Intersex, in humans and other animals, is a variation in sex characteristics including chromosomes, gonads, or genitals that do not allow an individual to be distinctly identified as male or female. Such variation may involve genital ambiguity, and combinations of chromosomal genotype and sexual phenotype other than XY-male and XX-female. Intersex infants with ambiguous outer genitalia may be surgically 'corrected' to more easily fit into a socially accepted sex category. Others may opt, in adulthood, for surgical procedures in order to align their physical sex characteristics with their gender identity or the sex category to which they were assigned at birth. Others will not become aware that they are intersex—unless they receive genetic testing—because it does not manifest in their phenotype. Some individuals may be raised as a certain sex (male or female) but then identify with another later in life, while others may not identify themselves as either exclusively female or exclusively male. Research has shown gender identity of intersex individuals to be independent of sexual orientation, though some intersex conditions also affect an individual's sexual orientation. Recent legal and regulatory developments in Australia have distinguished "intersex status" from both gender identity and sexual orientation.
Intersexuality as a term was adopted by medicine during the 20th century. In Anne Fausto Sterling's book, Sexing the Body, she mentions the most common types of intersexuality. They are congenital adrenal hyperplasia (CAH), androgen insensitivity syndrome (AIS), gonadal dysgenesis, hypospadias, and unusual chromosome compositions such as XXY (Klinefelter Syndrome) or XO (Turner Syndrome). Intersex conditions received attention from intersex activists, who criticized traditional medical approaches in sex assignment and sought to be heard in the construction of new approaches. The passports and identification documents of some nationalities have adopted "X" as a valid third category besides "M" (male) and "F" (female), at least since 2003. In 2013, Germany became the first European nation to allow babies with characteristics of both sexes to be registered as indeterminate gender on birth certificates.
Research in the late 20th century has led to a growing medical consensus that diverse intersex bodies are normal—if relatively rare—forms of human biology. Milton Diamond, one of the most outspoken experts on matters affecting intersex people, stresses the importance of care in the selection of language related to such people.
- 1 Definition
- 2 Conditions and scope
- 2.1 Prevalence
- 2.2 Signs
- 2.3 "Phall-o-Meter"
- 2.4 Sexual Ambiguity
- 2.5 Management
- 2.6 Gender dysphoria
- 2.7 Causes
- 2.8 Complications
- 3 Human rights and medical intervention
- 4 Civil status and personal identification documents
- 5 Anti-Discrimination Protection
- 6 Language
- 7 Intersex people in society
- 7.1 History
- 7.2 Sociological approaches
- 7.3 Intersex in popular culture
- 7.4 Education
- 7.5 Notable intersex people
- 7.6 Discussion in media and on internet
- 7.7 Noted researchers on intersex development
- 7.8 Exclusion from Standard Model of Sex and Gender
- 8 See also
- 9 References
- 10 Bibliography
- 11 External links
In humans, biological sex is determined by five factors present at birth:
- the number and type of sex chromosomes;
- the type of gonads—ovaries or testicles;
- the sex hormones,
- the internal reproductive anatomy (such as the uterus in females), and
- the external genitalia.
People whose five characteristics are not either all typically male or all typically female are intersex.  Many conditions can lead to the underdevelopment of the sex characteristic collectively referred to as intersex conditions. These can involve differences of the genitals, either externally or internally. Some of these differences include:
- genitals that cannot be classified as male or female
- Incomplete development of internal reproductive organs
- Variations of the sex chromosomes
- different development of the testes or ovaries
Intersex traits are not always apparent at birth; some babies may be born with ambiguous genitals, while others may have ambiguous internal organs (testes and ovaries).
Definitions used by international institutions
The term “intersex” refers to atypical and internal and/or external anatomical sexual characteristics, where features usually regarded as male or female may be mixed to some degree. This is a naturally occurring variation in humans and not a medical condition. It is to be distinguished from transsexuality, a phenomenon where someone has an evident sex, but feels as if he or she belongs to the other sex and is therefore ready to undergo a medical intervention altering his or her natural sex.
The term intersex covers bodily variations in regard to culturally established standards of maleness and femaleness, including variations at the level of chromosomes, gonads and genitals.
The Office of the UN High Commissioner for Human Rights defined intersex as follows, as part of the Free & Equal campaign, 2013:
An intersex person is born with sexual anatomy, reproductive organs, and/or chromosome patterns that do not fit the typical definition of male or female. This may be apparent at birth or become so later in life. An intersex person may identify as male or female or as neither. Intersex status is not about sexual orientation or gender identity: intersex people experience the same range of sexual orientations and gender identities as non-intersex people.
Intersex is defined as a congenital anomaly of the reproductive and sexual system.
Definitions used by national governments
The Australian federal Sex Discrimination Amendment (Sexual Orientation, Gender Identity and Intersex Status) Act 2013 defines intersex as:
intersex status means the status of having physical, hormonal or genetic features that are:
(a) neither wholly female nor wholly male; or (b) a combination of female and male; or (c) neither female nor male.
Australian guidelines on the recognition of sex and gender (2013) explicitly recognise that intersex is innate, and that intersex people may identify their gender in three broad, legally recognised, ways:
An intersex person may have the biological attributes of both sexes or lack some of the biological attributes considered necessary to be defined as one or the other sex. Intersex is always congenital and can originate from genetic, chromosomal or hormonal variations. Environmental influences such as endocrine disruptors can also play a role in some intersex differences. People who are intersex may identify their gender as male, female or X.
Conditions and scope
There are a variety of opinions on what conditions are and are not intersex. For instance, the defunct Intersex Society of North America (ISNA) definition states that the following conditions "sometimes involve intersex anatomy" (note this does not mean they are always intersex conditions):
- 5-alpha reductase deficiency
- androgen insensitivity syndrome
- congenital adrenal hyperplasia
- gonadal dysgenesis (partial & complete)
- Klinefelter syndrome
- mosaicism involving sex chromosomes
- ovo-testes (formerly called "true hermaphroditism")
- partial androgen insensitivity syndrome
- progestin-induced virilisation
- Swyer syndrome
- Turner syndrome
- Non-Klinefelter XXY
The prevalence of intersex depends on which definition is used. According to the ISNA definition above, 1 percent of live births exhibit some degree of sexual ambiguity. Between 0.1% and 0.2% of live births are ambiguous enough to become the subject of specialist medical attention, including surgery to assign them to a given sex category (i.e., male or female). According to Fausto-Sterling's definition of intersex, on the other hand, 1.7 percent of human births are intersex.
According to Leonard Sax the prevalence of intersex "restricted to those conditions in which chromosomal sex is inconsistent with phenotypic sex, or in which the phenotype is not classifiable as either male or female" is about 0.018%.
The ISNA claims that there is no concrete definition of what counts as intersex, therefore statistics on the prevalence of biological sex variations may be controversial. The INSA cites Anne Fausto-Sterling's article that reviewed medical literature from 1955 to 1998, in which an attempt was made to gauge the frequency of intersex conditions.
The following is a summary of the frequency statistics:
|Not XX and not XY||one in 1,666 births|
|Klinefelter (XXY)||one in 1,000 births|
|Androgen insensitivity syndrome||one in 13,000 births|
|Partial androgen insensitivity syndrome||one in 130,000 births|
|Classical congenital adrenal hyperplasia||one in 13,000 births|
|Late onset adrenal hyperplasia||one in 66 individuals|
|Vaginal agenesis||one in 6,000 births|
|Ovotestes||one in 83,000 births|
|Idiopathic (no discernable medical cause)||one in 110,000 births|
|Iatrogenic (caused by medical treatment, for instance progestin administered to pregnant mother)||No estimate|
|5 alpha reductase deficiency||No estimate|
|Mixed gonadal dysgenesis||No estimate|
|Complete gonadal dysgenesis||one in 150,000 births|
|Hypospadias (urethral opening in perineum or along penile shaft)||one in 2,000 births|
|Hypospadias (urethral opening between corona and tip of glans penis)||one in 770 births|
Ambiguous genitalia appear as a large clitoris or as a small penis.
Because there is variation in all of the processes of the development of the sex organs, a child can be born with a sexual anatomy that is typically female or feminine in appearance with a larger-than-average clitoris (clitoral hypertrophy) typically male or masculine in appearance with a smaller-than-average penis that is open along the underside. The appearance may be quite ambiguous, describable as female genitals with a very large clitoris and partially fused labia, or as male genitals with a very small penis, completely open along the midline ("hypospadic"), and empty scrotum.
Fertility is variable. According to some, the distinctions "male pseudohermaphrodite", "female pseudohermaphrodite" and especially "true hermaphrodite" are vestiges of outdated 19th century thinking. According to others, the terms "male pseudohermaphrodite", and "female pseudohermaphrodite" are used to define the gender in terms of the histology (microscopic appearance) of the gonads.
Members of the Intersexual Rights Movement have designed the "phall-o-meter," a small ruler that decides the permissible range of the phallus size for males and females. In her Sexing the Body Anne Fousto-Sterling states how the "phall-o-meter" is used. "If the clitoris is "too big" to belong to a girl, doctors will want to downsize it, but in contrast to the penis, doctors have rarely used precise clitoral measurements in deciding the gender of a newborn child. Such measurements, however, do exist. Since 1980, we have known that the average clitoral size of newborn girls is 0.34 centimeters. More recent studies show that clitoral length at birth ranges from 0.2 to 0.85 centimeters." According to Anne Fausto-Sterling's Sexing the Body the Phall-o-meter is a scale from one to five and is measured in centimeters. The way the meter works is by setting up the acceptable measurements. For a girl, a medically acceptable clitoris can be no bigger than one centimeter. For a boy, the penis what would be accepted must be between 2.5 centimeters and 4.5 centimeters. According to the scale, the range between one and 2.5 in unacceptable in either sexes.
A "true hermaphrodite" is defined as someone with both testicular and ovarian tissue.
In 2003, researchers at UCLA published their studies of a lateral gynandromorphic hermaphroditic zebra finch, which had a testicle on the right and an ovary on the left. Its entire body was split down the middle between female and male, with hormones from both gonads running through the blood. This is an example of mosaicism or chimerism.
This extreme example of hermaphroditism is quite rare.
Though naturally occurring true hermaphroditism in humans is unknown, there is, on the other hand, a spectrum of forms of ovotestes. The varieties include having two ovotestes or one ovary and one ovotestis, often in the form of streak gonads. Phenotype is not determinable from the ovotestes; in some cases, the appearance is "fairly typically female"; in others, it is "fairly typically male," and it may also be "fairly in-between in terms of genital development."
Other diagnostic signs
In order to help in classification, methods other than a genitalia inspection can be performed. For instance, a karyotype display of a tissue sample may determine which of the causes of intersex is prevalent in the case.
Sexual ambiguity refers to somebody whose sex is not clearly displayed. It would not be clear to an outsider what the sex of that person would be. Because what counts as female or male is more on a continuum rather than black or white, it can be hard to define sexual ambiguity. Some people live and die with interest anatomy without ever knowing that they are intersex. What is male, female, or even ambiguous is largely classified by society. The ambiguity can come from dress, physical attributes, or the way that one carries themselves. People can come off as sexually ambiguous by choice, but also from their genetics. Some people are born with ambiguous genitalia (meaning it does not fit the description for men's or women's genitalia), some people are born with different genotypes and phenotypes than just XX or XY, and many other disorders that fit into this category. There are many different intersex syndromes, such as Klinefelter syndrome, which is a chromosomal condition affecting males, androgen insensitivity syndrome, which is when a biological male is resistant to male hormones, and ovotestis, which is when there are both testicular and ovarian aspects to a human gonad.
John Money, who was a psychologist as well as a sexologist, studied sexual identity and gender. He was cited as saying that the overall sense of gender was "privately experienced" and "publicly manifest" regardless of biological sex and genital anatomy. Money is perhaps best known for his work with David Reimer, a biological male who was raised as female due to a mishandled circumcision. In Anne Fausto-Sterling's Sexing the body, she gives John Money's view of intersexuality by stating,: “Intersexuality, in Money's view, resulted from fundamentally ab-normal processes. Their patients required medical treatment because they ought to have become either a male or a female. The goal of treatment was to assure proper psychosexual development by assigning the young mixed-sex child to the proper gender…”  John Money declared in Anne Fausto Steling's Sexing the Body, "From the sum total of hermaphroditic evidence, the conclusion that emerges is that sexual behavior and orientation as male or female does not have an innate, instinctive basis.” Money is disproved in chapter 3 of Sexing the Body when it is stated that congenital adrenal hyperplasia (CAH) girls tend to manufacture larger amounts of masculine hormones until birth and the production of these male hormones raises the question among scientist of whether or not the excess male hormones that a CAH girl produces has an effect on her brain development. Robert Stoller was another frontrunner in the gender field. Stoller is quoted as saying "sex is a biological state, consequent to prenatal biological forces, which almost always results in a newborn with unambiguous female or male genitals. Gender is a psychological state, a complex evolving intrapersonal and interpersonal experience", a quote that perfectly explains the difference between sex and gender.
Society has created a binary in the gender gap that states that there are only 2 definite gender assignments. Anne Fausto-Sterling takes part in refuting the standard model. She references intersexuality and how it “blurred the distinction between male and female”. Those who are of intersex are often surgically “corrected” by doctors to be either male or female at a young age. Scientists never “questioned the assumption that there were only 2 sexes, because their goal in studying intersex individuals was to find out more about “normal” development.". Sterling advocates that, instead of culturally shaping ideas about gender and creating a dimorphism, scientists should allow for intersexuality to become a part of the norm and “[move] from an area of sexual dimorphism to one of the variety beyond the number two.”
Not having a distinct gender being shown to the world can be very difficult. Often times, doctors decide the sex of an intersex infant immediately after birth. Doctors choose the sex based on what they believe a male or a female should look like. In essence, society decides what is male or female. People born intersex may experience teasing, stares, awkwardness in situations such as using a public restroom. When somebody does not fit into society's two boxes of "male" or "female" most people have a hard time understanding them, and therefore have a hard time knowing how to act toward them. This can cause true issues when it comes to organizations where we classify by sex. Anne Fausto-Sterling says, "[o]ur conceptions of the nature of gender difference shape, even as they reflect, the ways we structure our social system and polity; they also shape and reflect our understanding of our physical bodies." One of the main areas in which we separate by sex is organized sports. Professional sports are virtually always separated by male/female. Males are often considered superior in athletics because of the male body's natural strength. The benefits that sports can have for women is often overlooked. Sports can provide gender equity as well as empowerment for girls and women.
A current sports-related issue that has been in the media lately revolves around Caster Semenya. Semenya is a South African middle-distance runner and has won gold at the World Championships in the women's 800 meter and also competed in the 2012 Summer Olympics where she won the silver medal. Semenya has brought up some serious controversy, because her appearance and general way has her come off as more male than female. When Semenya won gold in the World Championships, the International Association of Athletics Federation requested gender verification tests. They were concerned with whether or not she was "eligible" to compete in women's sports. The International Association of Athletics Federation were concerned because of Semenya's deep voice, muscular build, and her rapid improvement in her running times. Semenya identifies as a woman, her family and friends say she is a woman. The results were not released, but Semenya was cleared to race with the rest of the women. However, running is her passion, and this controversy put her in a spotlight she did not particularly want, and invaded her privacy. Simply because she did not perfectly fit female standards, she was put through potentially humiliating tests and temporarily suspended from competition.
People subconsciously categorize, label, and classify others within the few moments of meeting or seeing them. Gender is one of the first categories people think of when classifying someone else. Categorizing comes from both nature and nurture. The nature aspect relates to the fact that the brain automatically classifying someone new into a category seen fit. The nurture aspect is how someone classifies someone else, why they classify them as whatever they choose, and the feelings brought out when classifying someone. Humans tend to organize things into two opposing categories and are comfortable when they can make clear distinctions thus easily categorizing people, however uncertainty sets in when people come in contact with ambiguous objects, ideas, or people. The current pattern of gender binarism accelerates and polarizes the development of male and female beings. Nevertheless, for those “physically intermediate beings” who are considered as “abnormal, ambiguous, or intersexed” as it is mentioned in the article “From Molecules to Brains, Normal Science Supports Sexist Beliefs About Differences” by Bonnie Spanier, the cultural “sexual dimorphism in mammals left little room for ambiguity.” When it comes to the workplace, intersex people are more likely to experience discrimination and unfair treatment than a clearly male or clearly female individual. Women and minorities have experienced workplace inequality for decades past and continue to experience that today. Due to the fact that when people feel uncertain about something they tend to get insecure, nervous, and maybe even hostile so when, for example, an employer is uncertain about an employee, that employer may consciously or subconsciously treat this specific employee different than all of the other employees. This is another hardship intersex individuals must face and overcome even though it does not affect their abilities in any way.
Typically, surgery is performed at birth. Intersex advocates such as Anne Fausto-Sterling in her Sexing the Body argue surgery on intersex babies should wait until the child can make an informed decision, and label surgery without consent as genital mutilation. In "Sexing the Body", Sterling describes the grueling process of transforming an intersex person into the desired sex, and the appearance of a "densely scarred and immobile penis" or “extensive suturing [or] skin transplants in such a way that it seems difficult for anyone to endure. Although the decision should be made strictly by the parents without any coercion or influence presented by the doctor, it is ultimately the “physicians who decide how to manage intersexuality”. No matter how impartial they attempt to be, physicians simply “act out of, and perpetuate, deeply held beliefs about male and female sexuality, gender roles, and the (im)proper place of homosexuality in normal development” when performing the necessary surgery for the chosen gender.  The Intersex Society of North America indicated on their web page that “For decades, doctors have thought it necessary to treat intersex with a concealment-centered approach, one that features downplaying intersex as much as possible, even to the point of lying to patients about their conditions. A lot of people in our culture also had no interest in hearing that sex doesn’t come in two simple flavors.” As stated by Fausto Sterling, “…doing whatever was necessary to assure that the child and his/her parents believed in the sex assignment."
Depending on the type of intersex condition, surgery may be performed for aesthetic or social purposes. Unlike other aesthetic surgical procedures performed on infants, such as corrective surgery for a cleft lip (as opposed to a cleft palate), genital surgery may lead to negative consequences for sexual functioning in later life (such as loss of sensation in the genitals, for example, when a clitoris deemed too large or penile is reduced/removed), or feelings of freakishness and unacceptability, which may have been avoided without the surgery. In other cases, negative consequences may be avoided with surgery.
The exact procedure of the surgery depends on what is the cause of a less common body phenotype in the first place. There is often concern as to whether surgery should be performed at all. A traditional approach to the management of intersexuality has been surgery. However, some such as Alice Dreger say that surgical treatment is socially motivated and, hence, ethically questionable; without evidence, doctors regularly assume that intersex persons cannot have a clear gender identity. This is often taken further with parents of intersex babies advised that without surgery their child will be stigmatized. Further, since almost all such surgeries are undertaken to fashion female genitalia for the child, it is more difficult for the child to present as male if they later find they identify as or are genetically male. 20-50% of surgical cases result in a loss of sexual sensation (Newman 1991, 1992).
Typically, surgery is performed at birth. Intersex advocates such as Anne Fausto-Sterling in her Sexing the Body argue surgery on intersex babies should wait until the child can make an informed decision, and label surgery without consent as genital mutilation. Several variables are assessed when deciding on surgery for a baby with ambiguous genitals. There are distinct goals when deciding whether gender assignment surgery is necessary of preserving fertility (if possible), good bowel and bladder functions, preserving genital sensation and increasing the odds that the baby will be satisfied with the assigned gender.
Depending on the type of intersex condition, surgery may be performed for aesthetic or social purposes. Unlike other aesthetic surgical procedures performed on infants, such as corrective surgery for a cleft lip (as opposed to a cleft palate), genital surgery may lead to negative consequences for sexual functioning in later life (such as loss of sensation in the genitals, for example, when a clitoris deemed too large or penile is reduced/removed), or feelings of freakishness and unacceptability, which may have been avoided without the surgery. In other cases, negative consequences may be avoided with surgery.
Opponents maintain that there is no compelling evidence that the presumed social benefits of such "normalizing" surgery outweigh the potential costs. Opponents claim this led to the degrading interpretation that females are essentially castrated males. This view overlooks the embryological origin of the penis/clitoris.
Defenders of the practice argue that it is necessary for individuals to be clearly identified as male or female in order for them to function socially. The child was seen to be in need of correction in order to be socially accepted in the future. However the situation proved to be far more complex than was originally thought. In the first surgeries, parents were not often consulted on the decision-making process when choosing the sex of the child. Doctors took it upon themselves to decide what was best based on certain forms of evidence, such as hormonal levels, or other extreme forms. Biologist Anne Fausto Sterling states that in the past doctors would decide if the sex were to be male or female based on the measurements of the penis or the clitoris. For example in one study of 100 newborn males, those with penises measuring in at 2.9 to 4.5 centimeters are deemed acceptable and therefore designated as male. However one that measured less than 1.5 centimeters would undergo a female assignment. The idea of the environment and social norms shaping the sex of the child was completely ignored.
Intersex advocates and experts have critiqued the necessity of early interventions, citing individual's experiences of intervention and the lack of follow-up studies showing clear benefits. Specialists at the Intersex Clinic at University College London began to publish evidence in 2001 that indicated the harm that can arise as a result of inappropriate interventions, and advised minimising the use of childhood surgical procedures.
Studies done on individuals with intersex conditions or DSDS, have revealed how surgical intervention has had psychological effects, leading to the impact on well being and quality of life. Genitoplasty, plastic surgery done on the genitalia, does not ensure a successful psychological outcome for the patient and might require psychological support when the patient is trying to distinguish a gender identity. Other than the possible negative psychological outcomes, surgeries, like with a vaginoplasty, can have physical outcomes, one common one being scarring, which can be a factor to insensitivity. Other cases where vaginoplasty has caused complications, is that the implant or artificial vagina will not stay in place, or need further surgeries. One of the reasons there are many complications is doctors who do not specialize in genitoplasty or similar surgeries (phalloplasty, vaginoplasty) usually reconstruct the child's ambiguous genitalia.
Experience of medical procedures and photography
Biologist Anne-Fausto Sterling stated that either doctors will often advise parents to socially raise their child as either the male or female that they were surgically made to be, without telling them what sex their chromosomes dictate they are, or that the parents often make this choice on their own. This often causes confusion later on in life when children experience puberty or a relationship where they are confronted with the fact that their genitals do not function as they are told they should in sexual education and by friends. In the short documentary "XXXY", two intersex individuals talked openly about believing that intersex individuals should be raised as such and then allowed to choose whether or not they wanted surgery performed. A physician also featured agreed with these two and encouraged an end to surgery on infants. Children who were born intersex and then had surgery first as newborn infants and then continuously through their childhood and adolescence report experiencing severe emotional confusion and/or devastation, and the parents of these children are also impacted emotionally by the decisions they made to have their child undergo surgery from infant through adolescence. 
Photographs of intersex children's genitalia are circulated in medical communities for documentary purposes; an example of this appears in the medical section 3.2.1 above. Problems associated with experiences of medical photography of intersex children have been discussed along with the ethics, control and usage.
"The experience of being photographed has exemplified for many people with intersex conditions the powerlessness and humiliation felt during medical investigations and interventions".
The proposed revisions for DSM-5 include a change from using Gender Identity Disorder to Gender Dysphoria. This revised code now specifically includes intersex people as people with Disorders of Sex Development. This move has been criticised by intersex advocacy groups in Australia and New Zealand, and criticism from the intersex community has been lodged with the appropriate DSM5 subcommittee.
The UK Intersex Association (UKIA) is also highly critical of the label ‘disorders’ and points to the fact that there was minimal involvement of intersex representatives in the debate which led to the change in terminology. UKIA supports the suggestion put forward by Profs. Milton Diamond and Hazel Beh that the more neutral and less pathologising term "Variations of Sex Development" would be more appropriate in medical discussion.
Typical sex development
The common pathway of sexual differentiation, where a productive human female has an XX chromosome pair, and a productive male has an XY pair, is relevant to the development of intersex conditions.
During fertilization, the sperm adds either an X (female) or a Y (male) chromosome to the X in the ovum. This determines the genetic sex of the embryo. During the first weeks of development, genetic male and female fetuses are "anatomically indistinguishable," with primitive gonads beginning to develop during approximately the sixth week of gestation. The gonads, in a "bipotential state," may develop into either testes (the male gonads) or ovaries (the female gonads), depending on the consequent events. Through the seventh week, genetically female and genetically male fetuses appear identical.
At around eight weeks of gestation, the gonads of an XY embryo differentiate into functional testes, secreting testosterone. Ovarian differentiation, for XX embryos, does not occur until approximately Week 12 of gestation. In normal female differentiation, the Müllerian duct system develops into the uterus, Fallopian tubes, and inner third of the vagina. In males, the Müllerian duct-inhibiting hormone MIH causes this duct system to regress. Next, androgens cause the development of the Wolffian duct system, which develops into the vas deferens, seminal vesicles, and ejaculatory ducts. By birth, the typical fetus has been completely "sexed" male or female, meaning that the genetic sex (XY-male or XX-female) corresponds with the phenotypical sex; that is to say, genetic sex corresponds with internal and external gonads, and external appearance of the genitals.
|This section needs additional citations for verification. (April 2010)|
The final body appearance does not always correspond with what is dictated by the genes. In other words, there is sometimes an incongruity between genetic (or chromosomal) and phenotypic (or physical appearance) sex. Citing medical research regarding other factors that influence sexual differentiation, the Intersex Society of North America challenges the XY sex-determination system's assumption that chromosomal sex is the determining factor of a person's "true" biological sex.
|XX||Congenital adrenal hyperplasia (CAH)||The most common cause of sexual ambiguity is congenital adrenal hyperplasia (CAH), an endocrine disorder in which the adrenal glands produce abnormally high levels of virilizing hormones in utero. The genes that cause CAH can now be detected in the developing embryo. As Anne Fausto Sterling mentioned in chapter 3 of Sexing the Body, “a woman who suspects she may be pregnant with a CAH baby (if she or someone in her family carries CAH) can undergo treatment and then get tested.” To prevent an XX-CAH child's genitalia from becoming masculinized, a treatment, which includes the use of the steroid dexamethasone, must begin as early as four weeks after formation. Although many do not favor this process because "the safety of this experimental therapy has not been established in rigorously controlled trials", it does allow physicians to detect abnormalities, therefore starting treatment right after birth. Starting treatment as soon as an XX-CAH baby is born not only minimizes, but also may even eliminate the chances of genital surgery from being performed.
In XX-females, this can range from partial masculinization that produces a large clitoris, to virilization and male appearance. The latter applies in particular to Congenital adrenal hyperplasia due to 21-hydroxylase deficiency, which is the most common form of CAH.
Individuals born with XX chromosomes affected by 17α-hydroxylase deficiency are born with female internal and external anatomy, but, at puberty, neither the adrenals nor the ovaries can produce sex-hormones, inhibiting breast development and the growth of pubic hair.
See below for XY CAH 17α-hydroxylase deficiency.
|XX||Progestin-induced virilisation||In this case, the excess androgen hormones are caused by use of progestin, a drug that was used in the 1950s and 1960s to prevent miscarriage. These individuals normally have internal and external female anatomy, with functional ovaries and will therefore have menstruation. They develop, however, some male secondary sex characteristics and they frequently have unusually large clitorises. In very advanced cases, such children have initially been identified as males.|
|XX||Freemartinism||This condition occurs commonly in all species of cattle and affects most females born as a twin to a male. It is rare or unknown in other mammals, including humans. In cattle, the placentae of fraternal twins usually fuse at some time during the pregnancy, and the twins then share their blood supply. If the twins are of different sexes, male hormones produced in the body of the fetal bull find their way into the body of the fetal heifer (female), and masculinize her. Her sexual organs do not develop fully, and her ovaries may even contain testicular tissue. When adult, such a freemartin is very like a normal female in external appearance, but she is infertile, and behaves more like a castrated male (a steer). The male twin is not significantly affected, although (if he remains entire) his testes may be slightly reduced in size. The degree of masculinization of the freemartin depends on the stage of pregnancy at which the placental fusion occurs – in about ten percent of such births no fusion occurs and both calves develop normally as in other mammals.|
|XY||Androgen insensitivity syndrome (AIS)||People with AIS have a Y chromosome, (typically XY), but are unable to metabolize androgens in varying degrees.
Cases with typically female appearance and genitalia are said to have complete androgen insensitivity syndrome (CAIS). People with CAIS have a vagina and no uterus, cervix, or ovaries, and are infertile. The vagina may be shorter than usual, and, in some cases, is nearly absent. Instead of female internal reproductive organs, a person with CAIS has undescended or partially descended testes, of which the person may not even be aware.
In mild and partial androgen insensitivity syndrome (MAIS and PAIS), the body is partially receptive to androgens, so there is virilization to varying degrees. PAIS can result in genital ambiguity, due to limited metabolization of the androgens produced by the testes. Ambiguous genitalia may present as a large clitoris, known as clitoromegaly, or a small penis, which is called micropenis or microphallus; hypospadias and cryptorchidism may also be present, with one or both testes undescended, and hypospadias appearing just below the glans on an otherwise typical male penis, or at the base of the shaft, or at the perineum and including a bifid (or cleft) scrotum.
|XY||5-alpha-reductase deficiency (5-ARD)||The condition affects individuals with a Y chromosome, making their bodies unable to convert testosterone to dihydrotestosterone (DHT). DHT is necessary for the development of male genitalia in utero, and plays no role in female development, so its absence tends to result in ambiguous genitalia at birth; the effects can range from infertility with male genitalia to male underdevelopment with hypospadias to female genitalia with mild clitoromegaly. The frequency is unknown, and children are sometimes misdiagnosed as having AIS. Individuals can have testes, as well as vagina and labia, and a small penis capable of ejaculation that looks like a clitoris at birth. Such individuals are usually raised as girls. The lack of DHT also limits the development of facial hair.|
|XY||Congenital adrenal hyperplasia (CAH)||In individuals with a Y chromosome (typically XY) who have Congenital adrenal hyperplasia due to 17 alpha-hydroxylase deficiency, CAH inhibits virilization, unlike cases without a Y chromosome.|
|XY||Persistent Müllerian duct syndrome (PMDS)||The child has XY chromosomes typical of a male. The child has a male body and an internal uterus and fallopian tubes because his body did not produce Müllerian inhibiting factor during fetal development.|
|XY||Anorchia||Individuals with XY chromosomes whose gonads were lost after 14 weeks of fetal development. People with Anorchia have no ability to produce the hormones responsible for developing male secondary sex characteristics nor the means to produce gametes necessary for reproduction due to the lack of gonads. They may develop typically feminine secondary sex characteristics without or despite the administration of androgens to artificially initiate physical sex differentiation (typically planned around the age of puberty). Psychological and neurological gender identity may solidify before the administration of androgens, leading to gender dysphoria, as anorchic individuals are typically assigned male at birth.|
|XY||Gonadal Dysgenesis||It has various causes and are not all genetic; a catch-all category.
It refers to individuals (mostly XY) whos gonads don't develop properly. Clinical features are heterogeneous.
|XY||Hypospadias||It is caused by various causes,including alterations in testosterone metabolism.
The urethra does not run to the tip of the penis. In mild forms, the opening is just shy of the tip; in moderate forms, it is along the shaft; and in severe forms, it may open at the base of the penis.
|Other||Unusual chromosomal sex||In addition to the most common XX and XY chromosomal sexes, there are several other possible combinations, for example Turner syndrome (XO), Triple X syndrome (XXX), Klinefelter syndrome, (XXY) and variants (XXYY, XXXY, XXXXY), XYY syndrome, de la Chapelle syndrome (XX male), Swyer syndrome (XY female).|
|Other||Mosaicism and chimerism||A mix can occur, where some of the cells of the body have the common XX or XY, while some have one of the less usual chromosomal contents above. Such a mixture is caused by either mosaicism or chimerism. In mosaicism, the mixture is caused by a mutation in one of the cells of the embryo after fertilization, whereas chimerism is a fusion of two embryos.
In alternative fashion, it is simply a mixture between XX and XY, and does not have to involve any less-common genotypes in individual cells. This, too, can occur both as chimerism and as a result of one sex chromosome having mutated into the other.
However, not all cases of mosaicism and chimerism involve intersex.
In the cases where nonfunctional testes are present, there is a risk that these develop cancer. Therefore, doctors either remove them by orchidectomy or monitor them carefully. This is the case for instance in androgen insensitivity syndrome.
In a major Parliamentary report in Australia, published in October 2013, the Senate Community Affairs References committee was "disturbed" by the possible implications of current practices in the treatment of cancer risk. The committee stated:
clinical intervention pathways stated to be based on probabilities of cancer risk may be encapsulating treatment decisions based on other factors, such as the desire to conduct normalising surgery… Treating cancer may be regarded as unambiguously therapeutic treatment, while normalising surgery may not. Thus basing a decision on cancer risk might avoid the need for court oversight in a way that a decision based on other factors might not. The committee is disturbed by the possible implications of this...
— Senate of Australia
Human rights and medical intervention
Parliamentary inquiry, Australia
In October 2013, the Australian Senate published a report entitled 'Involuntary or coerced sterilisation of intersex people in Australia'. The Senate found that "normalising" surgeries are taking place in Australia, often on infants and young children, with preconceptions that it described as "disturbing":
"Normalising appearance goes hand in hand with the stigmatisation of difference".
— Community Affairs committee, Senate of Australia
"As OII commented, normalisation surgery is more than physical reconstruction. The surgery is intended to deconstruct an intersex physiology and, in turn, construct an identity that conforms with stereotypical male and female gender categories" 
— Community Affairs committee, Senate of Australia
"Enormous effort has gone into assigning and ‘normalising’ sex: none has gone into asking whether this is necessary or beneficial. Given the extremely complex and risky medical treatments that are sometimes involved, this appears extremely unfortunate".
— Community Affairs committee, Senate of Australia
The report makes 15 recommendations, including ending cosmetic genital surgeries on infants and children and providing for legal oversight of individual cases.
Organisation Intersex International (OII) Australia welcomed the report, saying that,
At a first view, many of the headline conclusions and recommendations are positive – accepting our recommendations on minimising genital surgery, concern over the lack of adequate data, insufficient psychosocial support, and concern that decision making on cancer risk is insufficiently disentangled from wider concerns about a person’s intersex status itself; we also broadly welcome the recommendations relating to the prenatal use of Dexamethasone ... The distinction between therapeutic and non-therapeutic treatment has failed many intersex people in Australia. We welcome the recommendation for the proper oversight of individual cases.
— OII Australia
Resolution by the Council of Europe
In October 2013, the Council of Europe adopted a resolution 1952, 'Children's right to physical integrity'. It calls on member states to
"undertake further research to increase knowledge about the specific situation of intersex people, ensure that no-one is subjected to unnecessary medical or surgical treatment that is cosmetic rather than vital for health during infancy or childhood, guarantee bodily integrity, autonomy and self-determination to persons concerned, and provide families with intersex children with adequate counselling and support"
— Resolution 1952/2013, Council of Europe
Report of UN Special Rapporteur on Torture
On 1 February 2013, Juan E Mendés, the UN Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, issued a statement condemning non-consensual surgical intervention on intersex people. His report states:
76. … There is an abundance of accounts and testimonies of persons being denied medical treatment, subjected to verbal abuse and public humiliation, psychiatric evaluation, a variety of forced procedures such as sterilization, State-sponsored forcible … hormone therapy and genital-normalizing surgeries under the guise of so called “reparative therapies”. These procedures are rarely medically necessary, can cause scarring, loss of sexual sensation, pain, incontinence and lifelong depression and have also been criticized as being unscientific, potentially harmful and contributing to stigma (A/HRC/14/20, para. 23).
77. Children who are born with atypical sex characteristics are often subject to irreversible sex assignment, involuntary sterilization, involuntary genital normalizing surgery, performed without their informed consent, or that of their parents, “in an attempt to fix their sex”, leaving them with permanent, irreversible infertility and causing severe mental suffering…
79. The mandate has noted that “members of sexual minorities are disproportionately subjected to torture and other forms of ill-treatment because they fail to conform to socially constructed gender expectations.
— UN Special Rapporteur on Torture
However, many intersex individuals have resented the medical intervention, and some have been so discontented with their surgically assigned gender as to opt for sexual reassignment surgery later in life. The Declaration of Montreal first demanded prohibition of unnecessary post-birth surgery to reinforce gender assignment until a child is old enough to understand and give informed consent. This was detailed in the context of existing UN declarations and conventions under Principle 18 of The Yogyakarta Principles, which called on states to:
B. Take all necessary legislative, administrative and other measures to ensure that no child’s body is irreversibly altered by medical procedures in an attempt to impose a gender identity without the full, free and informed consent of the child in accordance with the age and maturity of the child and guided by the principle that in all actions concerning children, the best interests of the child shall be a primary consideration;
C. Establish child protection mechanisms whereby no child is at risk of, or subjected to, medical abuse;
— The Yogyakarta Principles
Constitutional Court of Colombia
Although not many cases of children with intersex conditions are available, a case taken to the Constitutional Court of Colombia led to changes in their treatment. The case significantly reduced the power of doctors and parents to decide surgical procedures on the children's ambiguous genitalia. Due to the decision of the Constitutional Court of Colombia on Case 1 Part 1 (SU-337 of 1999), doctors are obligated to inform parents on all the aspects of the intersex child. Parents can only consent to surgery if they have received accurate information, and cannot give consent after the child reaches the age of five. By then the child will have, supposedly, realized their gender identity. The court case has led to setting legal guidelines to how doctor's surgical practice on intersex children.
Civil status and personal identification documents
Australia, Germany, Nepal, and New Zealand are states that have taken steps to allow for intersex (and other) people to list their gender as other than male or female in their civil status registries and on identification documents.
Australian federal guidelines enable intersex (and other) people to identify gender as male, female or X on all federal documents, including passports. Documentary evidence must be witnessed by a doctor or psychologist, but medical intervention is not required. Alex MacFarlane received the first Australian passport with an 'X' sex descriptor, reported in January 2003.
Birth certificates are a State and Territory issue in Australia. Organisation Intersex International (OII) Australia asserts that identification changes are managed as an administrative correction, and that this process has enabled some adults to obtain birth certificates with an indeterminate or unspecified sex.
Alex MacFarlane is believed to be the first person in Australia to obtain a birth certificate recording sex as indeterminate. This is stated by The West Australian to be on the basis of an indeterminate birth certificate issued by the State of Victoria. The newspaper reported in January 2003 that the Department of Foreign Affairs and Trade "had decided to accommodate people whose birth certificates recorded their sex as indeterminate ... Alex is also believed to be the first Australian issued with a birth certificate acknowledging a gender other than male of female". Councillor Tony Briffa JP, of the City of Hobsons Bay, Victoria, previously acknowledged as the world's first openly intersex mayor, states on Tony's website that "my birth certificate is silent as to my sex".
Germany is the first European country that has allowed the "determinate" sex as an option. A report by the German Ethics Council stated that the law was passed because, "Many people who were subjected to a 'normalizing' operation in their childhood have later felt it to have been a mutilation and would never have agreed to it as adults."  Deutsche Welle reported that an "indeterminate" 'option' was made available for the birth certificates of intersex infants with ambiguous genitalia on 1 November 2013. The move is controversial with many intersex advocates in Germany and elsewhere suggesting that it might encourage surgical interventions.
Birth certificates are available at birth showing "indeterminate" sex if it is not possible to assign a sex. The New Zealand Department of Internal Affairs states, "A person’s sex can be recorded as indeterminate at the time of birth if it cannot be ascertained that the person is either male or female, and there are a number of people so recorded."
"Intersex status" became a protected attribute in Australian federal law on 1 August 2013, recognising that intersex status is unrelated to gender identity, sexual orientation, sex or disability. The legislation, the Sex Discrimination Amendment (Sexual Orientation, Gender Identity and Intersex Status) Act 2013, passed Parliament without requiring a vote on 25 June 2013. The Act facilitates exemptions in competitive sport but does not support exemptions on religious grounds. The Explanatory Memorandum to the Act states,
During consultation, religious bodies raised doctrinal concerns about the grounds of sexual orientation and gender identity. However, no such concerns were raised in relation to ‘intersex status’. As a physical characteristic, intersex status is seen as conceptually different."
Milton Diamond, one of the most outspoken experts on matters affecting intersex people, stresses the importance of care in the selection of language related to intersex people:
Foremost, we advocate use of the terms "typical," "usual," or "most frequent" where it is more common to use the term "normal." When possible avoid expressions like maldeveloped or undeveloped, errors of development, defective genitals, abnormal, or mistakes of nature. Emphasize that all of these conditions are biologically understandable while they are statistically uncommon.
Gender and sexual self-identification with the term 'intersex'
Currently, however, hermaphroditism is not to be confused with intersex, as the former refers only to a specific phenotypical presentation of sex organs and latter to more complex combination of phenotypical and genotypical presentation, as well as social self-identification. Using "hermaphrodite" to refer to intersex individuals can be stigmatizing and misleading. In general, hermaphrodite is used for animal species in which the possession of both ovaries and testes (either serially or concurrently) is part of the typical life history of the species; intersex is used when this is not the case.
The term transgender describes the condition in which one's gender identity does not match one's assigned sex. Some individuals may be both intersex and transgender but the two terms are not synonymous.
Transgender is an umbrella term for persons (unlike Intersex) whose gender identity, expression and behavior does not match the typically associated sex that they were born with. Gender identity refers to the internal notion of being male or female. Gender expression refers to the nature in which a person communicates their gender.
Intersexuality and its Sexual Ambiguity
In “Of Gender and Genitals”, Anne Fausto-Sterling underscores the standard protocol many doctors adhered to in order to decrease the amount of hysteria in the hospital room. When facing the parents of an intersex newborn, doctors’ main goal was to keep the parents as calm as possible even if that meant leaving out information deemed unimportant. Currently, doctors are expected to relay all known knowledge to patients so that they are fully informed when making decisions concerning their health, but this was not the case years ago. Doctors’ main method used when attempting to define and describe the many processes and functions of the male and female anatomy was to reveal the findings and data collected from their biological research and inform, or convince, the public that that was what nature told them or that that was how men and women were meant to live. When it came to the question of what exactly nature was trying to accomplish by giving them anatomical qualities of both genders, doctors were confounded. They had in their possession no solid, definitive evidence or scientific findings that could point them in the right direction concerning the intersex individual's “true” gender, or the gender of which he or she was intended to embody. During earlier times, the choice of what gender the child would be given the ability to emulate was ultimately up to the doctors, not the parents. The doctors’ ability to determine what gender the child would grow up to be seen as was in direct relation to the dichotomy of nature versus nurture. At this time, doctors believed that the gender they were assigning the intersex child was the gender “nature” intended for the child to have, and that it was ultimately up to the parents to “nurture” the child in such a way that they would behave like that gender. There exists at least one example of a gender assignment that went wrong even though the parents “nurtured” exactly as they should, the John-Joan case study. This example was exactly what some scientists and researchers were looking for when aiming to disenchant the public’s belief in doctors’ having an understanding of nature to the point where they can determine what it is that nature wants.
Disorders of sex development
"Disorders of sex development" (DSD) is a term that has both supporters and opponents. It is defined to include congenital conditions in which development of chromosomal, gonadal, or anatomical sex is atypical.
A number of critics of traditional terminology, including the now defunct Intersex Society of North America, intersex activists, and some medical experts moved to eliminate the term "intersex" in medical usage, replacing it with disorders of sex development in order to avoid conflating anatomy with identity. Members of the Lawson Wilkins Pediatric Endocrine Society and the European Society for Paediatric Endocrinology accepted this term in their "Consensus statement on management of intersex disorders" published in the Archives of Disease in Children and in Pediatrics. It is not known if this consensus is still accepted, and the ISNA is now a defunct group since its founder left it.
Other intersex people, activists, supporters, and academics have contested the adoption of the terminology and its implied status as a "disorder", seeing this as offensive to intersex individuals who do not feel that there is something wrong with them, regard the DSD consensus paper as reinforcing the normativity of early surgical interventions, and criticizing the treatment protocols associated with the new taxonomy. Alternatives to categorizing intersex conditions as "disorders" have been suggested, including "variations of sex development". Organization Intersex International (OII) questions a disease/disability approach, argues for deferral of intervention unless medically necessary, when fully informed consent of the individual involved is possible, and self-determination of sex/gender orientation and identity.
Intersex people in society
Intersex people are treated in different ways by different cultures. In some cultures, such people were included in larger "third gender" or gender-blending social roles along with other individuals. In most societies, intersex people have been expected to conform to either a female or a male gender role. Surgeons pinpointed intersex babies as an emergency once they were born. The parents of the intersex babies were not content about the situation. Psychologists, sexologists, and researchers had a theory that it was better if the baby's genitalia were changed when they were younger than when they were a mature adult. The scientist thought that helped with the confusion.
Whether or not they were socially tolerated or accepted by any particular culture, the existence of intersex people was known to many ancient and pre-modern cultures. An example is one of the Sumerian creation myths from more than 4,000 years ago. The story has Ninmah, a mother goddess, fashioning mankind out of clay. She boasts that she will determine the fate – good or bad – for all she fashions. Enki, the father god, retorts as follows.
- Enki answered Ninmah: "I will counterbalance whatever fate – good or bad – you happen to decide." Ninmah took clay from the top of the abzu [ab = water, zu = far] in her hand and she fashioned from it first a man who could not bend his outstretched weak hands. Enki looked at the man who cannot bend his outstretched weak hands, and decreed his fate: he appointed him as a servant of the king.
- ... [Three men and one woman with atypical biology are formed and Enki gives each of them various forms of status to ensure respect for their uniqueness] ...
- Sixth, she fashioned one with neither penis nor vagina on its body. Enki looked at the one with neither penis nor vagina on its body and gave it the name Nibru [eunuch(?)], and decreed as its fate to stand before the king."
During the Victorian era, medical authors introduced the terms "true hermaphrodite" for an individual who has both ovarian and testicular tissue, verified under a microscope, "male pseudo-hermaphrodite" for a person with testicular tissue, but either female or ambiguous sexual anatomy, and "female pseudo-hermaphrodite" for a person with ovarian tissue, but either male or ambiguous sexual anatomy. In Europe, the term 'intersexual' was first to be used before the Second World War. The first suggestion to replace the term 'hermaphrodite' with 'intersex' came from British specialist Cawadias in the 1940s. This suggestion was taken up by specialists in the UK during the 1960s, by both those who rejected Money's framework (then emerging from the USA), and those who endorsed that approach.
Since the rise of modern medical science in Western societies, some intersex people with ambiguous external genitalia have had their genitalia surgically modified to resemble either female or male genitals. Since the advances in surgery have made it possible for intersex conditions to be concealed, many people are not aware of how frequently intersex conditions arise in human beings or that they occur at all. Contemporary social activists, scientists and health practitioners, among others, have begun to revisit the issue. Awareness of the existence of physical sexual variation in human beings has increased.
Some groups, such as ISNA, and some clinicians, such as those at University College Hospital London, have questioned the practice of performing genital corrective surgery on intersex children. Dialogue between what were once antagonistic groups of activists and clinicians has led to changes in medical policies and how intersex patients and their families are treated in some locations. There are intersex groups, such as OII, who argue that the various degrees of intersex are natural human variations that should not be subject to correction.
Anne Fausto-Sterling coined the words herm (for "true hermaphrodite"), merm (for "male pseudo-hermaphrodite"), and ferm (for "female pseudo-hermaphrodite"), and proposed that these be recognized as sexes along with female and male. Her terms were "tongue-in-cheek"; she no longer advocates these terms even as a rhetorical device. The activist Cheryl Chase criticized these terms in a letter to The Sciences, also criticizing the traditional standard of medical care. Chase announced the creation of the Intersex Society of North America.
The first sociologist to work on 'intersexuality' was Harold Garfinkel in 1967 using a method derived from sociological phenomenology he called ethnomethodology. He based his analysis on the everyday commonsense understandings of 'Agnes', a woman undergoing social and surgical gender reassignment. Ethnomethodology was also used in 1978 by Kessler and McKenna, who argue that, while gender can be seen as a social accomplishment, cross-cultural studies render gender as problematic as they highlight how it is usually regarded as a fact, when it can be shown to be constructed in different ways. They point to different cultural approaches to gender roles, and how 'hermaphrodites' and 'berdaches' are incorporated socially, as disruptive to fixed ideas about sex, gender, and gender-roles. They argue that what we 'know' about gender is grounded in the 'everyday social construction of a world of two genders', where gender attribution seems more important than gender differentiation.
Intersex in popular culture
The Japanese manga series I.S., first published in 2003, features intersex characters and how they deal with intersex-related issues and influence the lives of people around them.
The 1995 film Hermaphrodites Speak! is a 30 minute documentary film from the United States in which several intersex people at the first retreat of the Intersex Society of North America discuss their lives and the medical treatment and parenting they received.
In 2000, Porter Gale, Masters in Documentary Film and Video from Stanford University,and Laleh Soomekh, produced XXXY, a documentary revealing the intersex individuals' opinions on the surgical procedures done on children with intersex conditions or DSDs, while providing a medical professional's opinion as well. The film clearly shows the dissatisfaction and the painful repercussions for the children who went through sex reassignment surgeries.
In 2006, Ajae Clearway produced an award winning documentary giving voice to various intersex individuals and their experiences with surgeries, and advocates for informed consent. The film One in Two Thousand educates the viewer on notions of sexuality, and the opposition on unnecessary surgeries.
The 2007 Argentine film XXY centres around a young intersex person who is assisted in presenting as a girl with medication. The film deals with discrimination, sexuality and gender identity.
In 2010, Australian documentary-maker Phoebe Hart directed an autobiographical documentary of her personal experience as an intersex person. The film, Orchids, My Intersex Adventure, explores the various social scenarios faced by many intersex individuals.
In 2012, the film Intersexion was awarded the Best Feature Documentary award at the Documentary Edge Festival, hosted by Mani Bruce Mitchell, CEO of the first Intersex Trust in the world (ITANZ). The film was directed by Grant Lahood. The film follows Mani as s/he visits intersex people in America, Ireland, Germany, South Africa and Australia.
In 2013 the op-ed "Intersex, the Final Coming-Out Frontier," by intersex author Hida Vilora, was published in The Advocate.
TV and Radio
Intersex was discussed on British TV for the first time in 1966, and became a topic of interest for broadcast TV and radio in the United States and other countries from 1989.
In the 2000 Freaks and Geeks episode "The Little Things", Ken has to deal with the discovery that his girlfriend had been born with ambiguous genitalia.
In the 2009 episode of House entitled, "The Softer Side", a teenager with Genetic Mosaicism that is unaware of his (the gender his parents choose for him) condition develops dehydration and is admitted to Princeton Plainsboro Teaching Hospital.
In the 2010 Childrens Hospital episode "Show Me on Montana", Drs. Flame and Maestro try to convince a hermaphrodite child which gender to choose, with each doctor vying for their own gender.
In secondary schools, biology and sex education instructors often place most emphasis on the most common XX and XY genotypes. Thus, people nowadays may be more likely to look towards the sex chromosomes than, for example, the histology of the gonads. However, according to researcher Eric Vilain at the University of California, Los Angeles, "the biology of gender is far more complicated than XX or XY chromosomes". Many different criteria have been proposed, and there is little consensus.
In 2002 at the Reform seminary Hebrew Union College-Jewish Institute of Religion in New York, the Reform rabbi Margaret Wenig organized the first school-wide seminar at any rabbinical school which addressed the psychological, legal, and religious issues affecting people who are intersex or transsexual. In 2003 Margaret Wenig organized the first school-wide seminar at the Reconstructionist Rabbinical College which addressed the psychological, legal, and religious issues affecting people who are intersex or transsexual.
Notable intersex people
- Le Van Duyet, Nguyen Dynasty general and high-ranking mandarin.
- Herculine Barbin—the 19th century memoirs of this French intersex person were published by Michel Foucault in 1980.
- Sir Ewan Forbes, 11th Baronet, formerly Elizabeth Forbes-Sempill—in 1968 the Scottish courts confirmed Ewan Forbes' intersexuality cited in the correction of his birth certificate, placing him as the male heir to the family title, making him the 11th Baronet of Craigievar.
- Georgina Somerset (née Turtle), first openly intersex person in the UK; she was active in the media from the mid-1960s.
- Cheryl Chase, intersex activist.
- Erik Schinegger, alpine skier.
- Jim Sinclair, autism rights activist.
- Lady Colin Campbell, British aristocrat and author of Guide to Being a Modern Lady.
- Edinanci Silva, judoka and Gold medalist in the woman's half-heavyweight division at the Pan-American games.
- Del LaGrace Volcano, visual artist and speaker on queer and intersex issues (e.g. the Critical Sexology Seminars, London). Describes his intersexuality as self-constructed.
- Santhi Soundarajan, Indian athlete who competes in the middle distance track events. She was stripped of a silver medal won at the 2006 Asian Games after failing a sex verification test, disputing her eligibility to participate in the women's competition.
- Mauro Cabral, Argentine intersex activist, writer, Co-director of GATE (Global Action for Trans Equality)
- Cr Tony Briffa JP, Australian intersex and human rights activist. Former President of the AIS Support Group Australia, world's first out intersex Mayor (City of Hobsons Bay, Melbourne), world's first publicly elected out intersex person, and current councillor of the City of Hobsons Bay in Melbourne, Australia. Current Vice-President of Organisation Intersex International (OII) Australia and Vice-President of the AIS Support Group Australia.
- Mani Mitchell, New Zealand intersex activist, member of the New Zealand Association of Counsellors (NZAC), The World Professional Association for Transgender Health (WPATH), International Transactional Analysis Association (ITAA).
- Eden Atwood, American jazz musician, actress and an advocate for the civil rights of people born with intersex traits.
- Maddie Blaustein, American voice actress known for her roles as Meowth in Pokémon and E-123 Omega in the Sonic the Hedgehog series, a founder of Second Life
Discussion in media and on internet
- There has been intense speculation about Caster Semenya, the South African middle-distance runner, being intersex. The way she has been dealt with by the sporting community and the media has itself been the subject of debate in the media. Tests she was subjected to included what were described as humiliating genital photography.
Noted researchers on intersex development
- John Money
- Milton Diamond, professor of neurology, Univ. of Hawai'i at Manoa, and director of The Pacific Center for Sex and Society located at the University of Hawaii.
- Anne Fausto-Sterling
Exclusion from Standard Model of Sex and Gender
The standard model of the difference between sex and gender says that one’s sex is biologically determined while one’s gender is socially or culturally determined. Sex being biologically determined means that when a child is born, doctors classify the infant as either male or female depending on the anatomy. Gender being socially or culturally determined means that the way in which that child is raised, socialized, and taught determines whether he or she takes on masculine or feminine traits. The standard model says that humans are sexually dimorphic. This means each and every human being is either male or female, thus leaving out those who are born intersex, for example. The standard model explains that gender is categorized into two separate opposing sides being either masculine or feminine, again completely excluding those who are intersex, transgender, androgynous and so on. Modern scholars such as Anne Fausto-Sterling and Bonnie Spanier criticize and reject the standard binary of sex and gender for a variety of reasons such as objectivity in science, heteronormativity, inclusion of intersex individuals, and the trust our society gives doctors and scientists.
Anne Fausto-Sterling’s article titled “Of Gender and Genitals: The Use and Abuse of the Modern Intersexual” criticizes the standard model of sex and gender by using the case of intersex individuals by explaining how those individuals are neither male nor female so they do not fit in the sex binary. It is suggested that “bodies… only live within the productive constrains of certain highly regulatory schemas.” People must be “culturally intelligible as males or females”. While the standard model says that sex is biologically determined, Fausto-Sterling challenges this by stating “From the sum total of hermaphroditic evidence, the conclusion that emerges is that sexual behavior and orientation as male or female does not have an innate, instinctive basis."  Therefore, based on the study of hermaphrodites, sexual behavior is not determined by classifying one as either male or female. Basically, she is saying that nurture trumps nature. Fausto-Sterling portrays how our society puts a great deal of trust in doctors because they are seen as the experts and those who decide what nature tells us. Due to the fact that the standard model is a sexual binary, doctors for decades past have felt the need to immediately “correct” intersex children after birth. Fausto-Sterling states, “The attending physician, realizing that the newborn's genitalia are either/or, neither/both, consults a pediatric endocrinologist (children's hormone specialist) and a surgeon. They declare a state of medical emergency. According to current treatment standards, there is no time to waste in quiet reflection or open-ended consultations with the parents”. Doctors felt that this was a medical emergency because intersex children were seen as abnormal, and because we live in a society based on heternormativity, physicians were pressured to make anything abnormal, normal. Fausto-Sterling mentions that “no masculine women or effeminate men need apply.” These individuals are considered to be “unthinkable, abject, unlivable.” As this belief is deeply rooted in people’s mind, it is essential and imperative for “surgeons, psychologists, and endocrinologists, through their surgical skills, [to] try to make good facsimiles of culturally intelligible bodies.” Contrary to the belief that physicians thought it was vital to immediately decide a sex for an intersex child, evidence shows that just because science chooses a sex for a child that does not guarantee that the child will grow up to “fit” that gender role. For example, the article states, “These individuals seemed to be listening to some inner voice that said that everyone in authority surrounding h/her was wrong. Doctors and parents might have insisted that they were female, removed their testes, injected them with estrogen, and surgically provided them with a vagina, but still, they knew they were really males”. These individuals are the exception to the standard model and a prime example of why the standard model is not relevant. These types of people do not properly fit the sexual dimorphism so a more acceptable categorization would be the alternative model. The alternative model a spectrum with completely male on one side and completely female on the other, leaving room for sexually ambiguous humans to be categorized somewhere in between.
In "Of Gender and Genitals", Anne Fausto-Sterling illustrates how the standard model of the difference between sex and gender can be at times damaging and how it necessitates that doctors’ uphold to certain protocol in order to maintain it. She informs the reader that the extensive surgeries intersex children undergo soon after birth are both “unnecessary and sexually damaging”. The tiniest of humans, if born intersex, are subjected to a number of considerable surgeries as soon as they are born merely to uphold to society’s standard model. If society’s view changed to that of a gender-sex spectrum, these babies would be given the freedom to choose their own gender when they become of age. Unfortunately back then, that was not the case. Instead, for example, intersex babies, who were chosen to function as a male, experienced multiple surgeries “on the[ir] penis[es] during the first couple of years of [their] li[ves]”. When dealing with the parents of intersex children, doctors must follow certain guidelines so as not to dishearten the parents’ of their children’s normality. Fausto-Sterling specifically references some doctors’ endeavor towards “discouraging any feeling of sexual ambiguity” for their children. While Anne Fausto-Sterling believed doctors took questionable measures in order to determine how the intersex children would live, Bonnie Spanier, felt that scientists were completely off in their attempt to depict the standard model. In her short article, Spanier addresses the scientists’ unacceptable scientific tactics. The most important claim she makes against the scientists of her time concerning the standard model is that they “conflate the issue of sexual orientation with gender identity”. She explains how these scientists describe a gay man as being “more female” than a heterosexual man and the same with lesbian women being “more male”. An individual’s sexual preference is not necessarily included in the delineation of the gender identity. While these two things are somewhat associated, they are not associated enough where they can be placed in the masculine/feminine bins present in today’s society.
Bonnie Spanier’s article titled “From Molecules to Brains, Normal Science Supports Sexist Beliefs About Differences” discusses the role that hormones play in determining the gender roles that individuals take on. Our society is one based on heterosexism so anyone that falls outside the norm is seen as abnormal or needing to be fixed. Homosexual individuals do not fit the sex and gender dimorphism and Spanier states, “The conflation, based on heterosexism, reflects and reinforces what is normal and what is abnormal in sexual relations. Obviously, in this framework, gay men and deficient in maleness and thus are more female than “normal” males; conversely, lesbians are male” (368). This says that homosexual individuals are neither fully male nor fully female when it comes to gender so they too would be excluded from the standard model. Spanier’s article also discusses Dr. Ruth Bleier’s criticism of flawed medical studies involving the size of the corpus callosum in females compared to males. Bleier conducted three more studies by other researchers and failed to find sex-related differences in the size of the corpus callosum. Spanier writes “she [Bleier] argues very strongly for the predominant role of environmental influences” (369). This relates back to doctors feeling the need to treat intersex children as a medical emergency without consulting anyone, including the parents. Evidence shows that nurture has much to do with sex and gender roles so using the standard model in modern medicine is invalid because many individuals cannot be classified as completely male or completely female.
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