ompeted as women before World War II subsequently underwent reconstructive surgery and sex reassignment. These cases led to efforts to ensure that women competing at international events were in fact women, initially with rather crude and demeaning efforts at physical examination. In 2 instances, women athletes were required to parade nude before a panel of female physicians, and at another event women athletes were required to undergo direct gynecologic examination.
These initial crude attempts at gender verification were soon
replaced by less direct measures: first, the use of a buccal smear
for sex chromatin, which was implemented at the 1968 winter games
in Grenoble on an experimental basis and formally adopted at the
1968 summer games in Mexico City. Until the last decade, this
remained the standard for gender verification, notwithstanding
that by the mid-1970s, the test was discarded by medical professionals
as technically unreliable. More importantly, the test detected
athletes who were unassailably feminine
but who happened to have an XY chromosomal pattern. Many of these individuals had variants of androgen resistance, either complete or partial -- in which case, they are naturally resistant to the strength-promoting qualities of testosterone. Others had variants of XY gonadal dysgenesis. Ironically, the sex chromatin test would have permitted recognized males with an XXY karyotype, or Klinefelter's syndrome, and XX males, who have a portion of the testicular determining gene (SRY) transposed onto the X chromosome, to compete.[1,2]
Concerns regarding the appropriateness of sex chromatin for
gender verification were voiced continuously in the 1970s and
1980s, but their impact was limited because of the absence of
information regarding the frequency of positive results and the
subsequent diagnoses and follow-up. At virtually every Olympic
event, however, abundant rumors circulated; in one instance, this
author was informed that women athletes who were detected as "positive"
were instructed to feign injuries or in some cases were actually
fitted with casts. In 1 celebrated case, a Spanish hurdler, Maria
Patino, was publicly disclosed after failing her femininity test
during an event in Tokyo, at the cost of public disgrace and loss
of her athletic scholarship. It took 2 years and the active intercession
of a number of medical authorities for Ms. Patino, who has androgen
resistance, to be reinstated.
Circumstances such as these and the efforts of a number of
dedicated professionals resulted in some changes by the early
1990s. This author has had the privilege of working with an international
group of professionals, some of whom were convened by the International
Athletic Federation (IAAF) for a Workshop on Methods of Femininity Verification held in late 1990 in Monte Carlo. Our group concluded that laboratory-based sex determination should be discontinued, a recommendation that was accepted shortly thereafter by the IAAF and subsequently by all but 4 of the international athletic federations. The IOC, however, instead replaced sex chromatin with DNA-based methods to detect Y chromosomal material, principally the SRY sex-determining locus on the Y chromosome, implementing this procedure at the 1992 winter games in Albertville. At the insistence of the organizers, the 1996 Summer Olympic Games in Atlanta included a comprehensive process for screening, confirmation of testing, and counseling of individuals detected. Eight of 3387 female athletes (1:423) had positive test results. Of these, 7 had androgen insensitivity, 4 incomplete, and 3 complete; the other athlete had previously undergone gonadectomy and is presumed to have 5-alpha-steroid reductase deficiency. All individuals were given appropriate gender verification certificates and were permitted to compete.
After the Atlanta Olympics, efforts continued to persuade the
IOC to abandon gender verification. Indeed, by the time of the
1996 Summer Olympic Games in Atlanta, essentially all of the relevant
professional societies had endorsed resolutions that called for
