Intersex

An intersexual is a person with genitalia which combine features of both sexes. Intersexuals include both "true hermaphrodites", those with equally male and female genitals, and "pseudo-hermaphrodites", those with genitals which are closer to one sex or the other, while combining features of both; but many dislike these terms as being overly medical. It is estimated [1] that perhaps 1.7 percent of live births are actually intersexual.

True hermaphroditism is rare, and the causes are unknown. Psuedo-hermaphroditism is much more common, and several of the factors that lead to it are known. These include various chromsomal or endocrine conditions that disrupt the normal functioning of the human sex-determination system.

Intersexualism can be caused by various conditions. Some conditions produce normal appearing genitalia of one sex or the other, although the individual may have abnormal sex chromosomes or internal sex organs of both sexes. These include Klinefelters Syndrome (phenotypically male, but sometimes with some female characteristics; has XXY or XXXY chromosomes), Turners syndrome (external and internal female anatomy, but no menstruation or breast development; XO chromosome), Swyer syndrome (anatomical females with XY chromosomes; have damaged testis-determining factor on their Y chromosome) and persistent mullerian duct syndrome (individual appears male externally but has a uterus and fallopian tubes; XY, but Y chromosome fails to produce Mullerian inhibiting factor). Since the individual externally appears to be of only one sex, these conditions have tended not to raise the social issues that hermaphroditism has.

Hermaphroditism refers to conditions where an individual has genitalia which combine elements of both male and female genitalia. True hermaphrodites have both ovaries and testes, or gonads which are a combination of an ovary and testes (an ovotestis). True hermaphrodites most often have XX chromosomes, but true hermaphrodites have been known to have other chromosomal makeups as well. Psuedohermaphrodites have the internal organs of only one sex, but have some combination of the external organs.

A number of conditions lead to psuedohermaphroditism. One of these is androgen insensitivity syndrome. Persons with androgen insensitivity syndrome are genetically XY males with testes, but which develop either partially or fully as females, due to their bodies failing to respond to testosterone. In the case of complete androgen insensitivity syndrome, their tissues are totally insensitive to testosterone, and they will develop as females, with normal female external organs. However, they will not develop a uterus or fallopian tubes, due to the production of Mullerian inhibiting factor by their testes. At puberty breasts will develop due to the production of oestrogen by the testes; but no menstruation will occur due to the lack of a uterus. The tissues of individuals with partial androgen insensitivity, by contrast, have partial sensitivity to testosterone, but it is reduced compared to the male normal. These individuals can develop either with male external anatomy, or female external anatomy, or some combination, depending on the degree of insensitivity.

Another condition is 5-alpha-reductase deficency. In this condition, individuals have XY chromosomes and testes, and have a vagina and labia, but with a small penis capable of ejaculation instead of a clitoris (this penis, however, appears to be a clitoris at birth). These individuals are normally raised as girls. However, come puberty, their testes will descend, their voice will deepen and they often will develop a male sexual identity. But they develop only limited facial hair.

Individuals with congenital adrenal hyperplasia have an XX chromosome and female internal anatomy, but they often have ambiguous or male external genitalia, and develop male secondary sexual characteristics. This is caused by excessive in utero exposure to androgens. Another condition, also caused by excessive in utero exposure to androgens, is progestin-induced virilisation. In this case, the male hormones are caused by use of progestin, a drug that was used in the 1950s and 1960s in order to prevent miscarriage. These individuals have XX chromosomes, internal and external female anatomy. They develop however some male secondary characteristics, and they frequently have unusually large clitorises.

Intersexual individuals are treated in different ways by different cultures. In some societies, they have been treated as a third sex with a social role intermediate between those of men and women. In others, intersexed individuals have been expected to select one sex, and conform to its gender norms. Since the rise of modern medical science in Western societies, intersexuals with ambiguous external genitalia have had their genitalia surgically "corrected" to resemble either male or female genitals. But there are increasing calls for recognition of the various degrees of intersexuality 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 intersexuals as Western cultural equivalent of female genital mutilation. Despite the attacks on the practice, most of the medical profession still supports it.

"Corrective" surgery is generally not necessary for protection of life or health, but purely for aesthetic purposes. It very frequently leads to negative consequences for sexual functioning in later life, which would have been avoided without the surgery. Defenders of the practice argue however that it is necessary for individuals to be clearly identified as male or female, for proper "social functioning". However, some individuals have been so discontented with their surgically assigned gender as to opt for sexual reassignment surgery later in life.

Some writers have suggested the terms "herm" (for hermaphrodite), "merm" (for a pseudo-hermaphrodite that most closely resembles a male), and "ferm" (for a pseudo-hermaphrodite that most closely resembles a female), and that these be recognized as sexes along with male and female. However, these terms are now deprecated, and their author no longer advocates their use.

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References: [1] Fausto-Sterling, Anne, "The Five Sexes, revisited," Science World magazine, July 2000

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