Intersex 101

What is intersex?

In our society, it’s common to think that all people are born either male or female. But the biological truth is that sex is a spectrum, not a binary. It’s typical for people to lie near the male or female ends of the spectrum, but many people are born with bodies closer to the middle. Sometimes this fact is immediately clear at birth, because a baby has intermediate genitals. Sometimes a person may look male or female on the outside, but have different internal organs than would usually be expected. And sometimes a person may have a body with typical female or male organs, but have chromosomes that do not match expectations.

How common is intersexuality?

About 1 in 150 babies are identified at birth by doctors as having a "disorder of sex development" due to having visibly atypical genitalia. Other individuals are not diagnosed at birth, as their genitals appear fairly standard, but later are found to have an intersex condition. Some find out because they encounter fertility problems, or have a medical scan done for some unrelated reason. Some people never know--do you know if your chromosomes are XX, XY, XXY, or some other variation?

What is the gender of an intersex person?

The way to tell the gender of an intersex person is to ask them. Often intersex people identify as men or women, because that is contemporary Western norms frame gender as a binary. But a growing number of intersex people identify themselves as nonbinary--as do a growing number of people who are endosex (not intersex). You can’t tell by looking at an intersex person’s body what their gender identity will be—different people with similar-looking intermediate genitals will have different identities. Simply respect each individual’s sense of self!

What are central concerns for intersex people?

Contemporary Western medicine frames being intersex as a disorder, and being endosex--having a body that matches expectations of binary sex--as necessary and good. Intersex status has been treated as a source of shame in the U.S., which means that most intersex people are in the closet about their status. We have been called “freaks” and “monsters,” have been treated as sexually titillating, have been excluded from international sporting competitions, and have been subjected to medical treatment without our consent. Intersex people deserve to have their bodies, their gender identities, and their choices respected.

A major complaint of many intersex people is that they were subjected to childhood surgery that they are unhappy about. Every day in the U.S., hundreds of babies are surgically altered to “correct” atypical genitals to match social expectations. Doctors generally choose the binary sex they see as appropriate for an intersex infant based on appearance or surgical ease—and children may not mature to identify with this surgically-assigned sex. Furthermore, although doctors say they have gotten better at these surgeries over time, they often result in loss of genital sensation. I don't know about you, but I and many others would rather have sensitive genitals than somewhat-more-average-looking ones. Advocates for intersex people urge that no sex assignment or cosmetic surgery be performed on children. Instead, intersex children should be allowed to grow up to make their own decisions about what surgery, if any, they would like.

The decision about a binary sex of rearing for an intersex child is often rushed. This is because families are only given a day or two by law to decide whether to put an "M" or "F" on the birth certificate. What intersex advocates urge is that the requirement of listing a sex on the birth certificate be removed.  After all, in most states in the U.S. doctors used to be required to list a race on the birth certificate, but that requirement has been eliminated. The reason given for listing a sex--that it would help to identify an infant who was lost or abducted--is very weak. Footprints and blood samples taken at birth are vastly more identifying, and in any case, the family can give authorities information about the sex, race, hair color and other information about what a child looks like without it being listed on a birth certificate. So, removing the requirement of listing a binary sex of male or female on the birth certificate would not hurt anyone, and would give families of intersex children all the time they like to decide on a provisional sex of rearing.

Often, doctors and families try to keep chidren's intersex status a secret, even from the children themselves. Knowing that there is something deemed "wrong" with your body, but not what that is, is confusing. Knowing that your body is sex-variant, and that this is something that must be kept a secret from others, leaves a person feeling ashamed and isolated.  Advocates ask that children be informed about their bodies in a nonstigmatizing way. Having a body that is atypical can be seen as special--think of how our society celebrates having red hair, another atypical bodily status!

Sometimes an intersex child may be happy living in an assigned sex, but then experience bodily changes at puberty that are atypical for that sex. For example, an individual born with a typical-looking phallus but internal ovaries and a uterus will develop a menstrual period. If that child is happy being raised as a boy, he may find this difficult to deal with. In that case, the child should be given access to hormonal treatments to prevent menstruation and promote a typical male puberty.  If he wishes it, he should be given surgery to remove his ovaries. The decision should be his, and if he is comfortable leaving his body unaltered, that should be the course of action, and he should be supported in his embracing of his sex-variant body.

Intersex people may suffer from gender dysphoria if they were assigned by doctors to a sex but do not identify with it. If so, they should be assisted in securing hormonal and/or surgical treatment so that they can transition to the sex that is the same as their gender identity, if that is what they wish.

Intersex people and their families may also need supportive therapy. When a mother gives birth to an intersex baby, the family may be thrown into distress. It is especially important that the family receive support so that hasty decisions about “normalizing” surgery are not made. Adults who discover that they are intersex may also be thrown into an identity crisis and need support. And since all intersex people have to face lack of understanding and pressure to hide our sex status, many of us need access to counseling.

There is a myth that intersex people are almost always infertile. Sadly, many of us are infertile not because of how we were born, but because of surgical intervention in infancy. In fact, intersex people can have children (I did it. . .), but we may need fertility treatment and supportive medical assistance during pregnancy and birth.

What are some common types of intersexuality?

There are many conditions that lead to intersex status. I have no interest in getting overly clinical and showing the sort of medical photographs of dehumanized children with their genitals exposed that are so common in discussions of intersex. We are people, not . . . bits for display. However, I'll do a quick run through of some of the diagnoses given to intersex people, with physical description, to give some sense of how varied our bodies are.

People with Complete Androgen Insensitivity Syndrome usually have a clitoris, labia, and partial vagina, with testes internally. They develop breasts at puberty, but no periods. People with Partial Androgen Insensitivity Syndrome are born with intermediate genital appearance and internal testes.

People born with Congenital Adrenal Hyperplasia or CAH are born with a phallus of average or small size, an empty scrotum, a uterus, and ovaries. At puberty, people with CAH will develop breasts and get a period.

Hypospadias refers to a range of conditions in which a person has phallic tissue, but does not have the urethral opening at the tip. This can be a small displacement in an otherwise typical penis, or can occur with a fully intermediate genital appearance.

People who have Klinefelter Syndrome are born with XXY chromosomes. Individuals with Klinefelter’s have a penis and testes, are often tall and long-limbed, and may have wide hips and "gynecomastia," i.e. breast tissue in a man.

People who have ovotestes are diagnosed as "True Gonadal Intersex" by doctors. Ovotestes are gonads intermediate between ovaries and testes. Those of us with ovotestes may also have an ovary or a testis, and may develop a menstrual period, or produce sperm.

What can other people do to be allies for intersex folks?

The single most important thing allies can do is to refuse to treat intersex status as something shameful! Allies can help educate people about the fact that intersex happens and is not some sort of medical emergency requiring cosmetic surgery on infant genitals. Only an intersex person can determine what their gender is, and what surgery if any they want--doctors and parents can no more decide what gender a person will have than they can pick their sexual orientation or taste in music. Educating people about this will help lead to a day when parents welcome an intersex baby as a happy rather than tragic addition to the family.