It is Pride month, and I’m pretty sure that the pride flag redesigned to include intersex people in the movement would have caught everyone’s attention. Yet, there is a long way to go before achieving a completely inclusive society for them. Intersex people are born with variations in sex characteristics due to which they do no fit into the conventional definitions of male and female bodies. The differences could be in gonads, hormone levels, external genitalia, secondary sexual characteristics, etc. The number of newborns being reported as intersex varies depending on the definition of intersex the medical practitioner chooses to adopt. In many cases, the identification of intersex traits occurs after or during puberty. Mostly, the sex of a newborn is determined by the external genitalia. Ambiguity in genitalia, karyotype display of a tissue sample, hormone stimulation tests, and endoscopic exams are a few ways to identify intersex individuals.
There is a complex interplay of hormones, genetics and external factors during the gestation period that leads to the development of sex organs in the foetus. An uncommon change in this process could lead to the child being born as an intersex individual. Currently, there are four categories of intersex [1]
- 46, XX intersex - 46, XX intersex people possess XX chromosomes, internal female genitalia and ovaries. Yet, externally they possess a fused labia and an enlarged clitoris that appears like a penis. This occurs when the growing foetus is exposed to androgens during the gestation period. Aromatase enzyme converts male sex hormones to female sex hormones, so its deficiency could also lead to a 46, XX intersex foetus.
- 46, XY intersex- 46, XY intersex people possess XY chromosomes and underdeveloped, ambiguous or clearly female external genitalia. Androgen insensitivity syndrome (inability of the cells to respond to androgens) is the main cause for 46 XY intersex.
- True gonadal intersex- True gonadal intersex is an infrequent occurrence. This occurs when a person has both ovarian and testicular tissue with ambiguous, male or female external genitalia. The person may possess either XY or XX chromosomes.
- Complex or undetermined intersex- Any other chromosome arrangement (for example, XXY, XXX), and genetic or hormonal factors that are not covered by the categories mentioned above fall under the category of complex or undetermined intersex [2]. Usually, in this case, the changes are observed in the hormone levels, secondary sexual traits, chromosome numbers, etc.
[TW: This paragraph mentions obsolete terms often used in a derogatory manner.]
The terms that are used to describe intersex people are constantly being questioned and altered. Initially, demeaning terms like ‘congenital eunuchs’, ‘hermaphrodites’ were widely used. In fact, the term hermaphrodite describes an organism that produces both male and female gametes and is a stigmatizing, misleading and inaccurate way of describing intersex people.
[TW: This paragraph mentions medical procedures that can be disturbing.]
Intersex people possess inherent differences in their anatomies, and because of this, they face stigmatization and discrimination. People born with visible intersex traits like ambiguous genitalia face abandonment, infanticide and unnecessary medical intervention. Most medical practitioners view these traits as defects and proceed with their attempts to ‘fix’ them. Surgeries to remove reproductive organs, altering the external genitalia, and prepubescent hormone therapy could traumatize intersex children. Sometimes children could be surgically assigned the sex that does not conform to their gender identity. Surgeries to alter the genitals come with long-lasting effects like incontinence, loss of sexual feeling and distress. These surgeries must be left to a consenting person’s choice. In 2015, Malta became the first country to outlaw such medical interventions in children until they are old enough to consent [3]. It is hard for intersex people to access healthcare with dignity. Usually, intersex people born with ambiguous genitalia are forced to undergo repeated genital examinations, and the photographs of their genitalia get circulated among the medical fraternity. This makes them feel powerless and humiliated. The bodily autonomy of intersex people gets violated easily under the current medical setting. They also face discrimination while obtaining legal documents that require them to specify their gender. In sports, women who are perceived to have intersex traits face humiliation and trials by the media [4]. Lack of inclusive medical practices, language, and school curricula make it hard for them to feel included and accepted in society.
The issues faced by intersex people have not gained as much visibility as that of the rest of the LGBT+ community [5]. Normalizing the diversity in body, enforcing strict laws against discrimination, funding research to understand the body diversity, inclusive curriculum and medical practices can go a long way in creating an inclusive and safe environment for intersex people.
-Vishwathiga B’19
