Handouts and Information
What is an Ally? | Developing a Common Language | Gay and Lesbian Identity Development | Heterosexual Questionaire
Heterosexual Privilege | Trans Definitions | Overview of the Transgender World
The Intersexed Condition | What Does the Bible Say About Homosexuality | Choosing a Lesbian, Gay, Bisexual-Affirming Therapist
The Intersexed Condition
Again, we are in pretty murky waters when we try to define exactly what it means to be intersexed. Broadly speaking, intersexuality constitutes a range of medical conditions in which an individual’s anatomy mixes key masculine anatomy with key feminine anatomy. Sometimes, physicians will use the term “ambiguous genitalia” instead of “intersexuality”, but that begs the question “what should count as ambiguous?” (How small should a baby’s penis have to be before it counts as “ambiguous”; or conversely, how large should a baby’s clitoris be before it is ambiguous) This is a difficult question. And it doesn’t address intersexuality of internal sexual organs or genetic intersexuality, when the external genitalia appear to be clearly male or clearly female.
There is a lengthy list of medical conditions which can result in a child being born as intersexed. They vary greatly in how often they occur in the general population. The Intersex Society of North America estimates that in approximately 1 in 100 births, a child’s body differs, in some way, from standard male or female. They also estimate that in 1-2 births out of 1,000 the infant receives surgery to normalize their genital appearance. We’ll talk about possible effects of these surgeries in a few minutes.
First, I’d like to cover a few of the medical conditions that result in intersexuality – these are conditions that occur a little more frequently than the other, more rare, conditions. There are a several conditions in which the child’s genetic make-up is not clearly male (XY) or female (XX).
- Klinefelter’s Syndrome
You’ve probably heard of this before – it’s not uncommon and occurs in approximately 1 in 500 to 1 in 1,000 births. Instead of the typical, XX or XY chromosome pattern, the child is born with an XXY pattern. The condition is not hereditary and seem to develop in the fetus. The extra X chromosome results in feminizing effects on the body. They are typically seen as boys and are raised as boys. The condition is often not diagnosed until puberty, when expected secondary sexual characteristics don’t develop. These individuals are sterile, have enlarged breasts, small testicles & penis, tall in stature with long legs and short trunk, and are often learning disabled. Testosterone therapy seems to help with many of the results of Klinefelter’s, with the exception of sterility.
- Turner’s Syndrome (XO)
These are females that are born without a second X chromosome. 1 in 2,000-2,500 births. Not hereditary. They tend to be short in stature (average height of 4’8” if not treated with growth hormones). They tend to have ovarian failure which results in a lack of development of secondary sex characteristics. 99% are infertile. Hormone replacement therapy can help.
- Androgen Insensitivity Syndrome
Occurs in about 1 in 13,000 births. These individuals have a male genetic make-up (XY chromosomes). Testes develop during gestation, while the fetus is developing. These testes produce Mullerian Inhibiting Hormone (MIH) which prevents the development of a uterus, fallopian tubes, and cervix. The testes also produce testosterone. However, because cells fail to respond to testosterone, the genitals form in the female, rather than the male, pattern. Newborn infants may have the genitals of a normal female appearance. Occasionally, the testes may be partially descended. There is a short vagina with no cervix. Occasionally, the vagina is nearly absent. At puberty, the estrogen produced by the testes produces breast growth. She does not menstruate and is not fertile. Most AIS women have no pubic or underarm hair.
When AIS is diagnosed during infancy, physicians often perform surgery to remove the undescended testes. Vaginoplasty surgery is frequently performed on AIS infants or girls to increase the size of the vagina. Most AIS women who received surgery as a child state that they would have preferred that they had been given the choice when they were old enough to understand the surgery. Not all AIS women choose surgery. There are non-surgical options to increase the size of the vagina.Because AIS is a genetic defect located on the X chromosome, it runs in families. The mother of an AIS individual is a carrier, and her XY children have a 50% chance of having AIS. Her XX children have a 50% chance of carrying the AIS gene.
AIS women tend to have a feminine gender identity.
- Congenital Adrenal Hyperplasia
Occurs in both males and females. Occurs in about 1 in 13,000 births. In females (with an XX chromosome make-up), hypersecretions of steroid hormone from the adrenal gland causes masculinization of the external genitalia of the female fetus. Affected infants can have mixed genitalia. Internal female organs are intact. Many of these children receive “corrective” surgery during infancy. If the child is raised as male, following any "adjusting" surgery and given male hormones at puberty, the individual develops as a "normal" but sterile male with XX chromosomes. On the other hand, if the infant is surgically corrected to female and given female hormones, there is a 50/50 chance of transsexualism. So – this is more evidence that gender identity may be greatly influenced by hormones during development in the womb (rather than by chromosomal make-up).
- Corrective Surgery
This "correction" is the source of much unhappiness – most advocates for intersexed individuals promote not performing any corrective surgeries on children and raising them as either as a boy or girl following consultation with medical professionals who are familiar with intersexed conditions. But the parents should watch for signs of gender expression in the child, not attempt to suppress these expressions if they don’t fit with the gender they are being raised as, and when the adolescent is old enough to understand their condition, they should be informed and given the choice whether or not to proceed with surgery if an incongruity between physical sex and gender identity exists.
I don’t envy the parents of children who are intersexed – it is challenging in our society to provide a child with gender-neutral support and to possibly need to adjust parenting strategies to fit with the developing gender identity of the child.