This dissertation is about biological sex and how we ought to make sense of it. By biological sex I mean those elements of an individual’s body that are involved in reproduction of the individual’s species; by make sense of it I mean the way in which the occurrence of these elements and their interactions are conceptualized in our minds. Given certain things that are known about sex and reproduction, I argue in this dissertation that sex, maleness, and femaleness ought to be conceptualized in a specific way: this specific way is what I call the multidimensional model of sex. My argument challenges what I call the folk understanding of biological sex, which is (generally speaking) the understanding that most people in most places have about what makes a person male or female. This understanding, I argue, takes the concepts MALE and FEMALE to be logically opposed and atomistic, and constitutive of categories with homogeneous members. I explore three important facts that challenge this understanding: 1) the emphasis on continuity within biological thought, 2) the understanding of sex differences within biology, and 3) the occurrence of intersexuality in human beings. Some authors have already proposed continuum-based understandings of SEX as a replacement for the folk understanding. I identify and discuss three of these: 1) the basic continuum model (Fausto-Sterling 1993, 2000; Blackless, et al. 2000; Kessler 1998; Preves 2003; Intersex Society of North America 2011a; Organisation International des Intersexués 2011a), 2) the multiple continua model (Stoltenberg 1989), and 3) the hybrid model (Stein 2001; Dreger 1998). Inherent to different degrees within each of these models is the belief that maleness and femaleness are somehow conceptually opposite (which is a belief also shared by the folk understanding). This belief, I argue, is not borne out in nature, as demonstrated in part by the occurrence of intersexuality in the species Homo sapiens, and the occurrence of hermaphroditism in other species. These occurrences, I argue, suggest another way to make sense of sex. The model of sex that I present is inspired by the occurrence of intersexuality and hermaphroditism, and also by Sandra Bem’s (1974) work on the concept ANDROGYNY. Bem reconceptualized masculinity and femininity as dimensions of psychological androgyny. I argue that the concepts MALE and FEMALE, and thus BIOLOGICAL SEX, can be understood in a similar way. I propose a multidimensional model of SEX that includes the concepts MALE and FEMALE as intersecting continua that create a space in which the separate features of an individual’s sex are each individually located. The dissertation concludes by discussing the moral implications of the multidimensional model, as some of our judgments about the rightness or wrongness of a person’s actions are related to our understanding of that person’s sex. But if the words male and female come to refer to individual parts of the body and not whole people (as I argue they would, if the multidimensional model were adopted), how would our ideas about the moral acceptability of certain actions and practices change? By examining this general question, I show that adoption of the multidimensional model of sex is important not just because it offers a more biologically accurate representation of sex: it is also important, I conclude, because there is good reason to think that adopting it could improve the quality of life for many.

This dissertation is about biological sex and how we ought to make sense of it. By biological sex I mean those elements of an individual’s body that are involved in reproduction of the individual’s species; by make sense of it I mean the way in which the occurrence of these elements and their interactions are conceptualized in our minds. Given certain things that are known about sex and reproduction, I argue in this dissertation that sex, maleness, and femaleness ought to be conceptualized in a specific way: this specific way is what I call the multidimensional model of sex. My argument challenges what I call the folk understanding of biological sex, which is (generally speaking) the understanding that most people in most places have about what makes a person male or female. This understanding, I argue, takes the concepts MALE and FEMALE to be logically opposed and atomistic, and constitutive of categories with homogeneous members. I explore three important facts that challenge this understanding: 1) the emphasis on continuity within biological thought, 2) the understanding of sex differences within biology, and 3) the occurrence of intersexuality in human beings. Some authors have already proposed continuum-based understandings of SEX as a replacement for the folk understanding. I identify and discuss three of these: 1) the basic continuum model (Fausto-Sterling 1993, 2000; Blackless, et al. 2000; Kessler 1998; Preves 2003; Intersex Society of North America 2011a; Organisation International des Intersexués 2011a), 2) the multiple continua model (Stoltenberg 1989), and 3) the hybrid model (Stein 2001; Dreger 1998). Inherent to different degrees within each of these models is the belief that maleness and femaleness are somehow conceptually opposite (which is a belief also shared by the folk understanding). This belief, I argue, is not borne out in nature, as demonstrated in part by the occurrence of intersexuality in the species Homo sapiens, and the occurrence of hermaphroditism in other species. These occurrences, I argue, suggest another way to make sense of sex. The model of sex that I present is inspired by the occurrence of intersexuality and hermaphroditism, and also by Sandra Bem’s (1974) work on the concept ANDROGYNY. Bem reconceptualized masculinity and femininity as dimensions of psychological androgyny. I argue that the concepts MALE and FEMALE, and thus BIOLOGICAL SEX, can be understood in a similar way. I propose a multidimensional model of SEX that includes the concepts MALE and FEMALE as intersecting continua that create a space in which the separate features of an individual’s sex are each individually located. The dissertation concludes by discussing the moral implications of the multidimensional model, as some of our judgments about the rightness or wrongness of a person’s actions are related to our understanding of that person’s sex. But if the words male and female come to refer to individual parts of the body and not whole people (as I argue they would, if the multidimensional model were adopted), how would our ideas about the moral acceptability of certain actions and practices change? By examining this general question, I show that adoption of the multidimensional model of sex is important not just because it offers a more biologically accurate representation of sex: it is also important, I conclude, because there is good reason to think that adopting it could improve the quality of life for many.

The goal of this paper is to illustrate the real effects of maintaining an inaccurate and conflated view of the relationship between ‘sex’ and ‘gender,’ and to provide possible solutions to this quandary by analyzing the sources in both philosophy and the social sciences. The terms ‘sex’ and ‘gender’ are often rife with misunderstanding in the scientific and medical community, as well as in common usage. While neither term means the same thing contextually, both are constructed socially and require refinement for their usage in and outside of the scientific community. ‘Sex’ and ‘gender’ ought to be understood as interconnected socially constructed concepts, rather than hierarchically at odds where speculations about sex are valued greater than those on gender. A pluralistic, contextual understanding of both sex and gender as well as a clearer understanding of biological sex as an equally socially informed (and thus fallible) concept should be adopted to prevent possible harms as well as missuses of either term. The conflation of the terms within the medical community has significant consequences on some of the most vulnerable identities, particularly transgender people and especially trans people of color. The eventual delivery of poor health outcomes for trans people first begins with the fundamental definitions for ‘sex’ and ‘gender’ in the medical literature, as well as the medical literature’s basic understanding of non-normative sexuality. As a result, medical school education does not provide physicians in training with the adequate tools to provide care for trans people, or anyone outside the spectrum of accepted normative sexuality (heteronormative sexuality), and in addition primes them to further perpetuate and reinforce stigma. Possible solutions to this systemic medical injustice are to incorporate a pluralistic understanding of sex and gender to revise the medical literature, as well as going beyond simple cultural competency training for physicians and instead completely innovate how sexuality and sexual identity is taught in medical school education. / Urban Bioethics