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In many other cultures outside of the western medical tradition, a third gender is recognized which does not fit "male" or "female" medical definitions. Native American culture includes the Berdache, Indian culture recognizes the Hijra, and the Xanith recognize the Oman. In western culture, gender is assigned at birth based solely on external genitalia. The impact of this arbitrary gender assignment extends to every corner of our experience.
Most of the time, gender assignment goes unquestioned, but for some, it causes extreme discomfort. We may be forced to express the gender we were assigned even if we don't identify with that gender. If this describes you, your medical and mental health provider needs to meet you "where you are," without any assumptions or forced roles. He or she should not identify you as belonging to either pole in the dimorphic gender system. Furthermore, the provider needs to know that there's some controversy regarding the Diagnostic and Statistical Manual of Mental Disorders (DSM's) diagnosis of Gender Identity Disorder (GID). Intersexed people are petitioning the medical establishment to stop surgically altering intersexed infants. If your caregiver wants to provide the most respectful, ethical care he or she needs to understand the newly emerging issues involved in treating gender variant people. If a provider interacts with you in an inappropriate or hurtful way, they need to be taught that choosing the most respectful language and ways of communicating are the proper alternatives. We need to make them aware that crossing gender lines as a means of expressing oneself is not something we take lightly; it takes a great deal of courage. We're confident, though, that once most professionals are aware of the challenges they will be better able to assess and assist us and our family members. We can begin educating our health care providers by explaining to them that gender is fluid. It is not fixed or rigidly defined, it is not always either male or female. This may be a totally new way of thinking for them. Giving them the definitions for sex, sexual identity, gender identity, gender role, sexual orientation, and intersexuality will help illustrate the fluidity of gender. A common way to view sexuality is as a continuum from "feminine" to "masculine" with most people falling somewhere along a line between the two extremes. But a more accurate view uses overlapping concentric circles to show the interrelationship of these elements.
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