Интерсекс

Эта статья о интерсексе у людей. Для интерсекса у других животных см. Intersex (Biology) .

Не путать с гермафродитой .

Participants at the third International Intersex Forum, Malta, in December 2013

Интерсекс - это люди, родившиеся с какими -либо из нескольких половых характеристик , включая хромосом паттерны , гонады или гениталии , которые, согласно Управлению Верховного комиссара Организации Объединенных Наций по правам человека , «не соответствуют типичным бинарным представлениям мужского или женского тела».

Половое назначение ребенка при рождении обычно соответствует внешним гениталиям . Количество рождений с неоднозначными гениталиями находится в диапазоне 1: 4500–1: 2000 (0,02–0,05%). Другие условия включают развитие атипичных хромосом, гонад или гормонов. Некоторые люди могут быть назначены и выращены как девочка или мальчик, но затем идентифицируют себя с другим полом в более позднем возрасте, в то время как большинство продолжают идентифицировать себя с назначенным полом. Количество рождений, в которых ребенок находится в интернесе, сообщалось по -разному в зависимости от того, кто сообщает, и какое определение интерсекса используется. Энн Фаусто-Стерлинг и ее соавторы книги утверждают, что распространенность «нондиморфного сексуального развития» у людей может достигать 1,7%. However, a response published by Leonard Sax reports this figure includes conditions such as late onset congenital adrenal hyperplasia and Klinefelter syndrome, which most clinicians do not recognize as intersex; Sax states, "if the term intersex is to retain any meaning, the term should be 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", stating the prevalence of intersex is about 0.018% (one in 5,500 births), about 100 times less than Fausto-Sterling's estimate.

Terms used to describe intersex people are contested, and change over time and place. Intersex people were previously referred to as "hermaphrodites" or "congenital eunuchs". In the 19th and 20th centuries, some medical experts devised new nomenclature in an attempt to classify the characteristics that they had observed, the first attempt to create a taxonomic classification system of intersex conditions. Intersex people were categorized as either having "true hermaphroditism", "female pseudohermaphroditism", or "male pseudohermaphroditism". These terms are no longer used, and terms including the word "hermaphrodite" are considered to be misleading, stigmatizing, and scientifically specious in reference to humans. In biology, the term "hermaphrodite" is used to describe an organism that can produce both male and female gametes. Some people with intersex traits use the term "intersex", and some prefer other language. In clinical settings, the term "disorders of sex development" (DSD) has been used since 2006, a shift in language considered controversial since its introduction.

Intersex people face stigmatization and discrimination from birth, or following the discovery of intersex traits at stages of development such as puberty. Intersex people may face infanticide, abandonment, and stigmatization from their families. Globally, some intersex infants and children, such as those with ambiguous outer genitalia, are surgically or hormonally altered to create more socially acceptable sex characteristics. This is considered controversial, with no firm evidence of favorable outcomes. Such treatments may involve sterilization. Adults, including elite female athletes, have also been subjects of such treatment. Increasingly, these issues are considered human rights abuses, with statements from international and national human rights and ethics institutions. Intersex organizations have also issued statements about human rights violations, including the 2013 Malta declaration of the third International Intersex Forum. In 2011, Christiane Völling became the first intersex person known to have successfully sued for damages in a case brought for non-consensual surgical intervention. In April 2015, Malta became the first country to outlaw non-consensual medical interventions to modify sex anatomy, including that of intersex people.

Terminology

There is no clear consensus definition of intersex and no clear delineation of which specific conditions qualify an individual as intersex. The World Health Organization's International Classification of Diseases (ICD), the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), and many medical journals classify intersex traits or conditions among disorders of sex development (DSD).

A common adjective for people with disorders of sex development (DSD) is "intersex".

Etymology and definitions

Model Hanne Gaby Odiele photographed by Ed Kavishe for Fashionwirepress. In 2017, Odiele disclosed having the intersex trait androgen insensitivity syndrome.

In 1917, Richard Goldschmidt created the term "intersexuality" to refer to a variety of physical sex ambiguities. However, according to The SAGE Encyclopedia of LGBTQ Studies, it was not until Anne Fausto Sterling published her article "The Five Sexes: Why Male and Female Are Not Enough" in 1993 that the term reached popularity.

According to the UN Office of the High Commissioner for Human Rights:

Intersex people are born with sex characteristics (including genitals, gonads and chromosome patterns) that do not fit typical binary notions of male or female bodies. Intersex is an umbrella term used to describe a wide range of natural bodily variations.

Attitudes towards the term

Some intersex organizations reference "intersex people" and "intersex variations or traits" while others use more medicalized language such as "people with intersex conditions", or people "with intersex conditions or DSDs (differences of sex development)" and "children born with variations of sex anatomy". In May 2016, interACT published a statement recognizing "increasing general understanding and acceptance of the term 'intersex'".

Australian sociological research on 272 "people born with atypical sex characteristics", published in 2016, found that 60% of respondents used the term "intersex" to self-describe their sex characteristics, including people identifying themselves as intersex, describing themselves as having an intersex variation or, in smaller numbers, having an intersex condition. Respondents also commonly used diagnostic labels and referred to their sex chromosomes, with word choices depending on audience.

Research on 202 respondents by the Lurie Children's Hospital, Chicago, and the AIS-DSD Support Group (now known as InterConnect Support Group) published in 2017 found that 80% of Support Group respondents "strongly liked, liked or felt neutral about intersex" as a term, while caregivers were less supportive. The hospital reported that the use of the term "disorders of sex development" may negatively affect care.

Another study by a group of children's hospitals in the United States found that 53% of 133 parent and adolescent participants recruited at five clinics did not like the term "intersex". Participants who were members of support groups were more likely to dislike the term. A "dsd-LIFE" study in 2020 found that around 43% of 179 participants thought the term "intersex" was bad, 20% felt neutral about the term, while 37% thought the term was good.

The term "hermaphrodite"

Main article: Hermaphrodite

Historically, the term "hermaphrodite" was used in law to refer to people whose sex was in doubt. The 12th century Decretum Gratiani states that "Whether an hermaphrodite may witness a testament, depends on which sex prevails" ("Hermafroditus an ad testamentum adhiberi possit, qualitas sexus incalescentis ostendit"). Similarly, the 17th century English jurist and judge Edward Coke (Lord Coke), wrote in his Institutes of the Lawes of England on laws of succession stating, "Every heire is either a male, a female, or an hermaphrodite, that is both male and female. And an hermaphrodite (which is also called Androgynus) shall be heire, either as male or female, according to that type of sexe which doth prevaile."

During the Victorian era, medical authors attempted to ascertain whether or not humans could be hermaphrodites, adopting a precise biological definition for the term, and making distinctions between "male pseudohermaphrodite", "female pseudohermaphrodite" and especially "true hermaphrodite". These terms, which reflected histology (microscopic appearance) of the gonads, are no longer used. Until the mid-20th century, "hermaphrodite" was used synonymously with "intersex". Medical terminology shifted in the early 21st century, not only due to concerns about language, but also a shift to understandings based on genetics. The term "hermaphrodite" is also controversial as it implies the existence of someone fully male and fully female. This is a fantasy by certain people who seek "hermaphrodite" sex partners; in the Intersex movement, such people are called "wannafucks". As such the term "hermaphrodite" is often seen as degrading and offensive, although many intersex activists use it as a direct form of self empowerment and critique such as in the ISNA's first newsletter Hermaphrodites with Attitude.

The Intersex Society of North America has stated that hermaphrodites should not be confused with intersex people and that using "hermaphrodite" to refer to intersex individuals is considered to be stigmatizing and misleading.

Prevalence

The standard treatment in cases of androgen insensitivity syndrome and other intersex conditions was to lie to patients. This extract is from a book published in 1963.

Estimates of the number of people who are intersex vary, depending on which conditions are counted as intersex. The now-defunct Intersex Society of North America stated that:

If you ask experts at medical centers how often a child is born so noticeably atypical in terms of genitalia that a specialist in sex differentiation is called in, the number comes out to about 1 in 1,500 to 1 in 2,000 births [0.07–0.05%]. But a lot more people than that are born with subtler forms of sex anatomy variations, some of which won't show up until later in life.

Anne Fausto-Sterling and her co-authors stated in 2000 that "[a]dding the estimates of all known causes of nondimorphic sexual development suggests that approximately 1.7% of all live births do not conform to a Platonic ideal of absolute sex chromosome, gonadal, genital, and hormonal dimorphism"; these publications have been widely quoted by intersex activists. Of the 1.7%, 1.5% points (88% of those considered "nondimorphic sexual development" in this figure) consist of individuals with late onset congenital adrenal hyperplasia (LOCAH) which may be asymptomatic but can present after puberty and cause infertility.

Leonard Sax, in response to Fausto-Sterling, estimated that the prevalence of intersex was about 0.018% of the world's population, discounting several conditions included in Fausto-Sterling's estimate that included LOCAH, Klinefelter syndrome (47,XXY), Turner syndrome (45,X), the chromosomal variants of 47,XYY and 47,XXX, and vaginal agenesis. Sax reasons that in these conditions chromosomal sex is consistent with phenotypic sex and phenotype is classifiable as either male or female.

In a 2003 letter to the editor, political scientist Carrie Hull analyzed the data used by Fausto-Sterling and said the estimated intersex rate should instead have been 0.37%, due to many errors. In a response letter published simultaneously, Fausto-Sterling welcomed the additional analysis and said "I am not invested in a particular final estimate, only that there BE an estimate." A 2018 review reported that the number of births with ambiguous genitals is in the range of 0.02% to 0.05%.

Intersex Human Rights Australia says it maintains 1.7% as its preferred upper limit "despite its flaws", stating both that the estimate "encapsulates the entire population of people who are stigmatized—or risk stigmatization—due to innate sex characteristics", and that Sax's definitions exclude individuals who experience such stigma and who have helped to establish the intersex movement. According to InterACT, a major organization for intersex rights in the US, states that 1.7% of people have some variation of sexual development, 0.5% have atypical genitalia, and 0.05% have mixed/ambiguous genitalia. A study relying on a nationally representative survey conducted in Mexico between 2021 and 2022 obtained similar estimates: around 1.6% of individuals aged 15 to 64 reported being born with sex variations.

The following summarizes prevalences of traits that medical experts consider to be intersex:

Intersex condition	Sex specificity	Approximate prevalence
Late onset congenital adrenal hyperplasia (nonclassical forms)	Female (males are generally asymptomatic)	One in 50–1,000 births (0.1–0.2% up to 1–2% depending on population)
Hypospadias	Male	One in 200–10,000 male births (0.01%–0.5%), prevalence estimates vary considerably
Klinefelter syndrome	Male	One in 500–1,000 male births (0.1–0.2%)
Trisomy X	Female	One in 1,000 female births (0.10%)
Turner syndrome	Female	One in 2,500 female births (0.04%)
Müllerian agenesis (of vagina, i.e., MRKH Syndrome)	Female	One in 4,500 female births (0.022%)
Vaginal atresia	Female	One in 5,000 female births (0.02%)
45,X/46,XY mosaicism	None (usually male)	One in 6,666 births (0.015%)
XYY syndrome	Male	One in 7,000 male births (0.0142%)
Congenital adrenal hyperplasia (classical forms)	None (but virilization of female infants)	One in 10,000–20,000 births (0.01–0.02%)
XXXY syndrome	Male	One in 50,000 male births (0.002%)
XXXXY syndrome	Male	One in 85,000-100,000 male births (0.001%)
XXYY syndrome	Male	One in 18,000–40,000 male births (0.0025%–0.0055%)
XXXYY syndrome	Male	Less than one in 1000000 births
de la Chapelle syndrome	Male	One in 20,000 male births (0.005%)
Ovotesticular syndrome	None	One in 20,000 births (0.005%)
XY gonadal dysgenesis	Phenotypic female	One in 80,000 births (0.0013%)
Androgen insensitivity syndrome (complete and partial phenotypes)	Genetic male	One in 22,000-64,000 male births (0.0045-0.001%)
Androgen deficiency	None	No estimate
Idiopathic (no discernable medical cause)	None	One in 110,000 births (0.0009%)
Iatrogenic (caused by medical treatment, e.g., progestogen administered to pregnant mother)	None	No estimate
5-alpha-reductase deficiency	Male	No estimate
Aromatase excess syndrome	None	No estimate
Aromatase deficiency syndrome	None	No estimate
Anorchia	Male	One in 20,000 male births (0.005%)
Persistent Müllerian duct syndrome	Male	No estimate
46,XX/46,XY	None	No estimate
Leydig cell hypoplasia	Male	One in 1,000,000 male births (0.0.0001%)
Gonadotropin-releasing hormone insensitivity	None	No estimate
Familial male-limited precocious puberty	Male	No estimate
Cytochrome P450 oxidoreductase deficiency	None	No estimate
Isolated 17,20-lyase deficiency	None	No estimate
Testicular dysgenesis syndrome	Male	No estimate
Penoscrotal transposition	Male	No estimate
Kallmann syndrome	None	One in 30,000 male births, 1 in 125,000 female births (0.003–0.0008%)
Hyperandrogenism	None	No estimate
Hyperestrogenism	None	No estimate
Polyorchidism	Male	No estimate
Aphallia	Male	No estimate
Cryptorchidism	Male	One in 33–100 male births (3–1%)
Cloacal exstrophy (born with XY chromosomes)	Male	One in 400,000 live births (0.0025%)

Notes:

History

Main articles: Intersex in history, Timeline of intersex history, and History of intersex surgery

Hermaphroditus in a wall painting from Herculaneum (first half of the 1st century AD)

A Chola statue depicting Ardhanarishvara, a Hermaphroditus form of Shiva.

From early history, societies have been aware of intersex people. Some of the earliest evidence is found in mythology: the Greek historian Diodorus Siculus wrote of the mythological Hermaphroditus in the first century BC, who was "born with a physical body which is a combination of that of a man and that of a woman", and reputedly possessed supernatural properties. He also recounted the lives of Diophantus of Abae and Callon of Epidaurus. Ardhanarishvara, an androgynous composite form of male deity Shiva and female deity Parvati, originated in Kushan culture as far back as the first century AD. A statue depicting Ardhanarishvara is included in India's Meenakshi Temple; this statue clearly shows both male and female bodily elements.

Hippocrates (c. 460 – c. 370 BC, Greek physician) and Galen (129 – c. 200/216 AD, Roman physician, surgeon, and philosopher) both viewed sex as a spectrum between men and women, with "many shades in between, including hermaphrodites, a perfect balance of male and female". Pliny the Elder (AD 23/24–79), a Roman naturalist, described "those who are born of both sexes, whom we call hermaphrodites, at one time androgyni" (from the Greek andr-, "man", and gyn-, "woman"). Augustine (354 – 430 AD), the influential Catholic theologian, wrote in The Literal Meaning of Genesis that humans were created in two sexes, despite "as happens in some births, in the case of what we call androgynes".

In medieval and early modern European societies, Roman law, post-classical canon law, and later common law, referred to a person's sex as male, female or hermaphrodite, with legal rights as male or female depending on the characteristics that appeared most dominant. The 12th century Decretum Gratiani states, "Whether an hermaphrodite may witness a testament, depends on which sex prevails." The foundation of common law, the 17th century Institutes of the Lawes of England described how a hermaphrodite could inherit "either as male or female, according to that kind of sexe which doth prevaile". Legal cases have been described in canon law and elsewhere over the centuries.

Some non-European societies have sex or gender systems that recognize more than the two categories of male/man and female/woman. Some of these cultures, for instance the South-Asian Hijra communities, may include intersex people in a third gender category. Although—according to Morgan Holmes—early Western anthropologists categorized such cultures as "primitive", Holmes has argued that analyses of these cultures have been simplistic or romanticized and fail to take account of the ways that subjects of all categories are treated.

During the Victorian era, medical authors introduced the terms "true hermaphrodite" for an individual who has both ovarian and testicular tissue, "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. Some later shifts in terminology have reflected advances in genetics, while other shifts are suggested to be due to pejorative associations.

The term "intersexuality" was coined by Richard Goldschmidt in 1917. The first suggestion to replace the term "hermaphrodite" with "intersex" was made by Cawadias in the 1940s.

Since the rise of modern medical science, some intersex people with ambiguous external genitalia have had their genitalia surgically modified to resemble either female or male genitals. Surgeons pinpointed intersex babies as a "social emergency" when born. An 'optimal gender policy', initially developed by John Money, stated that early intervention helped avoid gender identity confusion, but this lacks evidence. Early interventions have adverse consequences for psychological and physical health. Since 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.

Dialogue between what were once antagonistic groups of activists and clinicians has led to only slight changes in medical policies and how intersex patients and their families are treated in some locations. In 2011, Christiane Völling became the first intersex person known to have successfully sued for damages in a case brought for non-consensual surgical intervention. In April 2015, Malta became the first country to outlaw non-consensual medical interventions to modify sex anatomy, including that of intersex people. Many civil society organizations and human rights institutions now call for an end to unnecessary "normalizing" interventions, including in the Malta declaration.

Human rights and legal issues

Further information: Intersex rights by country

Intersex activists on a boat at Utrecht Canal Pride in the Netherlands on 16 June 2018

Human rights institutions are placing increasing scrutiny on harmful practices and issues of discrimination against intersex people. These issues have been addressed by a rapidly increasing number of international institutions including, in 2015, the Council of Europe, the United Nations Office of the United Nations High Commissioner for Human Rights and the World Health Organization (WHO). In 2024, the United Nations Human Rights Council adopted its first resolution to protect the rights of intersex people. These developments have been accompanied by International Intersex Forums and increased cooperation among civil society organizations. However, the implementation, codification, and enforcement of intersex human rights in national legal systems remains slow.

Physical integrity and bodily autonomy

Main articles: Intersex human rights and Intersex medical interventions

  Legal prohibition of non-consensual medical interventions

  Regulatory suspension of non-consensual medical interventions

Stigmatization and discrimination from birth may include infanticide, abandonment, and the stigmatization of families. The birth of an intersex child was often viewed as a curse or a sign of a witch mother, especially in parts of Africa. Abandonments and infanticides have been reported in Uganda, Kenya, South Asia, and China.

Infants, children and adolescents also experience "normalising" interventions on intersex persons that are medically unnecessary and the pathologisation of variations in sex characteristics. In countries where the human rights of intersex people have been studied, medical interventions to modify the sex characteristics of intersex people have still taken place without the consent of the intersex person. Interventions have been described by human rights defenders as a violation of many rights, including (but not limited to) bodily integrity, non-discrimination, privacy, and experimentation. These interventions have frequently been performed with the consent of the intersex person's parents, when the person is legally too young to consent. Such interventions have been criticized by the WHO, other UN bodies such as the Office of the High Commissioner for Human Rights, and an increasing number of regional and national institutions due to their adverse consequences, including trauma, impact on sexual function and sensation, and violation of rights to physical and mental integrity. The UN organizations decided that infant intervention should not be allowed, in favor of waiting for the child to mature enough to be a part of the decision-making—this allows for a decision to be made with total consent. In April 2015, Malta became the first country to outlaw surgical intervention without consent. In the same year, the Council of Europe became the first institution to state that intersex people have the right not to undergo sex affirmation interventions.

Anti-discrimination and equal treatment

Main article: Discrimination against intersex people

  Explicit protection on grounds of sex characteristics

  Explicit protection on grounds of intersex status

  Explicit protection on grounds of intersex within attribute of sex

People born with intersex bodies are seen as different. Intersex infants, children, adolescents and adults "are often stigmatized and subjected to multiple human rights violations", including discrimination in education, healthcare, employment, sport, and public services. Researchers have documented significant disparities in mental, physical, and sexual health when comparing intersex individuals to the general population, including higher rates of bullying, stigmatization, harassment, violence, and suicidal intention, as well as substantial barriers in the workplace.

Several countries have so far explicitly protected intersex people from discrimination, with landmarks including South Africa, Australia, and, most comprehensively, Malta.

Remedies and claims for compensation

Main article: Intersex human rights

Claims for compensation and remedies for human rights abuses include the 2011 case of Christiane Völling in Germany. A second case was adjudicated in Chile in 2012, involving a child and his parents. A further successful case in Germany, taken by Michaela Raab, was reported in 2015. In the United States, the Minor Child (M.C. v Aaronson) lawsuit was "a medical malpractice case related to the informed consent for a surgery performed on the Crawford's adopted child (known as M.C.) at [Medical University of South Carolina] in April 2006". The case was one of the first lawsuit of its type to challenge "legal, ethical, and medical issues regarding genital-normalizing surgery" in minors, and was eventually settled out of court by the Medical University of South Carolina for $440,000 in 2017.

Information and support

Main article: Intersex human rights

Access to information, medical records, peer and other counselling and support. With the rise of modern medical science in Western societies, a secrecy-based model was also adopted, in the belief that this was necessary to ensure normal physical and psychosocial development.

Legal recognition

Main article: Legal recognition of intersex people

The Asia Pacific Forum of National Human Rights Institutions states that legal recognition is firstly "about intersex people who have been issued a male or a female birth certificate being able to enjoy the same legal rights as other men and women". In some regions, obtaining any form of birth certification may be an issue. A Kenyan court case in 2014 established the right of an intersex boy, "Baby A", to a birth certificate.

Like all individuals, some intersex individuals may be raised as a certain sex (male or female) but then identify with another later in life, while most do not. Recognition of third sex or gender classifications occurs in several countries, however, it is controversial when it becomes assumed or coercive, as is the case with some German infants. Sociological research in Australia, a country with a third 'X' sex classification, shows that 19% of people born with atypical sex characteristics selected an "X" or "other" option, while 75% of survey respondents self-described as male or female (52% as women, 23% as men), and 6% as unsure.

LGBT and LGBTI

Main article: Intersex and LGBT

ILGA conference 2018, group photo to mark Intersex Awareness Day

U.S. intersex activist Pidgeon Pagonis

Intersex conditions can be contrasted with transgender gender identities and the attached gender dysphoria a transgender person may feel, wherein their gender identity does not match their assigned sex. However, some people are both intersex and transgender; although intersex people by definition have variable sex characteristics that do not align with either typically male or female, this may be considered separate to an individual's assigned gender, the way they are raised and perceived, and their internal gender identity. A 2012 clinical review paper found that between 8.5% and 20% of people with intersex variations experienced gender dysphoria. In an analysis of the use of preimplantation genetic diagnosis to eliminate intersex traits, Behrmann and Ravitsky state: "Parental choice against intersex may ... conceal biases against same-sex attractedness and gender nonconformity."

The relationship of intersex people and communities to LGBTQ communities is complex, but intersex people are often added to the LGBT acronym, resulting in the acronym LGBTI (or when also including asexual people, LGBTQIA+). Emi Koyama describes how inclusion of intersex in LGBTI can fail to address intersex-specific human rights issues, including creating false impressions "that intersex people's rights are protected" by laws protecting LGBT people, and failing to acknowledge that many intersex people are not LGBT. Organisation Intersex International Australia states that some intersex individuals are homosexual, and some are heterosexual, but "LGBTI activism has fought for the rights of people who fall outside of expected binary sex and gender norms." Julius Kaggwa of SIPD Uganda has written that, while the gay community "offers us a place of relative safety, it is also oblivious to our specific needs". Mauro Cabral has written that transgender people and organizations "need to stop approaching intersex issues as if they were trans issues", including use of intersex conditions and people as a means of explaining being transgender; "we can collaborate a lot with the intersex movement by making it clear how wrong that approach is."

In society

Fiction, literature and media

Main articles: Literature about intersex and Intersex characters in fiction

Kristi Bruce after shooting the documentary XXXY, 2000

An intersex character is the narrator in Jeffrey Eugenides' Pulitzer Prize-winning novel Middlesex.

The memoir, Born Both: An Intersex Life (Hachette Books, 2017), by intersex author and activist Hida Viloria, received strong praise from The New York Times Book Review, The Washington Post, Rolling Stone, People Magazine, and Psychology Today, was one of School Library Journal's 2017 Top Ten Adult Books for Teens, and was a 2018 Lambda Literary Award nominee.

Television works about intersex and films about intersex are scarce. The Spanish-language film XXY won the Critics' Week grand prize at the 2007 Cannes Film Festival and the ACID/CCAS Support Award. Faking It is notable for providing both the first intersex main character in a television show, and television's first intersex character played by an intersex actor.

Civil society institutions

Main article: Intersex civil society organizations

Intersex peer support and advocacy organizations have existed since at least 1985, with the establishment of the Androgen Insensitivity Syndrome Support Group Australia in 1985. The Androgen Insensitivity Syndrome Support Group (UK) was established in 1988. The Intersex Society of North America (ISNA) may have been one of the first intersex civil society organizations to have been open to people regardless of diagnosis; it was active from 1993 to 2008.

Events

Main articles: Intersex Awareness Day and Intersex Day of Remembrance

Intersex Awareness Day is an internationally observed civil awareness day designed to highlight the challenges faced by intersex people, occurring annually on 26 October. It marks the first public demonstration by intersex people, which took place in Boston on 26 October 1996, outside a venue where the American Academy of Pediatrics was holding its annual conference.

Intersex Day of Remembrance, also known as Intersex Solidarity Day, is an internationally observed civil awareness day designed to highlight issues faced by intersex people, occurring annually on 8 November. It marks the birthday of Herculine Barbin, a French intersex person whose memoirs were later published by Michel Foucault in Herculine Barbin: Being the Recently Discovered Memoirs of a Nineteenth-century French Hermaphrodite.

Flags

Main article: Intersex flag

• 
  Intersex flag
• 
  Autistic intersex flag (2022)
• 
  Transgender intersex flag (2017)
• 
  The Progress Pride flag with the intersex flag (2021)

The intersex flag was created in July 2013 by Morgan Carpenter of Intersex Human Rights Australia to create a flag "that is not derivative, but is yet firmly grounded in meaning". The circle is described as "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."

The intersex flag has been remixed and adapted in numerous ways. One way has been to replace the middle ring with the symbol of another group, to indicate the intersection of these groups. For example, the autistic intersex flag replaces the ring with an infinity symbol to represent autism. Another technique is to inset another flag inside the ring: e.g. the pride flag for transgender intersex people puts the transgender flag in the centre. In 2021, Valentino Vecchietti of Intersex Equality Rights UK redesigned the Progress Pride Flag to incorporate the intersex flag. This design added a yellow triangle with a purple circle in it to the chevron of the Progress Pride flag. It also changed the color of green to a lighter shade without adding new symbolism. Intersex Equality Rights UK posted the new flag on Instagram and Twitter.

Religion

Main article: Intersex people and religion

In Judaism, the Talmud contains extensive discussion concerning the status of two types of intersex people in Jewish law; namely, the androgynous, who exhibit both male and female external sexual organs, and the tumtum, who exhibit neither. In the 1970s and 1980s, the treatment of intersex babies started to be discussed in Orthodox Jewish medical halacha by prominent rabbinic leaders, such as Eliezer Waldenberg and Moshe Feinstein.

Sport

Main article: Sex verification in sports

Stanisława Walasiewicz, an athlete posthumously diagnosed with Turner syndrome in 1980, photographed in 1933

Erik Schinegger, Foekje Dillema, Maria José Martínez-Patiño and Santhi Soundarajan were subject to adverse sex verification testing resulting in ineligibility to compete in organised competitive competition. Stanisława Walasiewicz, an athlete diagnosed posthumously with Turner syndrome was posthumously ruled ineligible to have competed.

The South African middle-distance runner Caster Semenya won 3 World Championships gold medals and 2 Olympic gold medals in the women's 800 metres. When Semenya won gold at the 2009 World Championships, the International Association of Athletics Federations (IAAF) requested sex verification tests on the very same day. The results were not released, and Semenya was ruled eligible to compete. In 2019, new IAAF rules came into force for athletes like Semenya with certain disorders of sex development (DSDs) requiring medication to suppress testosterone levels in order to participate in 400m, 800m, and 1500m women's events. Semenya objected to undergoing the treatment which is now mandatory. She has filed a series of legal cases to restore her ability to compete in these events without testosterone suppression, arguing that the World Athletics rules are discriminatory.

Katrina Karkazis, Rebecca Jordan-Young, Georgiann Davis and Silvia Camporesi have claimed that IAAF policies on "hyperandrogenism" in female athletes are "significantly flawed", arguing that the policy does not protect against breaches of privacy, requires athletes to undergo unnecessary treatment in order to compete, and intensifies "gender policing", and recommended that athletes be able to compete in accordance with their legally-recognised gender.

In April 2014, the BMJ reported that four elite women athletes with XY chromosomes and 5α-reductase 2 deficiency were subjected to sterilization and "partial clitoridectomies" in order to compete in sport. The authors noted that partial clitoridectomy was "not medically indicated" and "does not relate to real or perceived athletic 'advantage'". Intersex advocates regarded this intervention as "a clearly coercive process". In 2016, the United Nations Special Rapporteur on health, Dainius Pūras, criticized "current and historic" sex verification policies, describing how "a number of athletes have undergone gonadectomy (removal of reproductive organs) and partial clitoridectomy (a form of female genital mutilation) in the absence of symptoms or health issues warranting those procedures."

Biology

Main article: Intersex (biology)

The notion of intersex individuals can be understood in the context of sexual system biology that varies across different types of organisms. Most animal species (~95%, including humans) are gonochoric, in which individuals are of either a female or male sex. Hermaphroditic species (some animals and most flowering plants) are represented by individuals that can express both sexes simultaneously or sequentially during their lifetimes. Intersex individuals in a number of gonochoric species, who express both female and male phenotypic characters to some degree, are known to exist at very low prevalences.

Although "hermaphrodite" and "intersex" have been used synonymously in humans, a hermaphrodite is specifically an individual capable of producing female and male gametes. While there are reports of individuals that seemed to have the potential to produce both types of gamete, in more recent years the term hermaphrodite as applied to humans has fallen out of favor, since female and male reproductive functions have not been observed together in the same individual.

Medical

See also: Definitions of intersex

Research in the late 20th century led to a growing medical consensus that diverse intersex bodies are normal, but relatively rare, forms of human biology. Clinician and researcher Milton Diamond 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 such as 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.

Medical classifications

Sexual differentiation

Main article: Sexual differentiation

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. Up until and including 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 typical 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 AMH 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.

Signs

There are a variety of symptoms that can occur. Ambiguous genitalia is the most common sign. There can be micropenis, clitoromegaly, partial labial fusion, electrolyte abnormalities, delayed or absent puberty, unexpected changes at puberty, hypospadias, labial or inguinal (groin) masses (which may turn out to be testes) in girls and undescended testes (which may turn out to be ovaries) in boys.

Ambiguous genitalia

Ambiguous genitalia may appear as a large clitoris or as a small penis.

The Quigley scale is a method for describing genital development in AIS.

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) or 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 (a vulva) 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.

Measurement systems for ambiguous genitalia

The orchidometer is a medical instrument to measure the volume of the testicles. It was developed by Swiss pediatric endocrinologist Andrea Prader. The Prader scale and Quigley scale are visual rating systems that measure genital appearance. These measurement systems were satirized in the Phall-O-Meter, created by the (now defunct) Intersex Society of North America.

Other 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. Additionally, electrolyte tests, endoscopic exam, ultrasound and hormone stimulation tests can be done.

Causes

Intersex can be divided into four categories which are: 46, XX intersex; 46, XY intersex; true gonadal intersex; and complex or undetermined intersex.

46, XX intersex

Это состояние раньше называлось «женским псевдохермафродитизмом ». Люди с этим состоянием имеют женские внутренние гениталии и кариотип (xx) и различную степень вирилизации внешних гениталий . Внешние гениталии врожденно мужественны, когда женский плод подвергается воздействию избыточной андрогенной среды. Следовательно, хромосома человека имеет женскую, яичники женщины, но внешние половые органы, которые выглядят как мужчина. Объединение Labia расширяются , и клитор чтобы выглядеть как пенис. Причинами этого могут быть мужские гормоны, взятые во время беременности, врожденная гиперплазия надпочечников, опухоли, продуцирующие мужской гормон при дефиците матери и ароматазы .

46, XY Intersex

Это состояние раньше называлось «мужским псевдохермафродитизмом». Это определяется как неполная мужская маскулинизация внешних гениталий. Таким образом, у человека есть мужские хромосомы, но внешние половые органы являются не полностью образованными, неоднозначными или четко женскими. Это условие также называется 46, xy с недостаточной проживанием. 46, XY Intersex имеет много возможных причин, которые могут быть проблемами с яичками и формированием тестостерона. Кроме того, могут быть проблемы с использованием тестостерона. Некоторым людям не хватает фермента, необходимого для преобразования тестостерона в дигидротостостерон , который является причиной дефицита 5-альфа-редуктазы . Синдром нечувствительности андрогена является наиболее распространенной причиной 46, XY Intersex.

Настоящий гонад интерсекс

Это состояние раньше называлось « истинным гермафродитизмом ». Это определяется как имеющие асимметричные гонады с дифференцировкой яичников и яичек на сторонах отдельно или объединены как Ovotestis. В большинстве случаев причина этого состояния неизвестна.

Сложный или неопределенный интерсекс

Это условие наличия каких -либо конфигураций хромосом, а не 46, xx или 46, xy intersex. Это условие не приводит к дисбалансу между внутренними и внешними гениталиями. Тем не менее, могут возникнуть проблемы с уровнем пола -гормона, общим сексуальным развитием и измененным числом половых хромосом.

Условия

Дополнительная информация: расстройства сексуального развития

Существует множество мнений о том, какие условия или признаки являются и не являются интерсексуальными, зависимыми от определения используемого интерсекса. Современные определения, основанные на правах человека, подчеркивают широкое разнообразие половых характеристик, которые отличаются от ожиданий для мужского или женского тела. В течение 2015 года, Совет Европы , Агентство Европейского Союза по фундаментальным правам и межамериканская комиссия по правам человека призывали к рассмотрению медицинских классификаций на том основании, что в настоящее время они препятствуют наслаждению правом на здоровье ; Совет Европы выразил обеспокоенность тем, что «разрыв между ожиданиями правозащитных организаций интерсекс и развитием медицинских классификаций, возможно, расширился за последнее десятилетие».

Медицинские вмешательства

Основная статья: Интерсекс -медицинские вмешательства

Дополнительная информация: история интерсексуальной хирургии

Рациональные

Гонконг -интерсекс активист Small Luk

Медицинские вмешательства происходят для решения проблем физического здоровья и психосоциальных рисков. Оба типа обоснования являются предметом дебатов, особенно в качестве последствий хирургических (и многих гормональных) вмешательств являются пожизненными и необратимыми. Вопросы, касающиеся физического здоровья, включают точную оценку уровней риска, необходимости и времени. Психосоциальные обоснования особенно восприимчивы к вопросам необходимости, поскольку они отражают социальные и культурные проблемы.

По -прежнему не остается клинического консенсуса относительно доказательной базы, хирургического срока, необходимости, типа хирургического вмешательства и степень разницы, гарантирующих вмешательство. Такие операции являются предметом значительного спора из -за последствий, которые включают травму, влияние на сексуальную функцию и ощущение, а также нарушение прав на физическую и умственную целостность. This includes community activism, and multiple reports by international human rights и здоровье учреждения и национальные этики.

В тех случаях, когда гонады могут представлять риск рака, как в некоторых случаях синдрома нечувствительности андрогена , Было выражено обеспокоенность, что рациональные и принятие решений в отношении риска рака могут инкапсулировать решения о стремлении к хирургической «нормализации».

Типы

• Феминизация и мужские операции : хирургические процедуры зависят от диагноза, и часто возникает опасения относительно того, следует ли выполнять операцию вообще. Как правило, операция выполняется вскоре после рождения. Защитники практики утверждают, что люди должны быть четко идентифицированы как мужчины или женщины, чтобы они могли функционировать социально и развивать «нормально». Психосоциальные причины часто указываются. Это критикуют многие институты прав человека и авторы. В отличие от других эстетических хирургических процедур, выполняемых для младенцев, таких как корректирующая хирургия для расщелины губы , генитальная хирургия может привести к негативным последствиям для сексуального функционирования в более поздней жизни или чувства причудливости и неприемлемости.
• Обработка гормонов : имеются широко распространенные доказательства пренатального тестирования и гормонального лечения для предотвращения или устранения межсексуальных признаков, Связано также с проблемами сексуальной ориентации и гендерного несоответствия.
• Психосоциальная поддержка : все заинтересованные стороны поддерживают психосоциальную поддержку. Совместное международное заявление участников третьего международного интерсекс-форума в 2013 году, помимо прочих требований: «Признание того, что медикализация и стигматизация интерсекс-людей приводят к значительным проблемам с травмами и психическим здоровьем. С учетом обеспечения телесной целостности и благополучия Intersex People, автономная непатологическая психо-социальная поддержка и сверстников, доступны для интерсексуальных людей на протяжении всей своей жизни (как самооценка), а также для родителей и/или поставщиков медицинской помощи ».
• Генетический отбор и прекращения : этика преимплантационной генетической диагностики для выбора против интерсекс -признаков была предметом 11 работ в октябрьском выпуске Американского журнала биоэтики в октябре 2013 года . Существуют широко распространенные доказательства окончания беременности, возникающих в результате пренатальных испытаний, а также пренатальное лечение гормонами для предотвращения межсекс -признаков. Берманн и Равицкий находят социальные концепции пола, пола и сексуальной ориентации, которые «переплетены на многих уровнях. Выбор родителей против интерсекса может, таким образом, скрывать предубеждения в отношении однополых привлечений и гендерного несоответствия».
• Медицинский дисплей . Фотографии межсексуальных детских гениталий распространяются в медицинских сообществах для документальных целей, а люди с интерсекс -чертами могут быть подвергнуты повторным генитальным экзаменам и показать медицинским группам. Проблемы, связанные с опытом медицинской фотографии интерсекс -детей, обсуждались наряду с их этикой, контролем и использованием. «Опыт фотографирования, примером, примером для многих людей с интерсексуальными условиями бессильнее и унижение ощущалось во время медицинских исследований и вмешательств».
• Гендерная дисфория : DSM-5 включала изменение от использования гендерного расстройства идентичности на гендерную дисфорию. В этот пересмотренный код в настоящее время входит интерсекс, которые не идентифицируют себя со своим полом, назначенным при рождении и опыте клинически значимых расстройств или нарушений, используя язык расстройств сексуального развития .

Смотрите также

• День Intersex Infaceness
• Интерсекс людей и военная служба
• Сексуальная дифференциация у людей
• Intersex Healthcare
• Гинандроморфизм
• Endosex
• Истинный гермафродитизм
• Андрогинья
• 46, xx/46, xy

Библиография

Дополнительная информация: отчеты по правам человека Intersex Human

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• Комитет ООН против пыток , Комитет ООН о правах ребенка , Комитет ООН о правах людей с ограниченными возможностями , подкомитетом ООН по профилактике пыток и другим жестоким, бесчеловечным или унизительным обращением или наказанием, Хуан Мендес , Дайний Пурас, Дубравка Шмоновия, Марта Сантос Паис, Африканская комиссия по правам человека и народов , Комиссар по правам человека Совета по правам человека , Межамериканская комиссия по правам человека (24 октября 2016 года). «День осведомленности о интерсексе - среда, 26 октября. Окончание насилия и вредных медицинских практик в отношении интерсекс детей и взрослых, ООН и региональных экспертов призывают» . Управление Верховного комиссара по правам человека .
• Всемирная организация здравоохранения , OHCHR , ООН -женщины, UNAIDS, ПРООН, ЮНФПА, ЮНИСЕФ (2014). Устранение принудительного, принудительного и иного непроизвольной стерилизации, межведомственное заявление (PDF) . ISBN  978-92-4-150732-5 .
• Zwischengeschlecht (март 2014 г.). «IGM-исторический обзор. Гермафродиты в« развитом мире »: от юридического самоопределения до IGM, приложение 1» (PDF) . Отчет НПО 2 -го, 3 -го и 4 -го периодического отчета Швейцарии о Конвенции о правах ребенка (CRC) (2 Ed.). С. 49–62.

Внешние ссылки

• СМИ, связанные с интерсексом в Wikimedia Commons

Внешние видео
«Каково быть интерсексуал» , Lizz Warner, Buzzfeed