Intersex

This article is about intersex in humans. For intersex in other animals, see Intersex (biology).

Not to be confused with Hermaphrodite.

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

Intersex people are individuals born with any of several sex characteristics, including chromosome patterns, gonads, or genitals that, according to the Office of the United Nations High Commissioner for Human Rights, "do not fit typical binary notions of male or female bodies".

Sex assignment at birth usually aligns with a child's external genitalia. The number of births with ambiguous genitals is in the range of 1:4,500–1:2,000 (0.02%–0.05%). Other conditions involve the development of atypical chromosomes, gonads, or hormones. Some persons may be assigned and raised as a girl or boy but then identify with another gender later in life, while most continue to identify with their assigned sex. The number of births where the baby is intersex has been reported differently depending on who reports and which definition of intersex is used. Anne Fausto-Sterling and her book co-authors claim the prevalence of "nondimorphic sexual development" in humans might be as high as 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 probably 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). 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.

Flag

Main article: Intersex flag

Intersex flag

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."

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 gold at the World Championships in the women's 800 metres and won silver in the 2012 Summer Olympics. When Semenya won gold in the World Championships, the International Association of Athletics Federations (IAAF) requested sex verification tests. The results were not released. Semenya was ruled eligible to compete.

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

This condition used to be called "female pseudohermaphroditism". Persons with this condition have female internal genitalia and karyotype (XX) and various degree of external genitalia virilization. External genitalia is masculinized congenitally when female fetus is exposed to excess androgenic environment. Hence, the chromosome of the person is of a woman, the ovaries of a woman, but external genitals that appear like a male. The labia fuse, and the clitoris enlarges to appear like a penis. The causes of this can be male hormones taken during pregnancy, congenital adrenal hyperplasia, male-hormone-producing tumors in the mother and aromatase deficiency.

46, XY intersex

This condition used to be called "male pseudohermaphroditism". This is defined as incomplete masculinization of the external genitalia. Thus, the person has male chromosomes, but the external genitals are incompletely formed, ambiguous, or clearly female. This condition is also called 46, XY with undervirilization. 46, XY intersex has many possible causes, which can be problems with the testes and testosterone formation. Also, there can be problems with using testosterone. Some people lack the enzyme needed to convert testosterone to dihydrotestosterone, which is a cause of 5-alpha-reductase deficiency. Androgen insensitivity syndrome is the most common cause of 46, XY intersex.

True gonadal intersex

This condition used to be called "true hermaphroditism". This is defined as having asymmetrical gonads with ovarian and testicular differentiation on either sides separately or combined as ovotestis. In most cases, the cause of this condition is unknown.

Complex or undetermined intersex

This is the condition of having any chromosome configurations rather than 46, XX or 46, XY intersex. This condition does not result in an imbalance between internal and external genitalia. However, there may be problems with sex hormone levels, overall sexual development, and altered numbers of sex chromosomes.

Conditions

Further information: Disorders of sex development

There are a variety of opinions on what conditions or traits are and are not intersex, dependent on the definition of intersex that is used. Current human rights based definitions stress a broad diversity of sex characteristics that differ from expectations for male or female bodies. During 2015, the Council of Europe, the European Union Agency for Fundamental Rights and Inter-American Commission on Human Rights have called for a review of medical classifications on the basis that they presently impede enjoyment of the right to health; the Council of Europe expressed concern that "the gap between the expectations of human rights organisations of intersex people and the development of medical classifications has possibly widened over the past decade."

Medical interventions

Main article: Intersex medical interventions

Further information: History of intersex surgery

Обоснование

Гонконгский интерсекс-активист Смолл Лук

Медицинские вмешательства проводятся для решения проблем физического здоровья и психосоциальных рисков. Оба типа обоснований являются предметом дискуссий, особенно потому, что последствия хирургических (и многих гормональных) вмешательств сохраняются на всю жизнь и необратимы. Вопросы, касающиеся физического здоровья, включают точную оценку уровней риска, необходимости и сроков. Психосоциальные обоснования особенно чувствительны к вопросам необходимости, поскольку они отражают социальные и культурные проблемы.

До сих пор не существует клинического консенсуса относительно доказательной базы, сроков хирургического вмешательства, необходимости, типа хирургического вмешательства и степени различий, требующих вмешательства. Такие операции являются предметом серьезных споров из-за последствий, которые включают травмы, влияние на сексуальную функцию и ощущения, а также нарушение прав на физическую и психическую неприкосновенность. Сюда входит общественная активность, и многочисленные доклады международных организаций по правам человека и здоровье учреждения и национальные органы по этике.

В случаях, когда гонады могут представлять риск рака, как в некоторых случаях синдрома нечувствительности к андрогенам , Была выражена обеспокоенность тем, что обоснование лечения и принятие решений относительно риска рака могут включать в себя решения, связанные с желанием хирургической «нормализации».

Типы

• Феминизирующие и маскулинизирующие операции . Хирургические процедуры зависят от диагноза, и часто возникает вопрос, следует ли вообще проводить операцию. Обычно операцию проводят вскоре после рождения. Защитники этой практики утверждают, что люди должны быть четко идентифицированы как мужчины или женщины, чтобы они могли социально функционировать и развиваться «нормально». Часто указываются психосоциальные причины. Это подвергается критике со стороны многих правозащитных учреждений и авторов. В отличие от других эстетических хирургических процедур, выполняемых у младенцев, таких как корректирующая операция по поводу заячьей губы , операция на гениталиях может привести к негативным последствиям для сексуального функционирования в более позднем возрасте или к ощущению странности и неприемлемости.
• Гормональное лечение . Имеются широко распространенные данные о пренатальном тестировании и гормональном лечении для предотвращения или устранения интерсекс-признаков. связано также с проблематизацией сексуальной ориентации и гендерного неконформизма.
• Психосоциальная поддержка : Все заинтересованные стороны поддерживают психосоциальную поддержку. В совместном международном заявлении участников Третьего международного интерсекс-форума в 2013 году, среди прочего, содержались следующие требования: «Признание того, что медикализация и стигматизация интерсекс-людей приводят к серьезным травмам и проблемам с психическим здоровьем. В целях обеспечения телесной неприкосновенности и благополучия интерсекс-людей интерсекс-людям, автономная, непатологизирующая психосоциальная поддержка и поддержка со стороны сверстников должна быть доступна интерсекс-людям на протяжении всей их жизни (по мере их собственной необходимости), а также родителям и/или лицам, осуществляющим уход».
• Генетический отбор и терминация : Этика преимплантационной генетической диагностики с целью отбора против интерсексуальных признаков была темой 11 статей в октябрьском выпуске Американского журнала биоэтики за 2013 год . Имеются широко распространенные свидетельства прерывания беременности в результате пренатального тестирования, а также пренатальной гормональной терапии для предотвращения интерсексуальных признаков. Берманн и Равицкий считают, что социальные концепции пола, гендера и сексуальной ориентации «переплетены на многих уровнях. Таким образом, родительский выбор против интерсексуалов может скрывать предубеждения против однополого влечения и гендерного неконформизма».
• Медицинский дисплей . Фотографии гениталий интерсекс-детей распространяются в медицинских сообществах в документальных целях, а лица с интерсекс-чертами могут подвергаться повторным осмотрам гениталий и показываться медицинским бригадам. Обсуждаются проблемы, связанные с опытом медицинской фотографии детей-интерсексуалов. наряду с их этикой, контролем и использованием. «Опыт фотографирования стал для многих людей с интерсекс-состояниями примером бессилия и унижения, которые они испытывают во время медицинских обследований и вмешательств».
• Гендерная дисфория : DSM-5 включил переход от использования расстройства гендерной идентичности к гендерной дисфории. Этот пересмотренный кодекс теперь конкретно включает интерсекс-людей, которые не идентифицируют себя со своим полом, присвоенным при рождении, и испытывают клинически значимый дистресс или нарушения, используя язык нарушений полового развития .

См. также

• День распространения информации об интерсексах
• Интерсекс люди и военная служба
• Половая дифференциация у человека
• Гинандроморфизм
• Эндосекс
• Истинный гермафродитизм
• Андрогинность
• 46,ХХ/46,XY

Библиография

Дополнительная информация: отчеты о правах интерсексуалов.

• Азиатско-Тихоокеанский форум национальных правозащитных учреждений (июнь 2016 г.). Продвижение и защита прав человека в отношении сексуальной ориентации, гендерной идентичности и половых характеристик . ISBN  978-0-9942513-7-4 .
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• Совет Европы , Комиссар по правам человека (апрель 2015 г.). «Права человека и интерсексуалы, Тематический доклад» .
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• Элдерс М.Дж. , Сэтчер Д. , Кармона Р. (июнь 2017 г.). «Переосмысление генитальной хирургии у детей-интерсексуалов» (PDF) . Пальмовый центр .
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• Гаттас, округ Колумбия , Фонд Генриха Бёлля (2013). Права человека между полами: предварительное исследование жизненных ситуаций между людьми . Берлин: Фонд Генриха Бёлля. ISBN  978-3-86928-107-0 .
• Холмс М. , изд. (2009). Критический интерсекс . Странные вмешательства. Берлингтон, Вирджиния: Ashgate Publishing . ISBN  978-0-7546-7311-8 .
• Хьюз И.А., Хоук С., Ахмед С.Ф., Ли П.А., Консенсусная группа LWPES1/ESPE2 (июнь 2005 г.). «Заявление о консенсусе по лечению интерсексуальных расстройств» . Архив болезней в детстве . 91 (7): 554–563. дои : 10.1136/adc.2006.098319 . ПМК   2082839 . ПМИД   16624884 . {{cite journal}}: CS1 maint: числовые имена: список авторов ( ссылка )
• Маркус де Мария Арана, де Мария Арана М (2005). Правозащитное расследование медицинской «нормализации» интерсексуальных людей . Комиссия по правам человека города и округа Сан-Франциско.
• Хьюман Райтс Вотч , interACT (июль 2017 г.). Я хочу быть таким, каким меня создала природа . Хьюман Райтс Вотч. ISBN  978-1-62313-502-7 .
• Джонс Т., Харт Б., Карпентер М., Ансара Г., Леонард В., Лак Дж. (2016). Интерсекс: истории и статистика из Австралии (PDF) . Кембридж, Великобритания: Издательство Open Book. ISBN  978-1-78374-208-0 . Архивировано из оригинала (PDF) 27 мая 2018 года . Проверено 2 февраля 2016 г.
• Джонс Т. (2018). «Интерсекс-исследования: систематический обзор международной литературы по здравоохранению» . СЕЙДЖ Открыть . 2018 (1): 1–22. дои : 10.1177/2158244017745577 .
• Карказис К (2008). Исправление секса: интерсекс, медицинский авторитет и жизненный опыт . Издательство Университета Дьюка. ISBN  978-0-8223-4318-9 .
• Ли П.А., Норденстрём А., Хоук С.П., Ахмед С.Ф., Охус Р., Барац А., Барац Далке К., Ляо Л.М., Лин-Су К., Лоойенга Л.Х., Мазур Т., Мейер-Бальбург Х.Ф., Мурикванд П., Куигли К.А., Сандберг Д.Е., Vilain E, Witchel S и Глобальный консорциум обновлений DSD (28 января 2016 г.). «Обновление глобальных нарушений полового развития с 2006 года: восприятие, подход и уход» . Гормональные исследования в педиатрии . 85 (3): 158–180. дои : 10.1159/000442975 . ПМИД   26820577 .
• Организация Intersex International Australia , Карпентер М. (апрель 2014 г.). «Представление по обзору части B Этических рекомендаций по использованию вспомогательных репродуктивных технологий в клинической практике и исследованиях, 2007 г.» . Сидней. Архивировано из оригинала 6 октября 2014 года . Проверено 6 мая 2014 г.
• Регми Э (2016). «Истории интерсексуалов из Непала» (PDF) . Архивировано из оригинала (PDF) 3 мая 2016 года.
• Тамар-Мэттис А (2014). «Медицинское обращение с людьми с интерсекс-состояниями как пытки и жестокое, бесчеловечное или унижающее достоинство обращение и наказание». Пытки в медицинских учреждениях: размышления о тематическом докладе Специального докладчика по вопросу о пытках за 2013 год (PDF) . Вашингтон, округ Колумбия: Центр прав человека и гуманитарного права Вашингтонского юридического колледжа. стр. 91–104. Архивировано из оригинала 27 марта 2014 года. {{cite book}}: CS1 maint: неподходящий URL ( ссылка )
• Управление Верховного комиссара ООН по правам человека (2015 г.). «Информационный бюллетень кампании за свободу и равенство: интерсекс» (PDF) .
• Комитет ООН против пыток , Комитет ООН по правам ребенка , Комитет ООН по правам людей с ограниченными возможностями , Подкомитет ООН по предотвращению пыток и других жестоких, бесчеловечных или унижающих достоинство видов обращения и наказания, Хуан Мендес , Дайнюс Пурас, Дубравка Шимоновие, Марта Сантос Паис, Африканская комиссия по правам человека и народов , Комиссар Совета Европы по правам человека , Межамериканская комиссия по правам человека (24 октября 2016 г.). «День распространения информации об интерсексуалах – среда, 26 октября. Положить конец насилию и вредной медицинской практике в отношении детей и взрослых-интерсексуалов, призывают эксперты ООН и региональные эксперты» . Управление Верховного комиссара по правам человека .
• Всемирная организация здравоохранения , УВКПЧ , ООН-Женщины, ЮНЭЙДС, ПРООН, ЮНФПА, ЮНИСЕФ (2014). Устранение принудительной, принудительной и иной недобровольной стерилизации, Межведомственное заявление (PDF) . ISBN  978-92-4-150732-5 .
• Zwischengeschlecht (март 2014 г.). «IGM – Исторический обзор. Гермафродиты в «развитом мире»: от правового самоопределения к IGM, Приложение 1» (PDF) . Отчет НПО ко 2-му, 3-му и 4-му периодическому докладу Швейцарии по Конвенции о правах ребенка (КПР) (2-е изд.). стр. 49–62.

Внешние ссылки

• СМИ, связанные с интерсексом, на Викискладе?

Внешние видео
«Каково быть интерсексуалом» , Лизз Уорнер, BuzzFeed