Understanding Intersex and the Issues that People Face
As a follow-up to our guide to gender, this article will specifically focus on understanding intersex and the issues that people face.
May 2013 marked a milestone for intersex individuals. A landmark case forced the public to take a long, hard look at a condition that continues to be misunderstood. Recent studies reveal that difficulties encountered by intersex individuals from family, friends and the medical community cause devastating psychological trauma that lasts a lifetime.
The case was South Carolina versus “M.C.” The Crawfords of South Carolina didn’t think anything was amiss when they adopted a baby girl, M.C., eight years ago. As she grew older, her parents noticed that M.C. was tomboyish and a little rough around the edges, but they never gave it a second thought. But her family would soon have to come to terms with a decision made when she was approximately 16 months old and still a ward of the state. M.C. was born as an intersex child, and authorities of South Carolina child welfare had decided to remove all male organs, physically turning M.C. into a female.
Initially, doctors deemed the surgery a success. Unfortunately, as M.C. matured, she felt that something was not right. Extensive conversations with therapists and her parents revealed she wished to be male despite an obviously female appearance. Now, the Crawfords are in litigation with for what they determined as infringing on M.C.’s civil rights. Experts at the Southern Poverty Law Center state the early surgery removed all options from the patient and placated the whims of mainstream society.
What happened to M.C. is unfortunately not uncommon with intersex babies. Surgical treatment became prevalent in the 1950’s with the “optimum gender of rearing” – a treatment model created by a team at John Hopkins University. As part of this treatment, doctors would perform corrective surgery to make the baby look like a normal male or female. They chose girl more than boy because they thought female anatomy was easier to surgically construct. Parents were to raise the child as the assigned sex and its associated gender. This model sought to essentially get rid of the condition early on. Once the child started maturing, they could very well find themselves in an identity crisis if they were assigned the wrong sex (and many did).
Understanding What Intersex Is
Intersex is often associated with ambiguous genitals, but its definition actually extends beyond outer appearances. It describes individuals whose reproductive anatomy and / or sex chromosomes do not fit the patterns of male or female. Some intersex people are born with ambiguous genitals like in the case of M.C., while others are only affected through their internal anatomy or chromosomes. Examples of the former include a feminine child born with a large clitoris, or possessing an external vaginal opening with male internal sexual organs. Masculine children have small penises or scrotum that visually resembles labia. It is estimated that 1 in every 2,000 children born in the U.S. every year has ambiguous genitals such that their sex cannot immediately be determined. Originally called hermaphroditism, this condition featured the names of Greek gods known for sexuality and love (Hermes and Aphrodite). Hemaphrodite is now considered an offensive term for an intersex person.
In the case of sex chromosomes, an intersex person’s chromosomes do not follow the typical patterns of XX for females and XY for males. While this can affect the genitals’ appearance, some intersex people look totally normal on the outside. So there are some who will never even know that they are intersex. Since most people don’t know their sex chromosomes, it is difficult to estimate how many people overall are affected by an intersex condition. It could occur in as many as 1 in every 1,000 births.
Whether it affects the genitals, sex chromosomes and / or internal organs, intersex is a natural biological variation. The term exists because we needed a phrase to describe people that fall outside of male and female. Just like gender binary of boy and girl, the sex binary is also a social construct. Furthermore, just like gender can be seen as a spectrum of colors, so can reproductive and sexual anatomy. Nudists already know that genitals (and breasts) show a lot of variation from person to person. Well ambiguous genitals is just more of this natural variation.
The National Institute of Health officials indicate there are four major “types” / “categories” of intersex individuals (but there are hundreds of varying ways that it could manifest itself in people):
- XX involves female children born with external male organs. The condition occurs when fetuses receive exposure to male hormones.
- XY males are born as boys with disfigured and / or underdeveloped sexual organs.
- Gonadel describes children born with male and female internal sex organs. Physicians linked a number of cases to pesticide exposure.
- Undetermined disorders involve chromosome damage that results in general sexual development.
* All intersex sub-categories and types fall under the designation of “disorders of sex development” (DSD).
Examples of specific intersex conditions include Klinefelter’s Syndrome, Adrenal Hyperplasia, Sawyer Syndrome, Androgen Insensitivity Syndrome, and Turner’s Syndrome.
Surgical Issues Pertaining to Intersex and Treatments
Unfortunately, many improvements are still needed in medical protocols and treatment of intersex children. As outlined by the Intersex Society of North America (ISNA), a baby with ambiguous genitals is seen as a “psychosocial emergency” and doctors must immediately do what they can to normalize the child. Gender selection surgery remains an issue of contempt for many intersex individuals. Physicians claim to have the patient’s best interest in mind during a surgical procedure, but recent data states quite the opposite. As they get older, intersex people may deal with a plethora of physical and emotional issues as result of their medical treatment. In her piece for the Journal of Gay and Lesbian Psychotherapy, counselor and social worker Arlene Istar Lev reveals another startling fact about surgery. She states that reassignment surgeries today are still mainly male to female transitions. Female genitalia are easier to reconstruct and preserves childbearing abilities in people found to have working ovaries. Reassignment fixes some aspects of the external component, but it creates additional emotional damage.
Amy Hinton, an intersex woman and activist, describes looking at her body and wondering how she received multiple scars. After turning 21, her parents revealed she underwent sexual reassignment as a child. Doctors turned her into a girl, despite all her male sexual internal organs. After talking with other people, Ms. Hinton uncovered tales of botched operations that removed tissue and permanently eliminated a patient’s potential for sexual pleasure.
A rarely discussed topic within the medical community involves the change in dynamics between intersex people and their mothers. Female reassignment surgery involves a manual manipulation process designed to open newly constructed vaginal walls. The parent performs this painful process multiple times for optimal results. Therapists found the treatments cause emotional trauma that damages the nurturing bond between mother and child.
Intersex children and their families face a lot of issues and trauma overall, and the severe lack of counseling and therapy offered to them is also a big problem. Lev’s report states, “People with intersex conditions are mostly a hidden population and receive ‘little psychological support’ for either themselves or their families. Consquently, issues of trauma inherent for the families of children born with intersex conditions often go untreated” (p. 34).
Some of The Myths and Misconceptions Surrounding Intersex
Ignorance adds to the stigma experienced by intersex individuals. Common misconceptions listed by the Intersex Society of North America (ISNA) include:
– Public confusion exists between transgender and intersex. Transgender generally refers to someone who was born with typical sexual anatomy, but this doesn’t match their gender identity (ie, internal sense of their own gender – remember, gender is in the mind!). There are intersex people who identify as transgender, but being intersex does not make them transgender.
– Intersex is also not classified under trans* (a term of its own with the asterisk). Trans* is an umbrella term for variations in gender (mental), while intersex is about variations in reproductive anatomy / sex chromosomes (physiological).
– People think that surgery is an automatic requirement for intersex people. Experts found that surgical reassignment was unnecessary in many cases, and children still lead healthy lives when they receive accurate health information.
– Some people think that surgery gives the genital area an instantly “normal” appearance. People who receive surgical reassignment experience massive scarring and things can still look a little different. Alice Dreger of ISNA states that medicine is excellent at removing structures, but not as adept at rebuilding them.
Many individuals born with an intersex condition face emotional hardship from family members, the community and medical experts. Researchers are beginning to understand the importance of talking with children affected by this type of DSD and helping them understand they are, in almost every way, no different from anyone else. An open-mind, compassionate and honest interaction can help society eliminate the stigma associated with an intersex diagnosis.
Should you meet someone in a naturist setting who you think is intersex, you should treat them just as you would anyone else. Call them “he / she” based on the gender they are presenting, but if you’re not sure what to call them, then ask in a polite and respectful way. Don’t gawk at their bodies.
It’s common for intersex people to have body image issues, and they might feel very self-conscious when naked among others. Don’t ask personal questions about their genitals or their body or whether they’ve had surgery (unless the situation is appropriate). If you want to ask them questions about themselves or about being intersex, first ask them if they don’t mind talking to you about it. Always respect their privacy.
This comprehensive and erudite article was published by – Young Naturists and Young Nudists America YNA
Below are some additional resources and further reading:
Intersex Society of North America website: http://www.isna.org
“Parents Sue South Carolina for Surgically Making Child Female” (CNN): http://www.cnn.com/2013/05/15/health/child-sex-surgery-suit/
“Intersexuality in the Family: An Unacknowledged Trauma” by Arlene Istar Lev: http://www.choicesconsulting.com/assets/pro_writing/Intersexuality_in_the_Family_JOURNAL.pdf
Amy Hinton’s story on her blog: https://amyhinton.wordpress.com/
“Boys will be boys…or not? Straight Talk About Gender” (Scarleteen): http://www.scarleteen.com/article/gender/boys_will_be_boysor_not_straight_talk_about_gender
To learn more about this issue, you can view this three part Discovery Channel Documentary: Part 1 (http://youtu.be/8ITuuxmlfqs), Part 2 (http://youtu.be/YQESPaEj8dk) and Part 3 (http://youtu.be/jHQJmPbHSdM).