Understanding Intersex Individuals: Beyond Genital Differences and Beyond Discrimination

Introduction

Intersex individuals are often born with a variety of seemingly normal traits, such as ten fingers, ten toes, two arms, and a head and a heart. However, the term 'intersex' is far more complex and encompassing, representing a wide range of over a dozen medical conditions that can result in varied physical characteristics. This article aims to provide a comprehensive understanding of intersex individuals, highlighting key aspects including their medical conditions, fertility, and the societal challenges they face.

A Variety of Intersex Conditions

Intersex is an umbrella term that encompasses a wide range of medical conditions. Unlike conditions such as Polycystic Ovarian Syndrome (PCOS), Mild Androgen Insensitivity Syndrome (MAIS), or Hypogonadism, which can present characteristics of the opposite sex, they do not necessarily lead to an intersex diagnosis. These conditions, while different from each other, represent variations in sex development and do not consistently present in the same way.

Polycystic Ovarian Syndrome (PCOS)

PCOS is an example of a condition that affects female reproductive health but is not necessarily classified as intersex. PCOS can result in a higher likelihood of being born a lesbian or a trans man, but it does not always lead to an intersex diagnosis. Similar to other intersex conditions, PCOS highlights the complex interplay between hormones and physical traits, indicating how distinct these medical conditions can be.

Fertility and Medical Conditions in Intersex Individuals

Fertility Issues

Intersex individuals often face fertility challenges, a common element in their varied medical conditions. However, it is essential to note that many exceptions exist. For instance, some intersex women have given birth, even when doctors initially predicted they were infertile. Similarly, some intersex men have fathered children, demonstrating the variability in this aspect.

In the broader population, fertility issues are also quite common, suggesting that this is not solely a concern for intersex individuals. Over 11% of couples in the general population have difficulty conceiving, indicating that fertility challenges are not unique to intersex individuals.

Medical Conditions and Bullying

Bullying and Discrimination

Intersex individuals are at a higher risk of bullying at school and discrimination in adulthood due to not meeting rigid gender expectations. This can have serious repercussions, including early school leaving, unemployment, and poverty. Only eight countries currently have legal protections against discrimination for intersex individuals, leaving many without adequate support and protection.

In regions such as Africa and Asia, intersex infants are at a greater risk of infanticide or abandonment. In many other countries, there is widespread selective abortion leading to a reduced birth rate of intersex individuals.

Intersex and LGBTQ Population

Intersex people are more likely to be born LGBTQ than the general population, which is unsurprising given the complex interplay of gender and sexuality. However, the majority of intersex individuals are cisgender and heterosexual. The likelihood of being LGBTQ can vary based on specific intersex conditions, as seen in conditions like Hyperandrogenism, which can lead to a higher chance of being a lesbian or a trans man.

Genital Variations and Beyond

Genital Configurations

Intersex individuals are more likely to be born with ambiguous genitalia, making the assignment of sex at birth challenging. While some conditions can result in unique combinations like the presence of both a penis and a vagina, these are rare cases. Most intersex conditions result in variations that fall within the medical norms for male or female infant anatomy.

Rare Conditions

For some very rare conditions, like 5-alpha reductase deficiency, individuals are born with a vagina but develop a penis during puberty. Such rare conditions underscore the diversity of intersex individuals and the importance of personalized care and treatment.

Puberty and Diagnosis

Diagnosis at Puberty

For many intersex individuals, there is no sign of their intersex condition at birth. They only discover their condition later, often during puberty or when they attempt to have a baby. At this stage, testing for hormone levels, chromosomes, and internal anatomy often reveals the underlying medical condition.

Historically, many intersex children have undergone coercive cosmetic surgeries and hormone treatments to make them appear "normal," with a lack of informed consent. These practices should be illegal, but they remain common in many countries, raising important ethical and legal questions.

Conclusion

Understanding intersex individuals requires recognizing their diversity and the complex medical conditions that can affect their lives. Beyond genital differences, intersex individuals face significant societal challenges, including discrimination and limited legal protections. Education and awareness are crucial in addressing these issues and ensuring that intersex individuals receive the care and support they deserve.

Cosmetic Surgeries and Coercive Treatments

Throughout history, intersex individuals have often faced involuntary cosmetic surgeries and hormone treatments aimed at "normalized" them. While such practices were common, they were typically done without the patient's informed consent, and often under coercion. Today, such practices are increasingly scrutinized and, in some cases, banned legally. Only one country, Sweden, has outright banned these practices, making it a critical area of focus moving forward.

Ambiguous Genitalia

Ambiguous genitalia in infants can lead to complex decisions regarding sex assignment at birth. These decisions are often made based on medical advice, the desire for psychological gender consistency, and the expectations of cultural and societal norms. However, as understanding of intersex conditions evolves, the approach to managing and caring for intersex infants is also changing.

School Leaving and Employment

Early school leaving and employment discrimination among intersex individuals are significant issues that can contribute to poverty and social marginalization. While school leaving rates vary, intersex individuals face higher risks of leaving education prematurely due to bullying and systemic discrimination. In adulthood, these individuals often encounter significant obstacles in finding and maintaining employment, further highlighting the need for robust support systems and anti-discrimination policies.

The LGBTQ Spectrum and Intersex Individuals

Intersex individuals are more likely to identify as LGBTQ than the general population. This increased likelihood can be attributed to the complex interrelationship between sex and gender. For instance, PCOS, a condition primarily recognized in female reproductive health, can lead to a heightened risk of being born a lesbian or a trans man. However, the majority of intersex individuals are not part of the LGBTQ spectrum. This highlights the diversity within the intersex community and the importance of acknowledging individual experiences.