Intersex: Definition, Causes, Conditions, Medical Interventions, History, Disorders and Figures

Intersex people are born with various variations in sexual characteristics, including chromosomes, gonads, sex hormones or genitals.

These people, according to the Office of the United Nations High Commissioner for Human Rights, “do not conform to the typical definitions of male or female bodies.”

Such variations may involve genital ambiguity and combinations of chromosomal genotype and sexual phenotype other than XY-male and XX-female.

Intersex people were referred to earlier as hermaphrodites, “congenital eunuchs” or congenitally “frigid”.

Such terms have fallen out of favor; in particular, the term ” hermaphrodite ” is considered deceptive, stigmatizing and scientifically deceptive. The medical description of intersex traits as disorders of sexual development has been controversial since the label was introduced in 2006.

Intersex people can face stigmatization and discrimination from birth or the discovery of an intersex feature. This may include infanticide, abandonment and stigmatization of families.

Worldwide, some intersex babies and children, such as those with ambiguous external genitalia, are surgically or hormonally altered to create socially more acceptable sexual characteristics.

However, this is considered controversial, with no firm evidence of good results. Such treatments may involve sterilization. Adults, including female elite athletes, have also been subject to 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 on human rights violations, including Malta’s declaration of the third International Intersexuality Forum.

In 2011, Christiane Völling became the first intersex person to be known to have successfully sued for damages in a case filed for a non-consensual surgical intervention.

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

Some intersex people can be assigned and raised as a girl or boy, but then they identify with another gender later in life, while the majority continue to identify with their assigned sex.

Definitions of intersex

According to the Office of the United Nations High Commissioner for Human Rights:

“The intersex people are born with sexual characteristics (including genitals, gonads and chromosomal patterns) that do not fit the binary notions typical of male or female bodies.”

Intersex is a general term used to describe a wide range of natural bodily variations. In some cases, intersexual features are visible at birth, while in others, they are not evident until puberty.

Some intersex chromosomal variations may not be physically apparent at all. In biological terms, sex can be determined by a series of factors present at the time of birth, including:

  • The number and type of sex chromosomes.
  • The type of gonads: ovaries or testicles.
  • The sex hormones
  • The internal reproductive anatomy (like the uterus in women).
  • The external genitalia

People whose characteristics are not typically masculine or typically female at birth are intersex.

Some intersex features are not always visible at birth; some babies may be born with ambiguous genitalia, while others may have ambiguous internal organs (testicles and ovaries). Others will not realize that they are intersex unless they receive genetic tests, because they do not manifest in their phenotype.

The term ‘intersexual’

Some people with intersex features identify themselves as intersex, and others do not.

Australian sociological research published in 2016 found that 60% of respondents used the term “intersexual” to self-describe their sexual characteristics, including people who identified themselves as intersex, describing themselves as having an intersexual variation.

The majority of 75% of respondents also describe themselves as male or female. Respondents also commonly use diagnostic labels and refer to their sex chromosomes, with word choices that depend on the audience.

Research conducted by Lurie Children’s Hospital, Chicago, and the AIS-DSD Support Group published in 2017 found that 80% of the affected respondents “liked them a lot, liked them or felt neutral about intersexuality”, while the caregivers were less understanding

The hospital reported that “disorders of sexual development” can adversely affect attention.

Some intersex organizations refer to “intersex people” and “intersex traits or variations” while others use a more medicalized language such as “people with intersex conditions” or people “with intersex conditions or DDS (differences in sexual development)”.

As well as and “children born with variations of the sexual anatomy”.

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

 Ambiguous genitalia

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

Because there is a variation in all the processes of the development of the sexual organs, a child can be born with a sexual anatomy that is generally of feminine or feminine appearance with a clitoris bigger than the average (hypertrophy of the clitoris).

Or typically male, or male appearance with a penis smaller than the average that is open along the bottom.

The appearance can be quite ambiguous, describable as female genitals with a very large clitoris and partially fused lips, or male genitalia with a very small penis, completely open along the midline (“hypospadic”) and the empty scrotum. Fertility is variable.

Measurement systems

The orchidometer is a medical instrument for measuring the volume of the testicles. It was developed by the Swiss pediatric endocrinologist Andrea Prader. The Prader scale and the Quigley scale are visual assessment systems that measure the genital appearance.

Other signs

In order to assist in classification, methods other than inspection of the genitals may be performed. For example, a karyotype display of a tissue sample can determine which of the intersexual causes prevails in the case.

Causes of the intersex

The common pathway of sexual differentiation, where a productive human female has a pair of XX chromosomes, and a productive male has an XY pair, is relevant to the development of intersex conditions.

During fertilization, the sperm cells add an X chromosome (female) or a Y (male) chromosome to the X in the ovule. This determines the genetic sex of the embryo.

During the first weeks of development, the male and female genetic fetuses are “anatomically indistinguishable”, and the primitive gonads begin to develop approximately during the sixth week of gestation.

The gonads, in a “bipotential state”, can become testicles (the male gonads) or ovaries (the female gonads), depending on the consequent events.

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

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 12 weeks of gestation.

In normal female differentiation, the Müllerian duct system develops in the uterus, the fallopian tubes, and the inner third of the vagina. In men, the Muller duct inhibitory hormone causes this duct system to recede.

Then, androgens cause the development of Wolff’s duct system, which develops in the vas deferens, seminal vesicles and ejaculatory ducts.

By birth, the typical fetus has been completely “sexed”, male or female, which means that the genetic sex (XY-masculine or XX-feminine) corresponds to the phenotypic sex; that is, the genetic sex corresponds to the internal and external gonads and the external appearance of the genitals.

Terms

There is a variety of opinions on what conditions or traits are and are not intersex, depending on the definition of intersexual that is used.

Current definitions based on human rights emphasize a wide diversity of sexual characteristics that differ from expectations for male or female bodies.

During 2015, the Council of Europe, the Agency for Fundamental Rights of the European Union and the Inter-American Commission on Human Rights have requested a review of medical classifications on the basis that they currently impede the enjoyment of the right to health.

The Council of Europe expressed concern that:

“The gap between the expectations of intersex human rights organizations and the development of medical classifications may have widened over the past decade.”

Medical interventions

Basics:

Medical interventions are carried out to address physical health problems and psychosocial risks. Both types of reasoning are debated, especially because the consequences of surgical interventions (and many hormones) are permanent and irreversible.

Questions related to physical health include accurate assessment of risk levels, need and timing. Psychosocial reasons are particularly susceptible to issues of need as they reflect social and cultural concerns.

There is no clinical consensus on a basis of evidence, the surgical moment, the need, the type of surgical intervention and the degree of difference that justifies the intervention.

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

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

In cases where the gonads may present a cancer risk, as in some cases of androgen insensitivity syndrome, concern has been expressed that the basics of treatment and decision making regarding cancer risk may encapsulate the decisions about the desire for surgical normalization.

Types:

Feminizing and masculinizing surgeries : Surgical procedures depend on the diagnosis, and there is often concern about whether surgery should be performed at all. Usually, surgery is done soon after birth.

Advocates of the practice argue that it is necessary for people to clearly identify themselves as men or women so that they function socially and develop normally.

Psychosocial reasons are often mentioned. This is criticized by many human rights institutions and authors.

Unlike other aesthetic surgical procedures performed on babies, such as corrective surgery for cleft lip, genital surgery can have negative consequences for sexual functioning in later life, or feelings of extravagance and unacceptability.

Hormonal treatment : there is ample evidence of prenatal tests and hormonal treatment to prevent or eliminate intersex traits, also associated with the problematization of sexual orientation and gender nonconformity.

Psychosocial support : all interested parties support psychosocial support. A joint international declaration of the participants in the Third Intersexo International Forum in 2013 sought, among other demands:

“Recognition that the medicalization and stigmatization of intersex people result in significant trauma and mental health problems.”

“In order to guarantee the physical integrity and well-being of intersex people, psycho-social and peer support will be provided autonomously and non-pathologizing to intersex people throughout their lives (as required by themselves), as well as to parents and / or care providers. ”

Genetic selection and terminations : the ethics of preimplantation genetic diagnosis to select against intersex traits was the subject of 11 articles in the October 2013 issue of the American Journal of Bioethics.

There is ample evidence of pregnancy interruptions derived from prenatal testing, as well as prenatal hormonal treatment to prevent intersex traits.

Behrmann and Ravitsky find that the social concepts of sex, gender and sexual orientation are:

“Intertwined on many levels. The choice of parents against intersexuality can hide the prejudice against same-sex attraction and gender non-conformity. ”

Gender dysphoria : DSM-5 included a change from the use of gender identity disorder to gender dysphoria.

This revised code now specifically includes intersex people who do not identify with their assigned sex at birth and experience clinically significant distress or impairment, using the language of sexual development disorders.

This movement was criticized by intersex defense groups in Australia and New Zealand.

Medical photography and exhibition : the photographs of the intersexual genitalia of the children are distributed in the medical communities for documentary purposes. The problems associated with medical photography of intersex children have been debated due to experiences of humiliation and impotence on the part of children, along with their ethics, control and use.

History of the intersex

Regardless of whether they were socially tolerated or accepted by any particular culture, the existence of people with intersex was known in many ancient and premodern cultures.

The Greek historian Diodoro Sículo wrote about “hermaphrodite” in the first century before the common era that the hermaphrodite “is born with a physical body that is a combination of that of a man and that of a woman”, and with supernatural properties.

In European societies, Roman law, postclassic canon law and later common law referred to the sex of a person as male, female or hermaphroditic, with legal rights such as male or female according to the characteristics that seemed most dominant. The Decree Gratiani of the XII century declares that:

“If a hermaphrodite can be a witness of a will, it depends on which sex prevails.”

The foundations of the common law, the Institutes of the Lawes of England of the seventeenth century, described how a hermaphrodite could inherit:

“As a man or woman, according to that kind of sex that prevails.”

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

In some non-European societies, sex or gender systems with more than two categories may have allowed other forms of inclusion of intersex and transgender people.

Such societies have been characterized as “primitive”, while Morgan Holmes says that the later analysis has been simplistic or romantic, without taking into account the ways in which subjects of all categories are treated.

During the Victorian era, medical authors introduced the terms “true hermaphrodite” for an individual who has ovarian and testicular tissue, “male pseudohermaphrodite” for a person with testicular tissue, but a feminine or ambiguous sexual anatomy, and “pseudo female”.

“Hermaphrodite” for a person with ovarian tissue, but with a male or ambiguous sexual anatomy.

Some later changes in the terminology have reflected advances in genetics, while other changes are due to pejorative associations.

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

Since the emergence of modern medical science, some intersex people with ambiguous external genitals have been surgically modified genitals to resemble the female or male genitalia.

Surgeons singled out intersex babies as a “social emergency” when they were born.

An “optimal gender policy”, initially developed by John Money , stated that early intervention helped avoid confusion of gender identity, but this lacks evidence, and early interventions have adverse consequences for physical and psychological health.

Given that advances in surgery have made it possible to hide intersex conditions, many people are not aware of the frequency with which intersexual conditions arise in humans or their occurrence.

The dialogue between what were once antagonistic groups of activists and doctors has led to minimal changes in medical policies and how intersex patients and their families receive treatment in some places.

In 2011, Christiane Völling became the first intersex person to know that she had successfully sued for damages in a case filed for a non-consensual surgical intervention.

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

Many civil society organizations and human rights institutions are now calling for the end of unnecessary “standardization” interventions, including the declaration of Malta.

Human rights and legal issues

Human rights institutions are increasingly examining harmful practices and issues of discrimination against intersex people.

These issues have been addressed by an increasing number of international institutions, including, in 2015, the Council of Europe, the Office of the United Nations High Commissioner for Human Rights and the World Health Organization.

These developments have been accompanied by International Intersex Forums and greater cooperation among civil society organizations. However, the implementation, codification and application of intersex human rights in national legal systems remains slow.

Areas of concern include: non-consensual medical interventions; stigma, discrimination and equal treatment; access to reparations and justice; access to information and support, and legal recognition.

Physical integrity and body autonomy

Stigmatization and discrimination from birth can include infanticide, abandonment and stigmatization of families.

Mothers in East Africa can be accused of witchcraft, and the birth of an intersexual child can be described as a curse. Dropouts and infanticide were reported in Uganda, Kenya, South Asia and China.

Babies, children and adolescents also experience “normalizing” interventions in intersex people that are medically unnecessary and the unnecessary pathologization of variations in sexual characteristics.

Medical interventions have been carried out to modify the sexual characteristics of intersex people, without the consent of the intersex person in all the countries where the human rights of intersex people have been studied.

These interventions have been carried out frequently with the consent of the parents of the intersex person, when the person is too young to give their consent.

These interventions have been criticized by the World Health Organization, other United Nations agencies such as the Office of the High Commissioner for Human Rights and a growing number of regional and national institutions due to its adverse consequences, including trauma, its impact in the sexual function and sensation and violation of the rights to physical and mental integrity.

In April 2015, Malta became the first country to outlaw surgery without consent. In the same year, the Council of Europe became the first institution to affirm that intersex people have the right not to undergo sexual affirmation interventions.

Anti-discrimination and equal treatment

Inclusion in the law of equal treatment and hate crime.

Because people born with intersex bodies are considered different, intersex babies, children, adolescents and adults “are often stigmatized and subjected to multiple human rights violations,” including discrimination in education, health care, employment, sport and public services.

Several countries so far have explicitly protected intersex people from discrimination, with milestones such as South Africa, Australia and, more broadly, Malta.

Reparations and justice

Facilitate access to justice and reparations. Access to redress seems limited, with a shortage of legal cases, such as the 2011 case of Christiane Völling in Germany.

A second case was awarded in Chile in 2012, involving a child and his parents. Another successful case in Germany, taken by Michaela Raab , was reported in 2015.

In the United States, the “MC” The legal case, filed by Interact Advocates for Intersex Youth with the Southern Poverty Law Center, is still before the courts.

Information and support

Access to information, medical records, colleagues and other counseling and support.

With the rise of modern medical science in Western societies, a model based on secrecy was also adopted, in the belief that this was necessary to ensure a “normal” physical and psychosocial development.

Legal recognition

The Forum of National Human Rights Institutions of Asia Pacific states that legal recognition is, first of all, “about intersex people who have been granted a male or female birth certificate and may enjoy the same legal rights as others. men and women”.

In some regions, obtaining a birth certificate can be a problem. A court case in Kenya in 2014 established the right of an intersex child, “Baby A”, to a birth certificate.

Like all individuals, some intersex individuals can be raised as a certain sex (male or female) but then identified with another later in life, while most do not.

The recognition of classifications of third sex or gender occurs in several countries, however, it is controversial when it is assumed or is coercive, as is the case of some German children.

Sociological research in Australia, a country with a third “X” sexual classification, shows that 19% of people with atypical sexual characteristics selected an “X” or “other” option, while 52% are women, 23 % men and 6% insecure

Language

Research in the late twentieth century led to a growing medical consensus that diverse intersex bodies are normal, but relatively rare, forms of human biology.

The physician and researcher Milton Diamond emphasizes the importance of attention in the selection of language related to intersex people:

  • First of all, we defend the use of the terms “typical”, “usual” or “more frequent”, where it is more common to use the term “normal”.
  • When possible, avoid expressions such as poorly developed or undeveloped, developmental errors, defective genitalia, anomalies or errors of nature.
  • Emphasize that all of these conditions are biologically understandable while they are statistically uncommon.

Hermaphrodite

A hermaphrodite is an organism that has male and female reproductive organs. Until the middle of the 20th century, “hermaphrodite” was used as a synonym for “intersexual”.

The distinctions “male pseudohermaphrodite”, “female pseudohermaphrodite” and especially “true hermaphrodite” are vestiges of the obsolete thinking of the 19th century, which reflect the histology (microscopic appearance) of the gonads.

Medical terminology has shifted not only because of concerns about language, but also to a shift to gene-based understandings.

Currently, hermaphroditism should not be confused with intersexuality, since the former refers only to a specific phenotypic presentation of the sexual organs and the latter to a more complex combination of phenotypic and genotypic presentation.

The use of “hermaphrodite” to refer to intersex people is considered stigmatizing and deceptive.

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

Disorders of sexual development

“Sexual development disorders” (DSD) is a contested term, defined to include congenital conditions in which the development of chromosomal, gonadal or anatomical sex is atypical.

Members of the Pediatric Endocrine Society Lawson Wilkins and the European Society of Pediatric Endocrinology adopted this term in their “Consensus Statement on the treatment of intersex disorders”.

While adopting the term, to open “many more doors,” the now defunct Intersexual Society of North America pointed out that intersexuality is not a disorder.

Other intersex people, activists, sympathizers and academics have challenged the adoption of the terminology and its implied status as a “disorder”, as this is offensive to intersex people who do not feel there is something wrong with them.

With respect to the disorders of the consensus document on sexual development, it reinforces the normativity of early surgical interventions and criticizes the treatment protocols associated with the new taxonomy.

Sociological research in Australia, published in 2016, found that 3% of respondents used the term “sexual development disorders” or “DDS” to define their sexual characteristics, while 21% used the term when accessing services. doctors

In contrast, 60% used the term “intersexual” in some way to self-describe their sexual characteristics.

US research UU Del Lurie Children’s Hospital, Chicago, and the AIS-DSD Support Group, published in 2017, found that the terminology of “sexual development disorders” can negatively affect care, offend and reduce attendance at medical clinics.

Alternatives to the categorization of intersex conditions have been suggested as “disorders”, which include “variations in sexual development”.

The Intersexual International Organization (OII) questions an approach to illness and / or disability, defends the postponement of the intervention unless it is medically necessary, when possible the informed consent of the individual involved and the self-determination of sexual orientation and identity / gender.

The UK Intersex Association is also very critical of label “upsets” and points to the fact that there was minimal participation of intersex representatives in the debate that led to the change in terminology.

LGBT and LGBTI community

The intersexuality can be contrasted with homosexuality or attraction to the same sex.

Numerous studies have shown higher rates of sexual attraction in intersex people, with a recent Australian study of people with atypical sexual characteristics who found that 52% of respondents were not heterosexual.

Therefore, research on intersex subjects has been used to explore means of preventing homosexuality.

However, current studies do not support a statistical correlation between generic intersex traits and transgender people.

Therefore, intersexuality can be contrasted with that of transgender, which describes the condition in which one’s gender identity does not coincide with the assigned sex. Some people are both intersexual and transgender.

A 2012 clinical review article 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:

“The choice of parents against intersexuality can … hide biases against same-sex attraction and gender non-conformity.”

The relationship of intersex communities with lesbian, gay, bisexual and transgender people is complex, but intersex people often join LGBT people to create an LGBTI community.

Emi Koyama describes how the inclusion of intersexuality in LGBTI may not address intersex human rights issues, including creating false impressions “that the rights of intersex people are protected” by laws that protect LGBT people, and not recognizing that many intersex people are not LGBT.

The Intersex International Organization Australia states that some intersex individuals are attracted to the same sex, and some are heterosexual, but “LGBTI activism has fought for the rights of people who fall outside the norms of gender and binary sex”.

Julius Kaggwa of SIPD Uganda has written that while the gay community “offers us a place of relative safety, it is also foreign to our specific needs”.

Mauro Cabral has written that transgender people and organizations “need to stop addressing intersexual issues as if they were trans”.

Including the use of intersexuality as a means to explain that they are transgender; “We can collaborate a lot with the intersexual movement by making it clear how wrong that approach is.”

Intersex in society

The intersexuality in fiction and other media:

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

Television works on intersexuality and films on intersex are scarce. The Spanish film XXY won the Grand Prize of the Critics’ Week at the 2007 Cannes Film Festival and the ACID / CCAS Support Award.

” Faking It ” is noted for providing the first intersex main character in a television show, and the first intersex television character played by an intersex actor.

Institutions of civil society:

Peer advocacy and advocacy organizations have existed since at least 1985, with the establishment of the Australian Support Group for Androgen Insensitivity Syndrome in 1985.

The Support Group for Androgen Insensitivity Syndrome (United Kingdom) was established in 1988.

The Inter-Sexual 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; He was active from 1993 to 2008.

Events dedicated to intersexuality:

The Intersexual Awareness Day is an internationally observed civil awareness day designed to highlight the challenges faced by intersex people, which occurs annually on October 26.

It marks the first public manifestation of intersex people, which took place in Boston on October 26, 1996, outside of a place where the American Academy of Pediatrics was holding its annual conference.

The Intersex Day of Remembrance, also known as Intersex Solidarity Day, is an internationally observed civil awareness day designed to highlight the problems faced by intersex people, which occurs annually on November 8.

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 memories of a nineteenth-century French hermaphrodite .”

Flag of intersexuality:

The intersex flag was created by the Intersex International Australia organization in July 2013 to create a flag “that is not derived, but that is firmly rooted in meaning”. The organization aimed to create a symbol without pink and blue gender colors.

Describe the yellow and purple colors as “hermaphrodite”. The organization describes it as freely accessible “for the use of any intersex person or organization that wishes to use it, in a community context of affirming human rights.”

The intersexuality in religion:

In Hinduism, Sangam literature uses the word pedi to refer to people born with an intersexual condition; it also refers to antharlinga hijras and several other hijras. Warneand Raza argue that an association between intersex people and hijra is mostly unfounded, but it causes fear in parents.

In Islam, scholars of Islamic jurisprudence have detailed discussions about the status and rights of intersexuality based on what is primarily displayed on their external sex organs.

However, scholars of modern Islamic jurisprudence resort to medical examinations to determine the predominance of their sex.

Intersex rights include inheritance rights, rights to marriage, rights to live as any other man or woman. The rights are usually based on whether they are true hermaphrodites or pseudo hermaphrodites.

Scholars of Islamic jurisprudence generally consider their rights based on most of what appears from their external sex organs.

In Judaism, the Talmud contains a broad discussion about the state of two intersex types in Jewish law; that is, the androginus, which exhibits male and female external sex organs, and the tumtum that exhibits none.

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

The intersexuality in sport:

Several athletes have been humiliated, excluded from the competition or forced to return medals after the discovery of an intersex feature. Examples include Erik Schinegger , Foekje Dillema , Maria José Martínez-Patiño and Santhi Soundarajan .

On the contrary, Stanisława Walasiewicz (also known as Stella Walsh ) was the subject of a posthumous controversy.

South African middle distance runner Caster Semenya won gold at the Women’s 800m World Championship and won silver at the 2012 Summer Olympics.

When Semenya won gold at the World Championship, the International Association of Athletics Federations (IAAF) requested sex verification tests. The results were not published, but Semenya was authorized to compete with other women.

Katrina Karkazis , Rebecca Jordan-Young , Georgiann Davis and Silvia Camporesiargued that the new IAAF policies on “hyperandrogenism” in athletes (applied, for example, to the case of Dutee Chand ), established in response to the Semenya case , are “significantly deficient. ”

Arguing that the policy will not protect against privacy violations, it will require that athletes undergo unnecessary treatment in order to compete and intensify the “gender police”.

They recommend that athletes can compete according to their legal gender.

In April 2014, the BMJ reported that four elite athletes with 5-ARD were subjected to sterilization and “partial clitoridectomies” to compete in the sport.

The authors noted that the “partial clitoridectomy” was “not medically indicated, it is not related to the actual or perceived sports advantage”. The defenders of intersexuality consider this intervention as “a clearly coercive process”.

In 2016, the United Nations Special Rapporteur for Health, Dainius Pūras, criticized the “current and historical” sexual verification policies and described how “several athletes underwent gonadectomy (removal of reproductive organs) and partial clitoridectomy.

Population figures with intersex

There are few firm estimates of the number of intersex people.

While human rights institutions have called for the demedicalization of intersex traits, medical definitions are often still used as much as possible.

The now defunct Intersex Society of North America stated that:

“If you ask medical center experts how often a child is born who is so remarkably atypical in terms of genitalia that a specialist in sexual differentiation is called, the figure is about 1 in 1500 to 1 in 2000 births.”

“But many more people are born with more subtle forms of variations in the sexual anatomy, some of which will not appear until later in life.”

According to Blackless , Fausto-Sterling et al ., 1.7 percent of human births are intersex, including variations that may not be apparent until, for example, puberty or even trying to conceive. Some doctors are not in favor of such definitions.

According to Leonard Sax , intersexual should be “restricted to those conditions in which chromosomal sex is inconsistent with phenotypic sex, or in which the phenotype is not classifiable as male or female”, around 0.018%.

This definition excludes Klinefelter syndrome and many other variations.

In turn, he criticizes Fausto-Sterling for having late-onset congenital adrenal hyperplasia in 88% of his figure. Your rebuttal concludes,

“The most original feature of the Faustus-Sterling book is its reluctance to classify true intersexual conditions as pathological. He often uses the word natural as a synonym of normal. However, the natural and the normal are non-synonymous. ”

“A cow can give birth to a Siamese or two-headed calf by natural processes, understood naturally according to the Faustus-Sterling definition as” produced by nature “. However, that two-headed calf indisputably manifests an abnormal condition. ”

“Fausto-Sterling’s insistence that all combinations of sexual anatomy be considered normal … continues that the classifications of normal and abnormal sexual anatomy are mere social conventions, prejudices that can and should be left aside by an enlightened intellectuality”.

“This type of extreme social constructionism is confusing and is not useful for doctors, their patients or the families of their patients. Diluting the term intersexual to include “any deviation from the Platonic ideal of sexual dimorphism,” as Fausto-Sterling suggests, deprives the term of any clinically useful meaning. ”

However, many conditions excluded from Sax’s analysis are currently considered as disorders of sexual development.

People with such diagnoses may experience stigma and discrimination due to their sexual characteristics, including sexual “normalization” interventions, so that such diagnoses and life experiences meet the definitions of intersexual in use by the UN and other agencies .

As a result, the statistical analyzes of Blackless and Fausto-Sterling , despite their antiquated and perceived offensive use of the term hermaphrodite, have been widely cited, even by other physicians.

The population figures may vary due to genetic causes. In the Dominican Republic, 5-alpha-reductase deficiency is not uncommon in the city of Las Salinas, resulting in social acceptance of the intersexual trait.

Men with the trait are called “guevedoces” (eggs at twelve). 12 of 13 families had one or more male members carrying the gene. The overall incidence for the city was 1 in 90 men were carriers, with other men, either non-carriers or unaffected carriers.