Intersex Health

Illustrated pamphlet on fetal external genital development
Illustrated pamphlet on fetal external genital development

There are two sexes, right? WRONG! More than two sexes are commonly found throughout the animal kingdom. In humans alone there are over 40 natural sexual/reproductive variations that can affect the genitals, gonads, and/or genetics of a person. A person with such differences are so common as redheads in the general population, or about 1-2% of the planet. 

So how is sex determined? At birth, a doctor assigns the infant a sex (and therefore, a gender) based on the appearance of the external genitals. Assigning sex does not involve chromosomes, gonads, hormone prevalence, etc. — and it certainly doesn’t include gender identity (which typically begins to develop around age 4.) Virtually no one has genetic testing done to determine chromosome type; or a gonadal biopsy to confirm testicular, ovarian, or ovo-testicular tissue types; or a hormone panel at birth and again at puberty to test levels of testosterone/androgens and estrogens; etc. The list goes on. For centuries, Western medicine has debated which of these characteristics determine “true” sex, ironically breaking apart the very binary their research sought to prove.

Infants whose external “protrusion” (clitoris/phallus) falls between a narrow range or those who have other “non-typical” genital or gonadal anatomy and/or non-XX/XY chromosomes are branded as having a “Disorder/Variation of Sex Development” (D/VSD) — a recently named and unnecessarily pathological label used to validate medical intervention. Many in this biocommunity prefer the term intersex (as in LGBTQAI+), though this term as an identity label is in flux. With rare exception, intersex characteristics are not life-threatening. Despite this, parents of intersex children are often pressured by physicians to submit their child to genital “normalization” surgeries, which are often kept as a secret from the child. Progress by intersex activists is being made around the world to end these unnecessary procedures, including the recent apology and commitment from Lurie Children’s Hospital of Chicago.

The lack of information about intersex people in sex, science, and health education is an act of erasure that perpetuates the notion of two “biological” sexes. Medical illustrations of sex/reproductive organs typically only represent two idealized standard forms though there is significant genital variation among those assigned male and female at birth; these images rarely include depictions of common intersex anatomy,  such as hypospadias, Partial/Androgen Insensitivity Syndrome, etc. While generalizations in medical illustration (as opposed to unique representation of a particular specimen) are helpful to show commonalities across a group, it is imperative to remember that such images should not be used to push the agenda of any idealized form. This is especially true of simplified line drawings of infant genitals that more closely approximate idealized forms of adult genitals, such as the majority of pediatric medical illustrations and highly criticized clinical measurement tools of the Prader scale, Quigley scale, and orchidometer

That being said, sometimes including genitalia (intersex or otherwise) in education materials about infant/child health is unnecessary and/or distracting. For example, external genitals do not help a physician discussing different hormones the body’s internal glands produce, even though testes, ovaries, and ovo-testes are part of the endocrine system. 

Illustration of infant endocrine system

A very common intersex characteristic is hypospadia, where the urethra (the tube that connects to the bladder) exits the body anywhere except the tip of the penis.

Educational pamphlet on infant hypospadia anatomy