So, what is intersex?
Intersex is an umbrella term used to categorize various reproductive and sexual anatomy differences that don’t fit the usual male or female definitions. In short, intersex individuals may have chromosomes, genitals, or internal reproductive organs that don’t fit into the typical male or female category or may possess characteristics of both male and female sexes.
Intersex, by definition, is when someone generally appears to be one sex but has the dominant anatomy of the other sex or when someone is born in between the typical male and female sexes. An example of this would be a female-presenting person having mostly male anatomy. Another example of someone born intersex is someone born with an in-between presentation of male and female genitals, such as someone born with a larger-than-usual clitoris and without a vaginal opening or someone who has been born with a scrotum that is divided into a labia-like form. A person may also be born with mosaic genetics or cells with XX and XY chromosomes.
While intersex is usually detected and assigned at birth, intersex anatomy isn’t always present then. Sometimes a person must reach the age of puberty before discovering they’re intersex. Some people may not even discover that they’re intersex until adulthood, when they discover that they’re infertile. In rare instances, intersex people are only diagnosed after they have passed away and are discovered through an autopsy.
It's important to note that being intersex is not a disease, disorder, or condition.
Sex vs. Gender vs. Gender Identity
Sex and gender are two terms often used interchangeably, but these two terms are not the same. Sex and gender have pretty stark differences. There’s also gender identity. But what are the differences between these three terms?
- Sex: Sex is what you’re physically born with and is defined as either female or male by the healthcare providers who assist in your birth. Sex assignment is often decided on the appearance of the genitals you’re born with and assigned on your birth certificate. Sex may also be defined by hormone levels, chromosomes, and reproductive anatomy. Sex is assigned based on a wide range of physical criteria, from genes and hormones to organs to genital shapes.
- Gender: Gender is based on cultural and societal opinions on how people should carry themselves and behave based on their assigned sex.
- Gender Identity: Gender identity is the gender you identify as, regardless of what you were assigned at birth. For example, if you were assigned male at birth but identify as female, then you may want to present as female. That would be your gender identity.
You might be wondering what intersex gender is or what the gender of an intersex person would be, but it’s not as black and white as sex or gender. The gender an intersex person identifies as depends on the specific individual and what they feel like in the face of many, many physical, social, and mental details, both those that "conform to the norm" and those that don't. Like anyone else, intersex individuals are free to identify as a range of gender identities, from male, female, nonbinary, and other genders.
Being intersex isn’t common. It’s estimated that around 2% of individuals worldwide fit into the intersex category. Of those individuals, 1 in 100 Americans have traits classified as intersex. There are no exact causes known for being intersex. Some characteristics can be inherited through genetics or passed down from one generation in a family to the next.
Some factors that may cause intersex to occur in an individual include:
- Genetic conditions that cause abnormal hormonal levels in genital development
- Y genes that are missing or misplaced
- Artificial or natural hormone exposure during the development of embryos
- Variations of the androgen hormone receptor gene
Being intersex was once considered a sexual development disorder, but it is neither a disorder, condition, or disease. Intersex individuals don’t require special treatments or care. However, some intersex individuals may choose to have gender affirmation surgery, particularly if their gender doesn’t match the one they were assigned at birth. Gender affirmation surgery is a personal choice and is not something that needs to be done.
Intersex individuals may have one or more of the following areas affected:
- Ovaries or testicles
- Reproductive organs
Intersex can occur in around 40 different ways, affecting individuals differently. The more common intersex traits occur when a combination of chromosomes happens or when there are mixed genitals and reproductive organs.
Intersex surgeries are not necessary. Some individuals may choose to receive them to better fit the gender they identify as. Due to this, they are known as non-lifesaving procedures aimed at changing genital appearance or altering the reproductive system.
There are many types of surgeries, including:
- Clitoroplasty, or clitoral reduction or recession, is aimed at reducing or repositioning the clitoris
- Vaginoplasty is aimed at creating or altering the appearance of the vagina
- Hypospadias repair is the repositioning of an already working urethra
- Gonadectomy is the removal of sex hormone organs
Risks and Complications
It’s important to understand the consequences of intersex surgeries, specifically, those performed on infants. Many intersex surgeries involve lifelong physical and emotional concerns, including reduced sexual function and high complication rates. Additionally, some surgeries risk UTIs developing throughout the individual’s life.
The United Nations considers the practice of intersex surgery to violate human rights, especially when performed without an individual’s consent.
Most surgeries are offered to parents with children under two. Some doctors accept these surgeries, but since children cannot consent to the surgery, it’s often at the expense of allowing a person later to make an important decision regarding their own body.
Intersex usually carries no risks, so getting the surgery is completely optional. Intersex differences are healthy, and surgery is generally required only when an infant cannot urinate due to these differences. However, this is rare.
Many people who are intersex or have intersex children wonder about reproduction and pregnancy rates. Whether an intersex person can get pregnant depends upon the person’s body parts. For example, if an intersex person has a penis and sperm-producing testicles, they may be able to cause pregnancy. Likewise, if an intersex person has a uterus, they may be able to become pregnant.
While many intersex differences may result in infertility, not all do. However, making the decision to have surgery performed on an intersex child who cannot consent to the surgery themselves may render them infertile.
Supporting Intersex Differences
If you know someone who is intersex, it’s important that you understand how to accept and support them. Intersex happens on its own and is not something that can be helped, nor should it be considered a disease. Instead of alienating those with intersex differences, you should educate yourself regarding the specific intersex differences that the specific individual has. Education on the subject can help prevent you from saying something that may be offensive or triggering to the intersex individual. Additionally, being self-aware of your attitude regarding sex and gender is just as important.
If the intersex individual you know is your child or someone else’s child, you must familiarize yourself with how to discuss sex and sexuality in an age-appropriate manner. You’ll also want to do your part to ensure that the intersex person is not discriminated against or teased about their differences.
Finally, it’s important to remember that most intersex individuals are happy with their differences and do not wish to have surgery. Do not make assumptions based on their sex or gender; allow them to identify with their choices. If you would like to learn more about how you can support these individuals, there are support groups available to intersex individuals and their loved ones.