Denmark
— As one of the consequences of the Cold War from
the end of World War II and up to 1989, the competition
on the battlefield of sport became fiercer and fiercer,
and at some point rumours started circulating in the west
about female athletes, mainly from the eastern countries,
who were not THAT female. Stories were told about
specific athletes who never undressed together with other
athletes, but came directly from their hotel, and went
straight back for a shower, and of athletes who had a
number of male features as for example a fast growing
beard.
Worse still, they
achieved stunning results on the sports field, which,
especially in athletics, could be measured and compared
directly.
Perhaps understandably a
cry soon rose about unfair competition and downright
cheating, followed by demands to bring an end to this
intolerable situation in international sport.
So, something had to be
done, and in accordance with medical experts, gender
verification was introduced in athletics by the
International Association of Athletics Federations (IAAF)
in 1966, at the European Championships in
Budapest, where all female athletes were required to
parade naked in front of a panel of
physicians.
I was present in
Budapest, and being at that time president of my club, I
had a rather nervous and embarrassed female high jumper
attending this (something similar was repeated at the
1967 Pan American Games in Winnipeg and on other
occasions).
Another female athlete in
Budapest was a Polish sprinter E.K. who passed the
examination. However, later after the introduction of a
new test, sex chromatin testing, she was found to have
one chromosome too many to be declared a woman for the
purpose of athletic competition.
A six man medical
commission who subsequently investigated her case,
discovered that she had a genetic condition known as
mosaiicism, whereby some of her cells had an XXY sex
chromosome make up, the remainder having a normal XX sex
chromosome composition. She was aware of the condition
and had not only undergone surgical treatment to remove
intra-abdominal testes, but was also being treated with
female sex hormones.
Nevertheless she suffered
public disgrace by being disqualified from further
competition in women´s events and her name was later
(in 1970) removed from the record books and she was
forced to return her olympic and other medals, and
retired from competition surrounded by
controversy.
At the 1966
Commonwealth Games in Kingston, a manual
examination of the external genitalia was carried out by
a gynaecologist on all female athletes, and I 1967, at
the E-cup final in Kiev, close-up visual inspection of
genitalia was used to establish eligibility.
Mary Peters, gold
medallist in Munich 1972 in pentathlon, is quoted as
having described her experience with the gender
verification test as "the most crude and degrading
experience I have ever known. The doctors proceeded to
undertake an examination which, in modern parlance,
amounted to a grope".
This new practice
quickly, in fact already from 1966, brought about that a
number of prominent athletes did not show up at the big
events, and vanished from the international scene of
athletics, which in turn was interpreted widely as a
great victory for the introduction of gender
verification, and certainly, in some events, competition
became less fierce.
In 1968 at the Olympic
Games in Mexico, the IOC introduced the sec chromatin
test (buccal smear screening test) which could indicate
inactivation of one of the two female X chromosomes. It
was the intention of the IOC that, should the screening
test prove negative, or inconclusive, a full chromosome
analysis would then be conducted and blood hormone levels
measured. If inconclusive results were again obtained, a
gynaecological examination would follow.
Nevertheless, the
IOC´s intentions have rarely been carried out in
practice. Shocked athletes, having failed the sex
chromatin screening test shortly before a major
competition, have tended to withdraw rather than undergo
further investigations which might have proved them
eligible. Indeed, these athletes were often advised by
their own officials and team physicians to feign illness
or injury and retire immediately to avoid public
humiliation.
From that time, every
international female had to have a gender verification
certificate with photo etc., stating that she had passed
the sex test used by the IOC.
At the 1985 World
Student Games a female Spanish hurdler M.P. was
publicly disclosed after failing her sex test, at the
cost of public disgrace and loss of her athletic
scholarship. It took two years and the active
intercession of a number of medical authorities for her,
to be reinstated – it turned out that she had
Androgen Insensitivity Syndrome. By that time though, her
sporting career was over.
Similar examples are to
be found within other sports.
Having used the sex
chromatin testing in sport for well over 20 years
(1968-1991), the medical experts stopped using it,
because of its inadequacy, and because it has been
realised that some women, who have genetic abnormalities
that offer no conceivable strength advantage, are
disqualified unfairly, some men with genetic disorder
would pass the sex chromatin test, and it is an
established fact that a number of genetic disorders in
women and men can make the test results point in whatever
direction, for example: Androgen Insensitivity Syndrome,
Gonadal Dysgenesis, Turners Syndrome, Klinefelter´s
Syndrome etc., etc.
To my knowledge,
following an IAAF workshop in 1990, the IAAF Council in
1991 adopted recommendations from the workshop that
laboratory based gender verification testing be
abandoned, alternatively introducing general medical
examination, including simple inspection of the
genitalia, to be performed by physicians accredited to
each national federation. However, due to lack of
unanimity regarding the exact content of the examination
a second working group discussion took place in 1992. The
result was to eliminate gender screening in any form at
IAAF competitions.
However, provision remain
to this day in the IAAF Rules that -
"The medical
Delegate shall also have the authority to arrange for
determination of the gender of an athlete should he
judge that to be desirable"
- except, that now
everything related to how such an investigation is to be
performed is hidden completely from the athletes and
officials, as opposed to the preceding some 20 years of
free and open information. Alas, this lead to criticism
and embarrassing exposure of the mistakes and
shortcomings of the scientific methods used, and
subsequently to changes. That cannot easily happen now
when everything is kept behind a white coat.
All along the IOC kept on
conducting laboratory testing for gender verification
purposes. In 1992 in Albertville the new polumerase chain
reaction (PCR) technique was introduced, only to be
criticised for not eliminating all the issues surrounding
the accuracy of the test by having the same shortcomings
as sex chromatin testing, and being merely a test for
presence of a DNA sequence and not a test for sex or
gender.
At the 1996 Olympics in
Atlanta, the IOC reverted to the buccal smear test, and a
comprehensive process for screening, confirmation of
testing, and counselling of individuals "detected", was
carried out.
Out of 3387 female
athletes 8 had positive test results. Eventually however,
all of these were ruled "false positive" as it was
established that 7 had androgen insensitivity, 4
incomplete, and 3 complete. The last one had previously
undergone gonadectomy (removal of internal testes) and is
presumed to have 5-alpha-steroid reductase deficiency
(deficiency of an enzyme necessary to activate
testosterone in responsive tissues). All individuals were
permitted to compete.
For the 2000 Olympics in
Sydney it was again intended to conduct the more and more
controversial gender verification. However, shortly
before the games, the IOC was forced to back down over
its plans, mainly because the IOC Athlete´s
Commission demanded the test being scrapped. However, the
IOC described the suspension of compulsory gender
verification as merely an "experiment" with no guarantees
that it would become a permanent arrangement.
And, sure enough, the IOC
still has a clause in its rules which -
"gives the IOC
Medical Commission the authority to conduct any
necessary investigation in order to verify the gender
of an Olympic participant, should that be judged
desirable".
- exactly along the same
lines as IAAF, and with exactly the same problems and
shortcomings.
In the late
1990´ties a number of relevant professional
societies in USA called for elimination of gender
verification, such as the American Medical
Association, the American Academy of
Pediatrics, The American College of
Physicians, the American College of Obstetrics and
Gynecology, The Endocrine Society, and the
American Society of Human Genetics, stating that
the method used was uncertain and ineffective.
So, what is the true
story behind all this ?
Some of the best kept
secrets within the human race, from ancient times and up
to today,can be described by two words: Intersex
condition.
Every embryo has the
possibility to develop either towards male or female, and
therefore the possibility exist that it develops to
something in between, within a vast number of variations.
Such "cases" have always been hushed up, by the medical
experts and, often on their advice, by the families, and
in most cases the doctors have advised the parents that
surgery be performed immediately to make the child look
like a girl.
Why a girl ?
Because, until very
recently, that was the easiest, in fact the only thing,
they could do. To make such a baby look like a boy was
much too difficult, and still is more difficult. So, the
doctors decided on, which sex a baby should live with for
the rest of its life, and the shocked and wretched
parents, placed in this tragic situation, could do little
but follow the doctors advice.
The pain and agony, when
later in life some people find themselves caught in a
body, to which they cannot relate, is beyond
comprehension.
But surely this concerns
only a few isolated cases ?
With all the hush up that
has always surrounded these problems, the extent on a
national or global basis has not been known publicly, and
statistics is hard to come by, whereas the medical world
surely should have had some grasp of it.
Only within recent years,
some people, some parents and some persons with intersex
conditions themselves have started to talk about it more
freely and publicly, but as of today, no one can say how
many people this has affected, only that it is an almost
unbelievable high number.
Recently it has been
estimated that in Great Britain alone there are living
more than 100.000 with some kind of intersex condition.
For example 1 in every 4.000 is born with Androgen
Insensitivity Syndrome (AIS), and 1 in every 10.000 with
Adrenogenital Syndrome (AGS), which is yet another of the
numerous variations in gender. There is no reason why
these figures should not relate to most other countries
too.
Other estimates are that
in general at least one in a few thousand people are born
with a body which deviates so much from the two accepted
genders, as to place them at serious risk of parental
rejection, stigmatisation, emotional pain of secrecy,
shame and isolation and often harmful medical
intervention, based not on scientific research, but for
sociological and ideological reasons.
All through the 20th
century they have been hidden away as a dark secret, and
their existence hushed up for a number of reasons,
including the standards set by society, by relatives, and
yes, by sport – the last big taboo of mankind. In
fact, besides the male and the female gender, I think it
should be considered to talk about a third gender, the
Double Gender encompassing all those who are neither
female nor male, but both and. As a matter of fact there
is information that at least one person in Australia has
been officially registered as being double gendered. It
is long overdue for society, to accept these facts of
life, which, in relation to sport are of minor
consequence compared to the ever flourishing problem of
doping.
As a very small part of
this huge, global issue, the double gender has, as
specified above, caused confusion in the world of sport,
where the medical experts have decided how to divide
those with the double gender between the two officially
accepted genders. They have, in their ignorance,
performed this with various procedures and various
medical techniques, which, one by one has proven to be
inadequate, insufficient or just plain impossible.
Procedures and techniques which the officials in sport
have had to accept, as obviously they were not experts in
this field.
It is obvious that there
are reasons why, after some 30 years of nude parades,
groping, scraping, screening, testing and certifying, all
of a sudden the compulsory gender verification is
completely abandoned, and all the comprehensive activity
and attention that has surrounded this has suddenly
vanished, so that all that is left is a "sleeping" rule
saying that it can be performed when "judged desirable",
with no further information added. (Within doping
control, which is also a medical matter, this would equal
that the only rule and information needed would be:
"Doping control may be performed when judged desirable".
Period.)
That this unspecified
rule concerning gender verification has been preserved at
all, by the IOC and the IAAF, combined with the fact that
I have not been able to obtain any information from the
chairman of the IOC Medical Committee, Arne Ljungqvist,
as to the details behind this, as he only wishes to state
that it "is ruled by the ethical and scientific standards
that prevail in medical practice", and "that it is not
for sports people to rule how medical persons should
exercise their profession" points to the obvious
conclusion that this is about saving face.
Nobody would be eager to
stand up and admit that "for 30 years we have been doing
this wrongly".
These some 30 years of
consternation, suffering, humiliation, shattered sports
careers and broken lives, and this enormous BIG BROTHER
set up, causing all this, has been, and apparently still
is, based completely on inadequate and inconclusive
grounds.
With the knowledge we
have today, no one, but absolutely no one, with any sense
of what is just and fair, can say that what was done, was
done with methods and procedures which were, or has later
been,proved to be beyond any reasonable doubt.
What all this leaves us
with is the fact that those who were excluded for not
passing the gender verification, or femininity test which
it was unpleasantly also called, were excluded wrongly on
inadequate and inconclusive grounds, and therefore they
should be exonerated. Those who were "just" scared away
it is, unfortunately, not possible to make it up
to.
But then, what now
?
Obviously international
sport will have to relate to double gender, to
intersexuality, to transsexuality and to all other
related issues. However, I think they should find some
other people to do it than those who have handled this up
till now.
Georg M. Facius -
www.facius-homepage.dk
August 2004
Member of the Anti-Doping Working Group of European
Athletics Chairman of the Technical Committee of the
Danish Athletic Federation
