Intersex (DSD*)
A medical definition of intersexuality
which is applied to human beings is "conditions in which
chromosomal sex is inconsistent with phenotypic sex, or in
which the phenotype is not classifiable as either male or
female". Applying this precise definition, the true
prevalence of intersex is seen to be about 0.018%
Hermaphrodite
The Heartbreak Of Not Having A Vagina
LGBT & Gender Non-Conforming (GNC) Girls Face in the CriminL Justicer System
What is
intersex?  Just one of hundreds of varients. The current medical protocol calls for the surgical "reconstruction" of these different but healthy bodies to make them "normal," but this practice has become increasingly controversial as adults who went through the treatment report being physically, emotionally, and sexually harmed by such procedures. There is no single "intersex body"; it encompasses a wide variety of conditions that do not have anything in common except that they are deemed "abnormal" by the society. What makes intersex people similar is their experiences of medicalization, not biology. Intersex is not an identity. While some intersex people do reclaim it as part of their identity, it is not a freely chosen category of gender--it can only be reclaimed. Most intersex people identify as men or women, just like everybody Are intersex people "third gender"? Many people with intersex conditions identify solidly as a man or as a woman, like many non-intersex people. There are some who identify as a member of an alternative gender, like some non-intersex people. While we support everyone's right to define her or his own identities, we do not believe that people with intersex conditions should be expected to be gender-transgressive just because of their condition. What is the difference between "hermaphrodite" and "intersex"? In biology, "hermaphrodite" means an organism that has both "male" and "female" sets of reproductive organs (like snails and earthworms). In humans, there are no actual "hermaphrodites" in this sense, although doctors have called people with intersex conditions "hermaphrodites" because intersex bodies do not neatly comform to what doctors define as the "normal" male or female bodies. We find the word "hermaphrodite" misleading, mythologizing, and stigmatizing. Although some intersex activists do reclaim and use this term to describe themselves, it is not an appropriate term to refer to intersex people in general. In short, snails are the hermaphrodites; humans are not. Also, please avoid using the word "intersexual" as a noun; we prefer "intersex people" or "people with intersex conditions/experiences." Are intersex conditions
harmful? Can't they just do a test to find
out babies' true sex? Beside stopping cosmetic genital
surgeries, what are intersex activists working
toward? What is the correct pronoun for
intersex people? Is intersex part of the trans
community? The
prevalence of intersex depends on which definition is
used. What's so significant about October
26? It's great! How can I help? What Intersex is
not It is not "Hermanphroditism," as this is a complete set of female and male reproductive organs, which is impossible in humans.
Hermaphrodite 4 Dreger, Alice Domurat (1999). Intersex in the age of ethics (Ethics in Clinical Medicine Series ed.). Hagerstown, Md.: Univ. Publ. Group. ISBN 978-1555721008. 5.Jump up ^ "Is a person who is intersex a hermaphrodite?". Intersex Society of North America. Retrieved 2 October 2011. 6. Jump up ^ Herndon, April. "Getting
Rid of "Hermaphroditism" Once and For All". Intersex Society
of North America. Retrieved 2 October 2011.
5:37The Heartache Of Having Two Vaginas
Malta Becomes
First Country to Ban Intersex Genital Cutting
On the 1st of April 2015 a historic reform is taking place within the Maltese law code. With the Gender Identity, Gender Expression And Sex Characteristics Act, historic steps are being taken to bring forth an end to non-medically necessary, cosmetic genital surgeries on intersex infants driven by social expectations enforced by the binary sex model. A key factor of the new law pertaining to protection for intersex individuals can be found in article 15.1-15.2. “15. (1) It shall be not be lawful for medical practitioners or other professionals to conduct any sex assignment treatment and, or surgical intervention on the sex characteristics of a minor which treatment and, or intervention can be deferred until the person to be treated can provide informed consent. (2) In exceptional circumstances treatment may be effected once there is an agreement between the Interdisciplinary Team and the persons exercising parental authority or tutor of the minor who is still unable to provide consent: Provided that medical intervention which is driven by social factors without the consent of the individual concerned will be in violation of this Act.” By making these procedures unlawful until the individual can provide informed consent Malta is taking vital steps to ensure that the individual’s primary rights to self- determination, bodily integrity and personal dignity are respected. For the first time in history intersex individuals will no longer be forced to endure arbitrary surgical sex assignment based on sociological factor´s. The past has seen national, theoretical and personal attitudes towards gender, surgical limitations and best guesses guide the process of gender assignment, of intersex infants worldwide, with dire sociological consequences and a lifetime of physical health complications for many following socially driven surgical intervention. With research showing that parental decision making is influenced greatly by information provided, no adverse effects of non-surgical intervention being found, poor surgical outcomes and satisfaction rates and almost no real research substantiating surgical intervention this timely law reform is finally acknowledging that purely social factors are being used as the basis for surgical interventions. Malta´s express acknowledgement of the social factors driving the surgical intervention of intersex infant´s sex characteristic´s is to be applauded as a first, worldwide, in affording intersex infant´s protection from so called reparative therapies. However while leading the way in this form of reform Malta must careful to take great care to ensure that social attitudes towards atypical sex characteristics do not lead interventions aimed at “fixing” or “repairing” a child, thus flouting this law and discriminating against individuals on the basis of their sex characteristics not being found socially acceptable. Simultaneously the new bill addressed gender identity and expression extensively and we are pleased that our Trans friends and allies are afforded greater protection, dignity and guaranteed a life of self-determination by the adoption of the reform found within the bill. OII-Europe emphatically urges the governments of other nations, along with the European Parliament and other law making entities to look towards the Malta law reform and adopt similar reform within their own countries and areas, ending decades of abusive reparative and gender confirming surgical intervention, taking place worldwide. About OII-EUROPE OII Europe (Organisation Intersex International Europe) is the umbrella organisation of European human rights based intersex organisations. OII Europe was founded on Human Rights Day, 10 December, during the Second Intersex Forum at Stockholm in 2012. OII Europe is an autonomous affiliate
of OII (Organisation Internationale des Intersexués),
a decentralised global network of intersex organisations,
which was founded in 2003 and has operated since then
through its national groups in every region of the
world. Tennis
Controversy: Female Player (with Male Past) Sarah Gronert, a 22-year-old tennis pro from Germany who was born with both male and female genitalia, has chosen to compete against women, and that has some in the tennis community up in arms. "There is no girl who can hit serves like that, not even Venus Williams," says the coach of an opponent Gronert recently beat. The coach, Schlomo Tzoref, also claims, "This is not a woman, it's a man." Is Tzoref just a disgruntled coach, trying to stir up controversy, or is there any validity to his claim? What makes a man a man, and what makes a woman a woman -- and how does being either affect one's ability to win? The Olympics has one answer; the WTA
has another; across the board at national and international
levels there seems to be a free-for-all in deciding how to
allow players who do not fit into the binary division of
traditionally defined female and male to compete. Meanwhile,
science has its own explanations and advice for the sports
community. Going beyond X
and Y (Scientific American) Parents sue South
Carolina for surgically making child female The surgery took place when the child was 16 months old and a ward of the state, according to a lawsuit filed by the parents against three doctors and several members of the South Carolina Department of Social Services. The child's biological mother was deemed unfit, and the biological father had apparently abandoned him, according to the suit. So others made the decision. The child, now 8 years old, feels more like a boy and "wants to be a normal boy," said Pamela Crawford, the boy's adoptive mother. "It's become more and more difficult, just as his identity has become more clearly male, the idea that mutilation was done to him had become more and more real," she said in a video released by the Southern Poverty Law Center, which is assisting in the case. "There was no medical reason that this decision had to be made at this time." Marilyn Matheus, a spokeswoman for the South Carolina Department of Social Services, said the agency does not have any comment on the pending litigation. The defendants named in the suit also include doctors from Medical University of South Carolina and Greenville Memorial Hospital. Sandy Dees, a spokeswoman for the
Greenville Health System, said she could not comment because
of the litigation. Assigned to be a
girl, but identifying as a boy "We just let him follow his instincts as much as we can," his adoptive father, John Mark Crawford, said in the video. Pamela Crawford said performing gender assignment surgery on a baby robbed her child of the ability to make the decision for himself. "I would have never made the decision to choose the gender either way," she said. "What I would have been working with is how do we preserve as much functioning in either direction because we can't know what this child's gender identity is going to be." The lawsuit claims doctors at a state hospital and Department of Social Services workers "decided to remove M.C.'s healthy genital tissue and radically restructure his reproductive organs in order to make his body appear to be female." The suit says the surgery violated the 14th Amendment, which says that no state shall "deprive any person of life, liberty, or property without due process of law." The suit also asks for "compensatory damages in an amount to be determined at trial." But the adoptive father said the real intent of the lawsuit "is just to uphold these constitutional principles -- integrity of a person's body, and some kind of due process for infants where people around them in power are considering doing surgeries like this." Pamela Crawford agreed. "I would give
anything for this to not have been done to our child," she
said. "I don't want it to happen to any more kids." Intersex and
Christian Theology Let me say upfront that I consider Megan to be a friend. We don’t know each other very well, but our interactions have been both engaging and humanizing. Megan is a very kind person and it’s clear that she’s passionate about Jesus and his kingdom. And I’m very honored that she wrote a gracious endorsement for my forthcoming book People to Be Loved, even though we come to different conclusions on several interpretive issues related to homosexuality. I also want to acknowledge that Megan’s book interacts with a large body of research that I’ve yet to engage. In many ways, I don’t feel very qualified to interact with her book—like Dusty Bottoms when he was handed that massive pistola at El Guapo’s birthday party in The Three Amigos. But I still want to interact with her book. In fact, I need to. Her arguments are quite compelling and her claims so significant that it would be irresponsible for me not to interact with to her work. But as I do, I’m going to be completely open and honest about my ignorance with many things she discusses. Hopefully I can learn more about her perspective, because there were several places where I found myself scratching my head thinking, “I don’t know; this just doesn’t seem right.” Dr. Megan DeFranza As the title suggests, Megan (pronounced MEE-gan, BTW) explores the significance of sex-difference in Christian theology in light of the presence of intersex persons. Intersex is a newer term that has replaced the older term “hermaphrodite.” Intersex persons are born with some sort of ambiguous biological sex. They don’t fit neatly into the categories of male or female. For instance, some people are born with XY (male) chromosomes, but have external female genitalia. Or they are born with ambiguous male or female genitalia. Or in some cases, their genitalia appears to be male (or female) at birth, but after puberty they begin to experience hormonal changes typical of the opposite sex. A “boy” who looks like a boy and experiences life as a boy during childhood may develop some female biological traits upon puberty (see Sex Difference ch. 1 for more details). This certainly challenges my assumptions about sexuality. Do we determine someone’s biological sex based on chromosomes or genitalia? What if a baby has gonads and a uterus? Is it a boy or girl? In the case of genital ambiguity, who gets to decide what sex the baby is? Could it be that some people are born neither male or female? Megan spends more than 40 pages exploring all the different intersex conditions; there’s no way I can do justice to the complexity in this short blog. Her discussion is super helpful and delves into some complicated issues without being overly technical. What I love most about her approach—something that’s woven throughout the entire book—is her compassion and empathy for intersex people. She doesn’t treat them like some issue, and she avoids using intersex people as evidence for her larger argument about human sexuality. She treats them like they deserve to be treated: like real people created in God’s beautiful image. I love that she includes testimonies of people who are intersex throughout the book, letting their voices shape our heart and mind on the question of sexuality. Megan’s overarching point is that the presence of intersex people challenges the common binary model of sexuality. Not everyone is either male or female. “The simplistic binary model is no longer sufficient,” Megan says. “It is dishonest to the diversity of persons created in the image of God” (p. 67). Now you may think that this goes against Christian teaching. The Bible clearly says that people are either male or female. But Megan spends a good deal of time looking at what the Bible says about Eunuchs (Isa 56)—especially “naturally born Eunuchs” (Matt 19)—as a lens to explore the possibility that some people are neither male nor female. “By recovering the concept of the eunuch, theologians will find fresh avenues for rethinking the meanings of sex and gender for theological anthropology…” (p. 67). The rest of Megan’s book digs into history, theology, biblical studies, sociology, and various other relevant fields in order to challenge the simplistic binary model of human sexuality that most Christians assume to be true. There’s no way I can sum up everything she says. You’ve got to read this book for yourself. But be warned: It will take you a while to digest it. The book is nearly 300 pages of thick research. Yet in my opinion, it’ll be time very spent. In short, Megan argues that we have wrongly forced “sexual others” into a male/female binary system. Society has done this. Christians have done this. And yet the Bible itself celebrates sexual others (e.g. Eunuchs) as possessing God’s image and becoming full participants in God’s kingdom—without being forced to identify as male or female. If Megan is right, then her conclusions will have massive consequences for how we think about sex difference, sexuality, gender, homosexuality, and other related topics. Are male and female the only two sexes? If sex difference is necessary for marriage, then who should intersex persons marry when sex differences aren’t clear? Does the presence of intersex persons validate those who identity as gender fluid or non-binary transgender (i.e. they don’t identify as male or female)? Christians can’t just shove their
fingers in their ears and say, “No! No!
LahLahLahLahLah…” We need to interact with these
questions in order to cultivate a robust Christian
anthropology. Megan has done the church a great service in
raising many good questions that most of us have never
considered. What to Know About
Having a Baby Who Is Intersex When a baby is born, they’re assigned a biological sex — either male or female — based on their genitals. You may have even learned your baby’s sex before birth in a similar way. Nothing between the legs on the ultrasound? “Congratulations — it’s a girl,” you hear. (Unless something is hidden from view, right?) But it can actually be a bit more complicated than that. Sometimes, a baby can have genitalia with some male characteristics and some female characteristics. And even deeper than external appearance, some people are born with a mix of male and female biological features (such as a uterus and testicles) that can’t be seen on the outside. When someone doesn’t fall exactly into the “male” or “female” sex designation, the term “intersex” may be used. Intersex isn’t new, and it isn’t political in and of itself. It’s just a more widely recognizable term now — though a lot of people still don’t understand it. So what does intersex look like? This is a popular question to Google, but it may not be the right one to ask. Keep in mind that people who are intersex are our co-workers, friends, neighbors, and classmates — in other words, you’ve likely interacted with someone who is intersex and had no idea. That’s because they look like anyone else you meet. Yes, sometimes the genitalia of a baby who has intersex traits is noticeably different. Here are some possibilities:
But the baby’s genitalia may also look completely male or completely female. In other words, they may have male anatomy on the outside but female anatomy on the inside or vice versa. It could be that a child’s status as intersex doesn’t become obvious until puberty when their body produces more of a hormone that doesn’t match their assigned sex. Or perhaps certain expected puberty milestones — like a deepening voice or growing breasts — don’t happen. Or maybe the ones that happen are characteristic of what you thought was the “opposite” sex. In these cases, a person who had more biological male features as a child might look more feminine after puberty, according to a society slow to reject the traditional binary system. Or a person who looked female as a child might start to look more stereotypically male as a teenager. And sometimes, a person might not learn they have intersex traits until even later, such as if they have difficulty having children and see specialists to learn why. (Note: Not all people with intersex traits have issues with fertility.) It’s even possible to have intersex traits and never know. Regardless, a person doesn’t “become” intersex. It’s what they’re born with, whether it’s clear at birth or not until later. A note about terminology What causes a baby to have intersex traits? The term “intersex” doesn’t describe one particular thing. There are many different varieties — it’s a spectrum. They typically occur naturally. If you’re a new parent trying to figure all this out, know that there’s nothing that you did or didn’t do to “make” your baby intersex. For example, you may have learned in sex ed that we’re born with sex chromosomes. Generally, females have a pair of X chromosomes and males have one X and one Y chromosome. But did you know that there are other variations? For example:
These variations can happen randomly and spontaneously during conception. Sometimes it’s due to egg cells, and sometimes it’s due to sperm cells. The variations can also happen due to other causes. These chromosomal variations sometimes result in what might be labeled as intersex. More commonly, though, a baby born with intersex traits does fit into either the XX or XY category. But we now know that biological sex is more complex than our chromosomes. For example: If a baby is born with female anatomy on the outside and male anatomy on the inside, this is something that happened randomly around the time of conception. They may have XX or XY chromosomes, but that alone doesn’t mean they’re a “girl” or a “boy.” ‘Treatment’ and things to consider Intersex isn’t a disease, and it can’t be “cured.” So in that sense, there’s no treatment. It’s possible to have health conditions that need to be addressed that relate to intersex anatomy. For example, if you have a uterus but no uterine opening, you may have painful menstrual cycles in which the blood doesn’t exit your body. In this case, you may want to have surgery to create an opening. But this isn’t “treating intersex.” This is treating a closed uterus. So what about your baby, who may not have typical genitalia? Do you ‘choose a sex’? The short answer: Unless there’s also a health condition (like urine not flowing out of the body properly), you don’t need to do anything in terms of medical intervention. But your doctor may recommend surgery to make the genitalia appear more typically male or typically female. American doctors have been doing this since at least the 1930s — especially performing clitoral surgery when parents intend to raise a baby with a large clitoris as a girl. There may be social reasons for this recommendation, and your doctor can go over these with you. But it’s essential to also consult non-medical professionals, like counselors. Currently, in the vast majority of U.S. states, every baby is assigned a binary sex — your baby’s birth certificate will say either male or female. So you may need to choose, at least initially. However, this practice is changing. A growing number of states are allowing an “X” in place of “M” or “F” on things like ID cards. However, this is still generally something that is changed later, when your child is older — or even an adult — and decides for themselves. And in most places, changing the sex on your birth certificate means changing it from male to female or vice versa. When it comes to raising your child, there’s good news for babies born with intersex traits — it’s more acceptable to raise kids in a “gender-neutral” way than ever before. But social stigma and barriers are still very real. Again, this is why many doctors still recommend surgery to make your baby’s genitals match the sex they’re assigned. This can lead to all sorts of questions, though:
All of these questions are more commonly stated as, “What if we chose wrong?” This worry can weigh heavily. This is why it’s crucial to talk with counselors familiar with intersex, social workers, a variety of medical professionals, trusted friends and family, and people with intersex traits themselves. Remember Here’s what to do next For many parents who are told that their baby is intersex, fears about their child’s future acceptance, relationships, and self-esteem are front and center. You may have questions like, “Will my child be able to go to sleepovers?” and “What if they’re made fun of in high school gym class locker rooms?” These are natural worries that show your love and concern for your little one. But you don’t have to go it alone. There are resources available that can help. In addition to a number of firsthand accounts from people who identify as intersex, helpful resources include:
Ask your doctor to put you in touch with a counselor or social worker who can recommend support groups in your area. Remember: There is no shame in
having a child with intersex traits or in being intersex
yourself. Until society is completely aligned with this
view, there will be some challenges ahead. But with a strong
support system that includes you, your baby can thrive into
adolescence and beyond. California Could Be
First State to Ban Non-Consensual Surgeries on Intersex
Babies - 1/15/21 A new bill introduced this week is looking to make California the first state in the U.S. to restrict doctors from performing non-consensual surgeries on intersex infants. On Thursday evening, openly gay state Sen. Scott Wiener (D-San Francisco) introduced Senate Bill 225, a proposal that would delay irreversible operations intended to “correct” the genitalia of people born intersex until they are six years old. That age requirement is based on research showing that children develop their gender identity as early as five, per a 2013 study published in the journal Psychological Science. Supporters of the legislation hope that delaying these surgeries will give young patients time to be able to develop greater understanding regarding what they entail, rather than immediately operating on newborn children with genital differences. In a statement, Wiener said SB 225 is intended to ensure these critical decisions about intersex people’s bodies are not “made for them and without their input.” “This legislation gives children and their families more time to research and opt in or out of non-emergency surgeries to irreversibly change a child’s sex characteristics,” Wiener said. “We must provide people the ability to make important healthcare decisions for themselves — especially when healthcare decisions are associated with a person’s gender assignment, and can result in long-term pain, PTSD, depression, and a loss of sexual sensation.” SB 225 is being backed by the advocacy groups interACT: Advocates for Intersex Youth, Equality California, and the American Civil Liberties Union of California, all of which have signed on as co-sponsors of the legislation. In a press release timed to the introduction of Wiener’s bill, interACT noted in a statement that the majority of operations on intersex youth are “performed on children under two years old.” These procedures, which include clitoroplasty and clitoral reduction, often result in “extreme scarring, chronic pain, chronic incontinence, loss of sexual sensation, post-traumatic stress disorder, incorrect gender assignment, and the need for additional surgeries to treat complications from the original surgery,” according to the organization. “Many adults who underwent these surgeries as infants have expressed deep concern and anguish about the procedures,” interACT said in an email. “The intersex community is leading the movement to ensure that no matter what gender identity a person grows up to have, everyone born with unique sex anatomy should be able to play a role in major healthcare choices.” Although no state legislature has ever passed a law like SB 225, advocacy groups are hopeful that California will break that trend after two hospitals announced last year that they would cease performing some forms of surgery on intersex children: Chicago’s Ann & Robert H. Lurie Children’s Hospital in Chicago and the Boston Children’s Hospital. (It must be noted, however, that neither of these medical institutions committed to halting the surgeries in all cases.) “Building on 15 years of advocacy work by interACT, we saw two premier children's hospitals finally commit to stopping infant clitoral and vaginal surgeries in 2020,” said Kimberly Zieselman, executive director of interACT, in a statement. “Now it's California's time to shine.” While legislation restricting nonconsensual intersex surgeries had been put forward in the California State Legislature in recent years, the bills were killed after meeting with resistance from the California Medical Association and Societies for Pediatric Urology. Wiener was able to successfully lobby for the passage of a resolution in 2018 calling on doctors to wait “until the child is able to participate in decision making” before operating, but that statement was nonbinding. But after Wiener narrowed the scope of this year’s bill to weaken opposition from past critics of the effort, LGBTQ+ advocates hope 2021 will be different. “The LGBTQ+ community — and transgender, nonbinary and intersex folks in particular — have been fighting for decades to secure our rights to make decisions about our own bodies,” Equality California Executive Director Rick Chavez Zbur said in a statement released Thursday. “That fight continues today. Children born with diverse physical sex traits and their parents should be able to participate in the critically important decision-making process regarding medically unnecessary and often irreversible surgical interventions.” Although the passage of California’s bill would be unprecedented, it’s not the only U.S. municipality that is seeking to prevent intersex young people from irreparable harm. New York City is weighing an ordinance that would mandate an education and outreach campaign intended to teach doctors, parents, and young people about the estimated 1.7% of children born intersex and the impact these operations can have on their bodies. According to the news publication
Bay
Area Reporter, federal
legislation regarding the medical treatment that can be
provided to intersex youth “is likely to be introduced
in Congress this year” with Democrats now in control of
both houses. Statistics of
intersex frequency
Short-cut to this chart
https://bit.ly/38WFfCB
Books
Films (Available through available from ISNA)
Web Sites
Key Issues Facing
People With Intersex Traits This column was produced in collaboration with interACT, an organization dedicated to using innovative strategies to advocate for the human rights of children born with intersex traits. There are currently limited data and information available on the population health and overall well-being of people with intersex traits. However, recent research has found that health disparities among intersex populations are driven largely by stigmatization, prejudice, and discrimination similar to what LGBTQ+ communities experience, and that people with intersex traits report identifying as noncisgender or nonheterosexual at higher rates than people who are not intersex. For these reasons, the National Institutes of Health and The National Academies of Sciences, Engineering, and Medicine include people with intersex traits as a sexual and gender minority population in their research agendas. This column presents Center for American Progress survey data that shed new light on the experiences of intersex respondents. It also provides policy recommendations informed by these data to improve the well-being and advance the rights of people with intersex traits. “Intersex” is an umbrella term used to describe people born with sex traits that do not fit binary medical definitions of male or female sexual or reproductive anatomy. Intersex populations are born with these differences in sex traits or may develop them during childhood. Human sex development is naturally diverse, with many variations possible in genitalia, hormones, internal anatomy, and/or chromosomes. It is estimated that up to 1.7 percent of the population has an intersex trait and that approximately 0.5 percent of people have clinically identifiable sexual or reproductive variations. Medically unnecessary, nonconsensual interventions are violations of human rights Mistreatment of intersex individuals begins early in life, with intersex infants and children commonly subjected to nonconsensual, medically unnecessary interventions to alter natural variations in genital appearance or reproductive anatomy with the aim of conforming their bodies to binary sex stereotypes. These procedures on intersex infants and children, such as clitoral reductions and sterilizing gonadectomies, are often justified by discriminatory attitudes about healthy variations in sex characteristics. They have high complication rates and lifelong consequences such as infertility, reduced sexual function, and other physical and mental health impacts. These outcomes contribute to the high physical and mental health disparities that intersex populations experience. In a 2018 study, for example, 43 percent of adult intersex respondents reported their physical health as “fair” or “poor,” and 53 percent reported the same of their mental health. Similar patterns are also evident in CAP’s nationally representative 2020 survey data of LGBTQI+ adults* that show mental and physical health disparities between LGBTQ+ intersex respondents and LGBTQ+ nonintersex respondents. (see Figure 1) Figure 1 The United Nations has found that these forced and coercive intersex surgeries on minors, frequently performed without their full, free, and informed consent, “violate rights to the security of person, right to bodily and mental integrity, freedom from torture and ill-treatment, and freedom from violence.” Increasingly, medical associations, LGBTQI+ advocates, human rights bodies, and intergovernmental organizations are asking policymakers to prevent medical professionals from engaging in these harmful practices and to postpone procedures on intersex minors until they can provide informed consent. Recommendations: The U.S. Department of Health and Human Services’ (HHS) Centers for Medicare and Medicaid Services (CMS) should issue guidance to state health officials for Medicaid and the Children’s Health Insurance Program (CHIP) on prohibiting nonconsensual, medically unnecessary surgeries on intersex youth and deferring all nonemergent interventions until patients can provide free, fully informed consent and drive decision-making. The guidance should also provide information on making the documentation of a patient’s informed consent a prerequisite for health care reimbursement for sterilizing or genital surgeries, absent an imminent risk of physical harm, and urge state health officials and providers to comply with Medicaid quality, comparability, and sterilization requirements; the Affordable Care Act (ACA); and the federal genital mutilation statute, all of which as written currently prohibit many of the procedures performed on intersex infants. HHS should also establish an education campaign for health professionals that would increase training, knowledge, and cultural competency on providing affirming, appropriate health care that respects the rights of people with intersex traits. Intersex people face high rates of discrimination and stigma According to CAP’s nationally representative 2020 survey data of LGBTQI+ adults, LGBTQ+ intersex individuals, when compared with their LGBTQ+ peers who are not intersex, experience higher rates of stigma and discrimination and high rates of engaging in behavior to avoid exposure to discriminatory treatment, such as avoiding going to the doctor. (see Figure 2) Figure 2 Sixty-nine percent of LGBTQ+ intersex respondents reported experiencing some form of discrimination in the year prior, roughly two times the rate of discrimination reported by LGBTQ+ nonintersex respondents (35 percent). Because people with intersex traits do not conform to binary sex and gender norms, they can encounter significant stigma and discrimination when accessing health care. According to the CAP survey, 88 percent of LGBTQ+ intersex respondents reported experiencing some form of discrimination from a doctor or health care provider in the year prior to CAP’s survey—including refusal of care, harsh language, or physical abuse—compared with 19 percent of LGBTQ+ nonintersex respondents. (see Figure 3 Figure 3 Thirty-four percent of LGBTQ+ intersex respondents to the CAP survey reported a household income of less than $25,000 annually, compared with 27 percent of LGBTQ+ nonintersex respondents. The high rates of economic insecurity and poverty experienced by intersex adults limit access to health care and contribute to higher rates of using social safety net programs, as shown in Figure 4. Figure 4 When it becomes known that someone has intersex traits or they are perceived as not conforming with gender norms, intersex individuals are often subjected to discrimination and harassment in other key areas of life, such as education, employment, sports, and beyond. Forty-seven percent of LGBTQ+ intersex respondents reported that they have “made specific decisions about where to work” in order to avoid experiencing discrimination, compared with 34 percent of LGBTQ+ nonintersex respondents. Figure 5 Recommendations: The U.S. Supreme Court’s decision in Bostock Clayton County, Georgia, should be enforced in a manner that is inclusive of its prohibition of discrimination based on sex characteristics, including intersex traits, in areas including but not limited to health care, employment, and educational settings. Discrimination based on sex characteristics, including intersex traits, should also be explicitly prohibited in future rulemaking on the ACA’s Section 1557, its central nondiscrimination provision, as well as CMS regulations for marketplace, Medicaid, and Medicare coverage. HHS should also create an awareness campaign focused on the need for affirming care and informed consent for intersex youth. The campaign should be designed with input from intersex communities and should target community stakeholders, families of people with intersex traits, and the public to increase awareness, visibility, and representation. Intersex people must have access to accurate identification Accurate forms of identification are crucial for accessing employment, essential services, transportation and more. In many states, burdensome requirements or lack of inclusive identification options prevent people with intersex traits and transgender people from obtaining accurate identification, increasing the risk of harassment, discrimination, and violence. Data from CAP’s 2020 survey find that 77 percent of LGBTQ+ intersex respondents who reported discrimination in the year prior said that it affected their “ability to obtain accurate ID documents” to some degree, compared with 23 percent of LGBTQ+ nonintersex respondents who reported discrimination.** Recently, the State Department has made progress on removing the medical requirement for gender marker selection and adopting “X” as a third gender marker for people who identify as nonbinary, intersex, and/or gender nonconforming. Recommendation: The White House should expand its efforts by directing all federal agencies to review their policies regarding the display of gender markers on federal identification documents with a focus on both ensuring that all individuals can self-select an M, F, or X designation and considering a phaseout of the display of personal gender information on certain documents that do not require that information. There is a lack of data on people with intersex traits The lack of available data on people with intersex traits and their experiences is a significant concern. Estimates of the size of the intersex population vary based on the definition researchers use, and ensuring a representative sample size outside clinical contexts is difficult. Stigma around intersex traits also makes many intersex individuals unwilling to disclose their intersex status. Unfortunately, no intersex status questions currently exist on any federally funded general population surveys, and population-level data on people with intersex traits are unavailable. Additionally, there are no nationwide data on the prevalence of surgeries performed on intersex individuals, as most hospitals opt not to disclose this information. Recommendations: HHS should expand research on intersex populations by testing, validating, and implementing measures for intersex status on large-scale federally funded surveys. It should also increase the inclusion of people with intersex traits in qualitative and quantitative health research, including cognitive interviews; promote best practices for intersex community-based participatory research; and invest in supporting the advancement of these research agendas. Conclusion Like other sexual and gender diverse populations, people with intersex traits experience significant discrimination, stigma, and prejudice that detrimentally affect their health and well-being. Policymakers have a responsibility to implement robust nondiscrimination protections, human rights safeguards, and research agendas that will deepen the understanding of intersex populations and generate data-driven policy solutions to improve their welfare. Additionally, Congress should pass the Equality Act, which would update federal civil rights laws to protect people from discrimination based on sexual orientation, gender identity, and sex characteristics (including intersex traits) in employment, housing, credit, jury service, and federally funded programs—such as those for health and education—as well as public accommodations. Caroline Medina is a policy analyst for the LGBTQ Research and Communications Project at the Center for American Progress. Lindsay Mahowald is a research assistant with the LGBTQ Research and Communications Project. The authors would like to thank Kimberly Zieselman, Alesdair Ittelson, and Bria Brown-King of interACT, as well as Harper Jean Tobin and Dr. Katherine Dalke, for their valuable feedback on this column. * This survey includes a sample of 1,528 LGBTQI+-identifying adults and was jointly conducted by the Center for American Progress and NORC at the University of Chicago. The sample has been weighted to account for both U.S. population characteristics and survey nonresponse. The study’s full results and methodology are on file with the authors. All in-text comparisons between LGBTQ+ intersex respondents (n = 75) and LGBTQ+ nonintersex respondents (n = 1,439) are significant at the 0.05 level. ** Select survey questions were asked only of respondents who reported experiencing discrimination in the year prior. This sample includes 46 intersex respondents and 467 nonintersex respondents. 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