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An Introduction to Intersex (aka Hermaphroditism)

By Jeffrey Sterling, MD November 15, 2018

Introduction

intersex definition

Today we address the challenges faced by intersex individuals. In the past, the term hermaphrodite was more common, but for many reasons that is no longer the case. In general, intersex speaks to a discrepancy between one’s external appearance and the internal genitals (ovaries and testes).

Let me start by discussing why this is so confusing. We want clarity and easy ways to categorize sexuality. However, the evolution of sexuality is such that there are at least four factors to consider:

  • External appearance
  • Gender identity
  • Internal and external organs
  • Genetics (chromosomes)

Intersex Categories

intersex graphic

There are many ways in which those considerations interact with the others. As a result, a myriad of options and realities for separate individuals exists. To make things easier to understand, It helps to divide intersex into 4 categories.

  • The 46 chromosomes, XX intersex (genetic female constitution). In this example, the external genitals appear male. Excess exposure by the female fetus to male hormones is a typical cause for this condition.
  • The 46 chromosomes, XY intersex (genetic male constitution). In this example, the external genitals are incompletely formed, ambiguous, or even female.
  • True gonadal intersex occurs with both XX and XY chromosomal structure. These individuals must have both ovarian and testicular tissue. This tissue could be joined together, or it could present as one ovary and one testis.
  • Complex or undetermined intersex disorders of sexual development represent many other presentations. In these examples, there are no discrepancies between internal and external genitalia. Many chromosome configurations other than simple 46, XX or XY can produce intersex individuals. Examples include 45, XO (only one X chromosome), and 47, XXY, 47, XXX. In the latter cases, an extra sex chromosome is present. Still, there may be problems with sex hormone levels, overall sexual development, and altered numbers of sex chromosomes.

Future Conversations

This is a very complicated topic, and this introduction and identification of current efforts to classify means to offer a fundamental consideration. Intersex does not represent a “one size fits all” consideration. It also does not present a uniform set of treatment options. A basic level of understanding, empathy and tolerance for what is an anatomic challenge is very important to these individuals. Future Straight, No Chaser posts will address ethical questions, treatment options and mental health challenges faced.

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