Intersex

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Intersex people are individuals born with any of several variations in sex characteristics including chromosomes, gonads, sex hormones or genitals that, according to the UN Office of the High Commissioner for Human Rights, "do not fit the typical definitions for male or female bodies". Intersex_sentence_0

This range of atypical variation may be physically obvious from birth – babies may have ambiguous reproductive organs, or at the other extreme range it is not obvious and may remain unknown to people all their lives. Intersex_sentence_1

Intersex people were previously referred to as hermaphrodites or "congenital eunuchs". Intersex_sentence_2

In the 19th and 20th centuries, some medical experts devised new nomenclature in an attempt to classify the characteristics that they had observed. Intersex_sentence_3

It was the first attempt at creating a taxonomic classification system of intersex conditions. Intersex_sentence_4

Intersex people were categorized as either having true hermaphroditism, female pseudohermaphroditism, or male pseudohermaphroditism. Intersex_sentence_5

These terms are no longer used: terms including the word "hermaphrodite" are considered to be misleading, stigmatizing, and scientifically specious in reference to humans. Intersex_sentence_6

A hermaphrodite is now defined as "an animal or plant having both male and female reproductive organs". Intersex_sentence_7

In 1917, Richard Goldschmidt created the term intersexuality to refer to a variety of physical sex ambiguities. Intersex_sentence_8

In clinical settings, the term "disorders of sex development" (DSD) has been used since 2006. Intersex_sentence_9

This shift has been controversial since the label was introduced. Intersex_sentence_10

Intersex people face stigmatization and discrimination from birth, or from discovery of an intersex trait, such as from puberty. Intersex_sentence_11

This may include infanticide, abandonment, and the stigmatization of families. Intersex_sentence_12

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. Intersex_sentence_13

However, this is considered controversial, with no firm evidence of favorable outcomes. Intersex_sentence_14

Such treatments may involve sterilization. Intersex_sentence_15

Adults, including elite female athletes, have also been subjects of such treatment. Intersex_sentence_16

Increasingly, these issues are considered human rights abuses, with statements from international and national human rights and ethics institutions (see intersex human rights). Intersex_sentence_17

Intersex organizations have also issued statements about human rights violations, including the 2013 Malta declaration of the third International Intersex Forum. Intersex_sentence_18

Sex assignment at birth usually aligns with a child's anatomical sex and phenotype. Intersex_sentence_19

The number of births where the baby is intersex has been reported to be roughly 1.7%, depending on which conditions are counted as intersex. Intersex_sentence_20

The number of births with ambiguous genitals is in the range of 0.02% to 0.05%. Intersex_sentence_21

Other intersex conditions involve atypical chromosomes, gonads, or hormones. Intersex_sentence_22

Some intersex 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. Intersex_sentence_23

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. Intersex_sentence_24

In April 2015, Malta became the first country to outlaw non-consensual medical interventions to modify sex anatomy, including that of intersex people. Intersex_sentence_25

Definitions Intersex_section_0

According to the UN Office of the High Commissioner for Human Rights: Intersex_sentence_26

According to World Health Organization: Intersex is defined as a congenital anomaly of the reproductive and sexual system. Intersex_sentence_27

An estimate about the birth prevalence of intersex is difficult to make because there are no concrete parameters to the definition of intersex. Intersex_sentence_28

In biological terms, sex may be determined by a number of factors present at birth, including: Intersex_sentence_29

Intersex_unordered_list_0

  • the number and type of sex chromosomes,Intersex_item_0_0
  • the type of gonads—ovaries or testicles,Intersex_item_0_1
  • sex hormone levels,Intersex_item_0_2
  • the internal reproductive anatomy (such as the uterus in females), andIntersex_item_0_3
  • the external genitalia.Intersex_item_0_4

People whose characteristics are not either all typically male or all typically female at birth are intersex. Intersex_sentence_30

Some intersex traits are not always visible at birth; some babies may be born with ambiguous genitals, while others may have ambiguous internal organs (testes and ovaries). Intersex_sentence_31

Others will not become aware that they are intersex unless they receive genetic testing, because it does not manifest in their phenotype. Intersex_sentence_32

History Intersex_section_1

Main articles: Intersex in history, Timeline of intersex history, and History of intersex surgery Intersex_sentence_33

From early history, societies have been aware of intersex people. Intersex_sentence_34

Some of the earliest evidence is found in mythology: the Greek historian Diodorus Siculus wrote of the mythological Hermaphroditus in the first century BCE, 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. Intersex_sentence_35

Ardhanarishvara, an androgynous composite form of male deity Shiva and female deity Parvati, originated in Kushan culture as far back as the first century CE. Intersex_sentence_36

A statue depicting Ardhanarishvara is included in India's Meenkashi Temple; this statue clearly shows both male and female bodily elements. Intersex_sentence_37

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". Intersex_sentence_38

Pliny the Elder (AD 23/24–79) the Roman naturalist described "those who are born of both sexes, whom we call hermaphrodites, at one time androgyni" (andr-, "man," and gyn-, "woman," from the Greek). Intersex_sentence_39

Augustine (354 – 28 August 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". Intersex_sentence_40

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. Intersex_sentence_41

The 12th-century Decretum Gratiani states that "Whether an hermaphrodite may witness a testament, depends on which sex prevails". Intersex_sentence_42

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." Intersex_sentence_43

Legal cases have been described in canon law and elsewhere over the centuries. Intersex_sentence_44

Some non-European societies have sex or gender systems that recognize more than the two categories of male/man and female/woman. Intersex_sentence_45

Some of these cultures, for instance the South-Asian Hijra communities, may include intersex people in a third gender category. Intersex_sentence_46

Hawaiian culture in the past and today see intersex individuals as having more power "mana", both mentally and spiritually, than a single sex person. Intersex_sentence_47

Although–according to Morgan Holmes–early Western anthropologists categorized such cultures "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. Intersex_sentence_48

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. Intersex_sentence_49

Some later shifts in terminology have reflected advances in genetics, while other shifts are suggested to be due to pejorative associations. Intersex_sentence_50

The term intersexuality was coined by Richard Goldschmidt in 1917. Intersex_sentence_51

The first suggestion to replace the term 'hermaphrodite' with 'intersex' was made by Cawadias in the 1940s. Intersex_sentence_52

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. Intersex_sentence_53

Surgeons pinpointed intersex babies as a "social emergency" when born. Intersex_sentence_54

An 'optimal gender policy', initially developed by John Money, stated that early intervention helped avoid gender identity confusion, but this lacks evidence. Intersex_sentence_55

Early interventions have adverse consequences for psychological and physical health. Intersex_sentence_56

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. Intersex_sentence_57

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. Intersex_sentence_58

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. Intersex_sentence_59

In April 2015, Malta became the first country to outlaw non-consensual medical interventions to modify sex anatomy, including that of intersex people. Intersex_sentence_60

Many civil society organizations and human rights institutions now call for an end to unnecessary "normalizing" interventions, including in the Malta declaration. Intersex_sentence_61

Human rights and legal issues Intersex_section_2

Further information: Intersex rights by country Intersex_sentence_62

Human rights institutions are placing increasing scrutiny on harmful practices and issues of discrimination against intersex people. Intersex_sentence_63

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. Intersex_sentence_64

These developments have been accompanied by International Intersex Forums and increased cooperation amongst civil society organizations. Intersex_sentence_65

However, the implementation, codification, and enforcement of intersex human rights in national legal systems remains slow. Intersex_sentence_66

Physical integrity and bodily autonomy Intersex_section_3

Main articles: Intersex human rights and Intersex medical interventions Intersex_sentence_67

Stigmatization and discrimination from birth may include infanticide, abandonment, and the stigmatization of families. Intersex_sentence_68

As noted in the "Intersex human rights" page, the birth of an intersex child was often viewed as a curse or a sign of a witch mother, especially in parts of Africa. Intersex_sentence_69

Abandonments and infanticides have been reported in Uganda, Kenya, South Asia, and China. Intersex_sentence_70

Infants, children and adolescents also experience "normalising" interventions on intersex persons that are medically unnecessary and the pathologisation of variations in sex characteristics. Intersex_sentence_71

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. Intersex_sentence_72

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. Intersex_sentence_73

These interventions have frequently been performed with the consent of the intersex person's parents, when the person is legally too young to consent. Intersex_sentence_74

Such interventions have been criticized by the World Health Organization, 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. Intersex_sentence_75

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. Intersex_sentence_76

In April 2015, Malta became the first country to outlaw surgical intervention without consent. Intersex_sentence_77

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. Intersex_sentence_78

Anti-discrimination and equal treatment Intersex_section_4

Main article: Discrimination against intersex people Intersex_sentence_79

People born with intersex bodies are seen as different. Intersex_sentence_80

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. Intersex_sentence_81

Several countries have so far explicitly protected intersex people from discrimination, with landmarks including South Africa, Australia, and, most comprehensively, Malta. Intersex_sentence_82

Standing to file in law and compensation claims Intersex_section_5

Main article: Intersex human rights Intersex_sentence_83

Standing to file in law and compensation claims was an issue in the 2011 case of Christiane Völling in Germany. Intersex_sentence_84

A second case was adjudicated in Chile in 2012, involving a child and his parents. Intersex_sentence_85

A further successful case in Germany, taken by Michaela Raab, was reported in 2015. Intersex_sentence_86

In the United States, the Minor Child (M.C. Intersex_sentence_87 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.) Intersex_sentence_88

at [Medical University of South Carolina] in April 2006". Intersex_sentence_89

The case was one of the first lawsuit of its kind 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. Intersex_sentence_90

Information and support Intersex_section_6

Main article: Intersex human rights Intersex_sentence_91

Access to information, medical records, peer and other counselling and support. Intersex_sentence_92

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. Intersex_sentence_93

Legal recognition Intersex_section_7

Main article: Legal recognition of intersex people Intersex_sentence_94

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." Intersex_sentence_95

In some regions, obtaining any form of birth certification may be an issue. Intersex_sentence_96

A Kenyan court case in 2014 established the right of an intersex boy, "Baby A", to a birth certificate. Intersex_sentence_97

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. Intersex_sentence_98

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. Intersex_sentence_99

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 52% are women, 23% men, and 6% unsure. Intersex_sentence_100

Language Intersex_section_8

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. Intersex_sentence_101

Clinician and researcher Milton Diamond stresses the importance of care in the selection of language related to intersex people: Intersex_sentence_102

The term "intersex" Intersex_section_9

Some people with intersex traits self-identify as intersex, and some do not. Intersex_sentence_103

Australian sociological research 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. Intersex_sentence_104

A majority of 75% of survey respondents also self-described as male or female. Intersex_sentence_105

Respondents also commonly used diagnostic labels and referred to their sex chromosomes, with word choices depending on audience. Intersex_sentence_106

Research by the Lurie Children's Hospital, Chicago, and the AIS-DSD Support Group published in 2017 found that 80% of affected Support Group respondents "strongly liked, liked or felt neutral about intersex" as a term, while caregivers were less supportive. Intersex_sentence_107

The hospital reported that "disorders of sex development" may negatively affect care. Intersex_sentence_108

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". Intersex_sentence_109

In May 2016, Interact Advocates for Intersex Youth published a statement recognizing "increasing general understanding and acceptance of the term "intersex"". Intersex_sentence_110

However, a study by the American Urological Association found that 53% of participants didn’t like the term intersex. Intersex_sentence_111

Another study in 2020 found that 43% didn’t like the term intersex. Intersex_sentence_112

Another study in 2020 found that around 43% of 179 participants thought the term intersex was bad, while 20% felt neutral about the term. Intersex_sentence_113

Hermaphrodite Intersex_section_10

Main article: Hermaphrodite Intersex_sentence_114

A hermaphrodite is an organism that has both male and female reproductive organs. Intersex_sentence_115

Until the mid-20th century, "hermaphrodite" was used synonymously with "intersex". Intersex_sentence_116

The distinctions "male pseudohermaphrodite", "female pseudohermaphrodite" and especially "true hermaphrodite" are terms no longer used, which reflected histology (microscopic appearance) of the gonads. Intersex_sentence_117

Medical terminology has shifted not only due to concerns about language, but also a shift to understandings based on genetics. Intersex_sentence_118

Currently, hermaphroditism is not to be confused with intersex, as the former refers only to a specific phenotypical presentation of sex organs and the latter to a more complex combination of phenotypical and genotypical presentation. Intersex_sentence_119

Using hermaphrodite to refer to intersex individuals is considered to be stigmatizing and misleading. Intersex_sentence_120

Hermaphrodite is used for animal and plant species in which the possession of both ovaries and testes is either serial or concurrent, and for living organisms without such gonads but present binary form of reproduction, which is part of the typical life history of those species; intersex has come to be used when this is not the case. Intersex_sentence_121

Disorders of sex development Intersex_section_11

Main article: Disorders of sex development Intersex_sentence_122

"Disorders of sex development" (DSD) is a contested term, defined to include congenital conditions in which development of chromosomal, gonadal, or anatomical sex is atypical. Intersex_sentence_123

Members of the Lawson Wilkins Pediatric Endocrine Society and the European Society for Paediatric Endocrinology adopted this term in their "Consensus statement on management of intersex disorders". Intersex_sentence_124

While it adopted the term, to open "many more doors", the now defunct Intersex Society of North America itself remarked that intersex is not a disorder. Intersex_sentence_125

Other intersex people, activists, supporters, and academics have contested the adoption of the terminology and its implied status as a "disorder", seeing this as offensive to intersex individuals who do not feel that there is something wrong with them, regard the DSD consensus paper as reinforcing the normativity of early surgical interventions, and criticize the treatment protocols associated with the new taxonomy. Intersex_sentence_126

Sociological research in Australia, published in 2016, found that 3% of respondents used the term "disorders of sex development" or "DSD" to define their sex characteristics, while 21% use the term when accessing medical services. Intersex_sentence_127

In contrast, 60% used the term "intersex" in some form to self-describe their sex characteristics. Intersex_sentence_128

U.S. research by the Lurie Children's Hospital, Chicago, and the AIS-DSD Support Group published in 2017 found that "disorders of sex development" terminology may negatively affect care, give offense, and result in lower attendance at medical clinics. Intersex_sentence_129

Alternatives to categorizing intersex conditions as "disorders" have been suggested, including "variations of sex development". Intersex_sentence_130

Organisation Intersex International (OII) questions a disease/disability approach, argues for deferral of intervention unless medically necessary, when fully informed consent of the individual involved is possible, and self-determination of sex/gender orientation and identity. Intersex_sentence_131

The UK Intersex Association is also highly critical of the label 'disorders' and points to the fact that there was minimal involvement of intersex representatives in the debate which led to the change in terminology. Intersex_sentence_132

In May 2016, Interact Advocates for Intersex Youth also published a statement opposing pathologizing language to describe people born with intersex traits, recognizing "increasing general understanding and acceptance of the term "intersex"". Intersex_sentence_133

However, another study found that around 69% agree the term disorders of sex development applied to their condition or were neutral, 31% thought the term didn’t apply to their condition. Intersex_sentence_134

LGBT and LGBTI Intersex_section_12

Main article: Intersex and LGBT Intersex_sentence_135

Intersex can be contrasted with transgender, which is the condition in which one's gender identity does not match one's assigned sex. Intersex_sentence_136

Some people are both intersex and transgender. Intersex_sentence_137

A 2012 clinical review paper found that between 8.5% and 20% of people with intersex variations experienced gender dysphoria. Intersex_sentence_138

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." Intersex_sentence_139

The relationship of intersex to lesbian, gay, bisexual and trans, and queer communities is complex, but intersex people are often added to LGBT to create an LGBTI community. Intersex_sentence_140

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. Intersex_sentence_141

Organisation Intersex International Australia states that some intersex individuals are same sex attracted, and some are heterosexual, but "LGBTI activism has fought for the rights of people who fall outside of expected binary sex and gender norms." Intersex_sentence_142

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". Intersex_sentence_143

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 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". Intersex_sentence_144

In society Intersex_section_13

Fiction, literature and media Intersex_section_14

Main articles: Literature about intersex and Intersex characters in fiction Intersex_sentence_145

An intersex character is the narrator in Jeffrey Eugenides' Pulitzer Prize-winning novel Middlesex. Intersex_sentence_146

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. Intersex_sentence_147

Television works about intersex and films about intersex are scarce. Intersex_sentence_148

The Spanish-language film XXY won the Critics' Week grand prize at the 2007 Cannes Film Festival and the ACID/CCAS Support Award. Intersex_sentence_149

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. Intersex_sentence_150

Civil society institutions Intersex_section_15

Main article: Intersex civil society organizations Intersex_sentence_151

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. Intersex_sentence_152

The Androgen Insensitivity Syndrome Support Group (UK) established in 1988. Intersex_sentence_153

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. Intersex_sentence_154

Events Intersex_section_16

Main articles: Intersex Awareness Day and Intersex Day of Remembrance Intersex_sentence_155

Intersex Awareness Day is an internationally observed civil awareness day designed to highlight the challenges faced by intersex people, occurring annually on 26 October. Intersex_sentence_156

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_sentence_157

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. Intersex_sentence_158

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. Intersex_sentence_159

Religion Intersex_section_17

Main article: Intersex people and religion Intersex_sentence_160

In Hinduism, Sangam literature uses the word pedi to refer to people born with an intersex condition; it also refers to antharlinga hijras and various other hijras. Intersex_sentence_161

Warne and Raza argue that an association between intersex and hijra people is mostly unfounded but provokes parental fear. Intersex_sentence_162

In Judaism, the Talmud contains extensive discussion concerning the status of two intersex types in Jewish law; namely the androgynous, which exhibits both male and female external sexual organs, and the tumtum which exhibits neither. Intersex_sentence_163

In the 1970s and 1980s, the treatment of intersex babies started to be discussed in Orthodox Jewish medical halacha by prominent rabbinic leaders, for example Eliezer Waldenberg and Moshe Feinstein. Intersex_sentence_164

Sport Intersex_section_18

Main article: Sex verification in sports Intersex_sentence_165

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. Intersex_sentence_166

Stanisława Walasiewicz was posthumously ruled ineligible to have competed. Intersex_sentence_167

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. Intersex_sentence_168

When Semenya won gold in the World Championships, the International Association of Athletics Federations (IAAF) requested sex verification tests. Intersex_sentence_169

The results were not released. Intersex_sentence_170

Semenya was ruled eligible to compete. Intersex_sentence_171

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 will not protect against breaches of privacy, will require athletes to undergo unnecessary treatment in order to compete, and will intensify "gender policing". Intersex_sentence_172

They recommend that athletes be able to compete in accordance with their legally recognised gender. Intersex_sentence_173

In April 2014, the BMJ reported that four elite women athletes with 5-ARD (an intersex medical condition) were subjected to sterilization and "partial clitoridectomies" in order to compete in sport. Intersex_sentence_174

The authors noted that partial clitoridectomy was "not medically indicated" and "does not relate to real or perceived athletic 'advantage'." Intersex_sentence_175

Intersex advocates regard this intervention as "a clearly coercive process". Intersex_sentence_176

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." Intersex_sentence_177

Population figures Intersex_section_19

Estimates of the number of people who are intersex vary, depending on which conditions are counted as intersex. Intersex_sentence_178

Leonard Sax estimated that the prevalence of intersex was about 0.018% of the world's population. Intersex_sentence_179

A 2018 review reported that the number of births with ambiguous genitals is in the range of 0.02% to 0.05%. Intersex_sentence_180

The now-defunct Intersex Society of North America stated that: Intersex_sentence_181

Anne Fausto-Sterling and her co-authors said in two articles in 2000 that 1.7 percent of human births (1 in 60) might be intersex, including variations that may not become apparent until, for example, puberty, or until attempting to conceive. Intersex_sentence_182

Their publications have been widely quoted, though aspects are now considered outdated, such as use of the now scientifically incorrect term hermaphrodite. Intersex_sentence_183

Eric Vilain et al. Intersex_sentence_184

highlighted in 2007 that the term disorders of sex development (DSD) had replaced "hermaphrodite" and improper medical terms based on it. Intersex_sentence_185

Of the 1.7%, 1.5 percentage points (88% of those considered intersex in this figure) consist of individuals with late onset congenital adrenal hyperplasia (LOCAH). Intersex_sentence_186

Leonard Sax stated that "[f]rom a clinician’s perspective, however, LOCAH is not an intersex condition." Intersex_sentence_187

The figure of 1.7% is still maintained by Intersex Human Rights Australia "despite its flaws". Intersex_sentence_188

"This estimate relates to any 'individual who deviates from the Platonic ideal of physical dimorphism at the chromosomal, genital, gonadal, or hormonal levels' and thus it encapsulates the entire population of people who are stigmatized – or risk stigmatization – due to innate sex characteristics." Intersex_sentence_189

Individuals with diagnoses of disorders of sex development (DSD) may or may not experience stigma and discrimination due to their sex characteristics, including sex "normalizing" interventions. Intersex_sentence_190

Human rights institutions have called for the de-medicalization of intersex traits, as far as possible. Intersex_sentence_191

The following summarizes some prevalence figures of intersex traits (a fuller 'List of conditions' is provided below, at the end of 'Medical classifications'): Intersex_sentence_192

Intersex_table_general_0

Demography of various intersex conditionsIntersex_table_caption_0
Intersex conditionIntersex_header_cell_0_0_0 Sex specificityIntersex_header_cell_0_0_1 Approximate prevalenceIntersex_header_cell_0_0_2
Late onset congenital adrenal hyperplasia/nonclassic congenital adrenal hyperplasiaIntersex_cell_0_1_0 female, males are generally asymptomaticIntersex_cell_0_1_1 one in 50–1000 births (0.1–0.2% up to 1–2% depending on population)Intersex_cell_0_1_2
HypospadiasIntersex_cell_0_2_0 maleIntersex_cell_0_2_1 one in 200–10,000 male births (0.01%–0.5%), prevalence estimates vary considerablyIntersex_cell_0_2_2
Klinefelter syndromeIntersex_cell_0_3_0 maleIntersex_cell_0_3_1 one in 500–1,000 male births (0.1–0.2%)Intersex_cell_0_3_2
47, XXX genotypeIntersex_cell_0_4_0 femaleIntersex_cell_0_4_1 one in 1,000 female births (0.10%)Intersex_cell_0_4_2
Turner syndromeIntersex_cell_0_5_0 femaleIntersex_cell_0_5_1 one in 2,500 female births (0.04%)Intersex_cell_0_5_2
Müllerian agenesis (of vagina, i.e., MRKH Syndrome)Intersex_cell_0_6_0 femaleIntersex_cell_0_6_1 one in 4,500 female births (0.022%)Intersex_cell_0_6_2
Vaginal atresia/agenesisIntersex_cell_0_7_0 femaleIntersex_cell_0_7_1 one in 5,000 female births (0.02%)Intersex_cell_0_7_2
45,X/46,XY chromosomal mosaicismIntersex_cell_0_8_0 maleIntersex_cell_0_8_1 one in 6666 births (0.015%)Intersex_cell_0_8_2
XYY genotypeIntersex_cell_0_9_0 maleIntersex_cell_0_9_1 one in 7000 male births (0.0142%)Intersex_cell_0_9_2
Classic congenital adrenal hyperplasiaIntersex_cell_0_10_0 noneIntersex_cell_0_10_1 one in 10,000-20,000 births (0.01%–0.005%)Intersex_cell_0_10_2
XXYY genotypeIntersex_cell_0_11_0 maleIntersex_cell_0_11_1 one in 18,000–40,000 male births (0.0025%–0.0055%)Intersex_cell_0_11_2
XX genotype (male)Intersex_cell_0_12_0 maleIntersex_cell_0_12_1 one in 20,000 male births (0.005%)Intersex_cell_0_12_2
Ovotesticular disorder of sex developmentIntersex_cell_0_13_0 noneIntersex_cell_0_13_1 one in 20,000 births (0.005%)Intersex_cell_0_13_2
46, XY Complete gonadal dysgenesisIntersex_cell_0_14_0 phenotypic femaleIntersex_cell_0_14_1 one in 80,000 births (0.0013%)Intersex_cell_0_14_2
Androgen insensitivity syndrome (complete and partial phenotypes)Intersex_cell_0_15_0 genetic maleIntersex_cell_0_15_1 one in 99,000 births (0.001%)Intersex_cell_0_15_2
Idiopathic (no discernable medical cause)Intersex_cell_0_16_0 noneIntersex_cell_0_16_1 one in 110,000 births (0.0009%)Intersex_cell_0_16_2
Iatrogenic (caused by medical treatment, e.g., progestin administered to pregnant mother)Intersex_cell_0_17_0 noneIntersex_cell_0_17_1 no estimateIntersex_cell_0_17_2
5-alpha-reductase deficiencyIntersex_cell_0_18_0 maleIntersex_cell_0_18_1 no estimateIntersex_cell_0_18_2
Mixed gonadal dysgenesisIntersex_cell_0_19_0 noneIntersex_cell_0_19_1 no estimateIntersex_cell_0_19_2
AnorchiaIntersex_cell_0_20_0 maleIntersex_cell_0_20_1 no estimateIntersex_cell_0_20_2
Persistent Müllerian duct syndromeIntersex_cell_0_21_0 maleIntersex_cell_0_21_1 no estimateIntersex_cell_0_21_2

Population figures can vary due to genetic causes. Intersex_sentence_193

In the Dominican Republic, 5-alpha-reductase deficiency is not uncommon in the town of Las Salinas, resulting in social acceptance of the intersex trait. Intersex_sentence_194

Men with the trait are called "güevedoces" (Spanish for "eggs at twelve"). Intersex_sentence_195

12 out of 13 families had one or more male family members that carried the gene. Intersex_sentence_196

The overall incidence for the town was 1 in every 90 males were carriers, with other males either non-carriers or non-affected carriers. Intersex_sentence_197

Medical classifications Intersex_section_20

Sexual differentiation Intersex_section_21

Main article: Sexual differentiation Intersex_sentence_198

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. Intersex_sentence_199

During fertilization, the sperm adds either an X (female) or a Y (male) chromosome to the X in the ovum. Intersex_sentence_200

This determines the genetic sex of the embryo. Intersex_sentence_201

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. Intersex_sentence_202

The gonads, in a "bipotential state", may develop into either testes (the male gonads) or ovaries (the female gonads), depending on the consequent events. Intersex_sentence_203

Through the seventh week, genetically female and genetically male fetuses appear identical. Intersex_sentence_204

At around eight weeks of gestation, the gonads of an XY embryo differentiate into functional testes, secreting testosterone. Intersex_sentence_205

Ovarian differentiation, for XX embryos, does not occur until approximately week 12 of gestation. Intersex_sentence_206

In typical female differentiation, the Müllerian duct system develops into the uterus, Fallopian tubes, and inner third of the vagina. Intersex_sentence_207

In males, the Müllerian duct-inhibiting hormone MIH causes this duct system to regress. Intersex_sentence_208

Next, androgens cause the development of the Wolffian duct system, which develops into the vas deferens, seminal vesicles, and ejaculatory ducts. Intersex_sentence_209

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. Intersex_sentence_210

Signs Intersex_section_22

There are a variety of symptoms that can occur. Intersex_sentence_211

Ambiguous genitalia being 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. Intersex_sentence_212

Ambiguous genitalia Intersex_section_23

Ambiguous genitalia may appear as a large clitoris or as a small penis. Intersex_sentence_213

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. Intersex_sentence_214

The appearance may be quite ambiguous, describable as female genitals 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. Intersex_sentence_215

Fertility is variable. Intersex_sentence_216

Measurement systems for ambiguous genitalia Intersex_section_24

The orchidometer is a medical instrument to measure the volume of the testicles. Intersex_sentence_217

It was developed by Swiss pediatric endocrinologist Andrea Prader. Intersex_sentence_218

The Prader scale and Quigley scale are visual rating systems that measure genital appearance. Intersex_sentence_219

These measurement systems were satirized in the Phall-O-Meter, created by the (now defunct) Intersex Society of North America. Intersex_sentence_220

Other signs Intersex_section_25

In order to help in classification, methods other than a genitalia inspection can be performed. Intersex_sentence_221

For instance, a karyotype display of a tissue sample may determine which of the causes of intersex is prevalent in the case. Intersex_sentence_222

Additionally, electrolyte tests, endoscopic exam, ultrasound and hormone stimulation tests can be done. Intersex_sentence_223

Causes Intersex_section_26

Intersex can be divided into four categories which are: 46, XX intersex; 46, XY intersex; true gonadal intersex; and complex or undetermined intersex. Intersex_sentence_224

46, XX intersex Intersex_section_27

This condition used to be called "female pseudohermaphroditism". Intersex_sentence_225

Persons with this condition have female internal genitalia and karyotype (XX) and various degree of external genitalia virilization. Intersex_sentence_226

External genitalia is masculinized congenitally when female fetus is exposed to excess androgenic environment. Intersex_sentence_227

Hence, the chromosome of the person is of a woman, the ovaries of a woman, but external genitals that appear like a male. Intersex_sentence_228

The labia fuse, and the clitoris enlarges to appear like a penis. Intersex_sentence_229

The causes of this can be male hormones taken during pregnancy, congenital adrenal hyperplasia, male-hormone-producing tumors in the mother and aromatase deficiency. Intersex_sentence_230

46, XY intersex Intersex_section_28

This condition used to be called "male pseudohermaphroditism". Intersex_sentence_231

This is defined as incomplete masculinization of the external genitalia. Intersex_sentence_232

Thus, the person has the chromosomes of a man, but the external genitals are incompletely formed, ambiguous, or clearly female. Intersex_sentence_233

This condition is also called 46, XY with undervirilization. Intersex_sentence_234

46, XY intersex has many possible causes, which can be problems with the testes and testosterone formation. Intersex_sentence_235

Also, there can be problems with using testosterone. Intersex_sentence_236

Some people lack the enzyme needed to convert testosterone to dihydrotestosterone, which is a cause of 5-alpha-reductase deficiency. Intersex_sentence_237

Androgen Insensitivity Syndrome is the most common cause of 46, XY intersex. Intersex_sentence_238

True gonadal intersex Intersex_section_29

This condition used to be called "true hermaphroditism". Intersex_sentence_239

This is defined as having asymmetrical gonads with ovarian and testicular differentiation on either sides separately or combined as ovotestis. Intersex_sentence_240

In most cases, the cause of this condition is unknown; however, some research has linked it to exposure to common agricultural pesticides. Intersex_sentence_241

Complex or undetermined intersex Intersex_section_30

This is the condition of having any chromosome configurations rather than 46, XX or 46, XY intersex. Intersex_sentence_242

This condition does not result in any imbalance between internal and external genitalia. Intersex_sentence_243

However, there may be problems with sex hormone levels, overall sexual development, and altered numbers of sex chromosomes. Intersex_sentence_244

Conditions Intersex_section_31

Further information: Disorders of sex development Intersex_sentence_245

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. Intersex_sentence_246

Current human rights based definitions stress a broad diversity of sex characteristics that differ from expectations for male or female bodies. Intersex_sentence_247

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". Intersex_sentence_248

Medical interventions Intersex_section_32

Main article: Intersex medical interventions Intersex_sentence_249

Further information: History of intersex surgery Intersex_sentence_250

Rationales Intersex_section_33

Medical interventions take place to address physical health concerns and psychosocial risks. Intersex_sentence_251

Both types of rationale are the subject of debate, particularly as the consequences of surgical (and many hormonal) interventions are lifelong and irreversible. Intersex_sentence_252

Questions regarding physical health include accurately assessing risk levels, necessity, and timing. Intersex_sentence_253

Psychosocial rationales are particularly susceptible to questions of necessity as they reflect social and cultural concerns. Intersex_sentence_254

There remains no clinical consensus about an evidence base, surgical timing, necessity, type of surgical intervention, and degree of difference warranting intervention. Intersex_sentence_255

Such surgeries are the subject of significant contention due to consequences that include trauma, impact on sexual function and sensation, and violation of rights to physical and mental integrity. Intersex_sentence_256

This includes community activism, and multiple reports by international human rights and health institutions and national ethics bodies. Intersex_sentence_257

In the cases where gonads may pose a cancer risk, as in some cases of androgen insensitivity syndrome, concern has been expressed that treatment rationales and decision-making regarding cancer risk may encapsulate decisions around a desire for surgical "normalization". Intersex_sentence_258

Types Intersex_section_34

Intersex_unordered_list_1

  • Feminizing and masculinizing surgeries: Surgical procedures depend on diagnosis, and there is often concern as to whether surgery should be performed at all. Typically, surgery is performed shortly after birth. Defenders of the practice argue that it is necessary for individuals to be clearly identified as male or female in order for them to function socially and develop "normally". Psychosocial reasons are often stated. This is criticised by many human rights institutions, and authors. Unlike other aesthetic surgical procedures performed on infants, such as corrective surgery for a cleft lip, genital surgery may lead to negative consequences for sexual functioning in later life, or feelings of freakishness and unacceptability.Intersex_item_1_5
  • Hormone treatment: There is widespread evidence of prenatal testing and hormone treatment to prevent or eliminate intersex traits, associated also with the problematization of sexual orientation and gender non-conformity.Intersex_item_1_6
  • Psychosocial support: All stakeholders support psychosocial support. A joint international statement by participants at the Third International Intersex Forum in 2013 sought, amongst other demands: "Recognition that medicalization and stigmatisation of intersex people result in significant trauma and mental health concerns. In view of ensuring the bodily integrity and well-being of intersex people, autonomous non-pathologising psycho-social and peer support be available to intersex people throughout their life (as self-required), as well as to parents and/or care providers."Intersex_item_1_7
  • Genetic selection and terminations: The ethics of preimplantation genetic diagnosis to select against intersex traits was the subject of 11 papers in the October 2013 issue of the American Journal of Bioethics. There is widespread evidence of pregnancy terminations arising from prenatal testing, as well as prenatal hormone treatment to prevent intersex traits. Behrmann and Ravitsky find social concepts of sex, gender and sexual orientation to be "intertwined on many levels. Parental choice against intersex may thus conceal biases against same-sex attractedness and gender nonconformity."Intersex_item_1_8
  • Medical display. Photographs of intersex children's genitalia are circulated in medical communities for documentary purposes, and individuals with intersex traits may be subjected to repeated genital examinations and display to medical teams. Problems associated with experiences of medical photography of intersex children have been discussed along with their ethics, control and usage. "The experience of being photographed has exemplified for many people with intersex conditions the powerlessness and humiliation felt during medical investigations and interventions".Intersex_item_1_9
  • Gender dysphoria: The DSM-5 included a change from using gender identity disorder to gender dysphoria. This revised code now specifically includes intersex people who do not identify with their sex assigned at birth and experience clinically significant distress or impairment, using the language of disorders of sex development.Intersex_item_1_10

See also Intersex_section_35

Intersex_unordered_list_2


Credits to the contents of this page go to the authors of the corresponding Wikipedia page: en.wikipedia.org/wiki/Intersex.