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Intersex is an umbrella term for various people who are born with or develop sex characteristics that differ from the binary notions of a "male" or "female" body. These differences are called variations, and may involve one's hormones, chromosomes, external and internal reproductive organs, or secondary sex characteristics. An individual's intersex traits may include variations in one or multiple of the aforementioned types. These differences can be noticed at birth or later in life. [1][2]
Etymology
The term "intersex" is comprised of "inter-", meaning "between", and "-sex". The term was coined in 1917 by geneticist Richard Goldschmidt,[3] but it did not gain popularity until used by biologist Anne Fausto-Sterling in 1993.[4]
Community
The word intersex also invokes a community. Intersex people are diverse, coming from all socioeconomic backgrounds, races, ethnicities, genders and orientations, faiths, and political ideologies. We are united by
1. our experiences living with variations in our sex traits,
2. the belief that these differences are a natural part of human diversity,
3. the idea that people deserve their own choices about their own bodies.
Between 0.05% and 1.7% of the population is born with intersex traits.[2] It is a decentralized community of people with very different characteristics or backgrounds.
Intersex individuals may have any gender identity or gender expression.[5] Each intersex person has a unique relationship to their gender, assigned gender at birth, the gender(s) they were assigned after birth, and how that relates to their experience being intersex.
Some intersex people use the terms CAFAB/CAMAB – Coercively Assigned Female At Birth/Coercively Assigned Male At Birth - [6] due to being subjected to nonconsensual, unnecessary surgery. However, the terms are not exclusively used in this manner. A variety of experiences and relationships with assigned gender exists within these labels. The terminology is used by trans and cis intersex people alike.[1]
For various reasons, some people with variations that fit under the intersex umbrella do not identify as intersex or as part of the intersex community.
Some examples of variations are:[1]
- Complete or partial androgen insensitivity
- Congenital adrenal hyperplasia
- Hypospadias
- Klinefelter's
- XY gonadal dysgenesis
History
Intersex people were known to exist as early as ancient history. Pliny the Elder wrote in his Natural History about "those who are born of both sexes [...] at one time androgyni."
In medieval times in Europe, law often recognized intersex people, but required them to legally use the gender identity which stereotypical characteristics prevail in the person's appearance.[7][8]
After years of activist efforts, members of the hijra community in India gained legal recognition in 2014 as part of a third gender category. Aspects of the hijra identity can include wearing clothing and cosmetics that are considered feminine. Some intersex people are part of the hijra community.[9]
In the second half of the 19th Century, surgeons in North America started offering cosmetic surgeries of genitals for those that did not meet the stereotypical "norm". However, most of these surgeries were performed on adults at their request. In the 1950s, Johns Hopkins University instead began a practice of performing pediatric surgeries on intersex children without consent. The practice was developed by psychologist John Money, who ignored evidence he himself had collected in 1953 that showed intersex adults had relatively low rates of psychopathology. He decided intersex children would best develop into what he defined as "normal" through surgically imposing a "male" or "female" body in early childhood, along with hormone treatments and being raised based on their coercive assignment. Surgeons "corrected" intersex children's bodies by surgically altering their genitals into either stereotypically male or female. Because surgeons considered it more difficult to perform operations that made a child "male", most intersex children were forcibly assigned female through the procedures. The children could not give consent, and their parents often were not consulted.[10]
Money based his theory about intersex children based on the infamous "John/Joan case" involving David Reimer, who was assigned male at birth in 1965 and was not intersex. When Reimer was eight months old, his genitals were damaged by the doctor performing a circumsion on him. Johns Hopkins University staff and Reimer's parents consulted and came to a conclusion that it would be easiest for them to raise their child as female. Money declared it had worked; he believed Reimer developed into a "normal" girl and later woman from Money's perspective. However, when Reimer's parents told him the truth many years later, it turned out that David Reimer had never felt fully female.[10]
Until late 20th century, being intersex still meant being forcefully assigned to cis male or cis female gender and not being fully recognized in North America and Europe. "Normalization surgery" for intersex children was standard practice. In 1993, biologist Anne Fausto-Sterling published articles in The Sciences and The New York Times and stated the fact that intersex exists.[4] Scientists and authors such as historian and bioethicist Alice Dreger, social psychologist Suzanne Kessler and aforementioned Anne Fausto-Sterling started publishing more works on the topic. Organizations such as ISNA or interACT were founded in the 90s and 2000s.[10]
Since 1993, the era of thorough medical research of intersexuality and advocacy for the intersex people has begun. More healthcare professionals started recognizing modern data and adjusting their standards to help intersex patients properly.[10] On the other hand, it took a decade more to start banning the harmful practice of "intersex surgery" on children. Malta became the first country to ban non-consensual normalization surgery on minors in 2015.[11] Chile passed legislation banning it in 2017.[12] California became the first US state to condemn nonconsensual surgeries on intersex children in 2018.[13]
According to medical consensus that is gaining more basis over time, intersex people's bodies are part of natural diversity and their characteristics appear less often than those seen in the majority, but they are as normal as bodies of the majority.[14][15][16][17][18]
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.
However, intersex people still face discrimination and misunderstanding in healthcare, often due to lack of updating one's knowledge as a healthcare professional, causing harm despite good intentions.[19]
In 2019, more than 50 intersex advocate organizations signed a joint statement in multiple languages that condemns the introduction of "disorders of sex development" language into the 11th Revision of the International Classification of Diseases (ICD-11). In the statement, organizations state that in some cases, the guidelines associated with ICD-11 codes require unnecessary surgeries or other procedures that are not lifesaving, often performed on children without their consent and are grounded in gender stereotypes. They call on the World Health Organization to reform their approach.[20]
Flag and Symbolism
The intersex flag was created by Morgan Carpenter from Intersex Human Rights Australia (IHRA, previously Organisation Intersex International Australia or OII Australia) in July 2013. The organization aimed to create a symbol that was unique - one that didn’t seem derivative of existing flags, and without pink and blue colors (which tend to be perceived as gendered. In Carpenter's words, the circle was chosen because it "is unbroken and unornamented, symbolising wholeness and completeness, and our potentialities. We are still fighting for bodily autonomy and genital integrity, and this symbolises the right to be who and how we want to be."[21]
Another symbol is the orchid, a flower that is often both male and female. Its name comes from the Ancient Greek word for testis or testicle (ὄρχις ). This symbol is used by many intersex organizations, however it is mainly and originally used by Androgen Insensitivity Syndrome (AIS) groups. It may also reference orchidectomy (removal of one or more testis), a surgery which many intersex people are subjected to.[22]
Perceptions and Discrimination
Intersex people often are forced and coerced into undergoing surgery or hormone replacement due to binarist views of gender and sex. The surgeries are known as intersex genital mutilation (IGM), intersex surgeries, or normalization surgeries. These surgeries often happen to children below 2 years old, however they happen to older children, teens, and adults as well. They include altering genitals which do not need surgery to function, or removing organs that produce sex hormones.[1] These procedures may be sterilizing.
They may be described to parents and patients by health professionals as an emergency or necessity; many parents and patients are never fully informed on the negative health effects, or given resources and insight from intersex people.[1][19]
United Nations has stated these are human rights violations.[23] The surgeries often result in complications, reduced sexual function, reduced fertility or worse emotional well-being.[1] There are studies that an estimate of 8.5-20% intersex people may experience gender dysphoria in regards to their assigned gender[24] and that these actions can cause mental suffering.[2] Due to this and the prevalence of nonconsensual medical intervention, the fight for the bodily autonomy of intersex people is a main objective of intersex organizations and activists.[25][26]
Controversy
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| This section uses a term that is recognized as a slur in medical context. Reader discretion is advised or skip to the next section. |
While many animal species are known to be hermaphroditic, for humans the term isn't considered polite or politically correct.[27] Using the term for humans is considered a slur in the English language, as it fails to reflect modern scientific understandings of intersex conditions. This is, because none of the kinds of hermaphroditism found in other species apply to humans.[28] However, the term is known to have been used in history to describe intersex individuals, and not all cultures and languages share this sentiment.
Media
Literature
Film
- XXY - 2007
Television
- Lauren Cooper in Faking It is an intersex person; the character was written after consulting and working with multiple interACT members[29]
Music
- Raven van Dorst is an intersex rock artist from the Netherlands.
Resources
- Intersex Support and Advocacy Groups
- interACT
- Intersex Human Rights International
- Organisation Intersex International
- Intersex Society of North America