What is Intersex? A Reply to Perry’s Applied Moral Theology of Sex, Intersex and Ordination

In his “Can Intersex Persons be Ordained as Catholic Priests?” (2021), John Perry begins with the hypothesis (which he later qualifies as not “confirmed” and was “overstated”) that the Catholic Churches’ limitation of the priesthood to exclusively men “cannot be applied with certainty…to any candidate for ordination” because of the presence of individuals with intersex conditions. “Without further guidance”, Perry writes, “the bishop would not know how to apply this rule to intersex individuals, because the rule presupposes that human sex is simpler than it is.” This is to say that “recent findings in biology suggest that the Church lacks a clear telos that could make sense of sex segregated ordination. Such studies that could clarify this telos are urgently needed, not least by the Church’s obligation to deal justly with intersex persons who have already been ordained and those intersex persons who sense a call to the ministerial priesthood.” Perry’s analysis of the theological puzzle of male-only ordination and intersex conditions, while commendable for pushing the discussion beyond the problem of female exclusion into the priesthood and its introduction of an applied moral theology of intersex, makes various implausible assumptions which ultimately undermine his larger argument.         

Here is how my response will proceed. First, it is argued that Perry’s discussion of “intersex” is predicated upon a misunderstanding of the reality of human beings’ binary, biological sex; i.e. as exclusively either male or female. Second, “intersex” – using intersex condition Congenital Adrenal Hyperplasia (CAH) as a litmus test – refers to sexual uncertainty or ambiguity, and is not a counter-example or exception to the sex binary in human beings. “Intersex” means neither clearly male nor female, but neither not male nor female, nor both male and female. Two pertinent observations regarding “intersex” are then made. “Intersex” is a disorder/difference of sexual development (DSD), and prevalence statistics of “intersex” have been (and continue to be) overinflated, giving the mistaken impression that “intersex” is no different statistically than male or female biological sexes. Finally, this response turns to Perry’s bishop-guidance problem. It is here argued that one of Perry’s solutions should be followed, namely, that bishops should use the “tools of biology” (since they work in 99.9% of cases), and that when these cannot be used e.g. in uncertain cases, the crux of the decision to be ordained into the priesthood (and all of its consequent moral weight) is not only on the bishop themselves, but on the intersex person as well. In the end, Mary Lofgren’s work “John Paul II’s Theological Anthropology and the Intersexual Body” (2020) is suggested as the rightful starting place for an applied moral theology of intersex ordination (and vocation more generally).

The problem of defining “sex” features early in Perry’s article:

This puzzle is concerned with a different twentieth century development: advances in genetics that show sexing mammals is a more complicated business than it appears. Some mammals, including some humans, are not biologically male but neither are they not not male. Such persons are among those called ‘intersex’ by physicians.

As already stated, this sets up his problem of bishop-guidance: if intersex individuals are not clear males, then the bishop does not know whether he might ordain them. However, conceptual clarification is needed here since there are two senses of “sexing mammals” (and it is worth pointing out that whether mammals or biological organisms are(n’t) sexually dimorphic is irrelevant). There is the epistemological (or taxonomological) problem of identifying the sex of a mammal, and then there is the metaphysical or biological reality of a mammal’s sex. While it is true that there are cases of sex uncertainty, the objective sex of the mammal, known or not for either epistemological or biological reasons, is in no way contingent upon our taxonomization (hence the social constructionist language of “sexing” is unhelpful at best, and ambiguous at worst). Second, “not biologically male but neither are they not not male” is both grammatically unclear as well as unhelpful as a working definition of “intersex.” It is important to have a working definition of “intersex” for two reasons. First, if “male” and “female” are not simple, binary categories with a clear biological basis, then the male-only ordination rule will appear to be superficial at best, and spurious at worst. However, (methodologically) a definition of “intersex” should proceed from first defining the sexes i.e. in human beings those sexes are “male” and “female”. If intersex is, after all, etymologically inter (between) sexus (sexes), then we need to know what is meant by the “sexes” and what is meant by being “between” them.

Perry notes that genetically underlying the chromosomal differentiation of the sexes,  “animal sex is first determined by a gene called the sex-determining gene…called SRY, which triggers other genes (SOX9, DMRT, FOXL2, etc.), which in turn causes the differences we all are accustomed to when distinguishing the sexes…”. He writes of this though that “sex markers known to biology do not dispose themselves to box ticking”, that “every single one of the markers has a spectrum of normal values; none of them are binary.” The problem is that the SRY gene is not what fundamentally distinguishes males and females, nor what makes males males and females females. Sexual differentiation between males and females is not primarily genetic but sexual. What it means to be male and female in the animal or mammalian world is to have a certain gamete size. Philosopher Alex Byrne clarifies how the discussion of “sex” in contemporary philosophy of sex – no less in applied moral theology – has unanimously missed this point: “…females produce large gametes (reproductive cells), and males produce small ones. (Since there are no species with a third intermediate gamete size, there are only two sexes.). A glance at the huge variety of females and males across the animal and vegetable kingdoms will confirm that there is nothing else the sexes can be. For instance, the equation female=XX is confused for a fundamental reason having nothing to do with human chromosomal variation: females of numerous species either have different sex chromosomes (as in birds) or else no sex chromosomes at all (as in some reptiles). The XX/XY system is merely the mechanism by which placental mammals like humans typically become female and male; other animals and plants use different means to achieve the same end result. Whenever it is suggested that being female or male is a matter of having certain chromosomes (or primary/secondary sex characteristics), that is a sure sign that the discussion has gone off the rails)” (Byrne 2018). Byrne qualifies that “it is more accurate (albeit not completely accurate) to say that females are the ones who have advanced some distance down the developmental pathway that results in the production of large gametes…males are the ones who have advanced down the developmental pathway that results in the production of small gametes” (2018). Consequently, Perry’s article sets up a discussion of “intersex” predicated upon misunderstandings of the reality of human beings’ binary, biological sexes i.e. males and females.

While “definitions in biology are never perfectly precise”, Byrne uses the intersex condition Congenital Adrenal Hyperplasia (CAH) as a litmus test of his definition. By far the most common form of a disorder/difference of sexual development (DSD), CAH comprises upwards of 60-70% of cases. It results from various genetic defects in the production of key enzymes normally required to produce steroid hormones and androgens, often resulting in overproduction of the latter and subsequent vitalization in 46XX females. Byrne writes: “…they [individuals with CAH] have progressed some considerable way down the developmental pathway that produces eggs (they have usual ovaries and fallopian tubes), and have not even started down the (male) sperm-producing pathway. They are…usually raised as girls, and indeed many of them go on to have children. Whether they are raised as boys or girls, the scientific literature correctly classifies them as female” (2018). This means that “intersex” should be thought of as sexual uncertainty or ambiguity: at birth, intersex children are neither clearly male nor female, but neither not male nor female, nor both male and female; however, their sex might be known (not to say constituted by) by other means such as learning more biologically or the child growing up to learn more about themselves phenomenologically.

This also highlights an important note about intersex conditions generally. What is meant by “intersex” from the perspective of medical professionals is a Disorder/Difference of Sexual Development (DSD). Elsewhere (Rehman 2022) I have argued that intersex medical nomenclature should adopt a both/and approach to “disorder” and “difference” (using a combined title “disorders/differences”) because some intersex conditions are medical disorders i.e., they involve abnormal pathophysiologies with negative functional consequences, analogical to other diseases and conditions. However, because some do not involve these properties characteristic of “disorders”, they are rightfully entitled “differences”. Since the DSD medical nomenclature is a broad umbrella, it should appreciate the variety of intersex conditions. Regardless of the “disorder/difference” distinction, all cases of intersex share the heterogeneous property of being cases of sexual uncertainty or ambiguity. Moreover, while Perry is right that, at least as far as the discussion in intersex scholarship goes, “assessing the frequency of such traits is more complicated and subject to much dispute”, a clear definition of “intersex” serves to undermine many statistics which over-inflate its prevalence. Perry is right in this regard to quote Anne-Fausto Sterling’s 1.7% and Leonard Sax’s correction of 0.018% (nearly one hundred times lower than Sterling had envisioned). This means that statistics which use “cases of the body not looking ‘normal’” or “cases that are not readily apparent (e.g. people who have an extra X chromosome, but appear otherwise typical” are mistaken because these are not cases in which there is any sexual uncertainty or ambiguity). This lessens the motivation – if there were any – to hold “intersex” as a counter-example to the sex binary in human beings.

This leads us back to the bishop-guidance problem, the crux of the justification for male-only ordination: “Without further guidance”, Perry wrote, “the bishop would not know how to apply this rule to intersex individuals”, a rule which is needed “to deal justly with intersex persons who have already been ordained and those intersex persons who sense a call to the ministerial priesthood.” Perry is careful to not identify the problem of intersex ordination of sex-segregation, but in the justification of sex-segregation:

Remember our question: can intersex persons be ordained as Catholic priests? Let’s start with the assertion that not every form of sex segregation is sexist. Could that be true? Sure. We already touched on sex classification of athletes. The IOC rules are not obviously sexist and could even enhance equality. In medicine, are there any reasons, apart from misogyny or misandry, that someone would prefer a male or female doctor? Yes. One reason could be that patients judge they receive better medical care from someone with whom they can identify or who shares some of the same symptoms. Perhaps a woman wants a gynecologist who knows what it is like to experience menstruation or how a pap smear feels.

He rightfully infers that from this “not every instance of sex segregation is sexist, but notice that in each of these three examples we were able to specify a telos behind the practice that justified the segregation.”

The justification for male-only ordination in light of intersex conditions is already present in his indictment of the Vatican’s 2019 document ‘Male and Female He Created Them’: Towards a Path of Dialogue on the Question of Gender Theory in Education (M&F). He comments specifically on the passage that reads “efforts to go beyond the constitutive male-female sexual difference, such as the ideas of ‘intersex’…lead to a masculinity or femininity that is ambiguous, even though (in a self-contradictory way), these concepts themselves actually presuppose the very sexual difference that they propose to negate or supersede” (M&F 2019, 25). He writes “I don’t know how to interpret this passage”, “perhaps we are seeing some linguistic confusion in this document”, “perhaps it is pointing to a deeper confusion” and “count this passage as anomalous data.” I do not share Perry’s confusion. This passage clearly means that the male-female sexual difference is not contradicted by “intersex” because being “intersex” presupposes a clear, intelligible meaning to the biological reality of “male” and “female” sex. There is no meaning of “intersex” without first “male” and “female”. Karol Wojtyla (later John Paul II) had echoed this much earlier:

Every human being is by nature a sexual being, and belongs from birth to one of the two sexes. This fact is not contradicted by the phenomenon of [intersex] – any more than any other sickness or deformity militates against the fact that there is such a thing as human nature and that every human being, even the deformed or the sick human being, has the same nature and is a human being precisely because of it…membership of one of the two sexes means that a person’s whole existence has a particular orientation which shows itself in his or her actual internal development. This development [is] more easily observable in the organism than in the psyche… (Wojtyla 1993, 47)

It seems then that this is the way forward, and Perry should accept a proposal he had already made: “…a bishop could justly say that he was ‘certain’ that a given ordinand was male, provided he checked all the sex markers so far known to biology and all markers ticked the box indicating Male. It isn’t logically certain, but it’s as close as anything empirical is ever likely to be.” To qualify, this suggestion constrains all moral culpability on the bishop; however, the crux of the decision to be ordained into the priesthood (and all of its consequent moral weight) is on the intersex person themselves. The bishop, not unlike any other ecclesiastical authority, has intrinsically limited knowledge in their prudential decision-making, and require full transparency of those they ordain, e.g. that the men in formation have discerned the priesthood is predicated on trusting the seminarian’s testimony. Intersex persons themselves are morally and ecclesiastically responsible for discerning, with whatever means they have available and with the Church’s support, their vocation to the priesthood. Like all others in the process of vocation discernment, intersex persons require support, encouragement and love – but this does not in any way cast into doubt the rationale (i.e., that they are not clearly males) for rejecting at least some cases of intersex persons to be ordained. Perry asks: “If the ordaining bishop cannot determine sex using the tools of biology, what tools should he use?” If the tools of biology work for over 99.9% of cases (in which “male” and “female” are certain), it should not be rejected lightheartedly as the most reliable to date – however we guide our bishops to handle the 0.018% of cases.

For those interested in the applied moral theology of intersex as it pertains to Wojtyla’s theology of the body (itself based on his sex binary philosophical anthropology), see Mary Lofgren’s recent excellent dissertation “John Paul II’s Theological Anthropology and the Intersexual Body” in which she “challenges the notion that intersex bodies necessarily destroy binary anthropologies” (2020, 4), the crucial task of those wishing to cast into doubt orthodox Catholic moral theology because of its reliance on sex binarism. If we are to develop a more systematic applied moral theology of intersex ordination (and vocation more generally), Lofgren’s work is the place to start.

My response to Perry proceeded as follows. First, it was argued that Perry’s discussion of “intersex” is predicated upon a misunderstanding of the reality of human beings’ binary, biological sex i.e., as exclusively either male or female. Second, “intersex” – using intersex condition Congenital Adrenal Hyperplasia (CAH) as a litmus test – refers to sexual uncertainty or ambiguity, and is not a counter-example or exception to the sex binary in human beings. “Intersex” means neither clearly male nor female, but neither not male nor female, nor both male and female. Two pertinent observations were made regarding “intersex”. “Intersex” is a disorder/difference of sexual development (DSD), and prevalence statistics of “intersex” have been (and continue to be) overinflated, giving the mistaken impression that “intersex” is no different statistically than male or female biological sexes. Finally, this response turned to Perry’s bishop-guidance problem. It was here argued that one of Perry’s solutions should be followed, namely, that bishops should use the “tools of biology” (since they work in 99.9% of cases), and that when these cannot be used, e.g. in uncertain cases, the crux of the decision to be ordained into the priesthood (and all of its consequent moral weight) is not only on the bishop themselves, but on the intersex person as well. In the end, it was recommended that the most plausible construction of an applied moral theology of intersex ordination is found in Mary Lofgren’s work “John Paul II’s Theological Anthropology and the Intersexual Body” (2020).