- Intersexuality
Intersexuality is the state of a living thing of a gonochoristic species whose
sex chromosomes ,genitalia , and/orsecondary sex characteristic s are determined to be neither exclusivelymale norfemale . An organism with intersex may have biological characteristics of both the male and female sexes. [ http://www.plantpath.cornell.edu/glossary/Defs_I.htm On-Line Glossary of Technical Terms in Plant Pathology]Intersexuality is the term adopted by medicine during the 20th century applied to human beings who cannot be classified as either male or female. [cite book |last=Marañón |first=Gregorio |title=Los estados intersexuales en la especie humana |year=1929 |publisher=Morata |location=Madrid ] [cite book |last=Money |first=John |coauthors=Ehrhardt, Anke A. |title=Man & Woman Boy & Girl. Differentiation and dimorphism of gender identity from conception to maturity |year=1972 |publisher=The Johns Hopkins University Press |location=USA ] [cite book |last=Domurat Dreger |first=Alice |title=Hermaphrodites and the Medical Invention of Sex |year=2001 |publisher=Harvard University Press |location=USA ]
Intersexuality is also the word adopted by the identitary-political movement, to criticize medical protocols in sex assignment and to claim the right to be heard in the construction of a new one. [ [http://www.isna.org/ Intersex Society of North America | A world free of shame, secrecy, and unwanted genital surgery ] ]
Language
Research in the late twentieth century has led to a growing medical consensus that diverse intersex physicalities are normal, but relatively rare, forms of human biology. Perhaps the most prominent researcher,
Milton Diamond , stresses the importance of care in selection of language related to intersexuality.cquote|Foremost, we advocate use of the terms "typical," "usual," or "most frequent" where it is more common to use the term "normal." When possible avoid expressions like maldeveloped or undeveloped, errors of development, defective genitals, abnormal, or mistakes of nature. Emphasize that all of these conditions are biologically understandable while they are statistically uncommon.cite journal
last=Diamond
first=Milton
authorlink=Milton Diamond
coauthors=H. Keith Sigmundson
title=Management of intersexuality: Guidelines for dealing with individuals with ambiguous genitalia.
journal=Archives of Pediatrics and Adolescent Medicine
volume=June
issue=
pages=
publisher=
date= 1997
url=http://www.hawaii.edu/PCSS/online_artcls/intersex/apam.html
doi=
id=
accessdate=2007-04-08 ]Nomenclature
Hermaphrodite
The terms "
hermaphrodite " and "pseudohermaphrodite", introduced in the 19th century, are now considered problematic as hermaphrodism refers to people who are both completely male and completely female, something not possible.Intersex Society of North America (May 24 ,2006 ). [http://www.isna.org/faq/hermaphrodite Is a person who is intersex a hermaphrodite?] Retrieved25 November ,2006 .] The phrase '"ambiguous genitalia'" refers specifically to genital appearance, but not all intersex conditions result in atypical genital appearance.Intersex Society of North America (May 24 ,2006 ). [http://www.isna.org/faq/ambiguous Is intersex the same as "Ambiguous genitalia"?] Retrieved25 November ,2006 .]Disorders of sex development
The
Intersex Society of North America and intersex activists have moved to eliminate the term "intersex" in medical usage, replacing it with "disorders of sex development" (DSD) in order to avoid conflating anatomy with identity.Intersex Society of North America (May 24 ,2006 ). [http://www.isna.org/node/1066 Why is ISNA using "DSD"?] RetrievedJune 4 ,2006 .] Members of The Lawson WilkinsPediatric Endocrine Society [http://www.lwpes.org/ LWPES] and the European Society for Paediatric Endocrinology [http://www.eurospe.org/ ESPE] accepted this term in their "Consensus statement on management of intersex disorders" published in the Archives of Disease in ChildrenHughes IA, Houk C, Ahmed SF, Lee PA; LWPES Consensus Group; ESPE Consensus Group. Consensus statement on management of intersex disorders. "Arch Dis Child." 2006 July;91(7):554-63. Epub 2006 April 19.] and in Pediatrics.Lee, P. A., C. P. Houk, S. F. Ahmed, and I. A. Hughes. 2006. Consensus statement on management of intersex disorders. Pediatrics 118 (2):e488-500. http://pediatrics.aappublications.org/cgi/reprint/118/2/e488]The term is defined by congenital conditions in which development of chromosomal, gonadal, or anatomical sex is atypical. However, this has been met with criticism from other activists who question a disease/disability model and advocate no legal definition of sexes, no gender assignments, no legal sex on birth certificates, and no official sexual orientation categories.French-speaking Intersex Network of Europe (
July 12 ,2005 ). [http://www.webglaz.ch/rife/eng-faq.html Frequently Asked Questions.] Translated from French-speaking by OII. Retrieved June 4, 2006.] Alternatives to labeling these as "disorders" have also been suggested, including "variations of sex development".Diamond M, Beh HG (27 July 2006 ). [http://adc.bmjjournals.com/cgi/eletters/91/7/554#2460 Variations of Sex Development Instead of Disorders of Sex Development.] " Arch Dis Child"]Intersex people in society
History
Intersex individuals are treated in different ways by different cultures. In some cultures intersex people were included in larger "
third gender " or gender-blending social roles along with other individuals. In most societies, intersexed individuals have been expected to conform to either a male or femalegender role . [Gagnon and Simon 1973]Whether or not they were socially tolerated or accepted by any particular culture, the existence of intersex people was known to many ancient and pre-modern cultures.
As an example, one of the
Sumer iancreation myth s from more than 4,000 years ago hasNinmah , amother goddess , fashioning mankind out of clay.cite web |url=http://etcsl.orinst.ox.ac.uk/cgi-bin/etcsl.cgi?text=t.1.1.2# |title=The Electronic Text Corpus of Sumerian Literature |accessdate=2007-12-09 |format= |work=] She boasts that she will determine the fate – good or bad – for all she fashions.Enki , the father god, retorts as follows.:Enki answered Ninmah: "I will counterbalance whatever fate -- good or bad -- you happen to decide." Ninmah took clay from the top of the "abzu" [ab = water, zu = far] in her hand and she fashioned from it first a man who could not bend his outstretched weak hands. Enki looked at the man who cannot bend his outstretched weak hands, and decreed his fate: he appointed him as a servant of the king.
:... [Three men and one woman with atypical biology are formed and Enki gives each of them various forms of status to ensure respect for their uniqueness] ...
: Sixth, she fashioned one with neither penis nor vagina on its body. Enki looked at the one with neither penis nor vagina on its body and gave it the name "Nibru" [eunuch(?)] , and decreed as its fate to stand before the king."
Since the rise of modern medical science in Western societies, some intersex people with ambiguous external genitalia have had their genitalia surgically modified to resemble either male or female genitals. Ironically since the advancements in surgery have made it possible for intersex conditions to be concealed, many people are not aware of how frequently intersex conditions arise in human beings or that they occur at all. ["Ambiguous Sex"--or Ambivalent Medicine? by Alice Domurat Dreger, published in The Hastings Center Report May/Jun 1998, Volume 28, Issue 3 Pages 24-35.] Contemporary social activists, scientists and health practitioners, among others, have begun to revisit the issue, and awareness of the existence of physical sexual variation in human beings is returning.
There are increasing calls for recognition of the various degrees of intersex as healthy variations which should not be subject to correction. Some have attacked the common Western practice of performing corrective surgery on the genitals of intersex people as a Western cultural equivalent of
female genital cutting . Despite the attacks on the practice, most of the medical profession still supports it, although activism has radically altered medical policies and how intersex patients and their families are treated. [Richard Ekins, Male Femaling: A Grounded Theory Approach to Cross-dressing and Sex-changing. New York: Routledge 1997, Page 55-M] [Marjorie Garber, Vested Interests: Crossdressing and Cultural Anxiety. New York: Routledge 1992, Page 101] Others, typicallysocial conservatives , have claimed that the talk about third sexes represents an ideological agenda to deride gender as asocial construct whereas they believebinary gender (i.e. there is only male and female) is abiological imperative . [Sex and Gender are Different: Sexual Identity and Gender Identity are Different, by Milton Diamond, Ph.D., published in Clinical Child Psychology & Psychiatry - Special Issue In Press for July 2002.]Depending on the type of intersex condition, corrective surgery may not be necessary for protection of life or health, but purely for aesthetic or social purposes. Unlike other aesthetic surgical procedures performed on infants, such as corrective surgery for a
cleft lip (as opposed to acleft palate ), genital surgery may lead to negative consequences for sexual functioning in later life (such as loss of sensation in the genitals, for example, when aclitoris deemed too large/penile is reduced/removed, or feelings of freakishness and unacceptability) which would have been avoided without the surgery; in other cases negative consequences may be avoided with surgery. Opponents maintain that there is no compelling evidence that the presumed social benefits of such "normalizing" surgery outweigh the potential costs.Intersex Society of North America (May 24, 2006). [http://www.isna.org/faq/healthy What evidence is there that you can grow up psychologically healthy with intersex genitals (without "normalizing" surgeries)?] Retrieved 25 November, 2006.] (Similar attitudes are present in some cases of botched infantcircumcision , in which the solution might involve intensive medical and parental efforts to reassign the male baby to a female identity, which opponents claim lead to the degrading interpretation that females are essentially castrated males. This view overlooks the embryological origin of the penis/clitoris.) Defenders of the practice argue that it is necessary for individuals to be clearly identified as male or female in order for them to function socially. However, many intersex individuals have resented the medical intervention, and some have been so discontented with their surgically assigned gender as to opt forsexual reassignment surgery later in life.During the
Victorian era , medical authors introduced the terms "true hermaphrodite" for an individual who has both ovarian and testiculargonadal histology , verified under a microscope, "male pseudo-hermaphrodite" for a person with testicular tissue, but either female or ambiguous sexual anatomy, and "female pseudo-hermaphrodite" for a person with ovarian tissue, but either male or ambiguous sexual anatomy. The writerAnne Fausto-Sterling coined the words "herm" (for "true hermaphrodite"), "merm" (for "male pseudo-hermaphrodite"), and "ferm" (for "female pseudo-hermaphrodite"), and proposed that these be recognized as sexes along with male and female. However, her use was "tongue-in-cheek"; she no longer advocates these terms even as a rhetorical device, and her proposed nomenclature was criticized by Cheryl Chase, in a letter to "The Sciences " which criticized the traditional standard of medical care as well as Fausto-Sterling's shorter names, and announced the creation of theIntersex Society of North America .Intersex in popular culture
Beginning as early as 1989, intersex became a topic of interest for broadcast TV and radio in the United States and other countries.
Jeffrey Eugenides ' novel "Middlesex" (2002) is narrated by an intersex character who discusses the societal experience of an intersex person.cite book |author=Eugenides, Jeffrey |title=Middlesex |publisher=Farrar, Straus, and Giroux |location=New York |year=2002 |pages= |isbn=0-374-19969-8 |oclc= |doi=] The Japanese manga series "I.S.", first published in 2003, features intersexual characters and how they deal with intersex-related issues and influence the lives of people around them.Notable intersex people
*
Cheryl Chase (activist) , intersex activist
*Erik Schinegger , alpine skier [Intersex: Case studies. Issue 15 of Cosmos, June 2007 by David Salt and Zoe Brain]
*Jim Sinclair [Sinclair, Jim (1997). [http://web.syr.edu/~jisincla/brief_bio.htm Self-introduction to the Intersex Society of North America.] Jim Sinclair's personal website. Retrieved on2007-12-02 ]
*Lady Colin Campbell , British aristocrat and author of "Guide to Being a Modern Lady" ["A very unladylike lady!" by Jenny Johnson "Daily Mail " 10 January 2008]
*Edinanci Silva , judoka and Gold medalist in the woman's half-heavyweight division at the Pan-American games. [ [http://www.guardian.co.uk/sport/2008/jul/30/olympicgames2008.gender The gender trap] ]
*Dawn Langley Simmons , American Author
*Alexis Arquette , American ActressNoted researchers on intersexed development
*
Milton Diamond , professor of neurology, Univ. of Hawai'i at Manoa
*Anne Fausto-Sterling Intersex organizations
* AIS Support Group UK & International
* AIS Support Group Australia
* Intersex Trust Aotearoa New Zealand (ITANZ)
*Organisation Intersex International Response from society
Lack in education
In high school, most emphasis is placed upon the most common XX and XY genotypes. Thus, people nowadays may be more likely to look towards the sex chromosomes than, for example, the histology of the gonads. However, according to researcher Eric Vilain at the
University of California, Los Angeles , "the biology of gender is far more complicated than XX or XY chromosomes". [ [http://www.eurekalert.org/pub_releases/2005-02/dnnl-dma020305.php Defining male and female ] ] Many different criteria have been proposed, and there is little consensus.ISNA. [http://www.isna.org/faq/what_is_intersex "What is intersex?"] ]Disorders and scope
Sax's strict definition of intersex is most relevant to family practice and psychological research. Other interest groups serve different communities and concerns and so broaden the definition of intersex in these fields.
For instance, the
Intersex Society of North America (ISNA) definition states that the following conditions "sometimes involve intersex anatomy":cite web |url=http://www.isna.org/faq/conditions |title=Intersex conditions | Intersex Society of North America |accessdate=2007-12-08 |format= |work=]*
5-alpha reductase deficiency
*androgen insensitivity syndrome
*aphallia
*clitoromegaly
*congenital adrenal hyperplasia
*gonadal dysgenesis (partial & complete)
*hypospadias
*Kallmann syndrome
*Klinefelter syndrome
*micropenis
*mosaicism involvingsex chromosomes
* MRKH (Müllerian agenesis ; vaginal agenesis; congenital absence of vagina)
*ovo-testes (formerly called "true hermaphroditism ")
*partial androgen insensitivity syndrome
*progestin-induced virilization
*Swyer syndrome
*Turner syndrome Some people with some of these conditions (such as
Kallmann syndrome and Turner syndrome) do not self-identify as intersex.Fact|date=December 2007 See also17-beta-hydroxysteroid dehydrogenase deficiency .Prevalence
The prevalence of intersex depends on which definition is used.
According to the ISNA definition above, 1 percent of live births exhibit some degree of sexual ambiguity, approximately one in every hundred births. [http://www.isna.org/faq/frequency How common is intersex? | Intersex Society of North America ] ] Between 0.1% and 0.2% of live births are ambiguous enough to become the subject of specialist medical attention, including
surgery to disguise their sexual ambiguity.According to Fausto-Sterling's definition of intersex, on the other hand, 1.7 percent of human births are intersex. She writes,cquote|While male and female stand on the extreme ends of a biological continuum, there are many bodies [...] that evidently mix together anatomical components conventionally attributed to both males and females. The implications of my argument for a sexual continuum are profound. If nature really offers us more than two sexes, then it follows that our current notions of masculinity and femininity are cultural conceits. [...] Modern surgical techniques help maintain the two-sex system. Today children who are born "either/or-neither/both" — a fairly common phenomenon — usually disappear from view because doctors "correct" them right away with surgery.cite book
last=Fausto-Sterling
first=Anne
authorlink=Anne Fausto-Sterling
coauthors=
title=Sexing the Body: Gender Politics and the Construction of Sexuality
publisher=Basic Books
date=2000
location=New York
pages=
url=
doi=
id= ] |According to Leonard Sax the prevalence of intersex "restricted to those conditions in which chromosomal sex is inconsistent with phenotypic sex, or in which the phenotype is not classifiable as either male or female" is about 0.018%.cite journal
last=Sax
first=Leonard
authorlink=Leonard Sax
coauthors=
title=How common is intersex? a response to Anne Fausto-Sterling.
journal=Journal of Sex Research
volume=39
issue=3
pages=174–178
publisher=
date= 2002
url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12476264&dopt=Abstract
doi=
id=
accessdate=2007-04-08 ]igns
Ambiguous genitalia
Ambiguous genitalia appear as a large clitoris or small penis and may or may not require surgery.
Because there is variation in all of the processes of the development of the sex organs, a child can be born with a
sexual anatomy that is typically female, or feminine in appearance with a larger than averageclitoris (clitoral hypertrophy ); or typically male, masculine in appearance with a smaller than averagepenis that is open along the underside. The appearance may be quite ambiguous, describable as female genitals with a very large clitoris and partially fused labia, or as male genitals with a very small penis, completely open along the midline ("hypospadic "), and empty scrotum.Fertility is variable. According to some, [W. S. Alexander M.D., O. D. Beresford M.D,. M.R.C.P. (1953) wrote about extensively about 'female pseudohermaphrodite' origins in utera, in his paper MASCULINIZATION OF OVARIAN ORIGIN, published An International Journal of Obstetrics and Gynaecology Volume 60 Issue 2 Page 252-258, April 1953.] [ Am J Psychiatry 164:1499-1505, October 2007: Noted Mayo Clinic researchers J.M. Bostwick, MD.. and Kari A Martin MD in A Man's Brain in an Ambiguous Body: A Case of Mistaken Gender wrote of the distinctions in male pseudohermaphrodite condition.] the distinctions "male pseudohermaphrodite", "female pseudohermaphrodite" and especially "true hermaphrodite" [Molina B Dayal, MD, MPH, Assistant Professor, Fertility and IVF Center, Division of Reproductive Endocrinology and Infertility, Medical Faculty Associates, George Washington University distingquishes what 'true hermaphroditism' encompases in their study of Ovotestis. Found here: http://www.emedicine.com/med/TOPIC1702.HTM] are vestiges of 19th century thinking. According to others, the terms "male pseudohermaphrodite", and "female pseudohermaphrodite" are used to define the gender in terms of the
histology (microscopic appearance) of thegonad s.cite book |author=Langman, Jan; Thomas Sadler |title=Langman's medical embryology |publisher=Lippincott Williams & Wilkins |location=Hagerstown, MD |year=2006 |pages=252 |isbn=0-7817-9485-4 |oclc= |doi=]"True hermaphroditism"
With some conditions of intersex, even the chromosomal sex may not be clear. A "
true hermaphrodite " is defined as someone with both male gonadal tissue (testes) and female gonadal tissue (ovarian tissue).In 2004, researchers at
UCLA published their studies of a lateral gynandromorphic hermaphroditic bird, which had a testicle on the right and an ovary on the left. Its entire body was split down the middle between male and female, with hormones from both gonads running through the blood. cite book
last=Sax
first=Leonard
authorlink=Leonard Sax
coauthors=
title=Why Gender Matters: What Parents and Teachers Need to Know About the Emerging Science of Sex Differences
publisher=Doubleday
date=2005
location=New York
pages=
url=http://whygendermatters.com
doi=
id= ]This extreme example of hermaphroditism is quite rare.
Ovotestes
Although there are no definite reports on any true hermaphroditism in humans, there is, on the other hand, a spectrum of forms of ovotestes. The varieties range, including having two ovotestes or having one ovary and one ovotestis. This is often in the form of
streak gonads . Phenotype is not determinable from the ovotestes; in some case the appearance is "fairly typically female," in others it is "fairly typically male," and it may also be "fairly in-between in terms of genital development."cite web |url=http://www.isna.org/faq/conditions/ovo-testes |title=ovo-testes (formerly called "true hermaphroditism") | Intersex Society of North America |accessdate=2007-12-09 |format= |work=]Intersex activist Cheryl Chase is an example of someone with ovotestes.Weil, Elizabeth (September, 2006). [http://www.nytimes.com/2006/09/24/magazine/24intersexkids.html What if It's (Sort of) a Boy and (Sort of) a Girl?] "
The New York Times Magazine "]Other diagnostic signs
In order to help in classification, other methods than a genitalia inspection can be performed:
For instance, a
karyotype display of a tissue sample may determine which of the causes of intersex is prevalent in the case.Management
Management of intersex can be categorized into one of the following two [ [http://jme.bmj.com/cgi/content/extract/26/5/413 Enhancing Human Traits: Ethical and Social Implications] Edited by Erik Parens, Washington DC, Georgetown University Press, 1998] :
# Treatments: Restore functionality (or potential functionality)
# Enhancements: Give the ability to identify with “mainstream” people e.g. breast enlargement surgeryHowever, there are other categorisation systems of management of intersexed, which falls into neither category. Holmes M. (2002). Rethinking the Meaning and Management of Intersexuality. Sexualities , 159-180."]
In any case, the most common procedure is surgery.
urgery
The exact procedure of the surgery depends on what is the cause of a less common body phenotype in the first place. There is often concern whether surgery should be performed at all. A traditional approach to the management of Intersexuality has been socially motivated surgery. However, some (Alice Dreger) say that surgical treatment is socially motivated and hence ethically questionable; without evidence doctors regularly assume that intersexed persons can not have a clear identity. This is often taken further with parents of intersexed babies advised that without surgery their child will be stigmatized. Further, since almost all such surgeries are undertaken to fashion female genitalia for the child, it is more difficult for the child to present as male if they later select a male gender identity. 20% to 30% of surgical cases result in a loss of sexual sensation (Newman 1991, 1992).
Conventionally, surgery is performed at birth. Intersex advocates such as Anne Fausto-Sterling in her "Sexing the Body" argue surgery on intersexed babies should wait until the child can make an informed decision, and label operation without consent as
genital mutilation .Causes
"Mainstream" sex development
The common pathway of
sexual differentiation , where a productive human female has an XX chromosome pair, and a productive male has an XY pair, is relevant to the development of intersexed conditions.During fertilization, the sperm adds either an X (female) or Y (male) chromosome to the X in the ovum. This determines the genetic sex of the embryo. During the first weeks of development, genetic male and female fetuses are "anatomically indistinguishable," with primitive gonads beginning to develop during approximately the sixth week of gestation. The gonads, in a "bipotential state," may develop into either testes (the male gonads) or ovaries (the female gonads) depending on the consequent events. Through the seventh week, male and female fetuses appear identical.
At around eight weeks of gestation, the gonads of an XY embryo differentiate into functional testes, secreting testosterone. Ovarian differentiation, for XX embryos, does not occur until approximately Week 12 of gestation. In normal female differentiation the Müllerian duct system develops into the
uterus ,Fallopian tubes , and inner third of the vagina.In males the Müllerian duct-inhibiting hormoneMIH causes this duct system to regress. Next, androgens cause the development of the Wolffian duct system, which develops into thevas deferens , seminal vesicles, and ejaculatory ducts. Citation
last=Kolodny
first=Robert C.
author-link =
last2 =Masters
first2 =William H.
author2-link = William Masters
last3 = Johnson
first3 = Virginia E.
author3-link = Virginia E. Johnson
title=Textbook of Sexual Medicine
place=
publisher=Little, Brown and Company
year=1979
location=Boston
volume=
edition = 1st
url=
doi=
id= ] By birth, the typical fetus has been completely "sexed" male or female, the hormones and genital development remaining consistent with the genetic sex.Conditions
The final body appearance doesn't always correspond with what is dictated by the genes. In other words, there is sometimes an incongruence between genotypic (chromosomal) and phenotypic sex. Although there neither no less common chromosomal sex nor mosaicism/chimerism, but just the most common types (XY or XX), less common phenotypes still appear in such cases. In this sense, the common habit in the 21st century of elevating the role of the
sex chromosomes above all other factors when determining gender may be analogous to the older habit of finding "true" sex in the gonads.
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