A corner of the Internet went up in flames yesterday. John Byrne at Raw Story had a disturbing headline: “Doctor testing drug to â€˜prevent’ lesbianism, interest in â€˜male careers.’” Dan Savage wrote on the same topic: “Doctor Treating Pregnant Women With Experimental Drug To Prevent Lesbianism.” Both stories express outrage that doctors and expectant parents are attempting to interfere with sexual orientation in utero. But this treatment, prenatal dexamethasone, isn’t being given to anyone at all in order to prevent lesbianism.
It’s being given to prevent the most extreme effects of congenital adrenal hyperplasia, notably the formation of ambiguous genitalia (photo NSFW) in potential victims of CAH, a rare genetic disorder that floods the developing fetus with androgens. Prenatal dex is not being given to just any pregnant women, only to those who are carriers of CAH-and certainly not because they fear having lesbian daughters.
What does “ambiguous genitalia” mean, exactly? A pregnant woman who is a carrier of CAH has a chance of her female baby being born with the following:
* An enlarged clitoris that has the appearance of a small penis.
* The urethral opening (where urine comes out) can be anywhere along, above, or below the surface of the clitoris.
* The labia may be fused, resembling a scrotum.
* The infant may be thought to be a male with undescended testicles.
* Sometimes a lump of tissue is felt within the fused labia, further making it look like a scrotum with testicles.
Time also reported on the effects of CAH on genital development:
Because the condition causes overproduction of male hormones in the womb, girls who are affected tend to have genitals that look more male than female, though internal sex organs are normal. (In boys, in contrast, the condition leads to early signs of puberty, such as deep voice, body hair and enlarged penis by age 2 or 3.)
The medical ethics problems (to say nothing of the potential health risks) surrounding the use of prenatal dexamethasone are not trivial, obviously. Dr. Maria New, the endocrinologist and researcher cited as an early champion of prenatal dex in the Time article, appears to be a controversial figure-for starters, she classifies a number of “male” characteristics as “abnormal” in women. This is brought to light at the Bioethics Forum at the Hastings Center, where they concur with pretty much the rest of the world that use of these drugs should take place in supervised clinical trials.
That seems fair. But it’s not fair to suggest that parents who are worried about the possible complications and problems their child might face as the result of being born with ambiguous genitalia, and who are offered a medical intervention that might help, are simply trying to avoid having a lesbian daughter. It’s very misleading of these two writers, both of whom I have a very high regard for, to position the story in this way.
Here’s my question for Messrs. Savage and Byrne. If we believe in the absolute sovereignty of a woman’s body, of her right to choose, then are we also bound to support her right to treat the fetus she is carrying with whatever medications or therapies are agreed on by her and her doctor?