sound correct?)

I am aware that some women have reported orgasm in spite of having been clitorectomized. I am also aware that many such women report erotic sensation in the stump. In my case there is no clitoral sensation whatsoever, and I am inclined to think that these women experienced clitoral amputation, rather than a deep removal. I am also aware of reports that a minority of Sudanese women who have been subjected to the Pharaonic circumcision (clitoral excision followed by labial infibulation) may be orgasmic. Although the damage to their genitals is certainly extreme, it strikes me that traditional practitioners lack the surgical technique to remove the clitoris as deeply as was done in my case.

You were a co-author of the article “Clitorectomy for sexual abnormalities: Indications and Technique” (Surgery, Feb 1966). I am also aware of your report in the Journal of Pediatric surgery earlier this year on long term follow-up of women after clitoral reconstruction, without removal of clitoral tissue.

I would like to know what knowledge you have of the sexual response of the women who were subjected to the deep removal described in 1966. Since they have had even more tissue removed than I have, a believable report of sexual adequacy, including orgasm, in them would be of some encouragement to me.

I have been in contact with a plastic surgeon, a specialist in transexual surgery, who tells me that he has performed clitorectomy repairs. He states that he has been able to achieve a positive effect on sexual satisfaction for more than one woman with this surgery. In a modification of the female to male surgery, he takes a flap of skin from the forearm and uses it to construct a clitoris, connecting the nerves to the severed pudendal nerve. Have you heard of this kind of thing? Do you have any opinion about the likelihood that it could work?

Yours Truly,

Bonnie Sullivan

Editorial note. The letter’s method is worth flagging for readers: the writer quotes her own operative note and pathology report, cites Randolph’s 1966 Surgery article by title and his recent Journal of Pediatric Surgery follow-up, and distinguishes “amputation” from “deep removal” — building a clinical case, in the profession’s own vocabulary, toward a single question: whether anyone with removal as extensive as hers retained sexual response.

2. Bonnie Sullivan to Judson Randolph, 5 December 1992

Metadata

• Date: 5 December 1992
• Sender: Bonnie Sullivan, San Francisco, CA [street address redacted]
• Recipient: Dr. Judson Randolph, Children’s National Medical Center, Washington, D.C.
• Medium: Typed letter
• Extent: 1 letter (1 p.)
• Signature: “Yours Truly” (typed); signed Bonnie Sullivan
• Provenance: Author’s retained copy
• Related: Encloses a copy of the 24 September 1992 letter (item 1); prompts Randolph’s reply of 7 January 1993 (item 3)
• Redaction flags: sender’s San Francisco street address, postal code, and telephone/fax — masked (city and state retained)
• Rights: Author’s own; publishable in full

Transcription

5 December 1992

Dr. Judson Randolph Department of Surgery Children’s National Medical Center 111 Michigan Ave NW Washington DC 20010 USA Tel: 202-745-5000 Fax: 202-939-4492

Bonnie Sullivan [street address redacted] San Francisco, CA [telephone / fax redacted]

Dear Dr. Randolph,

I am enclosing a copy of a letter which I transmitted to your office by fax in September. As I have received no response, I wonder if the letter did not find its way to you (I understand that you have retired).

I have now relocated to the United States in order to work on healing myself. I am working with a very helpful psychotherapist, but I want the information which you must possess about the outcome of clitoral extirpation. I would very much like to hear from you. You can reach me by mail or collect telephone at the above location. Note that I will be out of town from 15 December until 31 December.

Yours Truly,

Bonnie Sullivan

3. Judson Randolph to Bonnie Sullivan, 7 January 1993

Metadata

• Date: 7 January 1993 (dated “1-7-93”)
• Sender: Judson Randolph, M.D., Nashville, Tennessee [home street address redacted]
• Recipient: Ms. Bonnie Sullivan
• Medium: Autograph letter, signed (handwritten)
• Extent: 1 letter (2 pp. as scanned)
• Signature: “Sincerely Yours, Judson Randolph, M.D.” (autograph)
• Provenance: The transcription below follows Bo Laurent’s own contemporaneous transcription of the letter as received. The reproduced scans are of the copy preserved in the Suzanne Kessler Papers (call no. ams.0219), Box 1, folder “Correspondence — ‘Chase,’ 1992–1993,” Joseph A. Labadie Collection, Special Collections Research Center, University of Michigan Library. That folder was digitized by the Library in May 2025 at the request of Yarden Azoulay Katz, who provided the scan to Bo Laurent on 19 May 2025.
• Related: Replies to items 1–2; answered by item 4
• Redaction flags: Randolph’s home street address and telephone number — masked in this version (city and state retained, as these appear in his published obituaries)
• Rights: Author is Judson Randolph; copyright rests with his estate/heirs. Reproduced in full under a fair-use rationale (see Rights & permissions). The handwritten pages are reproduced as scanned images; the printed home address and telephone number on the final page have been redacted.

Scanned images

Transcription (from the recipient’s transcription of the handwritten original; [sic] marks the original’s spelling)

1-7-93

Dear Ms Sullivan,

Thank you for your confidence in [w]riting to me about the circumstances of your congenital anomaly and subsequent surgery. I believe I have a clear picture from your concise but detailed letter.

After writing an article on total extirpation of the clitoris (Surgery 1964), based on the hope that vaginal organism [sic] would be possible when these females, (deformed by unsightly penile-like enlargment [sic] of the clitoris) grew to maturity, I came to the conclusion that sparing the clitoris would be more physiologic [sic] and more appropriate. Thus my experience, and my studies over the subsequent 25 years has all been with an operation which was devised to conserve the sensitive tip of the clitoris, the erectile tissue in the shaft, and the blood vessels and nerve supply.

It is not surprising that the clitorectomy (performed at a time when that was all surgeons had to offer), improved your feminine appearance [sic] but removed much of your potential for orgasm, unless there is some in the vagina.

I have not heard of results with nerve re-anastomosis, but many things are now possible wiht [sic] skilled surgeons trained extensively in microvascular techniques. I send you now a warning to avoid a friendly, even competent doctor with a plan but without extensive experience in this difficult area of reconstruction. I recommend that you go seek advice form [sic] the head of the Gynecology service at a major institution like Stanford or U. of California, SF. It may require a program which involves plastic surgery, gynecologic surgery, and urologic surgery. You may wish to seek several opinions since I doubt that there are more than a half dozen surgical teams in the entire U.S. who are experienced extensively with your condition as presently presented. If I knew of them I would send you there. But my work has all been with children.

Be cautious, be wise, above all don’t hurry, its [sic] too important to rush this evaluation and therapy plan. If you feel I can serve as an opinion source at any time during this journey please call or write.

with good wishes for success, I am

Sincerely Yours Judson Randolph, M.D.

[home address redacted] Nashville, Tennessee [telephone redacted]

Editorial note. This is the pivotal document in the set. Its evidentiary weight comes from its source: the surgeon-author of the technique, writing privately and in his own hand, describing his own change of practice — from the total-extirpation paper, premised on the hope that “vaginal orgasm would be possible,” to a later conviction that “sparing the clitoris would be more physiologic” — and stating plainly that the earlier operation “improved your feminine appearance but removed much of your potential for orgasm.”

Randolph dates the extirpation paper to “Surgery 1964.” No such paper exists. Writing by hand nearly thirty years after the fact, he has misremembered the year: an extensive bibliographic search — PubMed together with the reference lists of Randolph’s own later papers (1970, 1981, 1992) and of numerous independent reviews of feminizing surgery — turns up no 1964 Surgery article by these authors, and indeed no 1964 paper by anyone, on clitoral extirpation. The only nearby 1964 title, Fortunoff, Lattimer & Edson’s “Vaginoplasty technique for female pseudohermaphrodites” (Surgical Gynecology & Obstetrics 118), is by other authors and describes a different operation. We therefore conclude that the article Randolph means is Gross, Randolph & Crigler, “Clitorectomy for Sexual Abnormalities: Indications and Technique,” Surgery 59 (1966): 300–308 — the same paper the writer herself cites, correctly, in her opening letter (item 1). It is worth noting for readers that this article, and Randolph’s later clitoroplasty papers, describe patients in the surgeons’ own words as “deformed,” “unsightly,” “embarrassing,” and “offensive”; his candor in this private letter stands against that published vocabulary. The contrast runs deeper than tone: in this letter Randolph names the loss of sexual function directly, whereas his published record has no place for it — his 1981 long-term study enters a patient’s refusal of further surgery only as a “disfiguring” cosmetic failure, her own reasons unasked. That article is taken up in the editor’s note below.

The technique was published as a plate of operative photographs. It appears here as Figure 4, redacted, with the surgeons’ own caption left intact:

4. Bonnie Sullivan to Judson Randolph, 31 January 1993

Metadata

• Date: 31 January 1993
• Sender: Bonnie Sullivan, San Francisco, CA [street address redacted]
• Recipient: Dr. Judson Randolph, Nashville, Tennessee [home street address redacted]
• Medium: Typed letter
• Extent: 1 letter (1 p.)
• Signature: “Yours Truly” (typed); signed Bonnie Sullivan
• Provenance: Author’s retained copy
• Related: Replies to Randolph’s letter of 7 January 1993 (item 3)
• Redaction flags: recipient’s (Randolph’s) home street address — masked. Sender’s own San Francisco street address, postal code, and telephone — masked (city and state retained).
• Rights: Author’s own; publishable in full

Transcription

31 January 1993

Dr. Judson Randolph [home address redacted] Nashville Tennessee

Bonnie Sullivan [street address redacted] San Francisco, CA [telephone redacted]

Dear Dr. Randolph,

Thank you very much for your kind letter. I have now had the chance to speak with several surgeons about the possibility of microsurgical repair. Two in particular seemed to be well qualified to educate me about what is possible. One of these surgeons is associated with a clinic that is a leading center in microsurgical reconstruction (although not genital surgery). The other has extensive experience with phallic reconstruction for trauma and for female to male transexual patients.

It seems that no one has done a clitoral reconstruction. It is theoretically possible to harvest some tissue from between toes or fingers, dissect my genitals, locate the severed pudendal nerve, attach the nerve from the harvested tissue to the pudendal nerve, open the abdomen to get an artery to deliver enough blood to allow adequate healing, and perhaps produce a neo-clitoris with some tactile, erotic sensitivity, but far less than an actual clitoris. My judgment is that there is some possibility of success, but not enough to justify the risk, the extensive surgery, the expense, the genital dissection (with possible damage to some of the sensation I do have now or even to urinary continence), and the ugly secondary defect. I have therefore abandoned the idea of surgery.

I am writing now to ask you a favor. My sexual anatomy, following clitorectomy, is very different from that of every other woman I know. There is no one who can really understand what my sexual experience is like, no one whose body works like mine and with whom I can talk about how to best use the sexual resources that remain to us. I have come to the conclusion that it would be very healing to form a support group. I know that there are other women in the same situation as me. It would be healing for me, and I think for them as well, to be able to share our experiences.

I am writing you now, therefore, to ask you to help me to meet some of your ex-patients. I realize that you cannot give me their names. I give you permission to give my name, address, and telephone number, as well as this letter, to any of your former patients, and to invite them to contact me. I do hope that you will be able to help me in this way.

Yours Truly,

Bonnie Sullivan

PS: Please note my new address. I have now settled into my own apartment in San Francisco.

Editorial note. The historically decisive turn. Having investigated microsurgical reconstruction and rejected it on a clear cost–benefit basis, the writer reframes the problem from a medical one to a collective one — proposing a support group of women with the same history, and offering her own name and letter as the point of contact. This is the founding impulse of the intersex-rights movement, recorded months before the Intersex Society of North America was established later in 1993.

Editor’s note: the 1981 article

The two surgical figures associated with this item come from Randolph’s long-term study of thirty-seven clitoroplasty patients, published in the Journal of Pediatric Surgery in 1981 (reference R3). The article is worth reading against the correspondence, for what it does not say.

Randolph reports that three of his patients had, in his term, an “unsatisfactory outcome”: their clitorises remained enlarged after surgery. One went on to clitorectomy; one was to be operated on again later; and one, he writes, “adamantly refused further surgery,” despite what he calls the “disfiguring prominence” of her clitoris.

That refusal is recorded entirely as a surgical problem. It appears as a cosmetic failure the surgeon was not allowed to correct — her clitoris is “disfiguring,” and the regret in the sentence is his own, that he could not operate again. What the article never asks is why she refused. She was old enough to decide; old enough, perhaps, to weigh what she had felt before the surgery against what she felt after, and to conclude that another operation would take more than it returned. The possibility that she had experienced the earlier surgery not as correction but as loss — as mutilation rather than disfigurement — is nowhere in the text. Randolph does not speculate — though in private, as his letter of 7 January 1993 shows, he could name exactly such a loss. The framework of the article has no column for the patient’s own sensation, only for the surgeon’s judgment of how she looks.

This is precisely the omission that the letters in this file press upon. Writing to Randolph a decade later, Bo Laurent put to him directly the question his article leaves out — what the surgery had done to sexual sensation and experience. The patient who “adamantly refused” is not named in the article and cannot be spoken for here; but the silence in the record about her reasons is itself part of the history this archive keeps.

Finding-aid summary

Associated material. Two surgical figures (Fig. 2 and Fig. 3) accompany the file (randolph.gif). They depict the clitoral recession technique — recession of the shaft beneath the pubis with sutures placed in the pubic periosteum and Buck’s fascia — associated with Randolph’s clitoroplasty publications (Randolph & Hung 1970; Randolph, Hung & Rathlev 1981; see references R2–R3). These are published journal illustrations; reproduction rights rest with the publisher, not with the author of the letters or with Randolph’s estate. Recommend citation/link, or a low-resolution excerpt under fair use with full citation, rather than clean reproduction.

Rights & permissions

Items 1, 2, and 4 were written by the author of the Papers and may be published without restriction.

Item 3 (Randolph’s reply) is reproduced in full — transcription and scanned images — under a fair-use rationale. Copyright in a letter belongs to its author, not its recipient; Judson Randolph died on 17 May 2015, so that copyright rests with his estate/heirs. The decision to publish accepts a considered, low residual risk in light of the document’s historical importance and the factors set out in the statement below. The one factor weighing against fair use is that the letter is unpublished; the countervailing factors — nonprofit educational purpose, documentary and critical framing, absence of any market for the work, the recipient’s ownership of the physical letter, and the fact that it concerns medical procedures performed on the recipient herself — are strong. The home address and telephone number printed on the final page have been redacted from both the transcription and the scanned image, which also reduces any privacy concern for the author’s surviving family. This is an editorial judgment, not legal advice.

References

DOIs are given where one has been assigned. Articles predating the DOI system are cited with journal, volume, and page; a PubMed ID (PMID) is supplied where available. All identifiers below were verified against the publisher or PubMed record.

The annotated original

The letter as Suzanne Kessler read it — seven pages carrying her handwritten responses in the margins. Click any page to open it full size; the complete scan is also available as a downloadable PDF (7 pp.). A transcription follows below, and Kessler’s annotations are transcribed as a separate layer.

The letter

29 January 1993

Suzanne Kessler
Division of Natural Sciences
SUNY Purchase
Purchase NY 10577

Dear Ms Kessler,

Thank you for taking time to talk with me the other day about management of intersex children. I was surprised by your resistance to the notion that the surgery being done on intersex genitals today is at the expense of sensation, and therefore amounts to mutilation. Let me tell you some of the facts and experiences which have led me to that conclusion. ¹

One of the physicians who was responsible for my care at Columbia is now the grand old man of pediatric endocrinology in the US, and Chief of Pediatrics at a major teaching hospital. I contacted him last year by phone, and asked him why I had received no emotional care whatsoever. In fact, no doctor ever offered to talk with me, explain what they were doing or had done to me, and I was illegally prevented access to my medical records.² He told me that emotional care had always been strongly emphasized in his program at Columbia, and I would understand that when I got my complete records. I got the records last year, and they confirmed my recollection that there was no emotional care. Claims that such care is being provided today should be believed only if independently confirmed.

Intersex specialists claim that the surgery is intended to save the child from the pain and stigma of growing up as a hermaphrodite in a culture which does not recognize hermaphrodites. In fact, a recent personal correspondence from Dr. Randolph clearly indicates his position that I was well served by having “your feminine appearance improved” even at the expense of an entire lifetime of normal sexual gratification.³

However, my experience, and the several life stories I have thus far collected indicate that medicine does not even achieve that goal. The others I have been able to contact tell me that, as in my case, information about their history and diagnosis, as well as medical records, were hidden from them. However, each of us eventually managed to obtain our records, in many cases investing enormous amounts of time and energy to obtain every scrap of documentation of events that occurred decades previously. And, when we obtain our records, we learn – that we are hermaphrodites! Medicine thus inflicts exactly the harm it claims the surgery is intended to prevent. It hurts. It shuts people up.⁴

I talked last year with a woman surgeon, one of the most respected in the field of surgical “correction” of infant’s genitals, and Chief of Child Surgery at a major hospital. I told her that my clitoris had been removed, my gonads operated on, and none of it explained or justified to me. She was impressed with the gonadal surgery, and told me, “you have received really excellent care.” In fact, could I choose, I would be happy to trade the slight risk of gonadal cancer for the chance to escape the mutilation of my genitals.⁵

I told my story last year to many of my friends (perhaps twenty to forty people). In so doing, I turned up two other stories. One, a woman with adrenal hyperplasia, was clitorectomized at age 17, in 1970. She is now an emotional disaster. She remembers clearly what sexual gratification felt like, feels the loss very keenly. I spoke not with her, but with her former lover, who told me that this woman was “one of the most hurt, damaged people” she had ever known.⁶

Another is the niece of a friend. I was able to speak by telephone with the surgeon, a local urologist. He removed the erectile tissue and part of the glans from her large clitoris, at age three and half months, two years ago. He told me that he had never seen an intersex infant before, but he spoke at a convention with a surgeon from Columbia, and one from Boston Children’s Hospital, and they explained to him how to perform the surgery. I told him about my history, then asked him about the prospects for clitoral sensation after the surgery he had recently performed. His voice became so choked with emotion he was unable to speak. I asked the family about emotional care for family and child. They told me “she will have to take oral hormones at puberty, since she has no gonads. The doctors who give her the hormones will provide good emotional care, certainly.”⁷

The prospect for sensation after transexual surgery is not so rosy as you seem to think, either. I recognized that the experience of transexuals might be of some relevance to me, so I visited a therapist who does psychotherapy and sex therapy for transexuals. I asked her how much feeling a male to female transexual had in the vagina created by penile inversion. “Usually none.” Then what is their sexual experience? “Closeness. The joy of being penetrated by a man, feeling close to him, giving him pleasure.”⁸

I talked with the patient counselor at the office of a well known sex reassignment surgeon. She told me that 40% of her mtf patients end up with no feeling in the vagina constructed from the penis. All transexual patients at all programs are required to sign a release stating that they realize the likelihood of having no sensation at all in the reconstructed genitals, and of never again having an orgasm.⁹

I have talked with a number of mtf transexuals. All told me that they were willing to trade sexual gratification for having their bodies made to fit their gender. They were willing to live without the possibility of orgasm or genital sexual pleasure again. However, some of them do experience orgasm after surgery.¹⁰ Those who have talked about it with me tell me that it is difficult and unreliable, sometimes achievable with 90 minutes of stimulation, sometimes not at all. One has told me that she achieves orgasm by manipulating her urethra. Another says that she does it by manipulating the stump of the penis, or the prostate through the vagina.¹¹ In her case, the surgeon left behind some of the erectile tissue of the base of the penis so that this erotic sensation would remain.

The female to male surgery has such poor prognosis for preservation of erotic sensation that many people choose to leave their clitoris intact. Some have a penis constructed in front of their own clitoris, while some simply have the clitoris (grown to an inch or more after taking androgens) freed up from the surrounding tissue.¹²

I have discussed transexual genital sensation at length because it is relevant to the Lattimer surgery, in which nearly all of the clitoral erectile tissue is removed, as was done to my friend’s niece. This surgery cannot be any less traumatic to the innervation of the clitoris than is penile inversion.¹³ Further, penile inversion is only performed by plastic microsurgeons who specialize in genital surgery. Clitoral reduction is often performed by inexperienced local surgeons. It is also significant that ts surgery has been refined over decades, by surgeons conferring with the patients. Since surgeons working with intersex children don’t talk to their patients about sexual response, it is not clear how they can refine their procedures or hone their skills. In fact, most doctors working with children (not only genital surgeons) seem to have an extreme aversion to seeing adult patients.¹⁴

The innervation of the clitoris is identical to that of the penis. There are receptors in the erectile tissue of the shaft, as well as in the glans. When a clitoris grows larger under the influence of androgen, it does not also grow new receptors. The existing receptors are merely spread out over a larger volume. Removing the clitoral shaft destroys as many receptors as removing the shaft of a penis would do.¹⁵

The clitoris functions both afferently and efferently. Sexual arousal leads to erection (efferent route) which produces sensation (afferent route). This occurs even without direct stimulation, so removing the erectile tissue drastically reduces the functionality. This is confirmed by the fact that some women who were subjected to amputation of the external part of the clitoris report the ability to achieve orgasm by stimulating the clitoral stump.¹⁶

Scar tissue is detrimental to feeling. If I apply a vibrator to my genitals, even inside my vagina, the only result is an irritating itching sensation. Sex therapists tell me this is typical of scar tissue. One man I have spoken to, raised male although his penis was completely hypospadic, tells me that plastic surgeries, repeated many times over the course of his childhood, resulted in scarring on his penis and left him with greatly impaired sensation. Today he would probably be assigned female and most of the penis (now conceptualized as a large clitoris) removed. Would this have left him (her) with better erotic sensation? All clitoral reduction techniques require very deep dissection of the genitals, a part of the body that does not heal well.¹⁷

The refusal to conceptualize a child as a potential sexual being is not limited to doctors performing genital surgery on intersex children. I have talked with one of the founders of the Turner Syndrome Society. Turner syndrome girls have no gonads, and therefore must take oral hormones to produce feminizing puberty. She has told me that resistance on the part of doctors and parents to beginning the hormones, thus allowing “my little girl” to become a sexual, adult woman, is a widespread problem, one which often leaves the girl feeling helpless, stranded in childhood as her peers are moving into womanhood.¹⁸

The importance of preserving erectile tissue was recognized by Randolph. After co-authoring a how-to article on extirpation (Gross’66), he apparently changed his mind. Although he did not publish any negative results for clitorectomy, one suspects such results led to his change of heart: Randolph’70 emphasizes the importance of erectile tissue for erotic sensation, and describes a technique for relocating, rather than removing, the clitoris.¹⁹

Some follow up results were published in Randolph’81. This article reveals a very interesting episode. “Three patients had an unsatisfactory outcome with persistent enlargement of the clitoris. One of the three required clitorectomy, another has thus far refused additional surgery, the third will undergo further corrections later.” “The final patient in this group has adamantly refused further surgery in spite of disfiguring prominence of her clitoris.” Did she refuse because she was old enough to compare sensation before and after the surgery, and experience it as mutilating? Randolph doesn’t even speculate. He is merely sad for her “disfigurement,” unhappy that he was not able to fix it further.²⁰

Although the Randolph technique would appear to have better prospects for preserving clitoral sensation, the Lattimer technique seems to be more common, and even clitorectomy is still not dead. For instance, the chapter on disorders of sexual differentiation in a standard endocrinology text simply states, “One of the clitoral recession techniques is to be preferred to clitorectomy.” (Conte’89) I did, though, locate a urology text (Perlmutter’92) which stated “clitorectomy is mentioned only to be condemned.” It describes a whole slew of techniques for recessing the clitoris, concealing it by stitching up labia majora, plicating it (similar to a dressmaker’s pleats), or simply excising the shaft and grafting the reserved glans onto the stump.²¹

Last year I was examined by a surgeon who is experienced in sex reassignment. He used a sort of vibrator to measure tactile sensitivity thresholds in my genital region. When I asked him the result, he told me that it was difficult to tell. There are huge atlases of normal tactile sensitivities for the whole body, he explained, which are used to quantify peripheral nerve damage, yet these atlases omit any data for the genitals. (I have not yet confirmed this.)²²

I have spoken to several surgeons who are performing the Lattimer surgery on a regular basis. Two told me that they had no long term data because the surgery was too new, and humans take such a long time to reach sexual maturity. The Lattimer technique, however, was published in 1961. (Lattimer’61) One surgeon, questioned about long term results, changed the subject, waxing enthusiastic about the new possibility of constructing an adequate penis rather than reducing the clitoris (although he does “lots” of clitoral reductions).²³

I have asked some of these surgeons what they thought of Randolph’s technique for moving and recessing the clitoris, without removing any erectile tissue. They were uniformly ignorant of it. It seems they don’t have time to read after they leave medical school.

I talked with a pediatric endocrinologist about my experience of clitoral extirpation as sexually debilitating. “Wait a minute,” he said. “That’s not sexually debilitating. Do you know that they do it in Africa?” (Honest, he really said that. It is present in print, too – Gross’66, Randolph’81.) I have now had the chance to discuss it with several Somali women, who tell me that it most certainly is sexually debilitating, in fact the express purpose is to eliminate sexual feeling in the woman, lest she bring shame to the family. The existence of a bodily modification as a cultural practice is no proof that it is harmless. Consider foot-binding, or the castration of eunuchs, or cultures which require women to amputate a finger whenever a close relative dies.²⁴

I visited a woman endocrinologist who manages the care of girls with adrenal hyperplasia at Columbia, where the Lattimer technique was developed and is still used. This doctor examined me every year from age 8 to age 12, and never volunteered any information about what she was doing or what had happened to me. I asked her last year if she had seen any other adults who were former patients. “Yes, a few.” Did she ask them about their sexual response or adequacy of reconstructed genitals? “No.”²⁵

I asked her what she knew about the possibility of orgasm without a clitoris. “I don’t know. It sounds as if you are more knowledgeable than I.” I told her that Money had told me that in order to achieve orgasm I need to have a partner with whom I am deeply in love. She was shocked, told me that as a fully functional, married woman, she couldn’t imagine ….²⁶

I asked her if she knew of reports by Money that adrenal hyperplasia females were more likely to be lesbian than the general population. No, she was not aware of that, she admitted.²⁷

This woman is probably the parents’ only source of information about their child’s sexual prospects. These girls have a hard life; sexual understanding and openness on the part of the doctors could make it better, both through direct interaction and by educating the parents. It is hard enough to grow up lesbian without having parents who suspect you to be a sexual freak, and lesbianism to be a perverted aberration.

Finally, the medical idea of gender, and medical confidence that it can be fixed with surgery and hormones, is terribly mistaken. I know of one person, surgically and hormonally fixed to be female, who now lives as a man, with female genitals. He regrets the loss of his small penis, which the surgeons removed as a large clitoris. His female assignment was imposed, and he rejected it as soon as he became adult. I know a person, surgically and hormonally fixed to be male, who now lives as a woman. Her vagina was removed and her labia stitched together into a “scrotum”. This was done to make her genitals match her outsized clitoris, and to satisfy the doctors’ need to force her body to match a sex assignment imposed, not chosen by her, one which was rejected as soon as she fought past alcoholism and found the emotional strength to do so.²⁸

When I began last summer to search out intersex specialists, I expected to find some help. I thought that these doctors would have excellent connections to therapists skilled in dealing with histories like mine. They have none, nor do they have any sympathy.²⁹

I thought it would be instructive to learn about the current state of the art in clitoral reduction surgery. I learned that there is no consensus: amputation, removal of erectile tissue by Lattimer’s technique, preservation of erectile tissue by Randolph’s technique, and reduction of the length by grafting the glans onto the base and discarding the shaft are all practiced.³⁰ There is no consensus on the optimal timing. Some say the sooner the better, before the girl can be aware of her genitals. Some say it is better to wait until around age three, when the genitals are larger and easier to work with, the ultimate proportions are more easily discernible, and the child is better emotionally equipped to tolerate hospitalization and separation from the mother.

I found that follow up of adult sexual response is close to non-existent, and too timid, too shy about sexual explicitness, to be useful where it does exist. My offers to share my history, along with complete medical documents, were met with a collective yawn, in spite of the fact that as a “true hermaphrodite” and fertile female I am one of the rarer and more interesting types of intersex.³¹

I found that many medical texts and articles have photos of slightly virilized female genitals, not freakish or disfiguring, which are about to undergo clitorectomy or clitoral reduction. They are accompanied by medical illustrations of severely virilized genitals, poor little girls with penises for God’s sake. In fact, I have slept with a woman whose clitoris was large enough to protrude forward from between her labia when aroused. She told me that when she was born, in 1960, doctors told her mother that her clitoris was a disfiguring defect, and that they would remove it, a very simple procedure. Her mother was horrified, and refused to allow it. She has never suffered any ill effect from her large clitoris.

Ultimately I came to the conclusion that the purpose of the surgery is to ease the parents’ pain, at the expense of the child’s future as a sexual adult. Doctors will tell you about the “bad old days, we don’t do that kind of thing anymore.” This is what they have always said, and will continue to say. This facade is easy to maintain, because their charges are too young to speak or know what is being done to them. By the time they are grown, they will be too emotionally traumatized, afraid to be stigmatized as a freak, to speak out.³²

I hope that I will hear back from you. In particular, I would welcome any criticism you may have of my arguments.

Yours Truly,
Cheryl [surname redacted in source]

Recipient’s annotations

Suzanne Kessler read this copy with a pen in hand and left comments in the margins. They are transcribed here as a second layer, keyed by superscript to the point in the letter they sit beside. She numbered many of her notes (1)–(18) in the left margin; those numbers are given in brackets where present. Readings marked [?] are uncertain from the scan and need a second look against the original.

Source and provenance

• Item ID: letter-kessler
• Date: 29 January 1993
• From: Bo Laurent (signed Cheryl, surname redacted in the source scan), Intersex Society of North America
• To: Suzanne Kessler, Division of Natural Sciences, SUNY Purchase, Purchase NY 10577
• Medium: Typed letter, physical original, 7 pp., with the recipient’s handwritten marginalia
• Source file: sources/letters/kessler/kessler-1993-01-29.pdf
• SHA-256: 08d4763932574d141b1cf4bfed3f6177e1b8c5f41a834946591e216c48fc0606
• Held at: Suzanne Kessler papers in the Labadie Collection at the University of Michigan
• Consent: Suzanne Kessler, 1 July 2026 — publish with her notes. sources/letters/kessler/consent-kessler-2026-07-01.eml and sources/letters/kessler/consent-kessler-2026-07-05.eml
• Related item: born-digital source of this letter is item correspondence-kessler-1993-1994 (Word-for-Mac file, letter 1 of 9)

Provenance note. This is the canonical scan Kessler saw and approved. A single redaction has been made: a handwritten phone number on page 1 (Bo’s own, long disconnected) was removed. The signature surname is blacked out in the image (a pre-existing feature of the physical copy); the author is identified in full in the headnote and metadata. The upload’s filename carried a stray “1994,” but the letter’s dateline, 29 January 1993, is authoritative and is used throughout; the PDF’s internal title (“Chase to Kessler, 29 Jan 1993”) is correct. The scan was sent to Bo Laurent by Yarden Azoulay Katz via email/Dropbox on May 19, 2025.

Textual note — born-digital variant. A born-digital copy of this letter survives in the 1993–1994 correspondence file (correspondence-kessler-1993-1994). It is not identical to this mailed, annotated scan: the digital copy renders Dr. Randolph’s name as “Dr. -” (redacted) where the scan names him, and it omits the sentence about the adrenal-hyperplasia woman’s former lover (“one of the most hurt, damaged people…”) that appears in the scan. The mailed scan thus appears to be the later revision (or the digital master was redacted afterward) — confirm the direction before treating either as canonical.

Works cited in this edition