Intersex

Intersex pride flag

**Intersex** is an umbrella term for people who are born with or develop sex characteristics that differ from the binary notions of a "male" or "female" body. The dissimilarities between individuals in terms of their hormones, chromosomes, external and internal reproductive organs, or secondary sex characteristics are commonly referred to as variations. An individual's intersex traits may include variations in one or multiple of the aforementioned types. These variations can be noticed at birth or later in life.

## Etymology

The term "intersex" is comprised of "inter-", meaning "between", and "-sex". The term was coined in 1917 by geneticist Richard Goldschmidt, but it did not gain popularity until used by biologist Anne Fausto-Sterling in 1993.

## Community

> The word intersex also invokes a community. Intersex people are diverse, coming from all socioeconomic backgrounds, races, ethnicities, genders and orientations, faiths, and political ideologies. We are united by
> 1. our experiences living with variations in our sex traits,
> 2. the belief that these differences are a natural part of human diversity,
> 3. the idea that people deserve their own choices about their own bodies.
>
> interACT. FAQ: What is intersex?

According to the ISNA it is estimated that as many as 1.7% of individuals are born with intersex traits; however, cases of intersex people can be unreported or undiagnosed. Additionally, many people may be unaware of their intersex traits unless they receive genetic testing. Intersex people are not as uncommon as once believed; they have just been invisible until recent years. Intersex individuals may have any gender identity or gender expression.

Some examples of variations are:

* Complete or partial androgen insensitivity
* Congenital adrenal hyperplasia
* Hypospadias
* Klinefelter syndrome
* XY gonadal dysgenesis

After years of activist efforts, members of the hijra community in India gained legal recognition in 2014 as part of a third gender category. Aspects of the hijra identity can include wearing clothing and cosmetics that are considered feminine. Some intersex people are part of the hijra community.

#### Coercive gender assignments

Intersex people often are forced and coerced into undergoing surgery or hormone replacement due to binarist views of gender and sex. The surgeries are known as intersex genital mutilation (IGM), intersex surgeries, or normalization surgeries. These surgeries often happen to children below 2 years old. However, they also happen to older children, teens, and adults. These surgeries include ones which alter genitals that do not need surgery to function or removing organs that produce sex hormones. Health professionals may describe these surgeries to parents and patients as an emergency or necessity; many parents and patients are never fully informed on the negative health effects or given resources and insight from intersex people. The United Nations has stated nonconsensual and unnecessary surgeries for intersex people are human rights violations. They often cause reduced sexual function, reduced fertility, worse emotional well-being, and other complications. One study estimates that 8.5-20% intersex people may experience gender dysphoria in regard to their assigned gender and that these actions can cause mental suffering. Due to this and the prevalence of nonconsensual medical intervention, the fight for the bodily autonomy of intersex people is a main objective of intersex organizations and activists.

Some intersex people use the terms CAFAB/CAMAB – Coercively Assigned Female at Birth/Coercively Assigned Male at Birth due to being subjected to nonconsensual, unnecessary surgery. However, the terms are not exclusively used in this manner. A variety of experiences and relationships with assigned gender exists within these labels. The terminology is used by trans and cis intersex people alike.

In the second half of the 19th Century, surgeons in North America started offering cosmetic surgeries of genitals for those that did not meet the stereotypical "norm." However, most of these surgeries were performed on adults at their request. In the 1950s, Johns Hopkins University instead began a practice of performing pediatric surgeries on intersex children without consent. The practice was developed by psychologist John Money, who ignored evidence he collected in 1953 that showed intersex adults had relatively low rates of psychopathology. He decided intersex children would best develop into what he defined as "normal" through surgically imposing a "male" or "female" body in early childhood, hormone treatments, and raising them based on their coercive assignment. Surgeons "corrected" intersex children's bodies by surgically altering their genitals into either stereotypically male or female. Because surgeons considered it more difficult to perform operations that made a child "male," most intersex children were forcibly assigned female through the procedures. The children could not give consent, and their parents often were not consulted.

Money based his theory about intersex children based on the infamous "John/Joan case" involving David Reimer, who was assigned male at birth in 1965 and was not intersex. When Reimer was eight months old, his genitals were damaged by a circumcision. Johns Hopkins University staff and Reimer's parents concluded that it would be easiest to raise their child as female. Money declared it had worked, as he believed Reimer developed into a "normal" girl and later woman. However, Reimer's parents told him the truth many years later, saying that David Reimer had never felt fully female.

Until late 20th century, being intersex still meant being forcefully assigned to male or female and not being fully recognized in North America and Europe. "Normalization surgery" for intersex children was standard practice. In 1993, biologist Anne Fausto-Sterling published articles in The Sciences and The New York Times and stated that intersex people exist. Scientists and authors such as historian and bioethicist Alice Dreger, social psychologist Suzanne Kessler, and aforementioned Anne Fausto-Sterling started publishing more works on the topic. Organizations such as ISNA and interACT were founded in the 1990s and 2000s.

#### Medical advocacy

The era of thorough medical research of intersexuality and advocacy for intersex people began in 1993. More healthcare professionals started recognizing modern data and adjusted their standards to help intersex patients. However, it took a decade more to start banning the harmful practice of "intersex surgery" on children. Malta became the first country to ban non-consensual "normalization" surgery on minors in 2015. Chile passed legislation banning it in 2017. California became the first US state to condemn nonconsensual surgeries on intersex children in 2018.

In 2019, more than 50 intersex advocate organizations signed a joint statement in multiple languages that condemns the introduction of "disorders of sex development" language into the 11th Revision of the International Classification of Diseases (ICD-11). In the statement, organizations state that in some cases, the guidelines associated with ICD-11 codes require unnecessary surgeries or other procedures that are not lifesaving, often performed on children without their consent and are grounded in gender stereotypes. The intersex advocate organizations called on the World Health Organization to reform their approach.

### Flag

The intersex flag was created by Morgan Carpenter from Intersex Human Rights Australia (IHRA, previously Organisation Intersex International Australia or OII Australia) in July 2013. The organization aimed to create a symbol that was unique--one that did not derive from existing flags, and one without pink and blue (which tend to be perceived as gendered). In Carpenter's words, the circle was chosen because it "is unbroken and unornamented, symbolising wholeness and completeness, and our potentialities. We are still fighting for bodily autonomy and genital integrity, and this symbolises the right to be who and how we want to be."

An older version of the intersex flag was created by Natalie Phox on 11 August 2010, and posted to Wikimedia. The blue and pink gradient in the middle represents "the range of sexes between male and female", while the lavender color on the top and bottom of the flag represents "a combination of male and female traits". The flag was erroneously posted as a bigender flag, but the author clarified later on that they meant bigender as in "mixed sex characteristics, not gender", which is closer to the definition of intersex. Unfortunately due to being mistakenly labeled as a "bigender" design, this flag was also used as a bigender flag for some time.

Overall, the flag created by Morgan Carpenter has seen more recognition and use than the design by Natalie Phox. For example, the Carpenter design was used in combination with the pride progress flag to create an intersex-inclusive version of the progress flag. This design was first published on June 6, 2021.

### Perceptions and discrimination

From a medical perspective, the growing consensus among health care professionals is that intersex characteristics are part of natural human diversity. However, intersex people still face discrimination and misunderstanding in healthcare, often due to healthcare professionals failing to update their knowledge and causing harm regardless of their intentions.

### Controversy

Modern scientific understandings of intersex traits have proven that none of the forms of hermaphroditism found in other species apply to humans. While many animal species are described scientifically as "hermaphrodites", using the term to describe intersex humans is offensive and is considered a slur.

#### Adding the I

The movement to include the letter "I" for "intersex" in the acronym LGBTQIA+ is met with both support and hesitance from the intersex community. One reason people support including the "I" in the LGBTQIA+ acronym is the direct similarities of erasure of the queer community societally and in psychiatry. In addition, Western medicine and surgical treatments is heavily motivated by homophobia, transphobia, misogyny, and sexism, all of which are also experienced by people who want to transition. Both communities still fight for the right to not have their bodies 'rectified' or 'fixed'.

The criticism for the adding the "I" is a fear that the inclusion gives the impression that being intersex is inherently queer, or implies that intersex individuals are lesbian, gay, bisexual, and/or transgender or another queer label. This argument stems from the false premise that intersex falls under the umbrella term of transgender, despite the two not being related. Additionally, being intersex refers to biological features and is not a gender identity, which is another common motivator for the exclusion of the "I".

While some intersex people do identify as one or more of the LGBTQIA+ identities, there is a concern that the association with LGBT may drive away parents of intersex children who seek out information. Another critique is the conflation between LGBT and intersex, as being combined with LGBT may make it harder for intersex people to gain visibility on their own. Searching the terms "LGBTI" brings an overwhelming about of resources for LGBT-specific issues, with little to mention of issues pertaining to intersex people. Another concern is the inclusion of the "I" being used only for tokenism and not actually furthering the development of research or resources for the intersex community.

## Media

### Literature

* *None of the Above* by I.W. Gregorio in 2015, which features an intersex protagonist
* *Born Both: An Intersex Life* by Hida Viloria, an autobiography about Hida's life as an intersex person

### Film

* *XXY*, released in 2007 which features an intersex protagonist

### Television

* Lauren Cooper in *Faking It* is an intersex person. The character was written after consulting multiple interACT members

### Music

* Raven van Dorst is an intersex rock artist from the Netherlands.

## Resources

* Intersex Support and Advocacy Groups
* interACT
* Intersex Human Rights International
* Organisation Intersex International
* Intersex Society of North America

## References

1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 interACT: "FAQ: What is intersex?". interactadvocates.org.
2. ↑ 2.0 2.1 United Nations for LGBT Equality: "United Nations FACT SHEET Intersex" [PDF]. unfe.org.
Goldschmidt, Richard. "Vorläufige Mitteilung über weitere Versuche zur Vererbung und Bestimmung des Geschlechts.". *Biologisches Centralblatt*. German. (web archive)
4. ↑ 4.0 4.1 Fausto-Sterling, Anne: "The Five Sexes: Why Male and Female are not Enough". researchgate.net.
5. ↑ ISNA: "Frequency". isna.org.
6. ↑ InterAct: "Intersex 101: Everything You Want to Know!". live-interact-advocates.pantheonsite.io.
7. ↑ Intersex Campaign for Equality: "Who is intersex?". intersexequality.com.
8. ↑ "India's Third Gender Rises Again". sapiens.org.
9. ↑ 9.0 9.1 Re-Thinking Genital Surgeries on Intersex Infants
10. ↑ United Nations Human Rights Council, 48th session: "Joint Statement on the Human Rights of Intersex Persons". bmeia.gv.at.
11. ↑ Gender dysphoria associated with disorders of sex development
12. ↑ The human rights of intersex people: addressing harmful practices and rhetoric of change
13. ↑ The "Normalization" of Intersex Bodies and "Othering" of Intersex Identities in Australia
14. ↑ "Word of the Week: AFAB/AMAB, Variations". glbtrt.ala.org.
15. ↑ 15.0 15.1 15.2 15.3 ISNA: "What's the history behind the intersex rights movement?". isna.org.
16. ↑ Gender Identity, Gender Expression And Sex Characteristics Act
17. ↑ Circular 7 de 2016: UN PASO ATRÁS EN LA LUCHA POR LOS DERECHOS HUMANOS DE LAS PERSONAS INTERSEXUALES EN CHILE.
18. ↑ Senate Concurrent Resolution No. 110
19. ↑ Joint statement on the International Classification of Diseases 11
20. ↑ Morgan Carpenter: "An intersex flag" (2013-04-05). oii.org.au. (Archived on March 11, 2022).
21. ↑ "Intersex Flag, Natalie Phox". majesticmess.com. (Archived on December 3, 2021).
22. ↑ "ok, I’m getting tired of explaining this…" (2014-07-07). actuallyintersex.tumblr.com. (Archived on December 20, 2018).
23. ↑ "Intersex (1)" (2015-07-04). deviantart.com. (Archived on March 1, 2021).
24. ↑ Shar Jossell: "The Progress Pride Flag Is Getting an Intersex-Inclusive Makeover" (2021-06-08). them.us. (Archived on March 25, 2022).
25. ↑ Pediatric Gender Assignment: A Critical Reappraisal.
26. ↑ Health Care Professionals and Intersex Conditions
27. ↑ Ethical principles and recommendations for the medical management of differences of sex development (DSD)/intersex in children and adolescents
28. ↑ Diamond, Milton and Sigmundson, H. Keith: "Management of Intersexuality: Guidelines for Dealing With Persons With Ambiguous Genitalia". jamanetwork.com.
29. ↑ 29.0 29.1 "Is a person who is intersex a hermaphrodite?". isna.org. (Archived on January 25, 2022).
30. ↑ Diamond, Milton: "Intersexuality" (May 15, 2010). hawaii.edu. University of Hawaii. (Archived on January 23, 2022).
31. ↑ 31.0 31.1 31.2 31.3 Emi Koyama, Intersex Initiative: "Adding the "I": Does Intersex Belong in the LGBT Movement?". intersexinitiative.org.
32. ↑ 32.0 32.1 32.2 Angela Mascolo: "Should intersex people be included in the LGBT community?" (2020-02-04). exposure.org.uk.
33. ↑ Amnesty International: "Intersex Rights". amnesty.org.
34. ↑ I.W. Gregorio. *None of the Above*. Balzer + Bray, 07-04-2015. ISBN 978-0062335319.
35. ↑ Modi, Chintan Girish: "None of the Above's compassionate telling of an intersex individual's story trumps its author's cis privilege" (13-01-2020). firstpost.com. Firstpost. (Archived on January 17, 2021).
36. ↑ Viloria, Hida. *Born Both: An Intersex Life*. Hachette Books, 14-03-2017. ISBN 978-0316347846.
37. ↑ "Born both : an intersex life, Hida Viloria". link.umsl.edu. University of Missouri-St. Louis Libraries. (Archived on October 24, 2021).
38. ↑ "XXY (2007)". imdb.com. IMDb (Internet Movie Database). (Archived on October 1, 2022).
39. ↑ French, Phillip: "XXY | Movies" (10-05-2008). theguardian.com. The Guardian. (Archived on January 18, 2021).
40. ↑ Intersex Inclusion in Popular Media
41. ↑ ravenvandorst: "Raven van Dorst on Instagram" (05-05-2021) [Dutch]. instagram.com. "Translation: 'A few years ago I freed myself from the taboo surrounding my hermaphrodite and made the program 'Gender!' for BNNVARA. That was a huge relief: it felt good to finally say it out loud and the reactions that followed were heartwarming, for which my thanks are still very great!'" (Archived on October 8, 2022).
42. ↑ "COC kroont op 75e verjaardag nieuwe generatie activisten en rolmodellen" (07-12-2021) [Dutch]. coc.nl. "Translation of Raven van Dorst's profile in the article: 'as a programme maker, TV personality and openly intersex person, he makes short work of stereotypes about 'masculinity' and 'femininity' in a witty and completely unique way.'" (Archived on January 19, 2022).