I’m sick and tired of all the weird, made-up words for homos and transsexuals these days. I wince at “same-sex marriage”. Me marrying another woman probably wouldn’t be a same-sex marriage. Why not just say same-gender? It’s what you mean. I cringe when somebody describes “women whose sex is male”, or “female-sex men”. Sorry, but your opinion doesn’t change biology. I don’t see why we have to insert unnecessary politics and act like a cis woman’s body is female and mine isn’t. If trans women are valid, and just as much women as cis women, why is only a cis woman’s body defined as that of a woman? Don’t pretend that “female” and “male” aren’t literally the most gendered words in the English language.
What’s the issue with just treating physical sex as female and male? Firstly, even for cis people who clearly fit one description or another, there’s huge amounts of variation, in size, looks, function. A cis woman with XX chromosomes can have a uterus that can carry children, a uterus that can’t, or no uterus at all. A cis man with gynecomastia can grow breasts. A cis woman with PCOS can grow facial hair. Instead, we stereotype female sex as one thing and male as another, where many theoretically included go unrepresented.
Beyond that, people lie outside the poles. Intersex people are not talked about nearly enough, and often treated like inanimate objects without feelings who none of us will ever meet, like no intersex person is going to feel pained when you call them a "hermaphrodite". Most people are assigned a gender at birth, raised accordingly, and go their whole life thinking their body fits with expectation for that gender. If you’re intersex, that means living in ignorance that your chromosomes differ from the norm, or that you have dormant internal organs, or other variations.
What’s worse is that too many doctors look at newborns and don’t know what gender to assign them based on sex. You could just not assign gender off sex in the first place. It’s pretty weird. Instead, outdated social norms map onto medical practice in horrific fashion. Intersex babies face non-consensual surgeries, such as sewing up or chopping off genitals, reminiscient of female (“”) genital mutilation too often dismissed as exclusive to the Global South. While beyond the scope of this article, note it's also legal to perform non-consensual male (“”) circumcision, a practice no major medical organisation supports and which offers no benefit. It makes me sick to my stomach, living in this reality, how often I see people scaremongering about trans youth consensually modifying their bodies through hormones or surgery. There is so much ignorance to the real damage doctors are permitted to do to young bodies just after they've come into this world.
Often, intersex youth are not even told about their surgery. They don’t know for years why they don’t grow breasts or get tall like they expected. They find out later in life through unexpected symptoms or happenstance medical scans. It is a crime that children are being brutalised and the lives of teens and adults disrupted every year. They deserve far more medical care that meets their needs, including access to any consensual surgery necessary to improve quality of life. They ought to be broadly recognised and supported against the different challenges their bodies may create. We should make intersex pride possible , particularly in this month, for anybody intersex who wants to embrace the uniqueness of their body.
What other problems stem from equating sex with gender? It’s uncomfortable for some trans people - I know I hear language that assumes I don’t exist far too often. As usual, though, this is case-by-case. If you’re a trans man and want to call your physical sex female because you feel that sums it up, or you’re a trans woman and don’t mind your physical sex being described as male, more power to you. Nobody who tells you you can’t or shouldn’t is in the right.
As a systematic designation and the default for all of us, sex-gender equivalency breaks down. Many countries force people to get surgery, or even to be sterilised, before they will be recognised as their gender by the state. We get nonsense like cis people saying we’re always our birth sex, even though plenty of trans people literally change sex through surgery. If I’ve had vaginoplasty, what does it matter that my chromosomes are XY? There is a dangerous lack of education about how widely known scientific details like chromosomes and hormones actually shape bodies.
The way most of us currently view sex, not gender, as determinative inculcates everybody in the idea that gender is based on sex. That makes transphobes sound more convincing. TERFs believe that reserving bathrooms for cisgender women and transgender men is them defending “sex-based rights”. This is despite the fact that nothing whatsoever about your physical sex has anything to do with your ability to use or access a bathroom, how others will perceive you in there, how you will behave, or various other factors. As usual, what it comes down to is social views and norms that are fluid and can change being veiled in a respectable cloak of science and biology.
Besides the extremes, defining sex in such a gendered and binary way also leads to thoughtless malpractice by many well-meaning people. Health systems intended to ensure everybody gets their organs checked break down when confronted with trans bodies. When trans women are recorded in a health system as women, then they don't get notifications that they need to receive a prostate exam, because the assumption is that women don't need those. That’s how people get avoidable cancer.
A common refrain in response is that "male" and "female" are broadly useful classifications to encompass distinct sets of characteristics. Besides literally everything I've just been over, and how I'm obviously never going to accept my health needs being dismissed just because I'm in the minority...for goodness sake, they're medical professionals. They are the best people in the entire world at unflinchingly describing and examining bodies without being immature or squeamish about it. If you need to check everyone with a uterus for endometriosis, then just record whether someone has a uterus or not, not whether they're a woman or not, and act accordingly. You don't need to know if someone's sex is recorded as male to figure out what procedures they need, just record and ask for the relevant details. Otherwise, people slip through the cracks and get hurt when they're meant to be helped. More broadly, this creates more privacy and respect for trans people.
Finally, we also get screwed badly when scientists, researchers, students and professors equate sex with a set of physical stereotypes. They go and find only men or only women to do their research with. What you end up with is studies that only work when you’re talking about cis people. I can't look to studies on, for instance, breast development amongst trans women, because the focus has been so heavily on cis women. That makes it harder to appraise where we are and advocate for different outcomes.
What was going on in the real world that made me write this many words about arcane matters like language, social norms, and description? Labour MP Kiri Allan won the East Coast electorate last year to represent the Cape. I remember seeing her on Election Night and being so happy for her. I also remember being absolutely gutted by her cervical cancer diagnosis out of the blue. She is an absolute soldier and I have so much admiration for her, and anyone else going through that. She flies home today from treatment, and I hope all has gone well and that she makes a full recovery.
Her and many others have been doing an amazing job encouraging women to go and get cervical smears. That’s particularly important because wāhine Māori tend to check less often, thanks to a medical system that often doesn't fit or work that well for them, and consequently have higher levels of cervical cancer. I can’t speak to that like I can issues for trans people in the healthcare system, but that is also an urgent crisis. A lot of the same issues mentioned in this article about not studying and preparing for certain bodies applies to the bodies of wāhine Māori too.
I’m not going to critique a woman beating cervical cancer for how she worded her posts. That would be the absolute peak of ridiculousness. However, I do wish other messengers had done a better job thinking to include everyone who needs to hear this message. I want to be clear right now that the following paints a worst-case scenario. In my experience, medical professionals are amazing and inclusive, and things are only getting better. Please, if there’s even a chance reading a worst-case scenario might deter you from getting a test, don’t read on. The goal here is to ensure people do get tested.
Imagine you are a man. (If you are a man, skip to step two.) You walk in, and tell the receptionist you're here for a cervical scan. Maybe they frown at you and cock an eyebrow, or start telling you it's not for you. Or maybe they say sure, then call a nurse over and say "She's here for a cervical scan, do we have any rooms free for her?" You go into a room with pink walls and girlboss messages all around. The nurse does nothing to alleviate the dysphoria you feel on top of the discomfort of the procedure. It's actually quite quick, painless, and easy, but you still go away feeling sick and uncomfortable, deeply uncertain about whether you'd want to book this again.
We know this happens, though it’s a lot worse in other countries. The statistical problem above obscures its true seriousness, but one sample group in the UK suggested almost half of trans people with cervixes were not getting checked. People have seen their friends and family die horrible deaths. They would be here today if they’d felt comfortable going to get checked for cancer or recognising other symptoms. It’s part of why life expectancy for trans people is years below cis people, and it gets even worse for Māori and Pasifika trans people, compared to the rest of us.
Look, I'd feel a bit bloody silly if I were dying of prostate cancer because I was too afraid of likely nice, wonderful doctors doing a quick and easy check. It could still happen, though. Trans people, like any people, make stupid decisions sometimes based on lots of little things that pile up, and I condemn no one for feeling rightly uncomfortable if they've been mistreated before. I've been misgendered and belittled by counsellors, and made uncomfortable and felt intruded on by doctors. We know the solution to trans erasure and exclusion is not expecting us to get over it. It’s why the vast majority of people call me “Ellie” and “she” and “her” instead of whinging about how my parents gave me my name, or that pronouns are too confusing and complicated to learn.
The other thing is, as is often the case with trans people being excluded, there is no need for sex-based discrimination. You all can fix it all up with a bit of thoughtfulness and doing things differently. It costs nobody anything. Already, the Ministry of Health uses inclusive language on their websites.
Three things you can do. Think about where your language sounds inaccurate to reality. I’m no fan of being anal about language just because it’s technically grammatically incorrect or whatever, but consider where it might actually affect someone or spread misconceptions and misinformation. Provide more inclusive care and show more forethought about how to accommodate different people. Finally, think about the importance of motivating people to get issues checked out. Us youth mostly don't have to worry about the issues described in this article, but it's always a good truism to play it safe and make sure people get checked out if anything seems wrong. Save lives.
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