Transgender identity and intersex

Understanding intersex

Yes or no. On or off. True or false. Male or female.

While many people believe babies are either born male or female, nature is not always black and white. Just as different wavelengths of light allow us to see a full spectrum of colors, nature presents us with a sex anatomy spectrum. Intersex, therefore, is a term used to reflect biological variation: sex organs such as penises, gonads, and labia all vary in size and shape. Sex chromosomes can also vary. Genetically, some intersexed people are born with mosaic genetics—that is, some of their cells have XX chromosomes while others have XY chromosomes.

While social necessity leads us to label individuals as either male or female, the reality is that 1 in every 2,000 babies is born with a sexual anatomy that combines characteristics of both male and female, making it hard, even for an expert, to label the child one or the other.

This does not mean, however, that a baby is born with two full sets of genitals, one male and one female. This never happens. Rather, intersexed babies have ambiguous genitalia: either a penis that is deemed too small (micropenis), a scrotum that is divided so that it more closely resembles labia, or a clitoris that is deemed too large (clitoromegaly). Some intersexed people are born with genitals similar in appearance to that of other boys or girls, while others may have internal reproductive organs typically associated with the opposite sex. Similarly, other conditions such as vaginal agenesis (congenital absence of the vagina) or hypospadia (the urethral opening does not occur at the tip of the penis) are considered by many health professionals to be intersexed conditions. However, genital ambiguity, in itself, does not represent a health problem.

Although the above may imply that intersex is an inborn condition, intersex anatomy may not always appear at birth. Sometimes an individual isn?t found to have intersex anatomy until he or she reaches puberty: he or she may have a body that does not spontaneously go through puberty or one that shows signs of puberty many years ahead of what's considered the normal schedule. Other intersexed individuals may experience pubertal changes usually associated with the opposite sex or they may experience some of the pubertal changes of both sexes.

It's not uncommon for parents of a child born with genital ambiguity to have fears and concerns about their child's healthy future. They may fear their child will grow up to be lesbian or gay, or they may feel their child will be marginalized or otherwise adversely affected on account of being different.

So do parents have their children "changed"?

Actually, yes. Some do.

In the late 1950s, because medical practice was centered on the idea that sexual ambiguity is shameful and must therefore be concealed or "erased", it became common practice to subject intersexed children to surgeries and hormone treatments to ensure the child would be viewed as clearly male or female. These procedures were intended to make the child's genitals look more "normal".

Not medically necessary and based largely on social prejudice, these interventions subject intersexed individuals to disapproving medical attention to their bodies. Repeated exposure to public gaze and having their naked bodies poked and prodded by doctors and medical students alike is sometimes referred to a "public stripping" and the attitude among the medical community that sexual ambiguity is shameful and freakish can seriously undermine self-esteem.

What's more, an increased number of follow-up studies shows that medical interventions are detrimental to emotional and sexual functioning. Occasionally, a person's gender will turn out to be the opposite of their surgically determined sex. Other intersexed people have difficulty accepting their surgically altered genitalia. Let's face it, even today, surgeons cannot create "normal" looking genitalia, let alone genitals that enable the individual to engage in "normal" intercourse. As such, intersexed people who have undergone gender reassignment surgeries as infants or children are sometimes unable to relate intimately with others: their genitalia are no more than surgically created sexual dysfunction. These effects have led a growing number of intersexed people to speak out against these interventions, calling them harmful and unethical.

There is also, luckily, a growing current within the medical community to reconsider the surgical concealment of intersex anatomy on those too young to give informed consent. This is because genital "normalizing" surgery does not create a gender identity. It simply removes tissue the individual may want later.

Any child, regardless of whether he or she is intersexed, may decide later that he or she was given the wrong gender assignment and may want genitals—either the ones he or she was born with or surgically constructed anatomy different from what doctors may have chosen. Because surgically constructed genitals are impossible to "undo", intersex children altered at birth or in infancy are, essentially, "stuck" with what surgeons construct for them.

So how can you assign a gender without surgery?

Following diagnostic work-up in which hormonal, genetic, and radiological tests have been done, infants with intersex should be given a gender assignment—boy or girl—based on which of those genders the individual is more likely to feel as he or she grows up. Children should not be classed or raised as "third gender" or "intersex" because not only will this be traumatic to the child, the term "intersex" is not—and will never be—a discreet or natural category. It is, instead, as much a label created out of social necessity as "male" and "female". Thus, assigning a gender is assigning a label—boy or girl. And you don't need a surgeon for that.