There are people who cannot be clearly assigned to any gender. They carry characteristics of both genders and fall within the concept of intersexuality. In Greek mythology they were referred to as hermaphrodites.
What is intersex?
If there is a faulty sperm production and a sperm with expressions of both sexes fertilizes an egg cell, it can develop into X0 people who are missing a sex chromosome. See AbbreviationFinder for abbreviations related to Intersex.
The term intersexuality stands for a constellation in which people have physical dispositions for both sexes and therefore cannot be clearly assigned to one sex. The vernacular speaks of hermaphrodites. There are different manifestations: women or girls can look like a woman on the outside, but inside the uterus, ovaries and fallopian tubes can be missing.
Men can appear like men on the outside, but they can lack male hormone production and appear more feminine on the outside. It is also possible that the vagina or penis is not sufficiently developed. The term intersexuality is often confused with transsexuality, but in contrast to intersexuals, transsexuals belong to a certain gender, they just don’t feel really comfortable with it.
There are various reasons for an unclear gender assignment. Intersexuality is mainly based on chromosomal changes. Known effects of chromosomal abnormalities include Turner syndrome in women and Klinefelter syndrome in men.
Another possible cause can be a disturbance in the development of the sex glands (gonads), in which gametes and sex hormones are formed, in women in the ovaries and in men in the testicles. Functional restrictions can also favor intersexuality, because then not enough sex hormones are formed.
When a germ cell contains male and female rudiments, sperm and egg cells are produced (ovotestis). Hormone disorders that affect germ cells or chromosomes can also be the cause. In addition, disorders of kidney function or enzyme damage can be responsible for intersexuality.
Symptoms, Ailments & Signs
Just as there are different causes of intersex, so do the signs. In general, men have 22 pairs of chromosomes and one X and one Y chromosome, while women have two X chromosomes. If there is a faulty sperm production and a sperm with expressions of both sexes fertilizes an egg cell, it can develop into X0 people who are missing a sex chromosome.
If an X chromosome is present, it results in a woman, but she cannot have children. Medicine then speaks of Turner syndrome. If the sex chromosomes do not separate during sperm maturation, the father inherits two sex chromosomes to the child. Together with the X chromosome inherited from the mother, the child then has two X and one Y chromosome.
This manifestation is known as Klinefelter syndrome. If the Y chromosome is dominant, these people are male but have limited testosterone production, smaller testicles and are not fertile. With a normal chromosome set and androgen resistance, infertility can occur and beard growth and body hair can be reduced.
With complete androgen resistance, male sex organs cannot develop properly. In these cases, the testicles remain in the body, there is a vagina on the outside, but no uterus, ovaries and fallopian tubes inside the body. On the outside, those affected still look like women.
Diagnosis & History
Most of the time, the diagnosis of intersexuality is an incidental finding. If there are signs of intersexuality, the blood is examined at the beginning with a determination of the hormone status and an examination of the chromosome set. In addition, the abdomen and pelvis are examined with the help of an ultrasound scan to find out whether a uterus, ovaries and fallopian tubes are present in the pelvis.
In a special X-ray examination, a genitogram, it is examined whether a vagina is formed. Sometimes a biopsy of the gonads must also be performed in order to be able to see which tissue is contained in the gonads. This biopsy is performed in a hospital under anesthesia.
Extensive diagnostics in the case of intersexuality enable a prognosis with regard to possible infertility and also make it easier to decide which gender those affected want to live with and whether treatment is necessary.
Along with the fact that most Western cultures assume a naturally occurring binary gender system, intersexuality itself is often viewed as a complication. Doctors and sometimes also parents are involved in taking the appropriate measures to create a sense of well-being for the person concerned.
Correspondingly, several things result for the intersexual person: through the intervention in early childhood, an external gender is imposed on him. This can lead to an identity crisis in later years and in the course of the person’s psychosexual development. If the assigned and perceived gender do not match, there is also a form of transsexuality in the case of a binary understanding of gender, which can have far-reaching psychological (and possibly surgical) consequences.
The medical nomenclature excludes transsexuality under the condition that it goes hand in hand with a biologically clear gender, but in the case of intersexuality, which complicates the way those affected deal with themselves and doctors even more. Other conceptual barriers also make everyday life difficult for intersex people. Due to bureaucratic and cultural factors, the mandatory assignment of a gender is widespread.
However, since this may not correspond to the self-perception of the person concerned, conceptual difficulties arise that can be psychologically stressful. While intersexuality does not lead to physical complications in the sense of complaints, with the exception of frequent infertility, the complications are mostly of a social nature.
A lack of tolerance, acceptance and education in many social circles has a consistently negative effect on the psyche and self-perception of many intersex people, who are often forced into a gender role by their environment. Auto-destructive behaviors and depression are more common among intersex people than among people who are clearly identified by gender.
When should you go to the doctor?
Since there are many different forms of intersex, it is not possible to give a one-size-fits-all answer to this question. In general, it is strongly advisable to see a doctor, but the right time varies from person to person. In many cases, intersexuality is determined anyway due to the ambiguous genital status, either directly after birth or by the pediatrician. On the other hand, there are also those affected who only attract attention from adolescence, for example due to the lack of menstrual bleeding. Basically, parents should consult the pediatrician or a specialist if they have any doubts or suspect that they may be intersexual.
Only in this way can any diagnostic, therapeutic or surgical measures be taken at an early stage. So it is the wish of many of those affected to have the outer sex surgically adjusted. Although intersexuality itself is not to be regarded as pathological and does not always require complex medical treatment, it can sometimes be based on a serious underlying disease. In rare cases, such as hypofunction of the adrenal cortex, rapid drug treatment is necessary. For this reason, it is advisable to consult a doctor as soon as possible signs of intersex are noticed.
Treatment & Therapy
In the 1960s and 1970s, sex reassignment surgery was performed shortly after birth in children who were diagnosed with intersexuality at birth, followed by hormone treatment. However, these treatments often had serious consequences, including infertility.
Doctors were not yet sufficiently informed and many operations turned out to be unnecessary in retrospect. Today, medicine takes a rather critical view of gender correction operations. If the gender is not clear, parents can now decide on the future gender orientation. Since 2009, a birth certificate can also be issued without a clear gender determination.
This enables affected children later to decide for themselves about their gender orientation. Nowadays, the therapies are individually tailored. The focus is not on gender reassignment, but on stabilizing the mental state with regard to the existing physical conditions.
Many intersex people are arguing that intersex should not be viewed as a disease, but as an additional manifestation of normal sexual development. They also do not necessarily experience therapy as helpful, but rather as discriminatory.
Outlook & Forecast
The outlook and prognosis for intersex people is not about the course of intersex itself. This is given and can only be adjusted to a gender by surgical and hormonal procedures if desired. Nevertheless, it is worth mentioning that there are children with the XY chromosis set, for example, who look like a girl for the first time (also with regard to the sex organs). However, during puberty, a limb forms from the clitoris and the testicles descend. The fertility is then possible.
However, the prognosis with regard to fertility is more relevant, for example. For many intersex people, examination of the gonads is necessary to make a statement about fertility. Frequently, the gender is selected and adjusted accordingly on the basis of the determination made – in the case of the desire to have the gender adjusted. This is related to family planning.
Further forecasts are also based on the indirect and direct consequences of intersexuality. Psychological stress is possible due to gender not being perceived as suitable or correct. Discrimination and medical disregard do occur. After all, it was refrained from carrying out the legal gender reassignment after birth. This effectively means more self-determination for intersex people and can reduce any existing suffering.
There is no effective prevention of intersexuality because chromosomal defects and associated defects in the gonads are responsible for this development. In families in which genetic defects have occurred, genetic counseling before family planning can be useful.
Just as possible, self-determined treatment is optional with intersexuality, so is follow-up care. The fact that a person is intersex does not mean that they need treatment or follow-up care.
However, this occurs when the intersex person decides to change their gender. Since surgical and hormonal procedures come into consideration here, there are also different types of aftercare: If an operation is carried out, subsequent control of the scarring and healing is necessary. In the case of the sensitive genitals in particular, wound healing supported by a doctor is advisable.
Regular check-ups are necessary for hormone therapies, since certain hormone levels are aimed for. In addition, the effect of the therapy on the body must be observed and understood in order to anticipate and prevent possible complications.
Other forms of follow-up care for intersex people arise, for example, because of the psychological suffering that intersex people may experience as a result of their gender status and their environment. If mental illness and auto-aggressive behavior occur, treatment is advisable. Follow-up care can consist of further therapy talks and also opening up options for the life of the person concerned. Friends and family can be very supportive in such cases.
You can do that yourself
Intersexuality poses a challenge in terms of self-help measures or measures to improve the quality of life of those affected. This is mainly due to the fact that the assumption that intersexuality must or can be treated medically is based on the assumption that there are two defined genders. However, for many intersex people it is not crucial to be able to be assigned to a gender (they could, for example, behave accordingly in everyday life). In everyday life, it is more about problems of social and legal equality.
There are various self-help groups and organizations that are open to intersex people (and usually other people who are not clearly gendered). Here a point of reference and an exchange about everyday challenges in this context can be established.
The measures that intersex people take in everyday life are very different. Some do nothing because they can live contentedly, others require strong support from people and try many things to fit into a gender role. When it comes to increasing the quality of life in public space, those initiatives that aim to be able to freely choose the gender designation and the name in official documents – and this without the need for gender reassignment surgery – play a particularly important role. Public education and teaching intersexuality in education also play a role here.
It has also been shown that early childhood surgery in intersex people increasingly leads to a reduced quality of life later on. In this respect, the first step in guaranteeing a good attitude towards life is that parents let their child take these identity-determining steps at the right age.