EP16 Carved by the ‘Knife of the Norm’: The Biological Truth, Medical Secrecy, and Spiritual Exile of Intersex Lives

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Part 1: How decades of surgical violence and religious dogma silenced atypical bodies — and why the gender binary is a manufactured myth.

By Mau Kwok Lam

“I praise you, for I am fearfully and wonderfully made; wonderful are your works, that I know very well.” — Psalm 139:14

Every Sunday morning, congregations across the globe rise to sing these words in unison. Yet beneath the vaulted ceilings and stained glass, a piercing question goes unasked: what happens when a person’s body does not conform?

If a child is born with chromosomes, gonads, hormones, or external genitalia that refuse to sit neatly within the conventional boundaries of “male” or “female”, can they still sit in the pew and declare with an honest heart that their flesh is “fearfully and wonderfully made”? Or will their very existence be diagnosed—by doctor and deacon alike—as a defect, a ruined offcut of a fallen creation?

The Child in the Corridor: Twenty Surgeries in Search of a “Normal” Body

In the 1970s, inside a public hospital in Hong Kong where the sharp, eye-watering tang of antiseptic hung permanently in the air, lay an eight-year-old child named Yiu-hung.

While other children were running across playgrounds, Yiu-hung’s childhood had dissolved into a recurring nightmare: the sterile hum of operating theatre lamps, leather restraints pinning down small wrists and ankles, and the blinding, sickening agony of genital surgery. Between the ages of eight and thirteen, this young soul was wheeled onto the operating table more than twenty times. A succession of surgeons had taken it upon themselves to “correct” this small body, armed with steel blades and sutures, determined to fashion a penis and urethra that satisfied their textbook ideal of what a “proper boy” ought to look like.

Yet these operations—none of which were necessary to save a life—brought only catastrophe. Each intervention triggered fresh bouts of infection, tissue necrosis, bloody urine, and leaking fistulae. To prevent the newly sculpted, fragile urinary tract from scarring shut, clinicians repeatedly forced metal sounds into the raw, weeping wound to dilate it—routinely done without adequate anaesthesia. Delicate nerve endings were permanently damaged, leaving a legacy of chronic, burning neuropathic pain and incontinence. Unable to urinate standing up, Yiu-hung faced merciless bullying in the schoolyard, retreating into a private hell of shame, dread, and isolation.

That child would grow up to become Small Luk (Luk Yuet-ming)—one of the most influential pioneers of the intersex human rights movement in Asia and across the world. [1]

It was not until her thirties, during a comprehensive medical assessment, that Luk finally solved the riddle of her own flesh: she had been born with Partial Androgen Insensitivity Syndrome (PAIS). Genetically, her karyotype was 46,XY, but her cellular receptors lacked the ability to respond fully to male hormones. Inside her body lay undescended testes alongside an underdeveloped uterus and fallopian tubes. [2] She had never been a “botched boy in need of repair”; she was an intersex person, born with an authentic, coherent biological reality.

The criss-crossing scars carved into her body, and the neurological trauma that haunts her to this day, were never about healthcare. They were the collateral damage of a culture terrified of ambiguity—inflicted by what medical historians describe as the “Knife of the Norm” , [3] a scalpel wielded in the name of mercy to trim and stretch living human beings until they fit the Procrustean bed of typical gender categories.

I. Nature’s Lavish Spectrum: Dismantling the Myth of the Gender Binary

In the popular imagination, biological sex is treated like a light switch: flick it on for an XY male, flick it off for an XX female. It is an orderly, reassuring assumption—and one that modern science thoroughly refutes.

Over the past four decades, advances in developmental biology and genetics have demonstrated that sex differentiation is not an either/or toggle, but a kaleidoscopic spectrum shaped by the intricate choreography of genes, cells, hormones, and time.

1. The Five Dimensions of Biological Sex

As biologist Anne Fausto-Sterling and theologian Stephanie A. Budwey have observed, defining the biological sex of an organism requires untangling at least five distinct yet overlapping layers [4] :

  1. Chromosomal and Genetic Sex: Beyond the standard 46,XX and 46,XY pairings, nature presents us with 47,XXY (Klinefelter syndrome), 45,X0 (Turner syndrome), and mosaicism or chimerism (where an individual possesses multiple genetically distinct cell lines). Furthermore, the translocation or silence of the master-switch SRY gene frequently yields surprising physical variations.
  2. Gonadal Sex: In the early embryo, the bipotential gonads can differentiate into testes, ovaries, or develop into an “ovotestis” containing both ovarian and testicular tissues.
  3. Internal Reproductive Anatomy: Between the 8th and 12th weeks of gestation, the Wolffian ducts (precursors to male internal plumbing) and Müllerian ducts (which form the uterus, fallopian tubes, and upper vagina) respond to signals from anti-Müllerian hormone (AMH) and testosterone. The partial preservation or simultaneous development of both duct systems is a well-documented biological reality.
  4. External Genitalia: The extent to which the genital tubercle and labioscrotal swellings develop under the influence of androgens such as dihydrotestosterone (DHT) varies dramatically. Clinical tools like the Prader Scale and Quigley Scale—used to gauge degrees of virilisation—are, by their very nature, continuous anatomical spectrums.
  5. Hormonal Sex & Receptor Sensitivity: This encompasses the complex enzymatic pathways governing androgens, oestrogens, and progestogens (such as 5α-reductase), as well as the ability of target cells to register those chemical messages (as in Small Luk’s PAIS, where male hormones circulate freely but find locked doors at the cellular level).
  6. The Neurological Brain Mosaic: Contemporary research led by neuroscientist Daphna Joel confirms that the human brain does not divide into discrete “male” and “female” structures. Instead, human brains are intricate mosaics of feminine, masculine, and intermediate neural traits. [5]

2. The 1.7% Reality: As Natural as Red Hair

According to Fausto-Sterling’s landmark synthesis of decades of epidemiological and clinical literature, individuals born with variations of sex characteristics (VSC) make up roughly 1.7% of the global population. [6]

What does 1.7% actually mean in human terms? It is roughly the same proportion of people worldwide born with natural red hair. It is comparable to the global incidence of identical twins.

In a secondary school of 1,000 pupils, or a parish of 500 souls, there are statistically bound to be several people whose physical bodies deviate from strict male/female binaries. An intersex body is neither a medical disaster nor a bizarre mutation; it is part of the ordinary variety woven by the Creator into the fabric of the living world.

3. A Conspiracy of Silence: Why We Fail to See

If intersex people are as common as redheads, why do so few people believe they have ever met one?

As Budwey notes, their absence from public consciousness is not an accident of nature, but the outcome of five pervasive social and institutional veils [7] :

  • Infant Surgical Erasure: Infants born with ambiguous genitalia have routinely been subjected to cosmetic surgeries within their first months of life, standardising their appearance before they can speak or understand what is being taken from them.
  • Hidden Internal Variations: Most variations occur beneath the skin—in cellular receptors, chromosomes, or internal gonads. Many individuals only learn the truth later in life: when puberty fails to bring a period, during fertility investigations, or via routine genetic tests.
  • “Protective Deception” by Doctors and Families: For decades, standard paediatric protocol instructed clinicians and parents to keep the child’s medical history an absolute secret, inventing cover stories about “routine hernia repairs” and locking the truth in hospital archives.
  • Cultural Stigma and Degradation: In Chinese societies, as in the West, intersex people have long been saddled with derogatory slurs—branded as yin-yang persons (陰陽人) or “stone women” (石女, women with vaginal atresia)—and shamed into believing their bodies were a curse from the heavens.
  • Institutional Binarism: From birth certificates and identity cards to school enrolment forms and insurance databases, our systems recognise only two tick-boxes: Male or Female. The administrative state simply refuses to allow an intersex life to exist on paper.

II. The Scalpel and the Lie: How Medicine Sanitised Its Own Violence

The bodily torment inflicted on generations of intersex children was not born of ancient ignorance. It was modern medicine’s response to a flawed psychological theory that went unchallenged for nearly half a century.

1. John Money’s “Blank Slate” and the Reign of the Phall-O-Meter

In the 1950s, psychologist John Money and paediatric endocrinologist Lawson Wilkins at Johns Hopkins University pioneered the “Optimal Gender Policy” , an approach that would govern global clinical practice for decades. [8]

Money was an evangelist for “psychosexual neutrality at birth”. He argued that human infants are born as gender-neutral blank slates ( tabula rasa ). Provided that surgeons could remodel an infant’s ambiguous genitalia into an unambiguous male or female shape before the age of two and a half—and provided the parents reinforced that assignment with strict gender-role socialisation—the child, Money insisted, would seamlessly adopt their assigned gender.

To enforce this doctrine, clinicians turned to a deeply cynical diagnostic standard, later satirised by activists as the “Phall-O-Meter” [9] :

  • If a newborn boy’s stretched penile length was under 2.5 centimetres, it was deemed “incapable of functioning as a male”. Conversely, if a newborn girl’s clitoris was longer than 0.9 centimetres, it was treated as an intolerable threat of virilisation.
  • Constrained by the surgical techniques of the day, surgeons leaned on a callous rule of thumb: “It is easier to make a hole than build a pole.”
  • The result was horrific: countless genetically XY male infants with functional testes had their phalluses amputated and their gonads removed simply because their organs were considered too small, only to be forcibly reared as girls. Other infants, like Small Luk, were subjected to dozens of brutal reconstructive attempts fraught with excruciating complications, all in a desperate bid to fashion a “standard” male organ.

2. The Tragedy of David Reimer

Money’s regime rested on a foundation of systematic deceit. Parents were ordered never to tell their children the truth, under the guise of protecting them from “identity confusion”. Yet the most famous case in modern medical history—the so-called “John/Joan case” of David Reimer—would ultimately tear Money’s blank-slate myth apart.

Born Bruce Reimer in Canada in 1965, the healthy twin boy lost his penis at seven months old in a botched circumcision. When Bruce was twenty-two months old, his desperate parents followed Money’s counsel: they castrated the infant, surgically created a rudimentary vulva, renamed him Brenda, and raised him strictly as a girl.

Throughout the 1970s, Money published papers hailing “Joan” as a triumph of modern science, claiming the child was happy, well-adjusted, and undeniably feminine. The case became gospel, quoted in paediatric and psychiatric textbooks worldwide as conclusive proof that nurture triumphs over nature.

The truth was an unmitigated nightmare. From early childhood, David felt an overwhelming, instinctive certainty that he was a boy. He resisted female clothing, tore off dresses, and suffered from debilitating anxiety and depression. When his father finally broke down and told him the truth at age fourteen, David wept with relief—and immediately chose to live as a male. He took the name David, after the shepherd boy who felled the giant Goliath, symbolising his defiance of medical authority.

In the late 1990s, University of Hawaii biologist Milton Diamond and psychiatrist Keith Sigmundson tracked David down and exposed Money’s celebrated case study as an outright academic fraud. [10] Investigative journalist John Colapinto brought the scandal to the world with a searing Rolling Stone exposé and his bestselling book, As Nature Made Him . David chose to waive his anonymity, showing his face and telling his harrowing story to the global press so that no more infants would be butchered on the operating table.

Yet the emotional scars ran too deep. In 2004, having lost his twin brother to an overdose and struggling with the lifelong trauma of his mutilation, David took his own life at the age of thirty-eight.

As medical historian Alice Domurat Dreger observed, these normalising surgeries were never performed for the health of the child; they were performed to soothe the anxieties of adults. The costs were paid entirely by the patients: severed nerves, permanent loss of sexual sensation, chronic scar tissue, urinary stenosis, and an incurable sense of medical betrayal. [11]

3. A Human Rights Awakening: From Pathology to Bodily Integrity

Confronting this dark legacy, the Intersex Society of North America (ISNA), founded by activist Cheryl Chase in 1993, began speaking out. [12] Although the medical community introduced the label “Disorders of Sex Development” (DSD) at the 2005 Chicago Consensus Conference to retire outdated terms like “hermaphroditism”, the terminology remains controversial within the intersex community for its stubborn insistence on pathology. [13]

Today, the tide of international human rights has turned decisively:

  • The UN Committee Against Torture (CAT) and Human Rights Council (HRC): Have repeatedly condemned non-urgent, cosmetic genital surgery on intersex children as cruel, inhuman, and degrading treatment amounting to torture and a direct violation of bodily integrity. [14]
  • The Council of Europe and the World Health Organisation (WHO): Have called on all member states to outlaw irreversible genital surgeries on minors until the individual is old enough to give free, fully informed consent. [15]

The message from the international community is unmistakable: the right to bodily integrity belongs to the child, not the surgeon, the parent, or the state.

III. The Church and the Scalpel: When Religion Sanctions the Knife

If the surgeon’s blade cuts into the flesh of intersex people, the religious dogma of the institutional Church cuts even deeper—severing their spiritual bond with the God who made them.

1. The Religious Ghost Behind the Operating Theatre

In their foundational work The Social Construction of Reality , sociologists Peter Berger and Thomas Luckmann noted that religion has historically served as the supreme legitimator of human institutions. [16] While modern medicine wraps itself in the clean coat of empirical science, its value judgements are frequently drawn from deeply embedded cultural and religious assumptions.

In Western societies—and throughout Chinese churches shaped by Western missionary history—medicine’s obsession with carving bodies into two boxes inherited the Church’s theological binarism. As sociologists Valerie and Dennis Hiebert have argued, when surgeons rush to “normalise” an intersex infant, they are executing the unexamined orders of a culture whose imagination was forged by a particular theology. The Western church’s wooden, hyper-literal reading of Genesis—collapsing “male and female he created them” into an unbending biological law—is the cultural taproot of our revulsion toward ambiguous bodies. [17]

2. Epistemic Injustice: The Exiles of Sally Gross and Small Luk

The philosopher Miranda Fricker coined the term “Epistemic Injustice” to describe how power structures silence and invalidate marginalised voices [18] :

  1. Testimonial Injustice: When prejudice causes a hearer to dismiss or degrade the credibility of a speaker’s word.
  2. Hermeneutical Injustice: When a society lacks the collective conceptual tools to understand someone’s lived experience, leaving their suffering unintelligible or profoundly distorted.

The fate of Sally Gross (1953–2014), a South African intersex Dominican friar, offers a heartbreaking portrait of testimonial injustice. When Gross discovered her intersex biology and shared it with her religious order, church authorities expelled her, declaring that she “did not satisfy the divine criterion for humanness”. Canon lawyers went further still, ruling that her baptism was invalid—pronouncing that “she, like cats, dogs, or tins of tuna fish, was not among the class of creatures eligible for baptism.” [19]

Small Luk met an almost identical wall of cruelty within the Chinese church. When, battered and exhausted after dozens of surgeries, she entered a local church seeking healing and grace, she was met not with the radical hospitality of the Gospel, but with cold condemnation from the pulpit:

  • “God made male and female from the beginning; your body is a corrupted work of Satan.”
  • “This is the pathology of a fallen world. You must fast and repent for your body.”

Pause to imagine the horror: a person whose flesh had been sliced open more than twenty times since childhood, stepping into what should have been a sanctuary of divine love, only to be told that the Creator found her body abominable.

This spiritual asphyxiation pushed Small Luk to the brink of suicide. When the Church elevates an idolatry of rigid gender order above the living breath and dignity of human beings, it ceases to worship the crucified Christ. It is merely worshipping a cultural idol carved in its own image.

[Coming in Part 2] When the scalpel of medicine and the dogmas of religion combine to exile intersex bodies, where can healing be found? Do intersex people truly violate the biblical order of creation?

In The “Knife of the Norm” (Part 2) , we return to the biblical text to uncover the Hebrew poetic beauty of merism in Genesis, Jesus’ radical inclusion of eunuchs, and the subversive medieval mystical devotion to the “Wound of Christ”. We will also trace Small Luk’s profound journey from “Yiu-hung” to “Yuet-ming” (“Bright Moon”)—and explore the threefold covenant the Church must embrace if it is ever to tear down the walls that divide us.

Notes and Citations

[1] Small Luk (Luk Yuet-ming) is a Hong Kong registered traditional Chinese medicine practitioner, social worker, and founder of Beyond the Boundary – Knowing and Concerns Intersex , the foremost intersex human rights organisation in the Chinese-speaking world. For documentation of her childhood medical ordeal and spiritual journey, see: Amnesty International, “My body, not their choice: The struggle of intersex activist Small Luk” (2019); RTHK, Hong Kong Connection: You Are An Angel (2016); Apple Daily (Hong Kong), “Born Intersex: Small Luk’s Painful History of Surgeries” (2016). ↩

[2] Partial Androgen Insensitivity Syndrome (PAIS) is a rare X-linked condition caused by mutations in the androgen receptor ( AR ) gene. Although individuals typically possess a 46,XY karyotype and functional testes, cellular resistance to testosterone and dihydrotestosterone (DHT) results in a diverse spectrum of internal and external genital presentations. See: Ian A. Hughes et al., “Androgen Insensitivity Syndrome,” Endotext (South Dartmouth: MDText.com, Inc., 2021). ↩

[3] The concept of the “Knife of the Norm” draws on medical historian Alice Domurat Dreger’s critical analysis of French philosopher Georges Canguilhem’s classic text The Normal and the Pathological , exposing how modern medicine uses surgical force to imprint culturally constructed categories onto human bodies. See: Alice Domurat Dreger, Hermaphrodites and the Medical Invention of Sex (Cambridge, MA: Harvard University Press, 1998), 167–170; Georges Canguilhem, The Normal and the Pathological , trans. Carolyn R. Fawcett (New York: Zone Books, 1991). ↩

[4] For comprehensive clinical and biological accounts of human sex differentiation, see: Stephanie A. Budwey, Religion and Intersex: Perspectives from Science, Law, Culture, and Theology (London & New York: Routledge, 2023), Chapter 1 (“The Knife of the Norm: Intersex from Scientific Perspectives”), 10–33; Anne Fausto-Sterling, Sex/Gender: Biology in a Social World (London & New York: Routledge, 2012). ↩

[5] Daphna Joel et al., “Sex beyond the genitalia: The human brain mosaic,” Proceedings of the National Academy of Sciences 112, no. 50 (2015): 15468–15473. The authors demonstrate that human brains cannot be sorted into two neat dimorphic categories; rather, almost all individuals possess an idiosyncratic mosaic of masculine, feminine, and intermediate features. ↩

[6] Anne Fausto-Sterling, “The Five Sexes, Revisited: The Emerging Recognition that People Come in Bewildering Sexual Varieties is Testing Medical Values and Social Norms,” The Sciences 40, no. 4 (2000): 18–23; Melanie Blackless et al., “How sexually dimorphic are we? Review and synthesis,” American Journal of Human Biology 12, no. 2 (2000): 151–166. ↩

[7] On the structural and epistemic erasure of intersex persons in contemporary society, see: Stephanie A. Budwey, Religion and Intersex , 10–12; Ellen K. Feder, Making Sense of Intersex: Changing Ethical Perspectives in Biomedicine (Bloomington: Indiana University Press, 2014). ↩

[8] John Money, J. G. Hampson, and J. L. Hampson, “An Examination of Some Basic Sexual Concepts: The Evidence of Human Hermaphroditism,” Bulletin of the Johns Hopkins Hospital 97, no. 4 (1955): 301–319; John Money, Gay, Straight, and In-Between: The Sexology of Erotic Orientation (New York: Oxford University Press, 1988). ↩

[9] The “Phall-O-Meter” was a satirical graphic developed in the late 1990s by Cheryl Chase and the Intersex Society of North America (ISNA), laying bare the arbitrary clinical guidelines that dictated surgical reduction for clitorises over 0.9 cm and surgical reconstruction for phalluses under 2.5 cm. See: Suzanne J. Kessler, Lessons from the Intersexed (New Brunswick: Rutgers University Press, 1998), 42–45. ↩

[10] The exposure of the David Reimer case represents a watershed in modern bioethics. Milton Diamond and H. Keith Sigmundson published their damning clinical follow-up in “Sex Reassignment at Birth: Long-term Review and Clinical Implications,” Archives of Pediatrics & Adolescent Medicine 151, no. 3 (1997): 298–304. For the comprehensive journalistic investigation, see John Colapinto, “The True Story of John/Joan,” Rolling Stone , December 11, 1997; and his subsequent book, As Nature Made Him: The Boy Who Was Raised as a Girl (New York: HarperCollins, 2000). ↩

[11] Alice Domurat Dreger, ed., Intersex in the Age of Ethics (Hagerstown, MD: University Publishing Group, 1999); Alice Domurat Dreger, “‘Ambiguous Sex’—or Ambivalent Medicine? Ethical Issues in the Treatment of Intersexuality,” The Hastings Center Report 28, no. 3 (1998): 24–35. ↩

[12] Cheryl Chase, “Hermaphrodites with Attitude: Mapping the Emergence of Intersex Political Activism,” GLQ: A Journal of Lesbian and Gay Studies 4, no. 2 (1998): 189–211. ↩

[13] Peter A. Lee et al., “Consensus Statement on Management of Intersex Disorders,” Pediatrics 118, no. 2 (2006): e488–e500. For community critique of the medicalisation inherent in “DSD”, see: Morgan Holmes, ed., Critical Intersex (Farnham: Ashgate, 2009). ↩

[14] UN Committee Against Torture (CAT), “Concluding observations on the fifth periodic report of Germany,” UN Doc. CAT/C/DEU/CO/5 (2011), para. 20; UN Human Rights Council, “Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Méndez,” UN Doc. A/HRC/22/53 (2013), para. 77. ↩

[15] Council of Europe, Parliamentary Assembly, “Children’s right to physical integrity,” Resolution 1952 (2013); World Health Organization (WHO), Eliminating forced, coercive and otherwise involuntary sterilization: An interagency statement (Geneva: WHO, 2014). ↩

[16] Peter L. Berger and Thomas Luckmann, The Social Construction of Reality: A Treatise in the Sociology of Knowledge (Garden City, NY: Doubleday, 1966). ↩

[17] Valerie Hiebert and Dennis Hiebert, “Intersex Persons and the Church: Unknown, Unwelcome, Unwanted Neighbors,” Journal for the Sociological Integration of Religion and Society 5, no. 2 (2015): 39–55. ↩

[18] Miranda Fricker, Epistemic Injustice: Power and the Ethics of Knowing (Oxford: Oxford University Press, 2007). See also Stephanie A. Budwey, Religion and Intersex , 97–101. ↩

[19] Sally Gross, “Intersexuality and Scripture,” Theology & Sexuality 11 (1999): 65–74. See also: Stephanie A. Budwey, Religion and Intersex , 130–131; Leah DeVun, The Shape of Sex: Nonbinary Gender from Genesis to the Renaissance (New York: Columbia University Press, 2021), 18. ↩