Various criteria have been offered for the definition of intersex, including

ambiguous genitalia Intersex people are those born with any of several Sexual characteristics, sex characteristics, including chromosome patterns, gonads, or sex organ, genitals that, according to the Office of the United Nations High Commissioner for Human ...

, atypical genitalia, and differential sexual development.

Ambiguous genitalia Intersex people are those born with any of several Sexual characteristics, sex characteristics, including chromosome patterns, gonads, or sex organ, genitals that, according to the Office of the United Nations High Commissioner for Human ...

occurs in roughly 0.05% of all births, usually caused by

masculinization Virilization or masculinization is the biological development of adult male characteristics in young males or females. Most of the changes of virilization are produced by androgens. Virilization is a medical term commonly used in three medical a ...

or feminization during pregnancy, these conditions range from full

androgen insensitivity syndrome Androgen insensitivity syndrome (AIS) is a condition involving the inability to respond to androgens, typically due to androgen receptor dysfunction. It affects 1 in 20,000 to 64,000 XY (karyotype, karyotypically male) births. The condition result ...

ovotesticular syndrome Ovotesticular syndrome (also known as ovotesticular disorder or OT-DSD) is a rare congenital condition where an individual is born with both ovarian and testicular tissue. It is one of the rarest disorders of sex development (DSDs), with only 50 ...

. 1.7% of people are born with a disorder of sexual development (DSD) as defined by th
DSD consortium
such as those with

Klinefelter's syndrome Klinefelter syndrome (KS), also known as 47,XXY, is a chromosome anomaly where a male has an extra X chromosome. These complications commonly include infertility and small, poorly functioning testicles (if present). These symptoms are often not ...

. The DSD was specifically made to be as inclusive to all atypical sexual development; not all conditions within the DSD cause sexual ambiguity or affect individuals to the same extent. In other estimates, Definitions are limited to ambiguous conditions in which typical chromosomal categorization patterns is inconsistent with phenotypic sex, or in which the phenotype is not easily classifiable as either male or female," with the prevalence of about 0.018%.Alt URL
Most

intersex activism Intersex people are born with sex characteristics, such as chromosomes, gonads, or genitals, that, according to the UN Office of the High Commissioner for Human Rights, "do not fit typical binary notions of male or female bodies." Intersex pers ...

is based around the end of unnecessary medical interventions on intersex youth which attempt to assign an arbitrary

gender binary The gender binary (also known as gender binarism) is the classification of gender into two distinct forms of masculine and feminine, whether by social system, Culture, cultural belief, or both simultaneously. Most cultures use a gender binary, ...

, often causing physical harm with no input from the child. Intersex conditions are usually expanded to include the DSD more generally, including conditions without sexual ambiguity. 0.05% of births are medically treated or considered to have ambiguous genitalia.

Causes of intersex development

The overall causes of intersex conditions are complex, and are caused primarily by sexual development during

pregnancy Pregnancy is the time during which one or more offspring gestation, gestates inside a woman's uterus. A multiple birth, multiple pregnancy involves more than one offspring, such as with twins. Conception (biology), Conception usually occurs ...

. Certain individuals may have a masculinized clitoris or a feminized penis, however this might change after pregnancy. The exact differentiation of

ovotestis An ovotestis is a gonad with both Testicle, testicular and Ovary, ovarian aspects. In humans, ovotestes are an infrequent anatomical variation associated with gonadal dysgenesis. The only mammals where ovotestes are not characteristic of an infrequ ...

of intersex people are often ambiguous. Other cases of intersex conditions can occur when hormones are taken during pregnancy such as

estrogens Estrogen (also spelled oestrogen in British English; see spelling differences) is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three ma ...

androgen An androgen (from Greek ''andr-'', the stem of the word meaning ) is any natural or synthetic steroid hormone that regulates the development and maintenance of male characteristics in vertebrates by binding to androgen receptors. This includes ...

s, which can lead to atypical sexual development. Commonly intersex people are defined as those who are born with ambiguous genitalia, usually within the context of the OGR, or individuals with substantial atypical

sexual development Puberty is the process of physical changes through which a child's Human body, body matures into an adult body capable of sexual reproduction. It is initiated by hormone, hormonal signals from the Human brain, brain to the gonads: the ovary ...

such as those with XX male. Most conditions under the DSD are not apparent at

birth Birth is the act or process of bearing or bringing forth offspring, also referred to in technical contexts as parturition. In mammals, the process is initiated by hormones which cause the muscular walls of the uterus to contract, expelling the f ...

, and most are not

medicalized Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. Medicalization can be driven by new evid ...

. Certain definitions declare the need for atypical masculinization or feminization during fetal development to declare an intersex condition. Under this definition,

cloacal exstrophy A cloaca ( ), : cloacae ( or ), or vent, is the rear orifice that serves as the only opening for the digestive (rectum), reproductive, and urinary tracts (if present) of many vertebrate animals. All amphibians, reptiles, birds, cartilaginou ...

a rare condition which is caused by the stomach internal organs developing incorrectly would not be intersex. Individuals with cloacal exstrophy who are born with XY do not develop a penis and are usually

castrated Castration is any action, surgical, chemical, or otherwise, by which a male loses use of the testicles: the male gonad. Surgical castration is bilateral orchiectomy (excision of both testicles), while chemical castration uses pharmaceutical ...

and assigned female at birth. These people are

like other people with intersex conditions and the OGR model. Due to this individuals with cloacal exstrophy are often considered intersex.

InterACT Advocates for Informed Choice, dba interACT or interACT Advocates for Intersex Youth, is a 501(c)(3) nonprofit organization advocating for the legal and human rights of children with intersex traits. The organization was founded in 2006 and fo ...

the leading organization of intersex rights in the US, states that 1.5% of children are born with an intersex condition ( DSD), and 0.05% are born with full

Assigned sex

There is a high bias to assign intersex people with ambiguous genitalia as female at birth, as it was generally thought that it was easier to create a girl than a boy. Likewise as puberty would result in general feminization for most intersex children as well as a low libido, it was thought that they should be assigned female. This was also motivated by the fact that

vaginoplasty Vaginoplasty is any surgical procedure that results in the construction or reconstruction of the vagina. It is a type of genitoplasty. Pelvic organ prolapse is often treated with one or more surgeries to repair the vagina. Sometimes a vaginoplas ...

was far more developed than

phalloplasty Phalloplasty (also called penoplasty) is the construction or reconstruction of a penis or the artificial modification of the penis by surgery. The term is also occasionally used to refer to penis enlargement. History Russian surgeon Nikolaj B ...

. This system was known as the optimum gender of rearing model (OGR model) which attempted to define a binary for intersex children. Some individuals who did not have any intersex conditions were raised under the OGR model, such as

David Reimer David Reimer (born Bruce Peter Reimer; 22 August 1965 – 4 May 2004) was a Canadian man raised as a girl following medical advice and intervention after his penis was severely injured during a botched circumcision in infancy. The psychologis ...

who suffered a botched

circumcision Circumcision is a procedure that removes the foreskin from the human penis. In the most common form of the operation, the foreskin is extended with forceps, then a circumcision device may be placed, after which the foreskin is excised. T ...

and was assigned female at seven months. The primary goal of the OGR was to stop

gender incongruence Gender dysphoria (GD) is the distress a person experiences due to inconsistency between their gender identitytheir personal sense of their own genderand their sex assigned at birth. The term replaced the previous diagnostic label of gender ide ...

, and to assign a

for "proper" sex

socialization In sociology, socialization (also socialisation – see American and British English spelling differences#-ise, -ize (-isation, -ization), spelling differences) is the process of Internalisation (sociology), internalizing the Norm (social), norm ...

. The model often specifically involved the falsification of

medical history The medical history, case history, or anamnesis (from Greek: ἀνά, ''aná'', "open", and μνήσις, ''mnesis'', "memory") of a patient is a set of information the physicians collect over medical interviews. It involves the patient, and ev ...

, such as the karyotype falsification or that internal testis were ovaries and needed to be removed for "

cancer Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...

," despite no physical complications existing from their presence. Intersex advocates used a

feminist Feminism is a range of socio-political movements and ideology, ideologies that aim to define and establish the political, economic, personal, and social gender equality, equality of the sexes. Feminism holds the position that modern soci ...

perspective for criticism of the OGR as inherently

sexist Sexism is prejudice or discrimination based on one's sex or gender. Sexism can affect anyone, but primarily affects women and girls. It has been linked to gender roles and stereotypes, and may include the belief that one sex or gender is int ...

and cruel. The OGR modeled girls as

passive Passive may refer to: * Passive voice, a grammatical voice common in many languages, see also Pseudopassive * Passive language, a language from which an interpreter works * Passivity (behavior), the condition of submitting to the influence of ...

and the receivers of penetration, and boys as the givers of penetration. As most intersex conditions cause vagina-like development and no

phallus A phallus (: phalli or phalluses) is a penis (especially when erect), an object that resembles a penis, or a mimetic image of an erect penis. In art history, a figure with an erect penis is described as ''ithyphallic''. Any object that symbo ...

, medical staff were biased towards assigning female at birth. Transfeminists and

queer liberation The gay liberation movement was a social and political movement of the late 1960s through the mid-1980s in the Western world, that urged lesbians and gay men to engage in radical direct action, and to counter societal shame with gay pride.Hoff ...

ists particularly criticized the OGR model for not allowing children deviate from gender binary or expression. Likewise, feminists view

bodily autonomy Bodily integrity is the inviolability of the physical body and emphasizes the importance of personal autonomy, self-ownership, and self-determination of human beings over their own bodies. In the field of human rights, violation of the bodily int ...

as a fundamental

human right Human rights are universally recognized moral principles or norms that establish standards of human behavior and are often protected by both national and international laws. These rights are considered inherent and inalienable, meaning t ...

, which led to criticisms of the OGR taking away the bodily autonomy of intersex people.

Intersex and medical definitions

The OGR stated that

gender non-conformity Gender nonconformity or gender variance is gender expression by an individual whose behavior, mannerisms, and/or appearance does not match masculine or feminine gender norms. A person can be gender-nonconforming regardless of their gender identit ...

was a physiological threat which affected an individual's ability to function in normal society. Most research has found this to be false and that the medical procedures practiced against intersex individuals generally leads to isolation,

physiological stress Stress, whether physiological, biological or psychological, is an organism's response to a stressor, such as an environmental condition or change in life circumstances. When stressed by stimuli that alter an organism's environment, multiple s ...

and physical complications throughout life. The definition of intersex is closely linked to the specific medical interventions on intersex people. According to the ISNA 1.92% of the population will have some variation in sexual development throughout their lives, (0.42% excluding LOCAH). 1% of people have bodies that "differ from standard male or female," and 0.1-0.2% of births are considered for intersex genital surgeries. The DSD as a model was advocated for by intersex advocates to include all variation of atypical sexual development. Specifically the DSD exists as replacement for the OGR which was the

standard model The Standard Model of particle physics is the Scientific theory, theory describing three of the four known fundamental forces (electromagnetism, electromagnetic, weak interaction, weak and strong interactions – excluding gravity) in the unive ...

for individuals with atypical sexual development. This model stated goal was to assign a

, usually female via non-consensual

medicalization Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. Medicalization can be driven by new evi ...

, often via the falsification of

medical records The terms medical record, health record and medical chart are used somewhat interchangeably to describe the systematic documentation of a single patient's medical history and care across time within one particular health care provider's jurisdict ...

. After the publication of individuals who had undergone the OGR model and had gone through serious physiological distress, the model was discredited. The term "disorders of sexual development" was chosen to reflect the variation of

over differences which effects all individuals, this however has been controversial, with many instead opting for "differentiation" or "variation." The DSD has generally superseded the OGR in the US, although no official medical precautions exist against intersex

genital mutilation Genital modifications are forms of body modifications applied to the human sex organs, human sexual organs, including invasive modifications performed through genital cutting or surgery. The term genital enhancement seem to be generally used for ...

in the US. Another point of contention is intersex conditions and

karyotype A karyotype is the general appearance of the complete set of chromosomes in the cells of a species or in an individual organism, mainly including their sizes, numbers, and shapes. Karyotyping is the process by which a karyotype is discerned by de ...

, while many intersex individuals have atypical

gene expression Gene expression is the process (including its Regulation of gene expression, regulation) by which information from a gene is used in the synthesis of a functional gene product that enables it to produce end products, proteins or non-coding RNA, ...

, many intersex individuals are born due to hormonal changes in pregnancy, either natural or induced. As an example, a case of a woman who had a virilized

clitoris In amniotes, the clitoris ( or ; : clitorises or clitorides) is a female sex organ. In humans, it is the vulva's most erogenous zone, erogenous area and generally the primary anatomical source of female Human sexuality, sexual pleasure. Th ...

which was surgically altered during her birth, brought up the point that she was intersex, which was stated to be "false" by a doctor as her mother had gone on

progesterone Progesterone (; P4) is an endogenous steroid and progestogen sex hormone involved in the menstrual cycle, pregnancy, and embryogenesis of humans and other species. It belongs to a group of steroid hormones called the progestogens and is the ma ...

, instead of natural virilization which induced biological change. Generally those who have undergone the OGR model, or have ambiguous genitalia are considered intersex. The DSD consortium was specifically made to remedy this, and was advocated for by intersex activists by including all differentiation in sexual development. The definitions of intersex genitalia are difficult as different medical practices exist in different regions for what a "normal" penis or vagina should look like.

Spectrum approach

Many intersex activists have advocated for a spectrum based approach for intersex conditions, which would differentiate various intersex conditions, including hormonal differences. Intersex conditions, even the same conditions such as ovotesticular syndrome, can vary wildly in terms of organs, genetic expression,

phenotype In genetics, the phenotype () is the set of observable characteristics or traits of an organism. The term covers the organism's morphology (physical form and structure), its developmental processes, its biochemical and physiological propert ...

genotype The genotype of an organism is its complete set of genetic material. Genotype can also be used to refer to the alleles or variants an individual carries in a particular gene or genetic location. The number of alleles an individual can have in a ...

, and

. Under this model intersex conditions would be described via their own individualized effects described as effecting individuals on a spectrum. The DSD generally describes this by the description of individualized care for people with atypical sexual development, making the distinction between different conditions.

References

Intersex topics Sex differences in humans Intersex healthcare Intersex rights

External links