What Defines A Woman...And What Does California's Prop 8 Have To Do With Menopause?

Recently I have held some interesting conversations stemming from the debate about California's Prop 8. Specifically, if the law defines the state of matrimony to be legal only between a man and a woman, how does the law define a man and a woman? It has been ever present on my mind, as I have ventured into the interesting phase known as menopause, broadening my professional understanding of this passage as I pass through it myself. It is often said that a pediatrician cannot really understand the perspective of the parent until they themselves experience parenthood. I would add that as an obstetrician, my own pregnancy experience was an amazing "teacher," and that I was a better doctor because of it. Menopause is even more of a frontier as traditional medicine teaches the facts, without the anthropologic insight needed to shepherd a woman through the purpose of it all. The bottom line is that much of femininity is a state that is hormonally created, and when those hormones are withdrawn it is not shameful to ponder how that affects our "womanliness."

If I asked my husband if menopause made me less feminine he would see the question as rhetorical and pretend not to have any idea what I am talking about; a very safe strategy. My girlfriends discuss the implications with only obtuse musings about the change in our aesthetic, one remarking (unforgettably) to me, "Certain clothes I used to love now seem to look absurd, even though they still fit." It's as if the beguiling signs of fertility are withdrawn, making the mirror like that of Snowhite's nemesis. The changes are so subtle as to be ethereal; it seems the thin veil laden with pheromones is gradually snuffed out. There are many strategies to negotiate this passage, some involve embracing it. Still, it seems Mother Nature would have those of us whose gonads are retiring pass the proverbial reproductive baton to the next generation, saying goodbye to some of Her enhancements as we do so.

So, back to the original question, how does the law define a man and a woman? Apparently the definition varies from state to state in this country. None of them involve proving the presence of a gonad, specific genitals, or requiring a blood test for chromosomes. These strategies would leave many in the gray zone such as those that have had surgery for diseases of the testicles or ovaries, those that have chromosomal variances (i.e. there are approximately 60,000 individuals in the US with only the X sex chromosome, known as Turner's Syndrome), those that have had surgery to change their sex organs, or those that are chromosomally female (46XX), but because of a relatively common enzyme deficiency, may appear to be males at birth (Congenital Adrenal Hyperplasia), or those that appear female at birth but are actually chromosomally XY due to a rare enzyme deficiency that does not allow the production of the active form of testosterone...and there are others and combinations of the above. Some have proposed that the definition rely on what is on an individual's birth certificate, but assuming the sex assignment is "correct" in the first place, this documentation can be changed in most states (for example in Kansas if there is a "mistake" one can simply have the change notarized and submit for a corrected certificate) imparting a somewhat arbitrary nature to this document. Perhaps since the reason for mandating a male/female mix for marriage must be procreation, the definition should be: "Two individuals who could together procreate if they so choose." But that would not be fair to the woman whose tubes are tied, or the man with a vasectomy who want to get legally hitched...or for that matter menopausal women, or men with ED (erectile dysfunction). This is not to mention the more than 2 million couples that are infertile in this country that would not be eligible for a marriage defined by the "potential to procreate."

While the federal Defense of Marriage Act (DOMA) signed by President Clinton in 1996 was intended to protect states form being forced to accept the legitimacy of same sex marriage, it went on to define marriage as between, "One man and one woman." The definition of one man and one woman was not included. Perhaps it is like the definition of obscenity in the famous words of Justice Potter Stewart, "I know it when I see it...," but who will be the ultimate judge of our sexual assignment? Somehow the image of the Harry Potter "Sorting Hat" seems apropos.

I have spent my adult life devoted to the care of women; I have studied (and written) about every one of the features that make us unique, and I can honestly say that not only could I not define a woman, it would be diminutive to try and do so. Accordingly, with all of this debate, what if we simply accept the very human desire to partner for life and support that phenomenon between two people--period. Then I can go back to my musings about will he love me after my gonads have retired knowing that regardless, we're legally married, and he is quote: "stuck."

Comments

[scottyknows]

I would say that our gender is not gauged by how we feel at any given moment.

If scientists cannot figure it out, what good are they?

[FourteenthAmendment]

(Cont'd) If the argument against Prop 8 could present in the form of a pictograph, one might submit only 4 minutes of silent imagery: the news-reel footage from the San Francisco Mayor's office in 2004, displaying in moving picture the sheer, distilled euphoria of women and men who spontaneously had been offered -- however briefly -- the most fundamental right we have in society... men and women who streamed into City Hall as the news trickled out, ecstatic about their [fleeting] opportunity to pledge fidelity to another, to promise love and commitment for their lives? How can we as a citizenry deny this benign joy to our own... our co-workers, bosses, neighbors, sisters, nephews, brothers? Why in the world would we want to, when the promise of love and devotion to another is a stabilizing and uplifting phenomenon, good for the married, their children and the community as a whole? Repugnance to or fear of homosexuality, like the appendix, is moot today and will fade naturally as the planet's population increases toward unsustainability... But, unlike our appendix, our irrational fears and bigotry need not await time-warped evolutionary eradication. As a higher-order species -- through love and pragmatic thinking -- we can and will progress... toward common sense and common decency, for all.

Thank you, Dr. Booth.

Lady Booth Olson

[FourteenthAmendment]

A decade ago, my widowed, 80-year-old mother-in-law met a widowed, 80-year-old fellow... They fell in love and eventually married -- each at age 85. They pledged their fidelity at home under a giant oak tree, surrounded by three generations of offspring... all observing, supporting and sharing in their happiness. The childlike joy on their faces spread around the circle like an electric current... and continued to buoy the family for months to come. The beauty of these octogenarians' union had nothing to do with procreation, of course, but with the symbolic power of their declared love, the courage of their pledge, the stability of their promised future together. (Cont'd)

[FourteenthAmendment]

Intriguing.

One commenter casts aside ambiguously-sexed people as ".1%" of the population. So, I assume this commenter would accept denial of marriage rights to this citizenry... sheerly because of in-born attributes beyond their control?
How can a person without clearly defined gender prove his/her eligibility to marry? And what about hermaphrodites and the trans-gendered? Would their "sex" be determined by birth certificate or by alteration to the certificate after surgery? Can such alterations be made within a person's sole discretion?

Your blog lends a provocative contribution to the 14th Amendment Equal Protection discussion, highlighting the unfairness and inequality of Prop 8 in today's world. Traditional marriage's procreative societal origin is tending toward irrelevancy in our complex and crowded world, where the rate of change in our our life expectancy is accelerating exponentially and human cloning lurks on the horizon.

[vim876]

This is a problem about which I have spent a lot of time wondering. Of particular concern is the status of intersex people. Who are they allowed to marry? Are they allowed to marry at all? Some argue that the question affects such a small percentage of the population that it is irrelevant. I would counter that all people, regardless of the rarity of their condition, have a right to equal protection under the law. I also have a friend who, because she is transsexual (she was born male), was able to marry her girlfriend in the state in which they live. However, if they cross into other states, her legal sex changes, and their marriage may be invalid. Can you imagine any other situation in which governments could choose not to honor legally binding contracts made in another state?

[snugglepuss]

What an interesting and provocative way of framing the notion of "joined together to procreate"! Dr. Booth you should be co-counsel on the upcoming Prop 8 trial! Or a star witness. I love your articles and point of view!

[futuregirl]

Very well written and thought provoking. With the aging of our population it is clear that the majority of adult women are not able to procreate - either due to illness, infertility, menopause, or some of the other scientific phenomena you bring up here. If the conservative view is that the reason that marriage should only be between a man and a woman for the purpose of procreation, I think you've just shown that there are so many exceptions as to make this a ridiculous requirement. As a woman who has had a career, been a mom, a wife and assorted other roles, I have constantly had to deal with preconceived ideas of what a woman should be or do. I have always identified with simply being a great human - equal and no better than any other. It is very human to want companionship and we shouldn't worry that it comes along with active ovaries (or any ovaries) in the mix!

[pinkgoldfish]

Thought provoking and challenging - I continue to appreciate Dr. Booth's insight and perspective beyond the practice of traditional medicine.

[PhilipB]

What a beautifully written and thoughtful article.
Ideas and facts merge and are questioned every step of the way.
You ask big questions, and the reader is left with even more questions within an "aha!" moment; that kind of discovery about what makes us human.
Rebecca Booth, MD.: I have to say I was blown away by your writing.
Thank you

[RLDurham]

This is a fascinating contribution to the Proposition 8 debate. I continue to appreciate Dr. Booth's insight into the conversation about the intrinsic value of gender differences. It was a pleasant surprise to find her weighing in on this topic. Thank you, Dr. Booth. Tell me more!

[wayneperkey]

Another excellent article from Dr. Booth. I had not considered the issue in this light. Would that our political leaders had such insight......

[KidMohair]

I find that the lesbian community has less of a problem with racism and ageism than the gay male community.

Wonder why that is?

[DenverJim]

It's a myth. Labeling gays as more racist makes heteros feel better about discriminating against us.

[seehowtheyrun]

Excellent. Thanks .

[bannorhill]

Even the DMV can figure out who is a man and who is a woman.

Let's get real.

[thepoliticalcat]

That is incorrect, as you would now if you've followed the controversies on female athletes. There is one in progress right now, regarding a runner from South Africa, who identifies as a woman but has been subjected to a slew of ongoing tests to confirm her gender identity.

"Getting real" might mean finally acknowledging that our understanding of sex, gender, and sexuality are in their infancy. There is much to still learn. I highly recommend you read "The Memoirs of Herculine Barbin."

[bannorhill]

99.9% of the time there is no question. Someone is splitting hairs.