Instead, there is growing support for the possibility of utilizing additional categories that compare people without "prior assumptions about who is like whom". Scholars who study the gender binary from an intersectional feminism and critical race theory perspective agree that during the process of European colonization of the U.S., a binary system of gender was created and enforced as a means of protecting patriarchal norms and upholding European nationalism. This idea of a gender as a binary is thought to be an oppressive means of reflecting differential power dynamics. Studies of Two Spirit traditions have shown that various Native American nations understand gender and sexuality in a way that directly opposes Western norms. Gender binarism also poses limitations on the adequacy of medical care provided to gender nonconforming patients. There is a large gap in medical literature on nonbinary populations who have unique healthcare needs. Anne Fausto-Sterling suggests a classification of 23 sexes and to move away from the classification of male and female. In her paper "The Five Sexes: Why Male and Female Are Not Enough", she discusses the existence of intersex people, individuals possessing a combination of male and female sexual characteristics, who are seen as deviations from the norm, and who frequently undergo coercive surgery at a very young age in order to maintain the two-gender system. The existence of these individuals challenges the standards of gender binaries and puts into question society's role in constructing gender. Fausto-Sterling says that modern practitioners encourage the idea that gender is a cultural construct and concludes that, "we are moving from an era of sexual dimorphism to one of variety beyond the number 2."