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Intersex

Intersex is a term used to describe individuals who are born with physical or biological sex characteristics that do not fit typical binary definitions of male or female. Intersex variations can involve a range of conditions that may affect reproductive anatomy, sex chromosomes, or hormone levels. Intersex is a group of conditions in which there is a discrepancy between the external genitals and the internal genitals (the testes and ovaries).

The older term for this condition is hermaphroditism. Although the older terms are still included in this article for reference, they have been replaced by most experts, patients, and families. Increasingly, this group of conditions is being called disorders of sex development (DSDs). Intersex traits can manifest in various ways. For example, a person may have ambiguous genitalia, where the external genitalia do not clearly appear strictly male or female. Another intersex variation is having atypical combinations of sex chromosomes, such as XXY (Klinefelter syndrome) or XO (Turner syndrome).

1. 46, XX intersex - The person has the chromosomes of a woman, the ovaries of a woman, but external (outside) genitals that appear male. This most often is the result of a female fetus having been exposed to excess male hormones before birth. The labia ("lips" or folds of skin of the external female genitals) fuse, and the clitoris enlarges to appear like a penis. In most cases, this person has a normal uterus and fallopian tubes. This condition is also called 46, XX with virilization. It used to be called female pseudohermaphroditism.

2. 46, XY intersex - The person has the chromosomes of a man, but the external genitals are incompletely formed, ambiguous, or clearly female. Internally, testes may be normal, malformed, or absent. This condition is also called 46, XY with undervirilization. It used to be called male pseudohermaphroditism. Formation of normal male external genitals depends on the appropriate balance between male and female hormones. Therefore, it requires the adequate production and function of male hormones.

3. True gonadal intersex - The person must have both ovarian and testicular tissue. This may be in the same gonad (an ovotestis), or the person might have 1 ovary and 1 testis. The person may have XX chromosomes, XY chromosomes, or both. The external genitals may be ambiguous or may appear to be female or male. This condition used to be called true hermaphroditism. In most people with true gonadal intersex, the underlying cause is unknown, although in some animal studies it has been linked to exposure to common agricultural pesticides.

4. Complex or undetermined intersex - Many chromosome configurations other than simple 46, XX or 46, XY can result in disorders of sex development. These include 45, XO (only one X chromosome), and 47, XXY, 47, XXX - both cases have an extra sex chromosome, either an X or a Y. These disorders do not result in a condition in which there is a discrepancy between internal and external genitalia. However, there may be problems with sex hormone levels, overall sexual development, and altered numbers of sex chromosomes.

It is important to note that being intersex is distinct from being transgender. Intersex relates to physical sex characteristics, whereas transgender refers to an individual's gender identity differing from the sex they were assigned at birth.

The exact prevalence of intersex variations is difficult to determine due to various factors, including different definitions, medical interventions, and cultural practices. Some estimates suggest that intersex variations occur in approximately 1 in 2,000 births, though the frequency can vary depending on the specific intersex condition.

Intersex individuals have historically faced challenges and stigmatization. Medical interventions, such as surgeries performed on infants to conform their bodies to societal norms, have been common in the past. However, there is a growing movement advocating for the rights of intersex individuals and promoting autonomy in decision-making regarding medical interventions.

It is essential to respect the self-identified gender and rights of intersex individuals, including their right to bodily autonomy, informed consent, and access to appropriate medical and psychological support. Supportive and inclusive approaches are crucial in creating a more accepting and understanding society for intersex people.

As Secretary Blinken told heads of government and foreign ministers at the United Nations LGBTI Core Group in September 2022, “intersex people, including minors, continue to be subjected to unnecessary surgeries without their consent,” underscoring the important responsibility of governments to ensure LGBTQI+ persons across the globe are able to enjoy the same rights and protections as all other persons. In the President’s 2021 Memorandum on Advancing the Human Rights of LGBTQI+ Persons Around the World, he stated that it is the policy of the United States to pursue an end to violence and discrimination on the bases of sexual orientation, gender identity or expression, and sex characteristics. The United States stands in solidarity with intersex persons, honoring the advocacy of activists, organizations, and governments, and remains steadfast in its commitment to promoting and protecting the dignity and human rights of intersex persons around the world.