What is a ‘female’ in medicine?

Above is the definition of the word ‘female’ from the MedicineNet site. According to this, the classification of an individual who bears young (or at least potentially), or produces eggs as a ‘female’ is out of date.

The highlighted part of the definition says that a female is now determined by one of 3 things:

  • physical appearance – a person who looks like a female is a female
  • chromosomal makeup – a female generally has 46 chromosomes including 2 X chromosomes
  • gender identification – a person who claims to be a female is a female.

The final sentence of the definition qualifies the second case, by indicating chromosomal variations whose phenotypes are considered female. These include 45,x (Turner syndrome), and 47,XXX (triple-X syndrome), although other variations such as XX and XY gonadal dysgenesis are not mentioned, presumably implied.

If this were almost any other kind of site on the internet, we would imagine that the first and third branches of the definition might have been added out of some sort of political correctness or imagined solidarity with trans people, people with gender dysphoria, who knows – drag queens? Those people of course deserve their dignity and place in the world, just as any other member of society. However, the fact is that the above definition is taken from a medical site, published by the same group that publishes webmd. These are sites authored by medical professionals, and providing information that is widely trusted and consumed by users around the world in order to address questions of healthcare.

How did such a group determine that the old definition of ‘female’ should be replaced by a definition that includes individuals who are perceived to be females by physical appearance (presumably including any self-respecting transvestite), and individuals who claim to be female? Not only that, but the main phenotypic basis (producing eggs, being able to bear children, i.e. having a uterus) for being female is removed entirely and replaced by a purely genetic one.

Quite apart from the unfortunate case of phenotypic girls and women who don’t happen to have or want a terribly feminine appearance (sorry girls, you’ll need your chromosomes checked if we are to be sure), there is no end of obvious problems here for a profession that relies on objectivity and a realist view of the world to do its work.

In medicine, definitions matter, because professionals use words in precise ways, and increasingly today, so do IT systems that process our data. If a questionnaire asks your sex, and you indicate ‘female’, and are classified as such in the system, you may receive appointment offers for PAP smears, gardasil vaccination and Hormone Replacement Therapy. None of which will remotely apply if you are phenotypically male.

If you as a phenotypic male who prefers to identify as female have a GP consultation during which you describe the pain in your left testicle or erectile problems, the human doctor will probably understand, and may feel compelled to write notes about ‘June, 42 year old female’ out of respect, but any software that tries to process the notes will fail in interesting and possibly unsafe ways.

Statistical studies, reports and even basic public health data will be skewed and/or outright wrong if phenotypic males are routinely identified as ‘females’ in the healthcare system. Doing so will lead to absurdities like testicular cancer showing up as an increasing problem for the female half of the population.

It should go without saying that we should have no problem at all with any individual’s right to their identity, gender preference, or any other personal characteristic on which one’s common dignity is based. But language is not owned by individuals, it is owned by civilisations, and it can’t be messed with inconsequentially. Even if the purely social use of the word ‘female’ could be adjusted overnight (it can’t, for parents who don’t think their teenage daughters should start sharing changing rooms with men of any age, among others), shoddy definitions in the science-based professions such as medicine will not do.

Interestingly, the same site’s definition for ‘male’ is: ‘The sex that produces spermatozoa’. Given that many (a majority, by most reports) of ‘trans women’, and certainly male transvestites, male sufferers of gender dysphoria etc are phenotypic men, most of these individuals will produce spermatozoa. They may even experience medical problems with sperm production, or other aspects of their (male) uro-genital system, for which they seek medical help. These individuals, according to MedicineNet are therefore ‘female’ and ‘male’ at the same time.

We are in some trouble here.

About wolandscat

I work on semantic architectures for interoperability of information systems. Much of my time is spent studying biomedical knowledge using methods from philosophy, particularly ontology and epistemology.
This entry was posted in Ontology, Science. Bookmark the permalink.

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