Gender verification: a concept whose time has come and passed?

Gender verification: a concept whose time has come and passed? Gender verification was hardly an issue at the inception of the ancient Olympic games in Greece. Competition was restricted to men, and the competitors entered the stadium unclad. No doubt existed about their gender. However, with the addition of women to Olympic competition in 1912, concerns were raised about the possibility of men attempting to impersonate female competitors for the purpose of gaining unfair advantage. In an effort to allay these fears, sex testing (now known as gender verification) was introduced in the late 1960s to guarantee a level playing field. The first tests, which were conducted at the European Track and Field Championships in 1966 and the Pan American Games in 1967, resembled those employed at the ancient Olympic games-women paraded unrobed in front of a panel of physicians who confirmed their gender. Because of the humiliating nature of these tests, an objective measure of gender verification, the sex chromatin test, was introduced at the Mexico City Olympic Games in 1968. This consisted of examining cells from a smear taken from the buccal mucosa of female competitors for the presence or absence of a Barr body. This body is formed after inactivation of one of the two X chromosomes in female cells. The presence of a Barr body confirmed the female gender of a competitor, while its absence raised suspicion about the athlete's gender. The medical code provided for karyotyping and/or a physical examination by a member of the International Olympic Committee (IOC) Medical Commission under such circumstances. Unfortunately, many female competitors were unfairly disqualified by this test. Only the chromosomal or genetic sex of the competitor can be determined by this test and therefore phenotypic females with male sex chromatin patterns seen in conditions such as androgen insensitivity syndrome or XY gonadal dysgenesis are potentially subject to disqualification. While physical examination and careful review would usually result in a correct decision about the eligibility of these athletes, most women with abnormal sex chromatin tests "retired" or opted to forgo further assessment to be spared potential publicity and public scrutiny. In fact, pooled data have shown that 13 women have been excluded from athletic competition between 1972 and 1990 using sex chromatin testing: about one in every 500 female competitors.' Sex chromatin analysis fell out of favour of most geneticists shortly after it was instituted by the IOC. The …