Talk:Intersex/Archive 5

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Order of sections.

It is very easy for one issue to bleed into others in multifaceted topics such as this, so I am individuating them where possible under more descriptive titles.

Regarding the order of the section, it is not clear to me from your comment above, MishMich, whether you are okay with moving the medical aspects to immediately follow the lede sentence. Just to repeat an earlier point of mine, this is not to emphasize the medical aspects, but because the discussion of social aspects will (I believe) make more sense after the reader has had some information about the conditions themselves.
— James Cantor (talk) 22:31, 4 April 2009 (UTC)

I think that things should remain as they are. A number of people were involved in the construction of the page, and there has been quite a lot of discussion over the past week. It is only polite to give people time to see what is being proposed, and comment themselves. My own feeling is that the medical approach developed out of a historic situation, and then current debates developed in response to the medical approaches that began in the 1950's & 1960's. By putting the medical aspects first, it makes it appear as if the medical paradigm is in some way a base-level. It is not, it itself has changed over the years, and is set in the context of an ongoing history - part of which is the liberation of intersex people from social stigma, secrecy and shame. Although I accept that there are people involved in the medical side of goodwill, the history of medicalisation does, unfortunately, include reinforcement of stigma, secrecy and shame - as well as arbitrary assignment gender, surgical and social reinforcement of gender. The current debates and the whole medical taxonomy can only be appreciated in that context. So, I would prefer it that the re-organisation of the page is done in a way one would approach a major overhaul, and which seeks feedback from other contributors. Placing the medical aspects at the beginning is, for me, problematic.

MishMich (talk) 07:44, 5 April 2009 (UTC)

I suspect that you and I are referring to different things with "medical aspects;" it was perhaps a poor choise of words on my part. The section that I think should come after the lede is the table with the conditions and their descriptions. I didn't mean "medical aspects" to mean what should be done or has been when an intersex birth occurs.
— James Cantor (talk) 12:21, 5 April 2009 (UTC)

@ James. Section 3 - 8 seem to be discussing various aspects of the medical view of intersex, and I guess you are referring to section 7.2? Section 7.2 appears to be a more comprehensive list that section 3, and yet omits items included in section section 3. Section 7.2 is preferable, in that it talks about 'conditions', whereas section 3 talks about 'disorders' (although it includes symptoms in the list) - and disorder is a contested term. It seems to me that whole section (which is broken into five sections, for some reason, and containing discrepant duplications at the beginning and end) needs to be revised in a coherent way, and the scientific interest disentangled from the medical approach. I don't think that taking 7.2 out of that series of sections and placing it as section 2 really addresses that, especially as it is incomplete and focuses on chromosomal sex determination. If you like, I can ask Sophia Siedlberg of OII (who I understand is a biochemist very knowledgeable in this area) to take a look at section 3-7 (including 7.2) and see what she can come up with. I would suggest that the whole layout needs to be looked at, reorganised, then each section redeveloped as appropriate.

Introduction (lede)
Contents
1. Social and Cultural History of Intersex (2.1,2.2,2.6,+)
2. Medical Aspects (3,5,6,8,-)
3. Scientific Perspectives (7+)
4. Language, Discourse and Controversy (1+)
5. Community and Identity Issues
6.1 Notable Intersex People (2.3+)
6.2 Notable Researchers (2.4+)
6.3 Intersex Organisations (2.5+)
7 See Also
8 References
9 Bibliography
10 External Links

The + suggests the need for expansion, correction, assimilation, and so on
The - suggests the need for reform into a single coherent section with subsections

This does involve a bit of an overhaul, but given the number of contributions over a period of several years, it is not surprising that it comes across scrappy in the way it does. What is necessary seems more like editing than anything else, and regrouping into a more coherent layout. Once that is done, the gaps will become more obvious, and people will see more easily what needs filling in and where. MishMich (talk) 17:29, 5 April 2009 (UTC)

Following on from Banjeboi's last comment on 'El for OII', that the sort of overhaul suggested would be impractical, maybe we should continue as James began in this thread, and simply work through the article from top to bottom, and discuss the location of the section as well as the content as each one is reached. In this respect, we have only begun by addressing the first sentence. Because the first sentence speaks about humans, where the second sentence discusses 'organisms', this needs to be highlighted as referring to biological organisms generally. The next sentence:

Intersexuality is the term adopted by medicine during the 20th century applied to human beings whose biological sex cannot be classified as either male or female.[2][3][4]

mid-20th century would be more accurate.

Intersexuality is also the word adopted by the identitary-political movement, to criticize medical protocols in sex assignment and to claim the right to be heard in the construction of a new one.[5]

This appears quite laden. 'Intersex' tends to be the term preferred, and it was adopted by intersex individuals who sought to claim an intersex identity. Only later did 'intersex' become associated with the LGB(T) movement. The term was not adopted in order to critique medical protocols nor in order to be heard in the construction of new protocols. People who had experienced medical interventions and sex assignments critiqued the protocols and campaigned for new protocols, and at the same time identified themselves as intersex. Mish (talk) 11:13, 14 April 2009 (UTC)

Society section

This section is a bit of a mess. I would like to re-organise it, pulling in bits from other sections as appropriate (controversy, for example), leaving the medical section free of social matters. Is that OK? Mish (talk) 01:52, 19 April 2009 (UTC)

I have re-written and replaced the text in the 'controversies' section, following BeBoldInEdit's 2nd attempt at vandalism and censorship without discussion. I suggest incorporating this within the social/history section, and deleting the subsection on Anglo-Saxon terminology unless references are supplied to validate this. Mish (talk) 21:15, 20 April 2009 (UTC)

"derogatory"

there is no compelling reason why "hermaphrodite" or "pseudohermaphrodite" should be inherently "derogatory" as a term for this condition, and reference to some web page stating an opinion to such an effect hardly goes towards establishing this as a "fact". By all means, state that "Intersex Society of North America considers the term derogatory", for whatever it is worth. We report opinions by notability, we do not endorse or disendorse them. The highly dubious nature of the web page linked should be obvious from its comparison of "hermaphrodite" with slurs like "dyke and queer". "Queer" never was academic jargon for a medical condition, it's street slang for "homosexual". If anything, if there must be comparison with terms for homosexuals, compare "hermaphrodite" to the medical term "homosexuality", and "intersex" to the common self-designation "gay". --dab (𒁳) 14:52, 14 October 2008 (UTC)

Whether or not these terms are considered derogatory, they are both inaccurate and obsolete. Jacie Cady (talk) 02:07, 27 November 2008 (UTC)

Agreed. Amen. Chbse 07:21, 28 November 2008 (UTC) —Preceding unsigned comment added by Chbse (talk • contribs)

some people do seem to prefer 'hermaphrodite'. It is the way the word is used that determines whether it is derogatory or not - whether it is used in a way that dehumanises the subject or not. I think a better comparison would be intersexual with homosexual (rather than 'gay') or transsexual, and hermaphrodite with sodomite (not 'homosexual') or transvestite - that gives a clearer view of where these words are coming from. MishMich (talk) 11:38, 3 April 2009 (UTC)

The problem with that argument is that transsexual and transvestite are not synonyms, and refer to distinct (if, in parts, overlapping) groups of people. Furthermore, hermaphrodites, properly, are organisms with functioning male and female reproductive systems. "Hermaphrodite" used for an intersex individual should be deprecated as inaccurate (archaic historical usage notwithstanding), not as derogatory. --Dante Alighieri | Talk 20:18, 13 April 2009 (UTC)

I did not suggest that transvestite and transsexual were synonymous, my point was about etymology of the words - words ending in 'ite' do so because they were rooted in 19th century medical discourse - sodomite, transvestite, hermaphrodite, etc. (and along the way a variety of 'isms' used to describe a range of what were then seen as sexual psychopathies - sadists and masochists, viragonists and feminists, for example, as well as androgynes and gynands). Whereas the 'ualities' emerged more in the 20th century - homosexuality, transsexuality, heterosexuality, bisexuality, intersexuality. Transsexual is a good example of this, because prior to the 1940's, people who would now be considered transsexual were described as transvestite - see Hirschfeld's book 'Transvestites'. So, when Foucault dates the construction of the category 'homosexual' to 1869/1870, it is clear that people engaged in same-sex sexual practice long before this, and the term 'homosexual' itself did not emerge until many years after that date. Westphal himself used the term (translated) 'Contrary Sexual Feeling', and in English we had 'Sexual Inversion', and this persisted into the 20th Century, and was replaced by the medicalised term 'homosexual'. I certainly agree that hermaphrodite needs to be deprecated because it is medically redundant as well as being inaccurate in the way you describe - and like 'intersexuality' noted as having connotations perceived by some as derogatory or misleading, and by others claimed as self-identity. It is a matter of fact that hermaphrodite was regarded as derogatory, and ISNA helped ensure that the term was dropped publicly (although its deprecation in medical discourse began as early as the 1940's). Unfortunately, Wikipedia has not yet deprecated it, because it still features as titles of pages such as 'pseudohermaphrodtism' and 'true hermaphroditism', when the DSD guidelines give very clear alternatives to the redundant terminology - which can only be addressed by closing those pages and moving their content to an alternative page using more up-to-date terminology. I would offer to help with this task, but am not clear that I have the privileges to relocate, rename and delete pages. If I did, I would be editing the 'intersex' and 'VSD' pages right now, rather than bothering with a page the title of which should itself be deprecated following the decision of the consensus of medical experts to abandon 'intersexuality' in favour of 'DSD'. Mish (talk) 13:41, 14 April 2009 (UTC)

I question your analogy between "Sodomite" and "transvestite" and the rest. Sodomite as a term referring to male homosexuals predates any 19th century medical context by hundreds of years. And the suffix "-ite" itself in this case is clearly a reference to a denizen of Sodom.

-ite From: The Concise Oxford Dictionary of English Etymology | Date: 1996 -ite suffix corr. to F. -ite and Sp., It. -ito, G. -it — L. īta, -ītēs — Gr. ī́tēs, forming adjs. and sbs. with the sense ‘pert. to or connected with’, ‘member of’, as in hoplī́tēs HOPLITE, polī́tēs citizen (see POLITIC). There were many formations in Gr. on proper names; in LXX and N.T. and later Christian use this type was widely extended for the names of sects, heresies, etc., and in late L. and the mod. langs. the suffix has been used without limit for ‘follower, devotee, or admirer’, as in Jacobite, Shelleyite, Wycliffite.

Nevertheless, I am not opposed to harmonizing article titles/terminology on medical issues with established medical language, so if you have sources that suggest this is the case you should maybe start an RfC on the issue. --Dante Alighieri | Talk 21:49, 27 April 2009 (UTC)

Yes, true, but you get my point. Hermaphrodite stretches back into the ancient world too. Unlike transvestite. It was in the 19th century that these 'odd sexual habits and characteristics' (to quote a certain Guardian journalist) began to be seen as medical categories. These things all began to be dealt with in certain ways in the 19th century. Instead of executing and punishing queers as criminals, they began to be treated as sexual psychopaths instead (progress comes in small steps). This isn't the place to discuss this, at is way beyond the point of the discussion - which was that I was not using the two terms synonymously. I do take your point though - I got something slightly wrong. Not often I say that, but hopefully the sky will not fall on my head.

Reference to the DSD consensus is located in the text, but as I am not a part of that consensus, it would not be for me to do this (RfC) - it would be for those who agree with the DSD consensus to do this. Orv they could simply go. I am happy with 'intersex'. DSD is not a terminology that speaks to me or most intersex people I have spoken with, it is a terminology that speaks to medical scientists and the like. So, it would be for medical people to relocate with the terminology they have selected as a substitute for intersex, leaving this space for intersex. Mish (talk) 00:51, 28 April 2009 (UTC)

Synthesis of published material that advances a position

Do not put together information from multiple sources to reach a conclusion that is not stated explicitly by any of the sources.

Editors should not make the mistake of thinking that if A is published by a reliable source, and B is published by a reliable source, then A and B can be joined together in an article to reach conclusion C. This would be a synthesis of published material that advances a new position, and that constitutes original research.

Even if we call those two wikipedia pages reliable sources, I haven't read both articles in full but I don't think that either of them explicitly say that due to controversy they are not using pictures of young people even with consent.

I will admit that I may have edited too much because I failed to find any references to intersex in the medical journal besides in the title you cited because for some reason search wasn't working on the article, I later found the part you were referencing was way at the end. For your information it would be helpful on those citations (and I just found this out myself, I'm a fairly new editor) if you say where in the article you were getting your information as explained in: http://en.wikipedia.org/wiki/Wikipedia:CITE#SAYWHEREYOUGOTIT

I will need to look at that citation again but I don't know if it talks about any controversy either, I believe that it just said something like even though intersex people have special issues (but doesn't explain what these are), that they are still basicly the same as any other case and care should be taken. I still think that unless this section is cleaned up it should be removed, the fact that it is taking so much time to find reliable sources to back up all of the arguments is a sign that it probably isn't notable enough for this broad overarching article.

Be Bold In Edits (talk) 02:21, 22 April 2009 (UTC)

Hi BeBold,

Please be aware that I have a lot of the papers (1,000+) and books I use for reference and others are available to me online. If you want to seach a pdf, you do it within the pdf viewer, not the browser. Conclusions do tend to come towards the end, and along with the introduction at the start, they also tend to point to what is in the rest of the paper. However, a clue to the paper's relevance is in the title, and if you actually read the paper, you might understand more what it is about and why it is relevant. the reason I put the quotes in was so that it would be clear what was being said in the sources, rather than be open to suggestions of quoting unrelated material - I guess it would be better to cite the paper and include the link to the actual paper there, but I am learning as well. I am fine with the way it is editing out, because one of the three papers clearly belongs in the previous section, where I moved it to. As it stands now, the section only speaks to medical photography as relating to the two papers - and gives the picture further down the page as an example of the sort of photograph being discussed in the sources. I will merge the sections to be into a single section entitled 'medical proceedures which include surgery and photography', because they both interrelate, and strictly speaking the taking of a medical photograph is a medical procedure in its own right. Mish (talk) 14:54, 22 April 2009 (UTC)

I checked out the book refs again, and they have the page numbers marked quite clearly in the citation, taken directly from the books in question - feel free to do something useful like reorganise them to Wiki citation standards, otherwise I will eventually when I am sure it won't get hacked about again.

So, here I am looking at the paper, and it is only 6 pages, so not sure what the problem is in finding the section, but it is on the last page, p.71. It is not the only quote I could have used, for example, on p.69-70, there's this:

'"They made me be naked in a room and take pictures of me and they took pieces of my skin and left two marks one on each arm and nobody said to me why they were doing it. Those marks are still there, and I look at them and I think "Why did they do that?" You know, why did they make me stand in a room and have pictures taken with no clothes on and humiliate me like that without saying anything to me. Why, what was wrong with me?" A 53-year-old-with CAIS.

When this patient talked about having had clinical photographs taken in her early teens she had tears in her eyes and she was angry. She has skin biopsy scars to remind her of the experience that she has been trying to make sense of in the intervening 30 years. The patient asked these questions with imploring urgency. She knows that she has a rare genetic syndrome and suspects that doctors wanted to photograph the stigmata of her condition. In essence, she knows exactly what was `wrong' with her. What she still finds impossible to reconcile is why she was treated in this way and was made, or was allowed, to feel the way she did.

"I was shocked when I saw it (the picture)- not as shocked as my mom was, though! But we got through it. My mom was holding me when he took the pix, but had no idea he would publish them. She thought he was just taking pictures of me. I kind of like my little picture! I've made a little peace with that tiny child with the sad eyes." (Fig. 2).

The experience of being photographed has exemplified for many people with intersex conditions the powerlessness and humiliation felt during medical investigations and interventions.'

Or the main points from the conclusion, again p.71:

• A proportion of medical photography is for publication and presentation and is not essential to the care of any individual patient.

• Medical photography may have significant effects on the patient and their family. This is particularly true of intersex conditions but is likely to apply to other patients.

• Patients undergoing medical photography must be fully informed as to the purpose of the photograph and full consent for each use must be sought.

• Pictures taken by other than photographic staff should be subject to the same storage and use regulations as those taken by the professional photographic staff.

• Photographs of the genitalia and other sensitive areas in children and intersex patients should where possible be taken at the time of general anaesthetic for treatment or investigation.

• Whole-body naked photographs of children or adults with intersex disorders cause serious psychological sequelae and should not be taken. They do not educate or inform and should no longer be used for teaching and publication.

• Further objective work on the long-term influence of medical photography on patients is required.

Not all of these points apply to the photograph in question. The section as it stands advances no thesis, simply highlights that there are problems, points to references verifying that they are seen as problematic by individuals themselves and specialists working in the field, and utilises the photo as an example of this style of medical photography. Mish (talk) 15:49, 22 April 2009 (UTC)

Hir?

Do we have a convention on style governing the use of gender-neutral pronouns for this Wikipedia? --Dante Alighieri | Talk 20:13, 13 April 2009 (UTC)

If you do a search on 'Hir', you are directed to this page: [[1]] where the usage is detailed. I tend to use s/he and hir in my own writing as appropriate. Mish (talk) 23:24, 13 April 2009 (UTC)

Sorry, I may not have been clear. I'm looking for information on the use of gender-neutral pronouns on Wikipedia. Something along the lines of Wikipedia:Gender-neutral_language, but policy rather than simply an essay. Even that page doesn't mention "hi" and the like, though. --Dante Alighieri | Talk 00:26, 14 April 2009 (UTC)

If you read it, you will find this:-

Ze (or zie or sie) and hir[7] - Ze laughed - I called hir - Hir eyes gleam - That is hirs - Ze likes hirself

The page you referred me to is an essay as well - I think that you may be confusing the issue of self-identity with gender-neutral language. The style guide suggests avoiding using him/her, he/she, 'one' or 'they' as generic pronouns in the same way that masculine or feminine forms should be avoided, it stresses that people should be referred to as they would choose. Clearly, as this is a specific case, and Del prefers not to identify as male or female (see the interview with in Ekins & King 'The Transgender Phenomenon'), some other term is necessary - so hir is appropriate. However, if you want to change it to 'him' I'm not particularly bothered, as del is often referred to as a him, but do not change it to 'her', because Del doesn't like that. Perhaps, if Wikipedia does get around to incorporate the page you referred me to into its style guide, it should look at incorporating the page I referred you to as well. Mish (talk) 01:03, 14 April 2009 (UTC)

I'm a bit confused why you mentioned that the page I referred you to was an essay 'as well', since I explicitly said that it was, and that I was seeking something more along the lines of policy. As for the specifics of Del, how is hir more "appropriate" than any of the other alternative pronouns? --Dante Alighieri | Talk 22:00, 27 April 2009 (UTC)

Generally speaking, the issue simply does not arise - Wikipedia writes about very few subjects of ambiguous gender. If I were to propose a policy, it would be in favour of the use of singular they, which is a form already widely familiar to English speakers that would not be jarring or distracting in an article. To quote the Cambridge Guide to English Usage, "For those listening or reading, it has become unremarkable - an element of common usage." Although newly-invented gender-neutral language may be effective in drawing attention to gender issues and making a political statement (one that I'm quite in favour of), that's not really Wikipedia's focus. Dcoetzee 01:14, 15 April 2009 (UTC)

Sure, although Wikipedia policy states that 'they' should be avoided. The point here is not finding a substitute for he or she (which 's/he' will work as well as 'they' if 'ze', 'zie' or 'sie' is unacceptable), but 'his' or 'her' - 'their' won't cut it in that situation (neither will 'them' for 'him' or 'her'), and without 'hir', then the only alternative is to use 'his/her' or simply 'his'. I'll change it to 'his' anyway. Mish (talk) 01:52, 19 April 2009 (UTC)

A related question, does anyone have a pronunciation guide for "hir" and the other alternative pronouns? --Dante Alighieri | Talk 22:15, 27 April 2009 (UTC)

Interesting question. I saw one once. How does one choose? Personal preference or the stated preference of the subject. Mish (talk) 22:44, 27 April 2009 (UTC)

photographs

There are photographs of intersex anatomies on this page. Is there any evidence that these photographs have the fully informed consent of the indivduals concerned allowing these pictures to be placed on the internet in this way? MishMich (talk) 11:26, 3 April 2009 (UTC)

Nobody has responded on the subject of photographs. Does anybody have any objection to my removing the image of infant genitalia from the intersexuality page, or is there some evidence that the individual has consented to this photograph being used in this way on Wikipedia and the internet? MishMich (talk) 23:50, 5 April 2009 (UTC)

For what it's worth: If you click on the picture, you will get the source of the photo, which is a journal article. If you click on the link to the journal article, you will see (at the bottom of the article) the statement that consent was provided by the parents of the child in the photo (who is deceased).— James Cantor (talk) 00:03, 6 April 2009 (UTC)

clearly the child was never in a position to give or withhold consent. 10:51, 6 April 2009 (UTC) —Preceding unsigned comment added by MishMich (talk • contribs)

I'm not clear on what you're saying exactly: that the presence of the picture violates the WP standard for such pictures, or that you disagree with the WP standard for such pictures? — James Cantor (talk) 12:53, 6 April 2009 (UTC)

I'm not clear whether a picture of a child's genitalia is legitimate or not - you appear to be more familiar with the way it works than me; perhaps you should ask whether images of children's genitalia are acceptable on Wikipedia.

I object to it for several reasons. The is first that it is an image of a child's genitalia (albeit deceased), which is not usually accepted online for non-intersex children, and I am not sure why intersex childrens' genitals should be an exception to this. Second, the example in question is quite an extreme case, where the child had a number of complications which meant it did not survive, and the genital ambiguity was one aspect of those complications. I would worry that people seeking information and support would find this paper quite shocking, and as you are no doubt aware, it is an extremely rare case which has limited bearing on the experiences of the majority of intersex people. So, is it a representative image (and link) on intersex? No, it is not. So, why is it there? Finally, I resist the reduction of intersex issues to simply being about genital ambiguity - just as I resist the reduction to XY/XX chromosomes and all that entails. I am sure that there would be better, fully consensual, images available if required - although I am not sure why they are necessary. People who are involved with intersex in some way will not find it informative or helpful, so the only purpose appears to be either for 'shock' value or voyeurism, neither of which seem valid reasons for having the picture on Wikipedia. MishMich (talk) 17:55, 6 April 2009 (UTC)

So, I will ask this way: does anybody have any specific objection to my removing the image of a child's genitalia from this page? Mish (talk) 12:33, 11 April 2009 (UTC)

I do. Unless replaced with an image that serves a similar purpose (illustrating one or more specific instances of ambiguous genitalia in an intersex individual) it would be removing useful encyclopedic information from an article without reasonable justification. The argument that it is a child's genitalia is, IMO, a non-issue. This is as non-prurient a presentation of genitals as one could imagine. That is is only ONE example, and therefore not typical of MOST cases is an argument for including additional images, not removing this one. Your argument that you "resist the reduction of instersex issues to simply being about genital ambiguity" is a red herring. The inclusion of this image is not suggesting that intersex issues are solely (or even primarily) about genitalia (or, for that matter, chromosomes). If you are so sure that there are "better" images to include, I would encourage you to do the legwork, find one or more, and add them to the article. I do not see the benefit to throwing away someone else's work and replacing it with nothing. As for it not being informative or helpful to people "involved with intersex", I humbly submit that this encyclopedia (and this article) are for ALL people, and that simply because a certain group of people may not find value in one aspect of an article does not provide a compelling argument for redacting it. Aside from that, I would dispute the claim that it is not informative or helpful for such individuals, if only for your own claim that this may be an extremely rare case... and therefore unlikely to be in the common experiences of even those who are "involved with intersex". --Dante Alighieri | Talk 20:09, 13 April 2009 (UTC)

I removed it anyway. My point about this being an extremely rare case is that the genital ambiguity is only one aspect of the problems involved, and not representative of conditions characterised as intersex or DSD - if you look at the article cited, the condition of this child had features such as extra fingers, and severe diabetes, to the extent that it was non-viable. Whilst severe CAH can be life-threatening, intersex is only life-threatening in extreme cases. I doubt you will find many intersex people would be happy with such a photo, and those I have spoken with are not happy. This page has implications for inclusion as an LGBT project as well as a medical project, not simply sexology. The whole issue of inclusion of photographs of intersex children's genitals is both controversial and problematic. I am unclear why it should be seen as necessary. As the initial quote says on your page, dissent from this sort of approach is perfectly reasonable. Mish (talk) 22:18, 13 April 2009 (UTC)

Quote: My own experience with viewing these photos is often self-conscious as I sit in a library's medical stacks, flipping through articles with photographs that seem oddly reminiscent of child pornography. In an eerie way, these pictures also remind me of criminal mug shots. While the people in these pictures were posing for purposes of documentation, it is important to remember that they were in a vulnerable state that might not have allowed for thir refusal of being photographed... Intersex children not only experience a discrediting mark or stigma associated with their bodies, but also feel they lack control over their bodies due to involuntary exposure to ongoing examinations and other medical procedures. Sharon Preves, "Intersex and Identity, the Contested Self". (Rutgers, 2003) p.72. Mish (talk) 22:56, 13 April 2009 (UTC)

If you look through the sites associated with intersex (support groups as well as medical sites providing information) you will not find these sorts of photographs. They can be found in medical books and papers, but this sort of approach is contested, and in a page that addresses the issues of members of a community, it is disrespectful to ignore criticisms about approaches that reduce people to genital curiosities. There are charts which show the intermediate stages of genital development (for AIS, for example), that would be informative about intersex development, although these may have copyright implications - I am sure that there will be medical contributors who would have access to published material that would be less problematic than actual photographs of vulnerable children's genitalia. Mish (talk) 23:33, 13 April 2009 (UTC)

I've reverted your removal. Your argument seems to be, at it's core, "it makes me uncomfortable". This is not a valid reason for removing encyclopedic content. --Dante Alighieri | Talk 00:27, 14 April 2009 (UTC)

No, my argument is that it makes most of the subjects of the article uncomfortable. It seems a shame that the subjects of an article do not get to have a say in what is and is not appropriate for that article. Mish (talk) 01:13, 14 April 2009 (UTC)

The image is clearly highly relevant and informational regarding the topic of the article, and Wikipedia is not even its first place of publication. I move that it be restored. We do not require consent for subjects in photos. Dcoetzee 01:40, 14 April 2009 (UTC)

Your headed down the wrong path here. Even if some, many?, of the editors here don't agree with you it doesn't mean they are mistaken or malicious, although they might be. Even if it takes longer than it should generally articles improve and our policies guide us. In this case we don't censor. It's logical that an article that speaks to variance in human anatomy would illustrate that. Just as our articles on erection include the predictable and generally bland image of those. IMHO, it would be less stressful to focus on what the article needs in addition to the major problems it has. There is a lot of work here but it also doesn't need to all get done immediately. -- Banjeboi 01:44, 14 April 2009 (UTC)

I agree that it is an issue of some sensitivity, and rather than attempt to remove it again, I have noted that there is an objection to the photograph. I am canvassing elsewhere for something diagramatic that can be used instead, as that would be more informative and representative. It is worth noting that the pictures shown under vagina and penis are those of adults, and if you search under boy's or girl's genitals, nothing is found. It would be preferable, as I have suggested before, if the medical/sexological usage could be segregated away from the community/identity usage - and those concerned have already begun to do this by creating the terminology of 'DSD' - that should entail the subject 'intersexuality' marked as a redundant term from the 1960's in the same way that 'hermaphrodite' is its redundant predecessor. That would enable 'intersex' (which is unavilable, as it simply redirects on to this page) to become utilised by those who identify as intersex in a way that would avoid these problems. the only alternative would be to set up a task-force that incorporated this page under medicine/sexology & sexuality/LGBT projects - the latter accommodating community/identity interests in this page. Mish (talk) 02:19, 14 April 2009 (UTC)

This is an example of how this could be managed more sensitively, and informatively:

http://www.aboutkidshealth.ca/HowTheBodyWorks/The-Prader-Scale.aspx?articleID=7715&categoryID=XS-nh4-03

Although beyond a link like this, I am not sure it is possible to incorporate it into Wikipedia as an image. Mish (talk) 02:47, 14 April 2009 (UTC)

A good quality diagrammatic image would be fine (although I prefer having both, my position is more radical than general consensus). I do also support clear distinguishing of the social and biological terminology. It may also help eliminate the consent issue if we can locate an intersex adult who has not had surgery who would give permission to be photographed. Dcoetzee 03:05, 14 April 2009 (UTC)

An adult photo would be preferable. Although different issues, there are clear parallels with the way circumcision is handled, so the way this works in the article on male circumcision http://en.wikipedia.org/wiki/Male_circumcision, is to have adult genitalia shown as examplars of this practice (usually carried out on children, in the West in a medical setting, and without consent). Similarly, female circumcision http://en.wikipedia.org/wiki/Female_genital_mutilation manages this quite adequately with a diagram rather than photographs of children's genitalia. I have asked around, but very few adults who showed clear signs of ambiguity did not have surgery as children, and few would want pictures of their genitals posted online. An alternative would be to locate an intersex adult who has access to photographs of their genitals before surgery in childhood, and who consents to their use. Gaining consented photos is further complicated because of concerns about the fetishistic interest that exists about 'hermaphrodites'. Those who work with intersex people would be in the best position to source consented photos, as most of the people I have access to are dealing with issues of trauma etc. emanating from associated experiences, and many have no access to specific photo's of themselves beyond their (anonymous) use in texts and papers. Mish (talk) 10:26, 14 April 2009 (UTC)

Hello everyone, I am new at Wiki but try to learn quick. Reason of my being here is this article, and especially the discussion around the photography of a childs genitalia from (in my opinion questionable) medical context. I say questionable because there is one major problem for medical judgement when it comes to intersexuality: medical science bases its assumptions on our culture that believes people come in clear cut two sexes (which again is naturalized and medicalized by science in a self-referential circle). They mix up possible real medical issues and conditions that intersex people might have with the cultural assumption of how e.g. genitalia have to look like. This is an issue that has not been addressed by medical science yet - even though other critics have been pointing in that direction (I believe one recent example is the book Fixing Sex: Intersex, Medical Authority, and Lived Experience by Katrina Karkazis, 2008 (Intro to this book can be found here: [2] ). To make it short: a graphic is much less offensive and pornographic (like a medical photography that is taken out of its medical context) and I suggest instead of the problematic photograph to use the Prader-Scale from Milton Diamonds website, found here: [3] --Akin Ooloi (talk) 10:51, 14 April 2009 (UTC)

@Akin Ooloi. Thanks for this, it used to be on the AISSG(UK) site, but I could not find it again when I looked. I know Prof Diamond, so will ask him for permission to use it on Wikipedia. I don't think Kazankazis deals with the issue of medical photography specifically in her book. What she does write, which highlights the issue to some extent, is this:

'In addition to the trauma from these unexplained surgeries, some individuals recall a sense of discomfort, vulnerability, and humiliation due to repeated medical and genital examinations. Louise Rutherford, who has CAH, observes, "I remember feeling like a freak show because every doctor had to do a genital examination. It didn't matter how much you cried or that you were cold. No one cared." Several others I interviewed complained about being objectified by clinicians and of being spoken about as if not present' (Katrina Kazankazis, Fixing Sex: Intersex, medical Authority, and Lived Experience', 2008, p.222)

The problem is that such photos are part of that process of objectification of intersex bodies she describes. It would not be tolerated if on a page about African Americans the only images shown were of Michael Jackson, a lynching from the 1930's and a picture of a 'golliwog'. Mish (talk) 11:56, 14 April 2009 (UTC)

A user who does not identify himself beyond his pseudonym has removed my comment objecting to the use of this photograph, without speaking here, and at the same time suggested that I am acting as two people - I have clearly identified who I am, and have no known connection with the other objector to this photo. He has suggested that I have not substantiated the comment - this paper by members of the medical team at UCL makes it clear what the issue with medical photographs of intersex children is, and that when used they are for specific medical purposes: http://www3.interscience.wiley.com/cgi-bin/fulltext/118927929/PDFSTART Clearly, this photo was taken for medical purposes, and this public distribution of medical photography violates medical ethics in countries in which it will be viewed. Mish (talk) 12:44, 14 April 2009 (UTC)

I continue to strongly support inclusion of the image. Although the article makes the concerns of the community clear, until such time as an image with less ethical concerns is available, it is of higher priority that the article is a complete reference, which it cannot be without an image. The analogy with an article on race is inappropriate, because at present these are the only images available. Dcoetzee 23:05, 14 April 2009 (UTC)

@dcoetzee. I appreciate that, and will do what I can to get something better than the image there at present. Thank you for your edits, which have made my contribution more concise - although I have had to revise one or two minor points. I think that having a section which makes clear that there are controversies in this area, and spells out what they are, is a way forward for getting the article sorted out. We might want to discuss where that should be located (I placed it at the point where the DSD controversy was already raised). Mish (talk) 00:22, 15 April 2009 (UTC)

I too support inclusion of the medical photography. This article is slowly turning into a social article (instead of a medical article) if the photograph is removed. The figures are neccesary for the article to stay encyclopaedic/wikipaedic. Chbse 06:28, 15 April 2009 (UTC) —Preceding unsigned comment added by Chbse (talk • contribs)

@Chbse. It is a social as well as medical issue. It is already incorporated as a social category (sexology and sexuality) as well as medical. It should also be an LBGT project. Mish (talk) 07:02, 15 April 2009 (UTC)

@Mich. In my opinion (off-topic), I believe the medical as well as psychological aspects of intersexuality greatly exceeds it social aspect, because of the rareness of intersexuality. Still, I believe it is neccesary to display examplary pictures and figures to underline some medical aspects. Greetings Chbse 12:31, 15 April 2009 (UTC) —Preceding unsigned comment added by Chbse (talk • contribs)

@Cbhbse. (feel free to relocate this and your preceding comment to a new section if you wish) At what point does an issue become socially significant? Experts such as Professor Diamond and Eric Vilain state that 1-2% of the population are born intersex in some way. For those who experience intersex it is a social as well as medical issue, and it often has effects that stretch into adulthood, such as physical and psychological trauma. The stigma and silence associated with intersex are social issues, not medical, and only consequentially psychological. People think it is only a medical issue does not make it so - the phenomenon existed long before the medical profession became involved with it. I agree that the best possible medical information on this issue is highly important to help people understand intersex (the purpose of an encyclopedia is to provide information) but that is one part of intersex, and in not featuring other aspects this page would be misleading and incomplete. If people involved in treating intersex people and scientists can contribute to page on intersex, and not be seen as having any COI, then intersex people affected by scientific theories and medical treatments must be accorded a similar respect, so too academics with some understanding of the social issues affecting intersex people. I have pointed out that the medical and scientific community have rendered the title of this page redundant in favour of 'DSD', so one way round this would be to mark 'intersexuality' as an historical anachronism, relocate the medical information to the DSD page, and allow for the referral page 'intersex' (which points here) to become freed up in a way that it can cover the social and historical factors. The way things are, there is no other location for the social aspects, including the controversies and historic challenges to medical approaches - and denying them here would effectively be a form of censorship. Mish (talk) 14:26, 15 April 2009 (UTC)

Cbhbse and MishMich: You two appear to be addressing different things. MishMich's comment above and previously seem to be coming from the belief that someone is arguing for the removal of the social aspects of intersexuality. However, if there are "people think it is only a medical issue," no one has said so here. My personal opinion is that this is an article about a group of medical conditions, ones that have important social implications. I get the impression that Cbhbse thinks the same thing. I do not get the impression that Cbhbse wants to make this an entirely medical issue (nor do I); rather, Cbhbse thinks that this should not be an entirely social issue and that removal of medical photographs helps to push the overall article too far away from medicine (as do I). I don't mean to put words in Cbhbse's mouth; have I caught your thoughts fairly, Cbhbse?
— James Cantor (talk) 18:04, 15 April 2009 (UTC)

@James Cantor: you read my mind. Thanks! I didn't take my time to fully explain my motives, perhaps that caused some miscommunication. BTW: I enjoy seeing so much activity and discussion on the intersexuality page(s). It's been a long time. Greetings. Chbse 18:14, 15 April 2009 (UTC) —Preceding unsigned comment added by Chbse (talk • contribs)

I agree, it should not be an either/or thing if at all possible. The medical aspect is obviously highly significant. What I am saying is that the medical approaches both past and present need to be understood within the social context they 'operate' in. That is slightly different from saying that there are social consequences arising from medical interventions. There are, but medical intervention is not a neutral activity, it is driven in certain ways by socio-cultural influences. That is a discussion that is probably best not engaged in directly now. I understand that medical photographs are important, and I have suggested that explanatory diagrams could be used instead. I have also pointed to a paper by Sarah Creighton and the team at UCL which discusses the use of medical photographs. I can see that there may be a need for such photographs in medical texts, but I am not sure they are necessary in an encyclopedia not aimed at medical people. Since Alder Hay etc., [[4]] the approach to children here has changed quite a lot. If you read Creighton et al., you will see that the photographs used there were seen as problematic, but the subjects specifically consented to their use in order to raise awareness of the problems. So, one way of managing this might be to contact Creighton or Conway, and see if it is possible to get the permission of the subjects to reproduce one or two items from that paper for Wikipedia, and present them in a way that illustrates both the medical practice and the problems that can arise (as discussed in the paper). I am not sure the problematic photo works in any of the ways required (I do get a sense that the other photo appears problematic). I feel that making it my responsibility to source alternatives feels a bit like blackmail, and while I would be prepared to see what I can do, I am only prepared to spend the time doing so if there is some expression of commitment about the removal of the photograph under discussion. Mish (talk) 19:48, 15 April 2009 (UTC)

Please note that I have reversed BeBoldInEdits vandalism. If she has an issue with this, she should discuss that here. This is the second time she has sought to censor what is now a fully referenced contribution. This entailed a misleading and derogatory slur that this is a 'one man crusade' despite copious references to the contrary (and my not being a man), and that this is not a text book - which begs the questions why sensitive medical photographs should warrant inclusion - as this article is neither medical text nor paper Mish (talk) 08:12, 16 April 2009 (UTC)

Like Akin Ooloi, I am new to Wikipedia. I have followed this discussion over the photo with some interest over the past week. I have several objections to the photo, in fact I'm surprised that it wasn't removed when it was first put up. I haven't been able to find another example of an image of a baby's genitals anywhere else on Wikipedia. Could somebody please direct me to such an image if I'm wrong?

I have ethical concerns with images of this infant's genitalia being deemed acceptable, whereas were anyone to place an image of a non intersexed infant's genitals alongside it for a comparison, that would and should be taken down as unacceptable.

I think the editors need to reconsider opposition to the removal of this photo and allow it to be replaced with medical sketches. That solution would remove any further opposition on ethical grounds and would not leave Wikipedia open to charges of double standards. Joanne —Preceding undated comment added 12:42, 17 April 2009 (UTC).

Have you found a better illustration to use that qualifies for Wikipedia? I'm open to what people who want to remove it have to say but doing it based only on what someones "ethics" is not really possible such "ethics" are defined by that person. If would be against many peoples "ethics" to have a picture of their deity and their are many people that would say that the moon landing and holocaust never happened so its unethical to have pictures of either. Wikipedia would not work if anything that any one person didn't like got marked as controversial or removed.

Be Bold In Edits (talk) 12:23, 21 April 2009 (UTC)

Still waiting on responses. Could you give me some idea whether the items on Anglo-Saxon English (which has no sources) and Manga (which only has internal Wiki links) are a problem? Mish (talk) 15:54, 21 April 2009 (UTC)

I am so sick of you using the word censor and I don't think you have a clue what it means. Also, I have never vandalized this page, so in both cases I wish that you could use good faith. As you would say, according to the online encyclopedia Wikipedia Moral censorship, is the removal of materials that are obscene or otherwise morally questionable. Arn't you guys the one who are claiming this picture is obscene and trying to remove it? Just because you put a cite tag on something doesn't mean its properly cited. Wikipedia is also NOT a research paper, you can't cite a couple sources and then draw your own conclusion from them, which is what I feel has happened on this page. Once again my problem is that you are finding one or two other articles that use sketchs and then claiming some kind of special case that is being used for this article.

Also, my earlier problem I had with this page that you put on my talk page as "censorship" was that you posted that the picture was controversial in the description making it way to long. At the time the only person who had brought up that it was controversial was you so it was certainly original research.

As stated in: http://en.wikipedia.org/wiki/Wikipedia:No_original_research Be Bold In Edits (talk) 02:34, 22 April 2009 (UTC)

Also I didn't think about the use of "one mans crusade" as a slur it is a commonly used phrase and when I thought of it after posting I didn't feel that it was too late to remove the statement. I really don't CARE who you are in real life, and in fact you seem to think you are superior because you do post it in your talk page, in the world of Wikipedia everyone is supposed to be truly equal, including even people that edit from just an IP. This also addresses that you seem to believe that someone should get more weight here if they are transgendered, it should not matter here. I really feel like you need to learn the idea of good faith and take note that I didn't lash out at you for calling me a she when I clearly self identify as a asexualy reproducing dolphin from Africa who takes offense by the way that penquins are featured in the movie Happy Feet.

Be Bold In Edits (talk) 02:34, 22 April 2009 (UTC)

Dear BeBold,

Firstly, it was you who made the accusation that the other contributor to this discussion and were one person, so you are not in a position to lecture me about 'good faith'.

The information posted on my user page, as well as above, is there because I feel it relevant in the context of the pages I find myself editing. I am working through the morass of detail about how to do stuff here, and one of the things that became clear to me is about declaring things that might indicate a conflict of interest. I now appreciate that this is what James had tried to do, and having reciprocated on my user page, I have sought to make this clear here as well. If you choose to see that as my seeing myself as 'superior', that is up to you, but I am simply following what I read. If it also suggests that I know more about an issue than, say, you - and that is a problem for you, I am happy to take it off if you like. I am not sure where you get the idea that I assert people who are transgendered should be attributed more weight than anybody else, especially in relation to a page on intersex. My point is that intersex people should carry equal weight on a page about intersex as anybody else, and that includes doctors and sexologists. I would expect trainspotters to be able to make as significant a contribution to an item on trains as transport engineers (not a good analogy, but it makes the point).

I posted what i did on your user page, and here, and called you she, to make a point and get a response. Clearly it worked, as you are now communicating. I don't particularly care how I am referred to, but at the time I was frustrated that you were undoing what I had put in without being polite enough to come here and explain why you were doing this. How do you expect people to understand this if you do not take the time to explain why you are doing things? I think what I am talking about is manners, and I agree that this is not the place to discuss ethics. The problem is not obscenity, it is about respect. I have been involved with a different page, simply because I noticed how biased it appeared against the individual (who I have met) whose biography it was about - I mentioned it to somebody who had never heard of her before, took one look at it and immediately tried to apply the BLP policies. What was displayed was almost complete disrespect for the subject of the biography. Respect is important, and I guess this is similar to when you describe assuming good faith. Perhaps, while listening to Crosby Stills Nash and Young many years ago, I would have been better at that.

On the whole, this page works pretty well, although it does need tidying up more and going through quite carefully for wording and references etc. I think it would be great if we could do that.

I have spoken to a few people about the photo, not just intersex people, and they do not really understand why the photo is necessary and were surprised it was featured and that people were so keen to see it remain. There seems to be no way I can convey this, because unless I find papers or articles that demonstrate this then it is 'original research'. Of course it is, I am not aware of anybody placing confidential patient data, with parental consent, into a paper which is then published using a creative commons or GFPL license, taken by a third party and then placed on a third-party website like this before. The ethics of this do not actually lie with Wikipedia, I agree, it lies in the way the paper was originally published, effectively placing confidential patient data into the public domain. However, sources dealing with medical ethics pertaining to intersex treatment certainly do pertain to a page on intersex which is in part a medical project, and I would suggest that items dealing with specifically medical aspects would need to conform to medical ethics and standards in some way.

On the issue of the photo, I have written to the editors to establish whether they realised what would be the effect of publishing in this way. I support GFPL & creative commons as a way of copyrighting, which is why try to use Debian when I can instead of Ubuntu (but try getting wireless to work on Debian!), and I think that this situation is quite sad because it clearly highlights some problems involved in using it. I agree, this is not the place to discuss original research, and that is why I stopped discussing the photo, inserted some references that highlighted that there are issues about medical photography, referencing sources like Preves and Creighton to back that up, and minimalised these through your edits - I feel that the reduced comments probably work better now than including the text, and they are balanced as they make clear they are standard practice, but some have identified problems. I have spelled out what other possible problems might be involved here in discussion, but it is not going to become a crusade - I have lots of other things to do. Highlighting the problem should be sufficient, because I have carried out my responsibilities in bringing this to your attention. It is not my place to remove it again. It is up to people here whether they keep it there or not, that is their responsibility. I have said what I think, and two other people have come here specifically to state their view - others feel more strongly that it should stay, and indicated that they don't take our view seriously.

Since my previous response I have heard back from the source of an alternative image, but he refers me to the original source of that diagram, which will take longer to pursue.

Mish (talk) 14:22, 22 April 2009 (UTC)

I'm sorry about the two person thing, it was a confusion because I think at one point you had a couple entrys that would say mish and then mishmich then mish but both pointing to your page, somehow it looked like you were responding to yourself. Those two entries you picked out were very useful and I think that you are on your way to a great entry here.

Be Bold In Edits (talk) 20:45, 22 April 2009 (UTC)

Thank you, it would be great if we can get this page right. Mish (talk) 22:34, 22 April 2009 (UTC)

If I can help by making a form of illustration rather than us having to use a photo of a person, or having copyright issues about diagrams, say so. I am a decent artist and will give it a try. kriscrash (talk) 21:28, 22 April 2009 (UTC)

Thank you, I really appreciate this, let's see if we can find something 'out there' that will work first. Mish (talk) 22:34, 22 April 2009 (UTC)

Kriscrash - I appreciate your offer but I don't think that would qualify as a reputable source.

Be Bold In Edits (talk) 04:55, 23 April 2009 (UTC)

Good point, unless people agreed to using WP:IAR, in this one instance, to insert original material that represented the diagrammatic approach (released to Wikipedia using an appropriate free license) - and provided it did represent it. Mish (talk) 08:06, 23 April 2009 (UTC)

Can someone explain to me why there is so much fuss about childrens medical photography, whilst in the mean time MishMich uploaded a photograph of an erect penis with mild hypospadia? Chbse 18:59, 24 April 2009 (UTC)

I did not upload it, it is already part of the Wiki media project, and I did not load it during the preceding discussion, I uploaded it after. That is an exemplar of hypospadias, listed in that section, and looking at the pictures this was the only one that clearly showed the scars etc. It actually looks more like an example of hypospadias repair. As per the earlier discussion, it is an adult example. I'm happy to change it for one that is not erect, if you have an objection, but they don't show the scars etc. quite so clearly, because of the angle and the smaller dimensions when not erect. There are no problems with adult photographs (assuming they are consensual). Mish (talk) 20:01, 24 April 2009 (UTC)

I had another look on WikiMedia Commons, and the non-erect penis photos labeled 'hypospadias' don't show the phenomenon itself. There is one there that is less erect, and you can the phenomenon, without any intervention by the look of it, but I cannot get it to load into the page for some reason. This is the one http://commons.wikimedia.org/wiki/File:Hypospadias_erect_frontview.jpg, (http://commons.wikimedia.org/wiki/Hypospadias). I did find one with 'cryptorchidism' in the description, which I have also inserted. It is not the best example, but the only other one there is of a Chihuahua before sugery. It has affected the layout of the section a bit, but I'm not sure (technically) how to address that. If you think that there are too many pictures now, then we need to look at which are needed and which are not. I don't think any of them are ideal, but this is all I have been able to find so far. Mish (talk) 00:35, 27 April 2009 (UTC)

I too am new to Wikipedia, and I'm shocked that a picture of an infant's genitalia remains published on Wikipedia, and especially more shocked for it being on the Intersexuality WP page. Because even if we put aside the subject of ethics and morals, there are still the obvious Conflict Of Interest (COI) issue, and clearly a Human Rights issue. The COI issue, in my humble opinion, stems from the fact that many social conservatives and medical professionals and other self-proclaimed "experts" believe that binary sex is a biological imperative (i.e. only male & female), and by depiction of such an image it could be regarded primarily as a tactic employing a "shock-and-awe" effect to impose (or justify) their biased opinion on the unsuspecting reader/viewer; that ambiguity is an "abnormality" that cannot go by "uncorrected" surgically. Moreover, this depiction is by no means representative of all (or even a majority) of Intersex cases nor is it a standard of ambiguity for the subset of Intersex cases that exhibit genital ambiguity. On the other hand, from a Human Rights perspective, the picture is of a HUMAN BEING who never even had the chance to give (or revoke) consent for the redistribution of this photo, because they died prematurely. If we look at related WP pages such as Hermaphrodite and Phenotype, we see pictures of Plants, sculptures, engravings, Mollusks, Insects, but not non-consensual Human Beings. If we look at the Sex WP page, there is in fact pictures of male and female, but they are ADULTS, and we see that the model (herself) "disclaims rights on this photo and agrees to publication under the GFDL". Why not post pictures of "typical" Infant/Child's male/female genitalia (with parent's consent) on the Sex page as well, for having something "unambiguous" of the same age range to compare to? In the case of the infant's photo, James Cantor argues that consent was provided by the parents, a statement from the end of the journal article. I looked at the statement and it said "Written informed consent was obtained from the parent for the publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal." Therefore, I can argue that the parent's consent was for the reporting of the case report -as a whole- in the context of a medical journal, NOT explicitly disclaiming ALL rights on the photo nor agreeing to its publication (or distribution) under GFDL nor under the Creative Commons Attribution License. It can also be argued that a parent does not have the right to give permission for the publication of photos of their child's genitalia EXCEPT in the scope of an EXCLUSIVELY medical case report or medical journal. For instance, would a parent have the right to give permission for the publication of an image of their child's genitalia in Guinness Record if it was the biggest male/female genitalia known of or seen? If you say yes, then you might as well try to claim the right to giving permission for the publication of photos of your child's genitalia in Pornography, and then good luck to you in court trying to defend yourself with the argument that you are not bound by "someone else's ethics". Now wouldn't that sound preposterous? Jasmine.aura (talk) 23:45, 26 April 2009 (UTC)

Thanks Jasmin, I have said much the same, but it seems to have fallen on deaf ears. Somebody has incorporated an alternative adult photo, and I have since included two further adult images from WikiMedia, and been questioned about why I have done this, but the image in question has not been removed yet. Mish (talk) 01:45, 27 April 2009 (UTC)

The image in question is not removed because we (can) debate on its removal instead of removing it anyway. In respect to the infants ambiguous genitalia: find a photograph of a consented picture (18+) with severe genital ambiguity or leave this picture in. Ambiguous genitalia belong to most important medical/social issues of intersexuality: gender assignment, genital surgery etc. It's medical photography, not pornography. Chbse 07:19, 27 April 2009 (UTC) —Preceding unsigned comment added by Chbse (talk • contribs)

@Chbse "find a photograph of a consented picture (18+) with severe genital ambiguity or leave this picture in"? Like ambiguity isn't ambiguous enough for you (or rare enough to even find pictures of), so you can ask for SEVERE Ambiguity and a consensual (18+) one at that? Now what does that serve besides your interests of aggressively promoting your own biased personal "medical/social" opinions to impose "gender assignment and genital surgery etc." on non-consensual children or infants? Add to that, you're like playing chicken and egg, promoting the pushing of genital surgery on all sexually ambiguous infants, yet you feel it's someone else's responsibility to provide a consensual (18+) picture, not just ambiguous, but SEVERELY SO. So how about not? By the way, I think it's called "Sex assignment" not "gender assignment", and you should know better if you're really focused on teaching "Gender Identity in male DSD (Disorders of sex development) patients" in med school as you mention in your Biography. Remember that after you graduate, and before you are actually allowed to practice, you will have to abide by something called a Medical Practice Code of Ethics. Perhaps you should rethink your personal choice of words when labeling an extremely rare case of natural sex developmental differences. For instance, you could say "Obvious" rather than "Severe" genital ambiguity. As to the DSD label's controversy which you are obviously a proponent of, I think there's enough said on the Intersexuality page, so I won't even bother debate this one. But anyways, thanks for affirming my argument about the obvious Conflict Of Interest (COI) issue. I don't think anyone could have made it any clearer than you did. Cheers! Jasmine.aura (talk) 12:30, 27 April 2009 (UTC)

@Jasmine.aura. In South-Africa there is a saying: he who throws with dirt, loses ground. Your misreading my text, albeit likely because of my intermediate knowledge of the english language and my impatience to fully explain my views, have lead you to argue on things that do not matter in this discussion. My being, my knowledge, my reseach and my choice of words must have angered you, since I read insult after insult directed at me. Please discuss my freedom of speech in my talk page, not in a wiki project!

Concerning consent and infancy: if parents consented to dispersal of medical photography, there should not be a discussion here about placing it in this wikipedia/open-edit encyclopedia page. My point in previous entry was: if you can find a consented photograph of an individual with (yes I still use the medical term: severe) ambiguity who is not a infant, I would gladly see the infants photograph removed. Chbse 12:58, 27 April 2009 (UTC) —Preceding unsigned comment added by Chbse (talk • contribs)

@Chbase. If you know as much as you say you do, then you will also know that the set of people in the English-speaking world who did not have surgery for 'severe' genital anomalies is virtually an empty one. It is disingenuous to demand the impossible. I have not suggested that this picture is pornographic, so why are you bringing this into the discussion? The objection is nothing to do with whether it is pornographic. The objections have been listed clearly. It shows a lack of respect for the subject. The subject is not representative. We do not know that the consent was to have the photograph released into the public domain, only this paper, which was published in a way that released it into the public domain. The individual did not consent themselves. It could be used for other than medical purposes. It is a type of photo that is part of a process that has been reported as causing harm, and have experiential similarities to those experienced in CSA. Photos such as this may be offputting to individuals themselves who have been traumatised through their experiences of similar photography. If you are a medical student, or doctor, I would have thought you understood the need to minimise things that can potentially cause harm, or trauma. Your being more interested in keeping the photo in than the people affected by the treatments covered in this page worries me a great deal. Or do you seriously believe that people will be using Wikipedia as a medical reference, as opposed to medical texts and papers? If you could convince me that there may be doctors in South Africa (say) who have no other access to this information, then I might change my mind. I would find that just as worrying, but I might understand it. Mish (talk) 13:43, 27 April 2009 (UTC)

I do believe that wikipedia should be a reference for all, even for doctors to consult. Because DSD is so rare in western regions, we need photographs of genital ambiguity to show us what it is. Sadly for us, considering this (useless) discussion, we only have the infants genitalia at hand. Conflict of interest, harming or traumatising in my opinion is not an issue in the case of an (apparently) consented, anonymous photograph. I think it's medically relevant in this article. Removing it, in my opinion, creates photographical censorship. Now what are we going to do? Jasmine is bound to react on me (again) and it's probably not going to lead us anywhere. I think we need several unbiased moderators to judge this issue. Chbse 15:14, 27 April 2009 (UTC) —Preceding unsigned comment added by Chbse (talk • contribs)

@chbse In North Africa, there's a saying: He who's house is glass should not hurl rocks at others. If you were as sincere (and as knowledgeable) as you try to show you are, you wouldn't have been asking for a consensual (18+) photograph of "severe" genital ambiguity in the first place. You even came back to reinforce the unreasonability of your demand by saying that "DSD is so rare in western regions". And as a proponent of DSD terminology, you should know very well that genital ambiguity is not representative of all, nor even a majority of Intersex cases, so I asked what your proposition of depiction of "Severe Gential Ambiguity" provides for this article? It is your clandestine misdirection and subversion that angered me, not your opinions because they are yours and I don't have to take them with more than a grain of salt. Although, I was curious as to why in your bio you mention focus on "Male DSD". You say that I'm arguing things that do not matter to this discussion. Do you not see nor care if you offend and disenfranchise many Intersex people, their families, friends, and allies? Is it your intention to deceive the unsuspecting reader in getting an idea that Intersex means "Severe Ambiguity" which you go to great length to insist on highlighting? It is even more disturbing that you're trying to force these disparaging views of yours through the discussion page when challenged about a non-consensual photograph of a (deceased) child's genitals that has obviously raised a lot of controversy and fury. On top of that, you seem to have an agenda to spread that even further in medical training of fellow students. That's where the Conlict Of Interest arises from in the context of Wikipedia policy, not a freedom of speech issue, sir. I hope you read closely because there's nothing hiding between my words or lines, so please stop your insinuations. My original reply to your comment was definitely not meant to be favorable, but it was not meant to be taken as personal insults/attacks in anyway. I didn't attempt nothing more than to debate what is said, not attack you as a person. You call it a misunderstanding and blame it on your inability (or impatience) to express yourself well. Yet, you call this discussion "useless", showing no respect whatsoever to what others have to say. Could it simply be because they do not agree with you? Tell you what. You want personal criticism? Your attitude and behavior is unbecoming for someone who aspires to be a medical professional, and so I will have to decline your invitation to your talk page. By the way, since you're from the Netherlands, I suggest you make a scholar search for Peggy Cohen-Kettenis. I believe in one of her medical texts (that I've read previously) there were several (consensual) images of some intersex cases. Good luck. Jasmine.aura (talk) 19:37, 27 April 2009 (UTC)

@Chbse. I thought I had answered your last response, but in returning here I see it is not here (I keep losing connction with Wikipedia for some reason) and Jasmine has responded in the meantime. The points I wanted to make are that I see no reason for mediation, because I am not insisting for removal - I am asking politely. I have responded to every request about any editing I have made in ways that accommodate those requests. I have not suggested anything about this image being 'pornographic', only voyeuristic - in the sense that we here call 'rubbernecking'. You seem to have issues about displaying adult examples, and also seem to confuse intersex with DSD, as if intersex is about the kind of ambiguity suggested in the photo. Far from rare, Diamond, ISNA, Vilain and Fausto-Sterling all put it at between 1-2%. Your belief that doctors use Wikipedia as a reference disturbs me, because having taught undergraduates, I know they are not permitted to use Wikipedia in references, and they are failed for lifting sections from Wikipedia (not simply for plagiarism, either); the idea that doctors might resort to a resource we deny undergraduates is - mildly amusing. All I can say to you is WP:NOTTEXTBOOK. I can see the benefit for parents and intersex people and the general public having a page like this as a reference, and that it be part of a medical project in order to ensure that any medical information included is accurate. If you look at other entries, such as hypospadias and AIS, you will see they link to pages on that topic with far more detail and quality (and adult photo's, I see, in one case). I see no reason why this cannot be done with genital ambiguity, and I very much doubt I would feel any need to go there. I am unclear why this one - as you say - rare aspect of intersex needs to be dealt with in this way on this page. I have no objections to a link to the paper itself.

On the issue of referral on, I would prefer if this page were also included as part of the sociology and LGBT projects before this was referred for outside comment, and do not feel that a referral would serve much benefit as this page stands at present. If this is not acceptable, then let's have the 'intersex'page released from being a link to this page, and simply construct that as an LGBT and sociology project, mark this one as deprecated, and you can put your energies into the DSD page. I'm happy to work together on this page, but if you want to split it, then let us do that as quickly and painlessly as possible. Mish (talk) 20:55, 27 April 2009 (UTC)

@MishMich: Thank you very much for your input. I agree with all what you propose. Seems quite reasonable. Although, after removal of the photo of the deceased child's ambiguous genitalia, I do not see any benefit from inserting a link to the paper itself (from which the photo was gleaned). Mainly because it was primarily about a case of Diabetic fetopathy, in which a LOT fetal malformations can occur which are COMPLETELY UNRELATED to Intersex. The ONLY relation this particular case had was being the first ever reported case of associated ambiguous genitalia in a diabetic fetopathy condition, although this was only reported two years ago and published last year (2007-2008). Not so fitting in the context of Intersex now, don't you think? Now, I've suggested to Chbse to take a look at one medical text of Peggy Cohen-Kettenis where several cases of Intersex are depicted in (consensual) photography. In the book titled Transgenderism and Intersexuality in Childhood and Adolescence (google book search preview), page 25, there's a picture of Ambiguous Genitalia, consensual and ONLY permitted for publishing strictly in that text by the parents and the child and the doctor seeing them, and clearly categorized in a medical context as Intersex under section "Atypical Sexual Differentiation" (not labeled Disordered like the derogative DSD label) and its type clearly described as being DUE TO Congenital Adrenal Hyperplasia (CAH), and NOT due to some other unrelated thing like diabetic fetopathy which has nothing to do with Intersex. If we need an external link for examples of genital ambiguity, something along these lines would seem more proper, respectable and more fitting. All the best Jasmine.aura (talk) 22:09, 27 April 2009 (UTC)

@Jasmine. Yeah, I tried to point that out too, but medical discourse is not mine (I'm more keyed into social-phenomenological, post-structuralist, foucauldian and UNIX/linux discourse). Thanks. Having six fingers is not a DSD. Hypospadias and cryptorchidism are, apparently. Mish (talk) 22:17, 27 April 2009 (UTC)

@Jasmine. It's interesting to see how you seem to know me and my knowledge, considering you've only read my responses and my bio. My reactions on wikipedia however reflect neither of them. I aim to evoke reactions, and it seemed to have worked. I'm sick and tired of reading rediculous responses, with numerous assumptions that lead me to believe you already see me burn in hell. About everything I've responded to has been misinterpreted. But go ahead, judge me. Chbse 06:20, 28 April 2009 (UTC) —Preceding unsigned comment added by Chbse (talk • contribs)

Hi Chbse. Its interesting how you ignore the substantive point, dismissing it as ridiculous: The photo is from a paper that does not relate to this article. I had thought so, but not being a medical person was unsure of my ground on this. Now this has been confirmed by a second person. So, why does WP:SYNTHESIS not apply here, and why does WP:NOTTEXTBOOK not apply here, and why do WP policies only appear to get trotted out as a means of controlling the discourse? I have yet to see you make a reasonable contribution to this discussion or page. Yours is a fairly standard ploy - make opponents out to be unreasonable, do not engage discussion, trash the reputation of critics, ignore valid points, focus on trivia, appeal to notions of 'medical authority' and the like, give no ground. Seen it all before, it is ideology masquerading as medical normativity. Mish (talk) 10:54, 28 April 2009 (UTC)

Hi Mich. As said by the title of the photograph: it displays genital ambiguity. The picture in its context on this page never imposed to be an example of intersex/DSD/variations-SD. However, an important fraction of intersex/DSD/variations-SD consists of genital ambiguity (considering genital surgery or not; which I consider a social issue, sex/gender assignment etc) which is displayed in the photograph.

I've never imposed to have 'medical authority' and (in my opinion) I did not trash the reputations of critics. I've contributed a great deal to specific subpages of Intersexuality and I'm grateful for your contributions to this page its construction. Greetings Chbse 12:01, 28 April 2009 (UTC) —Preceding unsigned comment added by Chbse (talk • contribs)

Hi Chbse. My apology, I did say 'you', but was conjoining my criticism of what you just did with the sense I got when trying to manage this sensitive issue originally, where the 'you' was meant in a more general sense. It does get frustrating to be met with the sort of behaviours outlined above, and to see some of them carried out here as well.

Thank you for unpacking that last statement more clearly than before. My concern is that we resolve this without recourse to acrimony or having to go outside for input, because the issues are complex and not immediately obvious to those unaware of them. This is why discussion can appear tortuous at times, but I get the sense that those issues are being unpacked quite well - and I'm not sure that a simple referral for comment would work.

I don't really see the point for further discussion until an alternative diagram is made available, and we can look at this again then. I do think that it would be wise to extend this project to sociology and/or LGBT issues as well, but have to admit my knowledge of the mechanics of doing this is (as with archiving) nill. I am happy to learn how, and have looked, but would appreciate some advice on how to go about it. Mish (talk) 12:28, 28 April 2009 (UTC)

Hi Mich, I agree: this project can be extended to sociology and LGBT issues. Sorry to say that I too have nog idea how to do this. I'll accompany the search for knowlegde. In the mean time I will put my effort into finding an alternative image/diagram. Chbse 13:05, 28 April 2009 (UTC) —Preceding unsigned comment added by Chbse (talk • contribs)

I've found several forms of the same scale in a couple of places; the feminization scale (Quigley, CA; 1995) or Prader's classification (named after A. von Prader; early record of congenital adrenal hyperplasia). These schematics give a nice insight at the continuous scale of genital development. Maybe we can use/refer to these? Chbse 13:27, 28 April 2009 (UTC) —Preceding unsigned comment added by Chbse (talk • contribs)

The issue is the copyright, we cannot include them unless we they are released using CC or GDFL, we can demonstrate ownership and declare release, or permission that grants such release. That is why I understand this image was so important to people - finding an image that can be used in Wikipedia is not straightforward, because it has to be licensed using creative commons or GDFL. I have written to a couple of publishers to see if they will release their diagrams for our use, but still have yet to hear anything specific. The other alternative I could look into is to get somebody with the skill to produce a similar diagram, showing the Prader scale/grades. That could be placed onto a website somewhere, releasing it using CC, then it could be loaded into Wikimedia, and we can link to it from within the article. Shall I ask? I would prefer us to be getting on with going through the text rather than this type of discussion: checking to see where references are needed, ensuring existing references conform to Wki citation standards, checking links work, verifying information is accurate, marking text that needs verification, etc. Mish (talk) 14:13, 28 April 2009 (UTC)

Yes, thank you. A sketch or even an EL to an interactive presentation like this one from AboutKidsHealth: The Prader Scale would be very helpful, I think. Cheers Jasmine.aura (talk) 14:21, 28 April 2009 (UTC)

I have inserted some text and a reference to the Diamond paper that includes a link to the diagram of the Prader scale for AIS, followed by a link to the Kids Health site that illustrates this for CAH. This is just above the subsection for genital ambiguity. Mish (talk) 22:29, 28 April 2009 (UTC)