4.1 Intersex: Introduction

People born with intersex variations are born with sex characteristics (including genitals, gonads and chromosome patterns) that do not fit typical binary notions of male or female bodies. For example, girls born with Congenital Adrenal Hyperplasia can have genitalia where the clitoris is enlarged and resembles a penis.

Intersex is an umbrella term under which a broad range of medical conditions called “Disorders of Sexual Development” are grouped together. However, this is problematic because it medicalises all people born with intersex variations and pathologises their bodies. Traditionally, people born with intersex variations were treated so that they could fit in the binary notion of what a male or female body should look like. Treatments often included the removal of gonads (sterilisation) and genital surgeries with often poor cosmetic and functional outcomes. People born with intersex variations were often treated as infants because it was thought that they would not remember the surgery, would heal better and would grow up without having any doubts regarding their gender.

This approach, however, has been criticised by intersex individuals. Rather than forcing normalising surgeries, intersex people advocate for patient-centred care where the autonomy of the person is respected. This allows intersex individuals the opportunity to make informed consent about any treatment affecting their health. There has also been a growing movement to regard people born with intersex traits as having a normal variation of sexual development rather than labelling their bodies as “disordered”. This approach would, hopefully result in the respect of the the mental and physical integrity of the person by:

  1. Remembering that we are dealing with people, not conditions.
  2. Deferring any medically unnecessary treatment, especially irreversible cosmetic surgeries to when the person is competent to make an informed decision.
  3. overriding the right to physical integrity only when there is a clear medical reason for intervention.

People born with intersex variations are different to each other and it is important not to have a blanket treatment option for all of them. Each person will have a different need and it is paramount to put their needs first, rather than the needs of societal expectations. The health of intersex people is often discussed and managed in tertiary centres with multidisciplinary teams consisting of paediatricians, surgeons and fertility specialists amongst others. It’s always a good idea to have referral services at hand – for eg the Royal Children’s Hospital in Victoria.

Let’s not forget that the same broad principles of sexual history taking apply to intersex patients and these should be able to address most regular sexual health concerns.

The bodies of intersex patients should not be seen as a disease or pathology or something that requires unnecessary treatment.

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