A Research Study Pilot
Presented at Work, Love & Play: Core Issues in Practice, Third National Psychotherapy in Australia Conference, Melbourne 5-7 July 2002. Published May 2005.
This pilot study interviewed six couples, each of whom have a least one or more partners who are sex and gender diverse. I asked interviewees questions about the coping and managing strategies that help them have relationships. The analysis of conversational interviews reveals areas in which psychotherapists and relationship counsellors can help those individuals and couples sustain loving relationships.
All the sex and gender diverse people interviewed had at some time been brought up one sex and gender and then transitioned to another sex and gender in teenage or later years.
This is a pilot study qualitatively looking at the relationships, coping strategies and qualities within relationships of people who are sex and/or gender diverse (SGD) and their partners. The description SGD includes people who have certain physical characteristics that medically identifies them as intersex including Androgen Insensitivity Syndrome, Micropenis Syndrome, Klinefelter’s Syndrome, Mayer Rokitansky-Kuster-Hauser Syndrome, Turner’s Syndrome, 46X females, Progestin Induced Virilisation, Adrenal Hyperplasia, Male Double XX Syndrome, XYY Syndrome, 5-Alpha Reductase (5 AR) Deficiency, Acromegaly, Bifid Scrotum, Hypospadic Male, Ideopathic Adolescent Gynaecomastica, Congenital Virilising Adrenocorticism, Cloacal Exstrophy, Denys-Drash Syndrome, also known as Wilms’ Tumour ( (Droger 1998) and many others.
The study includes people who self-identify as being a form of intersex and self – label as transsexual, transgendered, androgyne (being more than one sex or gender), and sinandrogyne (being no sex or gender ie neuter) (O’Keefe 1999). There are many sex and gender diverse identities that have not been mentioned here because of the space restrictions but generally we can classify these groups of people as being those who do not physically, mentally or socially present in society as being typical of the bipolar male and female model previously recognised mainly within societies of European derivation.
Sex is defined as the anatomical and chromosomal genotyping of people into breeding categories or a person who resembles those breeding categories, but cannot or do not breed.
Gender is defined as the social constructionism of personal and social performance according to typical sex type or absence of sex associated gender identification.
Sexuality is defined as the preference for sexual interaction or its absence.
This study focuses on the relationships of people who are self-identified as sex and gender diverse and their partners. Although it asks interviewees about their sexuality and its changing concomitants, the main axis is on the management of relationships where one or both partners are SGD.
The aims of the pilot study are to interview six couples in relationships where one or both partners are sex and gender diverse so that we can learn how they cope with their relationships, what difficulties they encounter, and the outside pressures on that relationship in everyday life. Whilst there have been many autobiographies and biographies published about people who are SGD, little has been studied about how those people themselves cope with forming and sustaining close loving relationships with partners on a monogamous or polygamous basis.
Six couples were contacted who were known to the author to have one or more partners who are SGD. The partner/s who were SGD had all at some time been involved publicly with campaigning for the rights of sex and gender diverse people so although in everyday life, people did not generally or necessarily know that person was SGD the person themselves had publicly divulged their SGD to some sectors of society.
The couples were interviewed orally together at an appointed time in their own homes in person or on the telephone when partners were present and each partner could clearly hear what the other person was saying. One couple was interviewed long distance via telephone because of accessibility problems.
Each couple was asked a series of around 10 questions about their backgrounds, previous relationships, and present relationships and how they cope with the relationships and families in everyday life. Although there was a general format for the types of questions, sometimes the questions were varied according to what the author thought might be interesting to explore about each individual couple.
Of the six couples that were interviewed, their identities could loosely be described as follows.
1/ A heterosexual couple where the male had been brought up as female until the teenage years when he underwent sex and gender transition. He identified as being a man of transsexual origin. The couple had four children by artificial insemination. Their relationship had lasted over 20 years and at the time of the study, they would have liked to get married except that the law in their country does not permit them to.
2/ What appeared to be a heterosexual couple at first glance, but the female and sometimes androgynous partner had a sex and gender transition, having been raised as a boy and went on to live as female. After transition she moved her self-identification to being sometimes female, sometimes male, and sometimes neither or both. The male partner was identified as gay. They had been married at a community ceremony outdoors, but the law in the state where they lived did not recognise such a ceremony.
3/ Two gay men, one of whom had been raised as a female and had undergone some surgery and hormone treatment to live as a male.
4 / A heterosexual couple who had both been brought up as the opposite sex and are currently married.
5/ Two women living together, one of who had once been the husband in the relationship prior to a sex and gender transition to a female identity. There had been eight children prior to the transition. They were still legally married.
6/ A lesbian couple with one partner who had been brought up as male prior to sex and gender transition from male to female and had previously been married and fathered three children.
The above description of these relationships is approximate from the interviewer’s perspective and, as will become plain during the discussion of the interview as the interviewees describe their relationships, much more complicated and fluid than the aforementioned description. In advance the researcher apologises to the interviewees for her approximation of the relationships that has been used to assist the reader to have some kind of place to start from when considering these couples.
In all interviews, the SGD person or persons had undergone a transition from being brought up as one particular sex and/or gender and then deciding that another sex and/or gender role was more suitable for them.
What was seen was that SGD people and their partners came from different cultural and social backgrounds. Some had fixed and/or religious belief systems and some were bought up in a more liberal atmosphere concerning sex and gender presentation. In order for the SGD person to go forward to transition in the first place, any rigid belief systems had to be altered in order to accept the personal and social change of physical sex and gender performance.
Post transition, if the person had been brought up one sex and/or gender and then that sex and/or gender had been reclassified, the person did better if they were more flexible about their own concepts of their sex and gender fluidity.
Partners also did better in the relationship if their concepts of their own selves and partners were fluid and not rigid. In couple 5 the wife was of religious Catholic persuasion and had rejected her husband’s sex and/or gender transition still referring to him as ‘he’ and the previous male name.
Although the couple had genuine affection for each other they seemed to stay together out of fear of being alone rather than a desire to be in that relationship.
From the author’s clinical experience she has observed that the rejection of a partner is more likely to occur when a couple have been living together and then one partner transitions or declares their SGD without warning. This tends to make the second partner insecure in their own identity and they can become hostile and not wish to continue the relationship.
SGD people can end up with a sexuality that they did not envisage when they first identified themselves as having SGD issues and were sometimes surprised about how they related to potential partners differently. Couple 4 who were both SGD were profoundly accepting of each other’s sexual exploration and the now male partner talked about his foray into a gay male sexual encounter honestly and openly before his partner.
Couple 2 were also fluid about the sex, gender and sexuality identity of the SGD partner who was in a continual state of flux about what their sex, gender and sexuality was. The constant changing of the SGD person’s identity was not only not a problem for them, it seemed to be something in which they positively delighted.
Potential partners of SGD partners also do not seem to necessarily rule out a relationship with that person upon learning about their diversity as can be seen from couple 6. The lesbian identified partner of this SGD person stated that it was the attitude of the person that she was attracted to and was not put off when in public her partner was sometimes identified as being SGD.
The absence or presence of anatomical parts was not a solely deciding factor in partners wishing to have relationships with SGD people. Couple 3 in fact started to date at the beginning of the SGD person’s transition to male whilst breast tissue was still present. The gay male partner of couple 3 still saw his SGD partner as male even though he had not had surgery to create a neo penis.
With couple 1 the transmale partner was also seen as a heterosexual male and farther even though he did not have a penis constructed well into the relationship and after they had had four children. It can be seen for couple 1 that a family unit can be formed post-transition, either as a traditional nuclear family or in a more permissive sense. In this case, the biological female partner was able to conceive through an IVF programme and the absence of fertility was not a big problem for them. This would naturally be more difficult for couples where there might be a sex and gender diverse person who was born biologically male who had a partner who was a biological male.
Even though this is a small pilot study it seems that people can form successful relationships with people who are SGD people and vice versa. Partners of SGD diverse people, however, seem to do best when they abandon and dissolve any rigid stereotype concept of sex and gender identity in order for that relationship to work.
One of the major problems that SGD people and their partners suffered was that they encounter prejudice and ignorance about their identities. Relatives, society and the law often rejected them, misperceiving the SGD as a form of sexual perversion and demonising the SGD person and their partner. This can amount to discrimination, social ex-communication, and at times violence towards the couple.
Sometimes SGD people and their partners can be in a position of having to put up with discrimination and prejudice, as although laws often state that they should not be discriminated against, in reality such discrimination is enshrined in many of our cultures and legal systems.
Certainly being in a position where the law says you are a man in one state and a woman in another leads to disadvantages for SGD people and their partners in the areas of marriage, parental, medical, pension and personal rights, and this can even at times leads to denial of access to common social spaces.
Because of the many identities that are covered by the description SGD, the authors observations were limited by the small number of couples interviewed.
One major problem that emerged during the collecting of data was the accessibility of people who were willing to talk about their SGD identity and its relevancy to their relationships. At this present time there is great suspicion and paranoia in the many SGD self-help networks of professionals in medicine and psychological disciplines carrying out research into SGD people. This has historically arisen because of the many years of clinical abuse that has taken place by many medics and psychologists in attempting to force people to live as stereotypical male or female identities which were other than the person themselves believed would make them happy.
Many intersex people were operated on at birth by surgeons to change their sex and gender presentation without their permission and this practice has led to many intersex people becoming hostile against the scientific community today. This leads to a general paranoia in the intersex community when researchers from the scientific community try to interview them and led in this case to difficulty in assessing information about couples in other intersex relationships.
Another difficulty that this pilot ran into is that it interviews only people who were open about their SGD identity to their partners. The author knows from her own clinical practice that in fact many SGD people do not tell their potential or current partners about their SGD identity, therefore living a secret life with a secret past. This makes this population of SGD people almost impossible to interview when they have gone into relationships as they live in fear of discovery.
A Future Study
Wild estimates as to how frequent SGD people occur in the general population can indeed be sourced from many different scientific disciplines. What we do know is that genetic, physiological and psycho-social anomalies occur in at least 1 to 2 per cent of the population that are other than typical male and female.
I will now go on to expand the study to cover a greater number of couples so that the coping strategies developed by more SGD people in relationships can be further examined.
Whether a person identified is strictly male, female, androgynous or neuter was not a deciding factor of whether those people could make good trusting, loving relationships work for them. No matter how sex and gender diverse a person was, there seemed to be potential partners that were willing and happy to have relationships with those people.
Neither was the fact that someone passed socially as their desired identity in society a deciding factor as to whether they were able to have good relationships. What is more likely is that interpersonal and social skills are the deciding factors that enable all people to engage with potential partnerships.
Someone having had a relationship or not pre-transition was also not a deciding factor as to whether they were able to successfully have a good relationship post transition. Previous abusive relationships could, however, have a bearing on the trust factor that all relationships are dependent on.
Recommendations for Therapists
Psychological and relationship counsellors who find themselves dealing with SGD people and their relationships need to educate themselves about their clients’ personalised identity. Although in many cases the client may have a clearly identified medical condition, other clients may reject the medical model and define themselves within the personalised social and philosophical concepts of their own sex and gender expression.
Other SGD people may be extremely confused about their SGD, ignorant of such things and may need help from a therapist to work towards self-exploring. This may also be true for partners who will also have to adjust the way they see their own identities.
Non SGD partners in those relationships who have been unexpectedly exposed to their partner’s announcement of SGD will find they need a considerable time of adjustment to their own emerging identity and that of the SGD partner. Some never do adjust and prefer to leave relationships or seem to stay under sufferance, feeling victimised.
Therapists also need to help educate people entering into relationships with SGD diversity to embrace sex and gender fluidity with a positive attitude. The partners in this study undoubtedly did far better in the relationship when they had very educated and fluid perspectives about sex, gender and sexuality identity formation.
DREGER, ALICE DOMURAT
Hermaphrodites and the Medical Invention of Sex, Harvard University Press, London and USA, 1998.
Sex, Gender & Sexuality: 21st Century Transformations, Extraordinary People Press, London, 1999.
Dr Tracie O’Keefe DCH, BHSc, ND, Clinical Hypnotherapist, Psychotherapist. Counsellor, PACFA registered Mental Health Professional and Naturopath In Sydney. You can get help by booking an appointment with her at Australian Health & Education Centre.