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词条 Intersex
释义

  1. Definitions

  2. History

  3. Human rights and legal issues

      Physical integrity and bodily autonomy    Anti-discrimination and equal treatment    Reparations and justice    Information and support    Legal recognition  

  4. Language

     The term "intersex"  Hermaphrodite  Disorders of sex development  LGBT and LGBTI 

  5. In society

     Fiction and media   Civil society institutions    Events    Religion    Sport  

  6. Population figures

  7. Medical classifications

      Sexual Differentiation   Signs  Ambiguous genitalia   Measurement systems for Ambiguous genitalia    Other signs   Causes   Conditions  

  8. Medical interventions

     Rationales  Types 

  9. See also

  10. Notes

  11. Bibliography

{{short description|Innate variations in sex characteristics such that individuals differ from norms for male or female bodies}}{{Use dmy dates|date=July 2016}}{{Intersex sidebar}}Intersex people are individuals born with any of several variations in sex characteristics including chromosomes, gonads, sex hormones, or genitals that, according to the UN Office of the High Commissioner for Human Rights, "do not fit the typical definitions for male or female bodies".[1][2] Such variations may involve genital ambiguity, and combinations of chromosomal genotype and sexual phenotype other than XY-male and XX-female.[1][2]

Intersex people were previously referred to as hermaphrodites or "congenital eunuchs".[3][4] In 19th and 20th century medical literature, intersex was referred as true hermaphroditism, female pseudohermaphroditism, and male pseudohermaphroditism reflecting the first taxonomic efforts to classify intersex conditions.[5] These terms are no longer used: terms including the word "hermaphrodite" are considered to be misleading, stigmatizing, and scientifically specious.[6] A hermaphrodite is now defined as "an animal or plant having both male and female reproductive organs"[5] In 1917, Richard Goldschmidt created the term "intersexuality" to describe a variety of physical sex ambiguities.[5] In clinical settings, the term “disorders of sex development” (DSD) has been used since 2006.[11] This shift has been controversial since the label was introduced.[12][7][14]

Intersex people face stigmatization and discrimination from birth or discovery of an intersex trait such as from puberty. This may include infanticide, abandonment and the stigmatization of families.[15][16][17] Globally, some intersex infants and children, such as those with ambiguous outer genitalia, are surgically or hormonally altered to create more socially acceptable sex characteristics. However, this is considered controversial, with no firm evidence of good outcomes.[8] Such treatments may involve sterilization. Adults, including elite female athletes, have also been subjects of such treatment.[19][9] Increasingly these issues are considered human rights abuses, with statements from international[10][11] and national human rights and ethics institutions.[12][24] Intersex organizations have also issued statements about human rights violations, including the Malta declaration of the third International Intersex Forum.[25]

In 2011, Christiane Völling became the first intersex person known to have successfully sued for damages in a case brought for non-consensual surgical intervention.[26] In April 2015, Malta became the first country to outlaw non-consensual medical interventions to modify sex anatomy, including that of intersex people.[13][14]

Some intersex persons may be assigned and raised as a girl or boy but then identify with another gender later in life, while most continue to identify with their assigned sex.[2][2][31][32][33]

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Definitions

According to the UN Office of the High Commissioner for Human Rights:

{{quotation|Intersex people are born with sex characteristics (including genitals, gonads and chromosome patterns) that do not fit typical binary notions of male or female bodies.

Intersex is an umbrella term used to describe a wide range of natural bodily variations. In some cases, intersex traits are visible at birth while in others, they are not apparent until puberty. Some chromosomal intersex variations may not be physically apparent at all.[15]}}

In biological terms, sex may be determined by a number of factors present at birth, including:[16]

  • the number and type of sex chromosomes;
  • the type of gonads—ovaries or testicles;
  • the sex hormones;
  • the internal reproductive anatomy (such as the uterus in females); and
  • the external genitalia.

People whose characteristics are not either all typically male or all typically female at birth are intersex.[17]

Some intersex traits are not always visible at birth; some babies may be born with ambiguous genitals, while others may have ambiguous internal organs (testes and ovaries). Others will not become aware that they are intersex unless they receive genetic testing, because it does not manifest in their phenotype.

History

{{main|Intersex in history|Timeline of intersex history|History of intersex surgery}}

Whether or not they were socially tolerated or accepted by any particular culture, the existence of intersex people was known to many ancient and pre-modern cultures. The Greek historian Diodorus Siculus wrote of "hermaphroditus" in the first century BCE that Hermaphroditus "is born with a physical body which is a combination of that of a man and that of a woman", and with supernatural properties.[18]

In European societies, Roman law, post-classical canon law, and later common law, referred to a person's sex as male, female or hermaphrodite, with legal rights as male or female depending on the characteristics that appeared most dominant.[19] The 12th-century Decretum Gratiani states that "Whether an hermaphrodite may witness a testament, depends on which sex prevails".[20][21][22] The foundation of common law, the 17th Century Institutes of the Lawes of England described how a hermaphrodite could inherit "either as male or female, according to that kind of sexe which doth prevaile."[23][24] Legal cases have been described in canon law and elsewhere over the centuries.

In some non-European societies, sex or gender systems with more than two categories may have allowed for other forms of inclusion of both intersex and transgender people. Such societies have been characterized as "primitive", while Morgan Holmes states that subsequent analysis has been simplistic or romanticized, failing to take account of the ways that subjects of all categories are treated.[25]

During the Victorian era, medical authors introduced the terms "true hermaphrodite" for an individual who has both ovarian and testicular tissue, "male pseudo-hermaphrodite" for a person with testicular tissue, but either female or ambiguous sexual anatomy, and "female pseudo-hermaphrodite" for a person with ovarian tissue, but either male or ambiguous sexual anatomy. Some later shifts in terminology have reflected advances in genetics, while other shifts are suggested to be due to pejorative associations.[45]

The term intersexuality was coined by Richard Goldschmidt in 1917.[26] The first suggestion to replace the term 'hermaphrodite' with 'intersex' was made by Cawadias in the 1940s.[47]

Since the rise of modern medical science, some intersex people with ambiguous external genitalia have had their genitalia surgically modified to resemble either female or male genitals. Surgeons pinpointed intersex babies as a "social emergency" when born.[27] An 'optimal gender policy', initially developed by John Money, stated that early intervention helped avoid gender identity confusion, but this lacks evidence,[49] and early interventions have adverse consequences for psychological and physical health.[28] Since advances in surgery have made it possible for intersex conditions to be concealed, many people are not aware of how frequently intersex conditions arise in human beings or that they occur at all.[29]

Dialogue between what were once antagonistic groups of activists and clinicians has led to only slight changes in medical policies and how intersex patients and their families are treated in some locations.[30] In 2011, Christiane Völling became the first intersex person known to have successfully sued for damages in a case brought for non-consensual surgical intervention.[26] In April 2015, Malta became the first country to outlaw non-consensual medical interventions to modify sex anatomy, including that of intersex people.[13] Many civil society organizations and human rights institutions now call for an end to unnecessary "normalizing" interventions, including in the Malta declaration.[31][1]

Human rights and legal issues

{{further|Intersex rights by country}}

Human rights institutions are placing increasing scrutiny on harmful practices and issues of discrimination against intersex people. These issues have been addressed by a rapidly increasing number of international institutions including, in 2015, the Council of Europe, the United Nations Office of the United Nations High Commissioner for Human Rights and the World Health Organization. These developments have been accompanied by International Intersex Forums and increased cooperation amongst civil society organizations. However, the implementation, codification, and enforcement of intersex human rights in national legal systems remains slow.

Areas of concern include non-consensual medical interventions; stigma, discrimination and equal treatment; access to reparations and justice; access to information and support, and legal recognition.

Physical integrity and bodily autonomy

{{Main|Intersex human rights|Intersex medical interventions}}

Stigmatization and discrimination from birth may include infanticide, abandonment and the stigmatization of families. As noted in the "Intersex human rights" page, the birth of an intersex child was often viewed as a curse or a sign of a witch mother, especially in parts of Africa.[15][32] Abandonments and infanticides have been reported in Uganda,[33] Kenya,[34] South Asia,[61] and China.[35]

Infants, children and adolescents also experience "normalising" interventions on intersex persons that are medically unnecessary and the pathologisation of variations in sex characteristics. In countries where the human rights of intersex people have been studied, medical interventions to modify the sex characteristics of intersex people have still taken place without the consent of the intersex person.[36] Interventions have been described by human rights defenders as a violation to many rights, including (but not limited to) bodily integrity, non-discrimination, privacy, and experimentation.[37] These interventions have frequently been performed with the consent of the intersex person's parents, when the person is legally too young to consent. Such interventions have been criticized by the World Health Organization, other UN bodies such as the Office of the High Commissioner for Human Rights, and an increasing number of regional and national institutions due to their adverse consequences, including trauma, impact on sexual function and sensation, and violation of rights to physical and mental integrity.[1] The UN organizations decided that infant intervention should not be allowed, in favor of waiting for the child to mature enough to be apart of the decision-making - this allows for a decision to be made with total consent.[38] In April 2015, Malta became the first country to outlaw surgical intervention without consent.[13][14] In the same year, the Council of Europe became the first institution to state that intersex people have the right not to undergo sex affirmation interventions.[13][14][39][40][41]

Anti-discrimination and equal treatment

{{Main|Discrimination against intersex people}}

Inclusion in equal treatment and hate crime law. Because people born with intersex bodies are seen as different, intersex infants, children, adolescents and adults "are often stigmatized and subjected to multiple human rights violations", including discrimination in education, healthcare, employment, sport, and public services.[15][42][43] Several countries have so far explicitly protected intersex people from discrimination, with landmarks including South Africa,[14][44] Australia,[45][46] and, most comprehensively, Malta.[47][48][49][50][51]

Reparations and justice

{{Main|Intersex human rights}}

Facilitating access to justice and reparations. Access to reparation appears limited, with a scarcity of legal cases, such as the 2011 case of Christiane Völling in Germany.[52][53] A second case was adjudicated in Chile in 2012, involving a child and his parents.[54][55] A further successful case in Germany, taken by Michaela Raab, was reported in 2015.[56] In the United States, the "M.C." legal case, advanced by Interact Advocates for Intersex Youth with the Southern Poverty Law Centre is still before the courts.[57][58]

Information and support

{{Main|Intersex human rights}}Access to information, medical records, peer and other counselling and support. With the rise of modern medical science in Western societies, a secrecy-based model was also adopted, in the belief that this was necessary to ensure "normal" physical and psychosocial development.[12][28][59][60][61][62]

Legal recognition

{{Main|Legal recognition of intersex people}}

The Asia Pacific Forum of National Human Rights Institutions states that legal recognition is firstly "about intersex people who have been issued a male or a female birth certificate being able to enjoy the same legal rights as other men and women."[63] In some regions, obtaining any form of birth certification may be an issue. A Kenyan court case in 2014 established the right of an intersex boy, "Baby A", to a birth certificate.[64]

Like all individuals, some intersex individuals may be raised as a certain sex (male or female) but then identify with another later in life, while most do not.[1][2][65][66] Recognition of third sex or gender classifications occurs in several countries,[67][68][69][70] however, it is controversial when it becomes assumed or coercive, as is the case with some German infants.[71][72][73] Sociological research in Australia, a country with a third 'X' sex classification, shows that 19% of people born with atypical sex characteristics selected an "X" or "other" option, while 52% are women, 23% men, and 6% unsure.[31][113]

Language

Research in the late 20th century led to a growing medical consensus that diverse intersex bodies are normal, but relatively rare, forms of human biology.[2][74][75][76] Clinician and researcher Milton Diamond stresses the importance of care in the selection of language related to intersex people:

{{quotation|Foremost, we advocate use of the terms "typical", "usual", or "most frequent" where it is more common to use the term "normal." When possible avoid expressions like maldeveloped or undeveloped, errors of development, defective genitals, abnormal, or mistakes of nature. Emphasize that all of these conditions are biologically understandable while they are statistically uncommon.[77]}}

The term "intersex"

Some people with intersex traits self-identify as intersex, and some do not.[78][79] Australian sociological research published in 2016, found that 60% of respondents used the term "intersex" to self-describe their sex characteristics, including people identifying themselves as intersex, describing themselves as having an intersex variation or, in smaller numbers, having an intersex condition. A majority of 75% of survey respondents also self-described as male or female.[31] Respondents also commonly used diagnostic labels and referred to their sex chromosomes, with word choices depending on audience.[31][113] Research by the Lurie Children's Hospital, Chicago, and the AIS-DSD Support Group published in 2017 found that 80% of affected Support Group respondents "strongly liked, liked or felt neutral about intersex" as a term, while caregivers were less supportive.[80] The hospital reported that "disorders of sex development" may negatively affect care.[81]

Some intersex organizations reference "intersex people" and "intersex variations or traits"[82] while others use more medicalized language such as "people with intersex conditions",[83] or people "with intersex conditions or DSDs (differences of sex development)" and "children born with variations of sex anatomy".[84] In May 2016, Interact Advocates for Intersex Youth published a statement recognizing "increasing general understanding and acceptance of the term "intersex"".[129]

Hermaphrodite

{{Main|Hermaphrodite}}

A hermaphrodite is an organism that has both male and female reproductive organs. Until the mid-20th century, "hermaphrodite" was used synonymously with "intersex".[85] The distinctions "male pseudohermaphrodite", "female pseudohermaphrodite" and especially "true hermaphrodite"[86] are terms no longer used, which reflected histology (microscopic appearance) of the gonads.[87][88][89] Medical terminology has shifted not only due to concerns about language, but also a shift to understandings based on genetics.

Currently, hermaphroditism is not to be confused with intersex, as the former refers only to a specific phenotypical presentation of sex organs and the latter to a more complex combination of phenotypical and genotypical presentation. Using hermaphrodite to refer to intersex individuals is considered to be stigmatizing and misleading.[90] Hermaphrodite is used for animal and vegetal species in which the possession of both ovaries and testes is either serial or concurrent, and for living organisms without such gonads but present binary form of reproduction, which is part of the typical life history of those species; intersex has come to be used when this is not the case.

Disorders of sex development

{{Main|Disorders of sex development }}

"Disorders of sex development" (DSD) is a contested term,[91][7] defined to include congenital conditions in which development of chromosomal, gonadal, or anatomical sex is atypical. Members of the Lawson Wilkins Pediatric Endocrine Society and the European Society for Paediatric Endocrinology adopted this term in their "Consensus statement on management of intersex disorders".[92][93] While it adopted the term, to open "many more doors", the now defunct Intersex Society of North America itself remarked that intersex is not a disorder.[94] Other intersex people, activists, supporters, and academics have contested the adoption of the terminology and its implied status as a "disorder", seeing this as offensive to intersex individuals who do not feel that there is something wrong with them, regard the DSD consensus paper as reinforcing the normativity of early surgical interventions, and criticizing the treatment protocols associated with the new taxonomy.[95]

Sociological research in Australia, published in 2016, found that 3% of respondents used the term "disorders of sex development" or "DSD" to define their sex characteristics, while 21% use the term when accessing medical services. In contrast, 60% used the term "intersex" in some form to self-describe their sex characteristics.[113] U.S. research by the Lurie Children's Hospital, Chicago, and the AIS-DSD Support Group published in 2017 found that "disorders of sex development" terminology may negatively affect care, give offense, and result in lower attendance at medical clinics.[81][80]

Alternatives to categorizing intersex conditions as "disorders" have been suggested, including "variations of sex development".[96] Organisation Intersex International (OII) questions a disease/disability approach, argues for deferral of intervention unless medically necessary, when fully informed consent of the individual involved is possible, and self-determination of sex/gender orientation and identity.[97] The UK Intersex Association is also highly critical of the label 'disorders' and points to the fact that there was minimal involvement of intersex representatives in the debate which led to the change in terminology.[98] In May 2016, Interact Advocates for Intersex Youth also published a statement opposing pathologizing language to describe people born with intersex traits, recognizing "increasing general understanding and acceptance of the term "intersex"".[99]

LGBT and LGBTI

{{main|Intersex and LGBT}}

Intersex can be contrasted with homosexuality or same-sex attraction. Numerous studies have shown higher rates of same sex attraction in intersex people,[149][100] with a recent Australian study of people born with atypical sex characteristics finding that 52% of respondents were non-heterosexual,[101][102] thus research on intersex subjects has been used to explore means of preventing homosexuality.[103][100] However, current studies do not support a statistical correlation between genetic intersex traits and transsexual persons.[104][105]

Intersex can therefore be contrasted with transgender,[157] which describes the condition in which one's gender identity does not match one's assigned sex.[106][107][108] Some people are both intersex and transgender.[109] A 2012 clinical review paper found that between 8.5% and 20% of people with intersex variations experienced gender dysphoria.[65] In an analysis of the use of preimplantation genetic diagnosis to eliminate intersex traits, Behrmann and Ravitsky state: "Parental choice against intersex may ... conceal biases against same-sex attractedness and gender nonconformity."[110]

The relationship of intersex to lesbian, gay, bisexual and trans, and queer communities is complex,[111] but intersex people are often added to LGBT to create an LGBTI community. Emi Koyama describes how inclusion of intersex in LGBTI can fail to address intersex-specific human rights issues, including creating false impressions "that intersex people's rights are protected" by laws protecting LGBT people, and failing to acknowledge that many intersex people are not LGBT.[112] Organisation Intersex International Australia states that some intersex individuals are same sex attracted, and some are heterosexual, but "LGBTI activism has fought for the rights of people who fall outside of expected binary sex and gender norms."[113][114] Julius Kaggwa of SIPD Uganda has written that, while the gay community "offers us a place of relative safety, it is also oblivious to our specific needs".[115] Mauro Cabral has written that transgender people and organizations "need to stop approaching intersex issues as if they were trans issues" including use of intersex as a means of explaining being transgender; "we can collaborate a lot with the intersex movement by making it clear how wrong that approach is".[116]

In society

Fiction and media

{{main|Literature about intersex|Intersex characters in fiction}}

An intersex character is the narrator in Jeffrey Eugenides' Pulitzer Prize-winning novel Middlesex.

Television works about intersex and films about intersex are scarce. The Spanish-language film XXY won the Critics' Week grand prize at the 2007 Cannes Film Festival and the ACID/CCAS Support Award.[117] Faking It is notable for providing both the first intersex main character in a television show,[118] and television's first intersex character played by an intersex actor.[119]

Civil society institutions

{{main|Intersex civil society organizations}}

Intersex peer support and advocacy organizations have existed since at least 1985, with the establishment of the Androgen Insensitivity Syndrome Support Group Australia in 1985.[120] The Androgen Insensitivity Syndrome Support Group (UK) established in 1988.[121] The Intersex Society of North America (ISNA) may have been one of the first intersex civil society organizations to have been open to people regardless of diagnosis; it was active from 1993 to 2008.[122]

Events

{{main|Intersex Awareness Day|Intersex Day of Remembrance}}Intersex Awareness Day is an internationally observed civil awareness day designed to highlight the challenges faced by intersex people, occurring annually on 26 October. It marks the first public demonstration by intersex people, which took place in Boston on 26 October 1996, outside a venue where the American Academy of Pediatrics was holding its annual conference.[123]Intersex Day of Remembrance, also known as Intersex Solidarity Day, is an internationally observed civil awareness day designed to highlight issues faced by intersex people, occurring annually on 8 November. It marks the birthday of Herculine Barbin, a French intersex person whose memoirs were later published by Michel Foucault in Being the Recently Discovered Memoirs of a Nineteenth-century French Hermaphrodite.

Religion

{{main|Intersex people and religion}}

In Hinduism, Sangam literature uses the word pedi to refer to people born with an intersex condition; it also refers to antharlinga hijras and various other hijras.[124] Warne and Raza argue that an association between intersex and hijra people is mostly unfounded but provokes parental fear.[125]

In Islam, scholars of Islamic jurisprudence have detailed discussions on the status and rights of intersex based on what mainly exhibits in their external sexual organs. Yet, modern Islamic jurisprudence scholars turn to medical screening to determine the dominance of their sex. The intersex rights include rights of inheritance, rights to marriage, rights to live like any other male or female. The rights are generally based on whether they are true hermaphrodites or pseudohermaphrodite. Scholars of Islamic jurisprudence generally consider their rights based on the majority of what appears from their external sexual organs.{{citation needed|date=May 2016}}

In Judaism, the Talmud contains extensive discussion concerning the status of two intersex types in Jewish law; namely the androgynous, which exhibits both male and female external sexual organs, and the tumtum which exhibits neither. In the 1970s and 1980s, the treatment of intersex babies started to be discussed in Orthodox Jewish medical halacha by prominent rabbinic leaders, for example Eliezer Waldenberg and Moshe Feinstein.[126]

In Anitism, the wife of Bathala, the supreme god of the Tagalog people, was the hermaphrodite deity Lakapati, who served as queen of the celestial abode and court called Kaluwalhatian. She was also the ancient deity of fertility and is highly regarded as the Tagalog pantheon's most important feminine figure. Her relationship with the supreme god, Bathala, was symbolic for the ancient Tagalogs as it referred to marriage as a mutual bond between two parties regardless of gender, which was a common practice at the time. A record entry from 1613 noted that during sacrifices made in a new field, farmers would hold up a child and say, “Lakapati, pakanin mo yaring alipin mo; huwag mong gutumin (Lakapati, feed this thy slave; let him not hunger)”. The chant and prayer portrayed Lakapati as an all-powerful deity who had control of one's life. Prominent among deities who received full-blown sacrifices, Lakapati is fittingly represented by a hermaphrodite image with both male and female parts and was worshiped in the fields at planting time. Her bodily expression is notably feminine. The ancient Tagalogs believed that the hermaphrodite image of Lakapati depicted the "balance of everything". During early Spanish rule, Lakapati was depicted as the Holy Spirit, as the people continued to revere her despite Spanish threats. Modern interpretations have stated that Lakapati was transgender, although in a historical context, Lakapati was known as a hermaphrodite or intersex and not a transgender.[127]

Sport

{{main|Sex verification in sports}}

Multiple athletes have been humiliated, excluded from competition or been forced to return medals following discovery of an intersex trait. Examples include Erik Schinegger, Foekje Dillema, Maria José Martínez-Patiño and Santhi Soundarajan. In contrast, Stanisława Walasiewicz (also known as Stella Walsh) was the subject of posthumous controversy.[128]

The South African middle-distance runner Caster Semenya won gold at the World Championships in the women's 800 metres and won silver in the 2012 Summer Olympics. When Semenya won gold in the World Championships, the International Association of Athletics Federations (IAAF) requested sex verification tests. The results were not released, but Semenya was cleared to race with other women.[129] Katrina Karkazis, Rebecca Jordan-Young, Georgiann Davis and Silvia Camporesi argued that new IAAF policies on "hyperandrogenism" in female athletes (applied for example to the case of Dutee Chand), established in response to the Semenya case, are "significantly flawed", arguing that the policy will not protect against breaches of privacy, will require athletes to undergo unnecessary treatment in order to compete, and will intensify "gender policing". They recommend that athletes be able to compete in accordance with their legal gender.[130]

In April 2014, the BMJ reported that four elite women athletes with 5-ARD were subjected to sterilization and "partial clitoridectomies" in order to compete in sport. The authors noted that "partial clitoridectomy" was "not medically indicated, does not relate to real or perceived athletic "advantage".[131] Intersex advocates regard this intervention as "a clearly coercive process".[132] In 2016, the United Nations Special Rapporteur on health, Dainius Pūras, criticized "current and historic" sex verification policies, describing how "a number of athletes have undergone gonadectomy (removal of reproductive organs) and partial clitoridectomy (a form of female genital mutilation) in the absence of symptoms or health issues warranting those procedures."[133]

Population figures

There are few firm estimates of the number of intersex people. The now-defunct Intersex Society of North America stated that:

{{quotation|If you ask experts at medical centers how often a child is born so noticeably atypical in terms of genitalia that a specialist in sex differentiation is called in, the number comes out to about 1 in 1500 to 1 in 2000 births [0.07–0.05%]. But a lot more people than that are born with subtler forms of sex anatomy variations, some of which won't show up until later in life.[134]}}

Blackless, Fausto-Sterling et al., said in two articles in 2000 that 1.7 percent of human births (1 in 60) might be intersex, including variations that may not become apparent until, for example, puberty, or until attempting to conceive.[135][136] Their publications have been widely quoted,[39][137][138] though aspects are now considered outdated, such as use of the now scientifically incorrect term hermaphrodite.[139]

Eric Vilain et al. highlighted in 2007 that the term disorders of sex development (DSD) had replaced "hermaphrodite" and improper medical terms based on it.[140]

The figure of 1.7% is still maintained by Intersex Human Rights Australia "despite its flaws".[141] "This estimate relates to any "individual who deviates from the Platonic ideal of physical dimorphism at the chromosomal, genital, gonadal, or hormonal levels" and thus it encapsulates the entire population of people who are stigmatized – or risk stigmatization – due to innate sex characteristics."

Individuals with diagnoses of disorders of sex development (DSD) may or may not experience stigma and discrimination due to their sex characteristics, including sex "normalizing" interventions. Human rights institutions have called for the de-medicalization of intersex traits, as far as possible.[12][39][198][199]

The following summarizes some prevalence figures of intersex traits (a fuller 'List of conditions' is provided below, at the end of 'Medical classifications'):

Intersex Trait (genotype) Prevalence
Not XX, XY, Klinefelter, or Turner one in 1,500–2,000 births (0.07–0.05%)[134]
Klinefelter syndrome (47,XXY) one in 1,000 births (0.10%)
Turner syndrome (45,X) one in 2,710 births (0.04%)[142]
Androgen insensitivity syndrome (46,XY) one in 13,000 births (0.008%)
Partial androgen insensitivity syndrome (46,XY) one in 130,000 births (0.0008%)
Classical congenital adrenal hyperplasia (46,XY or 46,XX) one in 13,000 births (0.008%)
Late onset adrenal hyperplasia (46,XY or 46,XX) one in 50–1,000 births (2–0.1%)[143]
Vaginal atresia (46,XX) one in 6,000 births (0.017%)
Ovotestes (45,X/46,XY mosaicism) one in 83,000 births (0.0012%)
Idiopathic (no discernable medical cause; 46,XY or 46,XX) one in 110,000 births (0.0009%)
Iatrogenic (caused by medical treatment, e.g., progestin administered to pregnant mother; 46,XY or 46,XX) No estimate
5-alpha-reductase deficiency (46,XY) No estimate
Mixed gonadal dysgenesis (45,X/46,XY mosaicism) No estimate
Müllerian agenesis (of vagina, i.e., MRKH Syndrome; 46,XX) 1 in 4,500–5,000 births (0.022–0.020%)
Complete gonadal dysgenesis (46,XY or 46,XX or 45,X/46,XY mosaicism) one in 150,000 births (0.00067%)

Population figures can vary due to genetic causes. In the Dominican Republic, 5-alpha-reductase deficiency is not uncommon in the town of Las Salinas resulting in social acceptance of the intersex trait.[144] Men with the trait are called "güevedoces" (Spanish for "eggs at twelve"). 12 out of 13 families had one or more male family members that carried the gene. The overall incidence for the town was 1 in every 90 males were carriers, with other males either non-carriers or non-affected carriers.[145]

Medical classifications

Sexual Differentiation

{{Main|Sexual differentiation}}

The common pathway of sexual differentiation, where a productive human female has an XX chromosome pair, and a productive male has an XY pair, is relevant to the development of intersex conditions.

During fertilization, the sperm adds either an X (female) or a Y (male) chromosome to the X in the ovum. This determines the genetic sex of the embryo.[146] During the first weeks of development, genetic male and female fetuses are "anatomically indistinguishable", with primitive gonads beginning to develop during approximately the sixth week of gestation. The gonads, in a "bipotential state", may develop into either testes (the male gonads) or ovaries (the female gonads), depending on the consequent events.[146] Through the seventh week, genetically female and genetically male fetuses appear identical.

At around eight weeks of gestation, the gonads of an XY embryo differentiate into functional testes, secreting testosterone. Ovarian differentiation, for XX embryos, does not occur until approximately week 12 of gestation. In normal female differentiation, the Müllerian duct system develops into the uterus, Fallopian tubes, and inner third of the vagina.

In males, the Müllerian duct-inhibiting hormone MIH causes this duct system to regress. Next, androgens cause the development of the Wolffian duct system, which develops into the vas deferens, seminal vesicles, and ejaculatory ducts.[146]

By birth, the typical fetus has been completely "sexed" male or female, meaning that the genetic sex (XY-male or XX-female) corresponds with the phenotypical sex; that is to say, genetic sex corresponds with internal and external gonads, and external appearance of the genitals.

Signs

There is a variety of symptoms that can occur. Ambiguous genitalia being the most common sign, there can be micropenis, clitoromegaly, partial labial fusion, electrolyte abnormalities, delayed or absent puberty, unexpected changes at puberty, hypospadias, labial or inguinal (groin) masses (which may turn out to be testes) in girls and undescended testes (which may turn out to be ovaries) in boys.[208]

Ambiguous genitalia

Ambiguous genitalia may appear as a large clitoris or as a small penis.

Because there is variation in all of the processes of the development of the sex organs, a child can be born with a sexual anatomy that is typically female or feminine in appearance with a larger-than-average clitoris (clitoral hypertrophy) or typically male or masculine in appearance with a smaller-than-average penis that is open along the underside. The appearance may be quite ambiguous, describable as female genitals with a very large clitoris and partially fused labia, or as male genitals with a very small penis, completely open along the midline ("hypospadic"), and empty scrotum. Fertility is variable.

Measurement systems for Ambiguous genitalia

The orchidometer is a medical instrument to measure the volume of the testicles. It was developed by Swiss pediatric endocrinologist Andrea Prader. The Prader scale[147] and Quigley scale are visual rating systems that measure genital appearance. These measurement systems were satirized in the Phall-O-Meter, created by the (now defunct) Intersex Society of North America.[148][149][150]

Other signs

In order to help in classification, methods other than a genitalia inspection can be performed. For instance, a karyotype display of a tissue sample may determine which of the causes of intersex is prevalent in the case. Additionally, electrolyte tests, endoscopic exam, ultrasound and hormone stimulation tests can be done.[151]

Causes

  • Intersex can be divided into four categories of which are 46, XX intersex, 46, XY intersex, true gonadal intersex and complex or undetermined intersex.
46, XX intersex:

This condition used to be called "female pseudohermaphroditism" and they have female internal genitalia and karyotype (XX) and various degree of external genitalia virilization.[152] External genitalia is masculinized congenitally when female fetus is exposed to excess androgenic environment.[153] Hence, the chromosome of the person is of a woman, the ovaries of a woman, but external genitals that appear like a male. The labia fuse, and the clitoris enlarges to appear like a penis. The causes of this can be male hormones taken during pregnancy, congenital adrenal hyperplasia, male-hormone-producing tumors in the mother and aromatase deficiency.[153]

46, XY Intersex:

This condition was used to be called "male pseudohermaphroditism". This is defined as incomplete masculinization of the external genitalia.[154] Thus, the person has the chromosomes of a man, but the external genitals are incompletely formed, ambiguous, or clearly female.[153] This condition is also called 46, XY with undervirilization.[153] 46, XY intersex has many possible causes, which can be problems with the testes and testosterone formation.[153] Also, there can be problems with using testosterone. Some people lack the enzyme needed to convert testosterone to dihydrotestosterone, which is a cause of 5-alpha-reductase deficiency.[153] Androgen Insensitivity Syndrome is the most common cause of 46, XY intersex.[153]

True Gonadal Intersex

This condition used to be called "true hermaphroditism". This is defined as having asymmetrical gonads with ovarian and testicular differentiation on either sides separately or combined as ovotestis.[155] In most cases the cause of this condition is unknown, although in some clinical researches it has been linked to exposure to common agricultural pesticides.[155]

Complex or undetermined intersex

This is the condition of having any chromosome configurations rather than 46, XX or 46, XY intersex.[153] This condition does not result in any imbalance between internal and external genitalia.[153] However, there may be problems with sex hormone levels, overall sexual development, and altered numbers of sex chromosomes.[153]

Conditions

{{further|disorders of sex development}}

There are a variety of opinions on what conditions or traits are and are not intersex, dependent on the definition of intersex that is used. Current human rights based definitions stress a broad diversity of sex characteristics that differ from expectations for male or female bodies.[15] During 2015, the Council of Europe,[39] the European Union Agency for Fundamental Rights[198] and Inter-American Commission on Human Rights[199] have called for a review of medical classifications on the basis that they presently impede enjoyment of the right to health; the Council of Europe expressed concern that "the gap between the expectations of human rights organisations of intersex people and the development of medical classifications has possibly widened over the past decade".[39][156][157]

Medical interventions

{{main|Intersex medical interventions}}{{further|History of intersex surgery}}

Rationales

Medical interventions take place to address physical health concerns and psychosocial risks. Both types of rationale are the subject of debate, particularly as the consequences of surgical (and many hormonal) interventions are lifelong and irreversible. Questions regarding physical health include accurately assessing risk levels, necessity, and timing. Psychosocial rationales are particularly susceptible to questions of necessity as they reflect social and cultural concerns.

There remains no clinical consensus about an evidence base, surgical timing, necessity, type of surgical intervention, and degree of difference warranting intervention.[165][166][167] Such surgeries are the subject of significant contention due to consequences that include trauma, impact on sexual function and sensation, and violation of rights to physical and mental integrity.[42] This includes community activism,[168] and multiple reports by international human rights[10][39][63][169] and health[62] institutions and national ethics bodies.[28][170]

In the cases where gonads may pose a cancer risk, as in some cases of androgen insensitivity syndrome,[171] concern has been expressed that treatment rationales and decision-making regarding cancer risk may encapsulate decisions around a desire for surgical normalization.[12]

Types

  • Feminizing and masculinizing surgeries: Surgical procedures depend on diagnosis, and there is often concern as to whether surgery should be performed at all. Typically, surgery is performed shortly after birth. Defenders of the practice argue that it is necessary for individuals to be clearly identified as male or female in order for them to function socially and develop normally. Psychosocial reasons are often stated.[92] This is criticised by many human rights institutions, and authors. Unlike other aesthetic surgical procedures performed on infants, such as corrective surgery for a cleft lip, genital surgery may lead to negative consequences for sexual functioning in later life, or feelings of freakishness and unacceptability.[172]
  • Hormone treatment: There is widespread evidence of prenatal testing and hormone treatment to prevent or eliminate intersex traits,[173][174] associated also with the problematization of sexual orientation and gender non-conformity.[173][175]
  • Psychosocial support: All stakeholders support psychosocial support. A joint international statement by participants at the Third International Intersex Forum in 2013 sought, amongst other demands: "Recognition that medicalization and stigmatisation of intersex people result in significant trauma and mental health concerns. In view of ensuring the bodily integrity and well-being of intersex people, autonomous non-pathologising psycho-social and peer support be available to intersex people throughout their life (as self-required), as well as to parents and/or care providers."
  • Genetic selection and terminations: The ethics of preimplantation genetic diagnosis to select against intersex traits was the subject of 11 papers in the October 2013 issue of the American Journal of Bioethics.[176] There is widespread evidence of pregnancy terminations arising from prenatal testing, as well as prenatal hormone treatment to prevent intersex traits. Behrmann and Ravitsky find social concepts of sex, gender and sexual orientation to be "intertwined on many levels. Parental choice against intersex may thus conceal biases against same-sex attractedness and gender nonconformity."[110]
  • Gender dysphoria: The DSM-5 included a change from using gender identity disorder to gender dysphoria. This revised code now specifically includes intersex people who do not identify with their sex assigned at birth and experience clinically significant distress or impairment, using the language of disorders of sex development.[177] This move was criticised by intersex advocacy groups in Australia and New Zealand.[178]

See also

  • Intersex people and military service
  • The Left Hand of Darkness
  • Third gender

Notes

1. ^1 {{cite book|last=Money |first=John |authorlink1 = John Money|author2=Ehrhardt, Anke A. |title=Man & Woman Boy & Girl. Differentiation and dimorphism of gender identity from conception to maturity |year=1972|publisher=The Johns Hopkins University Press |location=USA |isbn=978-0-8018-1405-1}}
2. ^1 2 3 {{cite book |last=Domurat Dreger |first=Alice |authorlink = Alice Dreger |title=Hermaphrodites and the Medical Invention of Sex |year=2001 |publisher=Harvard University Press |location=USA |isbn=978-0-674-00189-3}}
3. ^Mason, H.J., Favorinus' Disorder: Reifenstein's Syndrome in Antiquity?, in Janus 66 (1978) 1–13.
4. ^Nguyễn Khắc Thuần (1998), Việt sử giai thoại (History of Vietnam's tales), vol. 8, Vietnam Education Publishing House, p. 55
5. ^1 2 {{Cite journal|last=Zucker|first=Kenneth J.|last2=Bradley|first2=Susan J.|last3=Sullivan|first3=Claire B. Lowry|date=March 1992|title=Gender Identity Disorder in Children|url=http://dx.doi.org/10.1080/10532528.1992.10559876|journal=Annual Review of Sex Research|volume=3|issue=1|pages=73–120|doi=10.1080/10532528.1992.10559876|issn=1053-2528}}
6. ^{{Cite journal|last=Dreger|first=Alice D.|last2=Chase|first2=Cheryl|last3=Sousa|first3=Aron|last4=Gruppuso|first4=Phillip A.|last5=Frader|first5=Joel|date=18 August 2005|title=Changing the Nomenclature/Taxonomy for Intersex: A Scientific and Clinical Rationale|journal=Journal of Pediatric Endocrinology and Metabolism|volume=18|issue=8|doi=10.1515/JPEM.2005.18.8.729}}
7. ^1 {{Cite journal|last=Holmes|first=Morgan|authorlink=Morgan Holmes|date=September 2011|title=The Intersex Enchiridion: Naming and Knowledge|journal=Somatechnics|volume=1|issue=2|pages=388–411|doi=10.3366/soma.2011.0026|issn=2044-0138}}
8. ^Submission 88 to the Australian Senate inquiry on the involuntary or coerced sterilisation of people with disabilities in Australia {{webarchive|url=https://web.archive.org/web/20150923174608/http://www.aph.gov.au/DocumentStore.ashx?id=aafe43f3-c6a2-4525-ad16-15e4210ee0ac&subId=16191 |date=23 September 2015 }}, Australasian Paediatric Endocrine Group (APEG), 27 June 2013
9. ^{{cite news|last1=Macur|first1=Juliet|title=Fighting for the Body She Was Born With|url=https://www.nytimes.com/2014/10/07/sports/sprinter-dutee-chand-fights-ban-over-her-testosterone-level.html|accessdate=9 February 2015|publisher=The New York Times|date=6 October 2014|deadurl=no|archiveurl=https://web.archive.org/web/20150112141415/http://www.nytimes.com/2014/10/07/sports/sprinter-dutee-chand-fights-ban-over-her-testosterone-level.html|archivedate=12 January 2015|df=dmy-all}}
10. ^1 Report of the UN Special Rapporteur on Torture {{webarchive|url=https://web.archive.org/web/20160824161117/http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf |date=24 August 2016 }}, Office of the UN High Commissioner for Human Rights, February 2013.
11. ^Eliminating forced, coercive and otherwise involuntary sterilization, An interagency statement {{webarchive|url=https://web.archive.org/web/20150711130919/http://www.who.int/reproductivehealth/publications/gender_rights/eliminating-forced-sterilization/en/ |date=11 July 2015 }}, World Health Organization, May 2014.
12. ^1 2 3 {{Cite book| work = Australian Senate| isbn = 978-1-74229-917-4| last1 = Senate of Australia| last2 = Community Affairs References Committee| title = Involuntary or coerced sterilisation of intersex people in Australia| location = Canberra| date = 2013| url = http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Involuntary_Sterilisation/Sec_Report/index| deadurl = no| archiveurl = https://web.archive.org/web/20150923181927/http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Involuntary_Sterilisation/Sec_Report/index| archivedate = 23 September 2015| df = dmy-all}}
13. ^1 2 3 {{Cite news| last = Reuters| title = Surgery and Sterilization Scrapped in Malta's Benchmark LGBTI Law| work = The New York Times| date = 1 April 2015| url = https://www.nytimes.com/reuters/2015/04/01/world/europe/01reuters-gay-rights-malta.html}}
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15. ^1 2 3 4 {{Cite web | author = | publisher = United Nations Office of the High Commissioner for Human Rights | title = Free & Equal Campaign Fact Sheet: Intersex | date = 2015 | url = https://unfe.org/system/unfe-65-Intersex_Factsheet_ENGLISH.pdf | access-date = 28 March 2016 | deadurl = no | archiveurl = https://web.archive.org/web/20160304071043/https://unfe.org/system/unfe-65-Intersex_Factsheet_ENGLISH.pdf | archivedate = 4 March 2016 | df = dmy-all }}
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27. ^{{cite journal|last1=Coran|first1=Arnold G.|last2=Polley|first2=Theodore Z.|title=Surgical management of ambiguous genitalia in the infant and child|journal=Journal of Pediatric Surgery|date=July 1991|volume=26|issue=7|pages=812–820|doi=10.1016/0022-3468(91)90146-K|pmid=1895191|citeseerx=10.1.1.628.4867}}
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56. ^{{Cite web| last = Zwischengeschlecht| title = Nuremberg Hermaphrodite Lawsuit: Michaela "Micha" Raab Wins Damages and Compensation for Intersex Genital Mutilations!| accessdate = 21 December 2015| date = 17 December 2015| url = http://stop.genitalmutilation.org/post/Nuremberg-Hermaphrodite-Lawsuit-Damages-and-Compensation-for-Intersex-Genital-Mutilations| deadurl = no| archiveurl = https://archive.today/20160511101133/http://stop.genitalmutilation.org/post/Nuremberg-Hermaphrodite-Lawsuit-Damages-and-Compensation-for-Intersex-Genital-Mutilations| archivedate = 11 May 2016| df = dmy-all}}
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108. ^{{cite web |url=https://oii.org.au/18194/differences-intersex-trans/ |title=Basic differences between intersex and trans |publisher=Organisation Intersex International Australia |accessdate=2013-07-10 |deadurl=no |archiveurl=https://web.archive.org/web/20140904081530/http://oii.org.au/18194/differences-intersex-trans/ |archivedate=4 September 2014 |df=dmy-all |date=2011-06-03 }}
109. ^{{Citation| publisher = Intersex Day| last = Cabral Grinspan| first = Mauro| authorlink1 = Mauro Cabral| title = The marks on our bodies| date = 25 October 2015| url = http://intersexday.org/en/mauro-cabral-marks-bodies/| deadurl = no| archiveurl = https://web.archive.org/web/20160405220557/http://intersexday.org/en/mauro-cabral-marks-bodies/| archivedate = 5 April 2016| df = dmy-all}}
110. ^1 {{Cite journal| doi = 10.1080/15265161.2013.828131| pmid = 24024805 | issn = 1526-5161 | volume = 13| issue = 10| pages = 39–41| last1 = Behrmann| first1 = Jason| last2 = Ravitsky| first2 = Vardit| title = Queer Liberation, Not Elimination: Why Selecting Against Intersex is Not "Straight" Forward| journal = The American Journal of Bioethics| date = October 2013}}
111. ^{{Cite journal| last = Dreger| first = Alice| title = Reasons to Add and Reasons NOT to Add "I" (Intersex) to LGBT in Healthcare| date = 4 May 2015| url = https://www.aamc.org/download/431576/data/reasonsdeck.pdf| publisher = Association of American Medical Colleges| access-date = 18 May 2016| deadurl = no| archiveurl = https://web.archive.org/web/20160609230211/https://www.aamc.org/download/431576/data/reasonsdeck.pdf| archivedate = 9 June 2016| df = dmy-all}}
112. ^{{Cite web| last = Koyama| first = Emi| title = Adding the "I": Does Intersex Belong in the LGBT Movement?| work = Intersex Initiative| url = http://www.intersexinitiative.org/articles/lgbti.html| access-date = 18 May 2016| deadurl = no| archiveurl = https://web.archive.org/web/20160517075057/http://www.intersexinitiative.org/articles/lgbti.html| archivedate = 17 May 2016| df = dmy-all}}
113. ^{{cite web | title = Intersex for allies | url = http://oii.org.au/allies | date = 21 November 2012 | access-date = 18 May 2016 | deadurl = no | archiveurl = https://web.archive.org/web/20160607042937/http://oii.org.au/allies/ | archivedate = 7 June 2016 | df = dmy-all }}
114. ^OII releases new resource on intersex issues {{webarchive|url=https://web.archive.org/web/20140606202143/http://gaynewsnetwork.com.au/news/oii-releases-new-resource-on-intersex-issues-13999.html |date=6 June 2014 }}, Intersex for allies and Making services intersex inclusive by Organisation Intersex International Australia, via Gay News Network, 2 June 2014.
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117. ^{{cite web|last1=Leffler |first1=Rebecca |title=Critics Week grand prize to 'XXY' |url=http://www.hollywoodreporter.com/hr/content_display/awards_festivals/cannes/news/e3id97fddd8a9cc782ed64893105887c4fc |website=The Hollywood Reporter |accessdate=12 February 2017 |date=26 May 2007 |deadurl=yes|archiveurl=https://web.archive.org/web/20070930222336/http://www.hollywoodreporter.com/hr/content_display/awards_festivals/cannes/news/e3id97fddd8a9cc782ed64893105887c4fc |archivedate=30 September 2007 |df=dmy-all }}
118. ^{{Cite web |title= Meet television's groundbreaking intersex character |url= https://www.buzzfeed.com/louispeitzman/meet-televisions-groundbreaking-intersex-character |website= Buzzfeed |deadurl= no |archiveurl= https://web.archive.org/web/20160529020917/https://www.buzzfeed.com/louispeitzman/meet-televisions-groundbreaking-intersex-character |archivedate= 29 May 2016 |df= dmy-all }}
119. ^{{Cite web|url=http://www.newnownext.com/faking-it-intersex/04/2016/|title="Faking It" Breaks New Ground With First Intersex Actor To Play Intersex Character On TV|website=New Now Next|access-date=5 April 2016|deadurl=no|archiveurl=https://web.archive.org/web/20160405070107/http://www.newnownext.com/faking-it-intersex/04/2016/|archivedate=5 April 2016|df=dmy-all}}
120. ^{{Cite web| last1 = Androgen Insensitivity Syndrome Support Group Australia| last2 = Briffa| first2 = Anthony| author-link2 = Tony Briffa (policitian)| title = Discrimination against People affected by Intersex Conditions: Submission to NSW Government| url = http://www.antidiscrimination.justice.nsw.gov.au/Documents/submission%20about%20intersex%20discrimination%20in%20nsw.pdf| date = 22 January 2003| access-date = 16 May 2016| deadurl = no| archiveurl = https://web.archive.org/web/20160311131348/http://www.antidiscrimination.justice.nsw.gov.au/Documents/submission%20about%20intersex%20discrimination%20in%20nsw.pdf| archivedate = 11 March 2016| df = dmy-all}}
121. ^{{cite web | url = http://www.aissg.org/INDEX.HTM | title = Androgen Insensitivity Syndrome Support Group (AISSG) | access-date = 16 May 2016 | deadurl = no | archiveurl = https://web.archive.org/web/20160121050955/http://www.aissg.org/INDEX.HTM | archivedate = 21 January 2016 | df = dmy-all }}
122. ^{{cite web | title = Dear ISNA Friends and Supporters | url = http://www.isna.org | date = 2008 | access-date = 16 May 2016 | deadurl = no | archiveurl = https://web.archive.org/web/20160519013103/http://www.isna.org/ | archivedate = 19 May 2016 | df = dmy-all }}
123. ^{{cite web |url=http://intersexday.org/en/max-beck-morgan-holmes-boston-1996/ |title=When Max Beck and Morgan Holmes went to Boston |last=Holmes |first=Morgan |author-link=Morgan Holmes |date=17 October 2015 |website=Intersex Day |access-date=2015-10-24 |quote= |deadurl=no |archiveurl=https://web.archive.org/web/20151020004238/http://intersexday.org/en/max-beck-morgan-holmes-boston-1996/ |archivedate=20 October 2015 |df=dmy-all }}
124. ^{{cite book |title=Maraikkappatta Pakkangal: மறைக்கப்பட்ட பக்கங்கள்|last=Winter |first=Gopi Shankar|year=2014 |publisher=Srishti Madurai |isbn=9781500380939 |oclc=703235508 |page= |pages=}}
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126. ^{{cite web|url=http://www.jweekly.com/article/full/72653/the-space-between-stanford-prof-talmudic-rabbis-were-into-analyzing-sexuali/|title=the space between - Stanford prof: Talmudic rabbis were into analyzing sexuality - j. the Jewish news weekly of Northern California|accessdate=6 October 2014|deadurl=no|archiveurl=https://web.archive.org/web/20141010140948/http://www.jweekly.com/article/full/72653/the-space-between-stanford-prof-talmudic-rabbis-were-into-analyzing-sexuali/|archivedate=10 October 2014|df=dmy-all|date=2014-09-19}}
127. ^https://www.aswangproject.com/lakapati-the-transgender-tagalog-deity/
128. ^{{cite journal|author=Klaudia Snochowska-Gonzales| title =Walasiewicz była kobietą (Walasiewicz Was a Woman)|journal=Gazeta Wyborcza|volume=190|issue=14 August 2004|page=8|url=http://szukaj.gazeta.pl/archiwum/1,0,4144041.html?wyr=Walasiewicz%2B%2B%2B | accessdate = 31 May 2006 |language=pl}}
129. ^{{cite journal|last=Cooky|first=Cheryl|author2=Shari L. Dworkin|title=Policing the Boundaries of Sex: A Critical Examination of Gender Verification and the Caster Semenya Controversy|journal=Journal of Sex Research|date=Feb 2013|volume=50|issue=2|pages=103–111|doi=10.1080/00224499.2012.725488|pmid=23320629}}
130. ^{{Cite journal| doi = 10.1080/15265161.2012.680533| pmid = 22694023| issn = 1526-5161| volume = 12| issue = 7| pages = 3–16| last1 = Karkazis| first1 = Katrina| last2 = Jordan-Young| first2 = Rebecca| last3 = Davis| first3 = Georgiann| last4 = Camporesi| first4 = Silvia| author-link1= Katrina Karkazis |author-link2= Rebecca Jordan-Young |author-link3= Georgiann Davis |title = Out of Bounds? A Critique of the New Policies on Hyperandrogenism in Elite Female Athletes| journal = The American Journal of Bioethics| date = July 2012 | pmc=5152729}}
131. ^1 {{Cite journal| doi = 10.1136/bmj.g2926| issn = 1756-1833| volume = 348| issue = apr28 9| pages = –2926–g2926| last1 = Jordan-Young| first1 = R. M.| last2 = Sonksen| first2 = P. H.| last3 = Karkazis| first3 = K.| author-link1= Rebecca Jordan-Young | author-link3= Katrina Karkazis |title = Sex, health, and athletes| journal = BMJ| date = April 2014 | pmid=24776640}}
132. ^{{cite web|url=http://oii.org.au/27745/un-human-rights-council-side-event-the-time-has-come/|title=UN Human Rights Council: resolution, statement and side event, "The time has come"|publisher=Organisation Intersex International Australia|accessdate=28 September 2014|deadurl=no|archiveurl=https://web.archive.org/web/20140930082248/http://oii.org.au/27745/un-human-rights-council-side-event-the-time-has-come/|archivedate=30 September 2014|df=dmy-all|date=2014-09-11}}
133. ^{{Citation | last2 = Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health | title = Sport and healthy lifestyles and the right to health. Report A/HRC/32/33 | last1 = Pūras | first1 = Dainius | publisher = United Nations | date = 4 April 2016 | url = http://ap.ohchr.org/documents/dpage_e.aspx?si=A/HRC/32/33 | deadurl = no | archiveurl = https://web.archive.org/web/20161215111551/http://ap.ohchr.org/documents/dpage_e.aspx?si=A%2FHRC%2F32%2F33 | archivedate = 15 December 2016 | df = dmy-all }}
134. ^1 {{cite web |url=http://www.isna.org/faq/frequency |title=How common is intersex? | Intersex Society of North America |publisher=Isna.org |accessdate=21 August 2009 |deadurl=no |archiveurl=https://web.archive.org/web/20090822212522/http://www.isna.org/faq/frequency/ |archivedate=22 August 2009 |df=dmy-all }}
135. ^{{Cite journal| doi = 10.1002/(SICI)1520-6300(200003/04)12:2<151::AID-AJHB1>3.0.CO;2-F| issn = 1520-6300| volume = 12| issue = 2| pages = 151–166| last1 = Blackless| first1 = Melanie| last2 = Charuvastra| first2 = Anthony| last3 = Derryck| first3 = Amanda| last4 = Fausto-Sterling| first4 = Anne| last5 = Lauzanne| first5 = Karl| last6 = Lee| first6 = Ellen| title = How sexually dimorphic are we? Review and synthesis| journal = American Journal of Human Biology| date = March 2000| pmid = 11534012| df = dmy-all}}
136. ^1 2 {{Cite book| publisher = Basic Books| isbn = 978-0-465-07714-4| pages = 53| last = Fausto-Sterling| first = Anne| title = Sexing the Body: Gender Politics and the Construction of Sexuality| date = 2000 | authorlink = Anne Fausto-Sterling| title-link = Sexing the Body}}
137. ^{{cite web |url=https://oii.org.au/16601/intersex-numbers/ |title=On the number of intersex people |date=28 September 2013 |website= |publisher=Organisation Intersex International Australia |access-date=4 July 2015 |quote= |deadurl=no |archiveurl=https://web.archive.org/web/20150704233705/https://oii.org.au/16601/intersex-numbers/ |archivedate=4 July 2015 |df=dmy-all }}
138. ^{{cite web |url=http://www.sbs.com.au/news/thefeed/story/intersex-i-lgbti |title=Intersex: the 'I' in 'LGBTI' |last1=Chaleyer |first1=Rani |date=10 March 2015 |website= |publisher=Special Broadcasting Service |access-date=4 July 2015 |quote= |deadurl=no |archiveurl=https://web.archive.org/web/20150705044518/http://www.sbs.com.au/news/thefeed/story/intersex-i-lgbti |archivedate=5 July 2015 |df=dmy-all }}
139. ^{{cite web |url=http://www.fd.unl.pt/docentes_docs/ma/TPB_MA_5937.pdf |title=The Five Sexes: why male and female is not enough |archiveurl=https://web.archive.org/web/20160313021411/http://www.fd.unl.pt/docentes_docs/ma/TPB_MA_5937.pdf |archivedate=13 March 2016 |df=dmy-all }}
140. ^{{cite journal | author1 = Vilain E | author2 = Achermann JC | author3 = Eugster EA | author4 = Harley VR | author5 = Morel Y | author6 = Wilson JD | author7 = Hiort O | year = 2007 | title = We used to call them hermaphrodites | url = | journal = Genetics in Medicine | volume = 9 | issue = 2| pages = 65–66 | doi=10.1097/gim.0b013e31802cffcf| pmid = 17304046 }}
141. ^{{Cite web | url=https://ihra.org.au/16601/intersex-numbers/ | title=Intersex population figures| date=2013-09-28}}
142. ^Per Fausto-Sterling. Donaldson et al. (2006) estimate one in 2,000 births and Marino (2013) estimates 1 in 5,000; see Turner syndrome.
143. ^{{cite journal |last1=Speiser |first1=Phyllis W. |last2=Azziz |first2=Ricardo |last3=Baskin |first3=Laurence S. |last4=Ghizzoni |first4=Lucia |last5=Hensle |first5=Terry W. |last6=Merke |first6=Deborah P. |last7=Meyer-Bahlburg |first7=Heino F. L. |last8=Miller |first8=Walter L. |last9=Montori |first9=Victor M. |last10=Oberfield |first10=Sharon E. |last11=Ritzen |first11=Martin |last12=White |first12=Perrin C. |title=Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency: An Endocrine Society Clinical Practice Guideline |journal=Journal of Clinical Endocrinology & Metabolism |volume=95 |issue=9 |pages=4133–4160 |year=2010 |doi=10.1210/jc.2009-2631 |pmid=20823466 |pmc=2936060 |quote=Nonclassic forms of CAH are more prevalent, occurring in approximately 0.1–0.2% in the general Caucasian population but in up to 1–2% among inbred populations, such as Eastern European (Ashkenazi) Jews}}
144. ^{{cite news|last1=Mosley|first1=Michael|title=The extraordinary case of the Guevedoces|url=https://www.bbc.com/news/magazine-34290981|website=BBC News|publisher=BBC News|accessdate=23 September 2015|deadurl=no|archiveurl=https://web.archive.org/web/20150923000145/http://www.bbc.com/news/magazine-34290981|archivedate=23 September 2015|df=dmy-all|date=2015-09-20}}
145. ^{{cite journal | last1 = Imperato-McGinley | first1 = Julianne | last2 = Guerrero | first2 = Luis | last3 = Gautier | first3 = Teofilo | last4 = Peterson | first4 = Ralph Edward | title = Steroid 5alpha-reductase deficiency in man: an inherited form of male pseudohermaphroditism | journal = Science | volume = 186 | issue = 4170 | pages = 1213–1215 |date=December 1974 | doi = 10.1126/science.186.4170.1213 | pmid = 4432067}}
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148. ^{{cite journal|last=Forrester | first = John | title = The psychology of the sexual–reproductive–gender system |issue=42 | journal = Wellcome History | date = 2009 | pages = 13–15 |url=http://eprints.whiterose.ac.uk/64236/1/Wellcome_History_42_Winter_2009_.pdf}}
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157. ^1 2 {{Citation| publisher = Comisión Interamericana de Derechos Humanos| last = Comisión Interamericana de Derechos Humanos| title = Violencia contra Personas Lesbianas, Gays, Bisexuales, Trans e Intersex en América| date = 12 November 2015| url = http://www.oas.org/es/cidh/informes/pdfs/ViolenciaPersonasLGBTI.pdf| language = Spanish| deadurl = no| archiveurl = https://web.archive.org/web/20160107143635/http://www.oas.org/es/cidh/informes/pdfs/ViolenciaPersonasLGBTI.pdf| archivedate = 7 January 2016| df = dmy-all}}
158. ^{{cite journal|last=Dreger|first=Alice|author2=Ellen K. Feder |author3=Anne Tamar-Mattis |title=Prenatal Dexamethasone for Congenital Adrenal Hyperplasia|journal=Journal of Bioethical Inquiry|volume=9|issue=3|pages=277–294|date=30 July 2012|doi=10.1007/s11673-012-9384-9|pmid=22904609|pmc=3416978}}
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160. ^{{cite web |url=http://www.emedicine.com/ped/topic1980.htm |title=eMedicine article on 5-ARD |publisher=Emedicine.com |date=23 June 2009 |accessdate=21 August 2009 |deadurl=no |archiveurl=https://web.archive.org/web/20081017193051/http://www.emedicine.com/ped/topic1980.htm |archivedate=17 October 2008 |df=dmy-all }}
161. ^{{cite book|title=Sexing the Body: Gender Politics and the Construction of Sexuality|year=2000|publisher=Basic Books|location=New York|author=Anne Fausto-Sterling|authorlink=Anne Fausto-Sterling|title-link=Sexing the Body: Gender Politics and the Construction of Sexuality}}
162. ^{{cite journal |vauthors=De Marchi M, Carbonara AO, Carozzi F |title=True hermaphroditism with XX/XY sex chromosome mosaicism: report of a case |journal=Clin. Genet. |volume=10 |issue=5 |pages=265–72 |year=1976 |pmid=991437 |doi=10.1111/j.1399-0004.1976.tb00047.x|display-authors=etal}}
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{{further|Intersex human rights reports}}{{external media | width = 210px | align = right | headerimage= | video1 = [https://www.buzzfeed.com/lizzwarner/what-its-like-to-be-intersex " What It's Like To Be Intersex"], Lizz Warner, BuzzFeed }}{{Commons category|Intersex}}
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{{Intersex}}{{Sex}}{{Sex (biology)|state=collapsed}}{{Reproductive health |state=collapsed}}{{Female congenital malformations of genital organs}}{{Male congenital malformations of genital organs, indeterminate sex and pseudohermaphroditism}}{{Sex|state=collapsed}}{{Authority control}}

5 : Intersex|Biology of gender|Gender|Gender studies|Sex
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