12.2.4 Intersex and the Ambiguities of Identity

A friend tells you, “My sister just had a baby last night!” You respond, “Is it a boy or a girl?” Your friend replies, “Well, they don’t know. Maybe neither, maybe both.”

Based on a detailed analysis of extensive data, Anne Fausto-Sterling (2000) concluded that in about 1.7 percent of births, a baby’s sex cannot be completely determined just by glancing at the baby’s genitalia. (Note that due to different or changing considerations of sex determination, you may see different percentages or other differences in information; this text is using the most widely accepted and adopted research.) Intersex is an umbrella term for people who have one or more of a range of variations in sex characteristics or chromosomal patterns that do not fit the typical conceptions of male or female; the prefix inter- means “between” and refers here to an apparent biological state “between” male and female. There are many causal factors that can make a person intersex. Genetically, the baby may have a different number of sex chromosomes. Rather than two X chromosomes (associated with females) or one X and one Y chromosome (associated with males), babies are sometimes born with an alternative number of sex chromosomes, such as XO (only one chromosome) or XXY (three chromosomes). In other cases, hormonal activity or even chance occurrences in the womb can affect the baby’s anatomy.

While it is true that the majority of humans display biological characteristics associated with either one sex or another, 1.7 percent is not insignificant. If that percentage were applied to the global total of about 140 million babies born every year, it would mean that that more than two million of these babies could be intersex. On a more local level, if that percentage were applied to any town of 300,000 people, there could be more than 5,000 intersex people.

Beyond biology, the category of intersex reveals a great deal about the cultural mechanisms of gender. Intersexuality can be recognized at any point in a person’s life, from infancy to well into adulthood. Parents often discover their child is intersex in a medical context, such as at birth or during a subsequent visit to the pediatrician. When a doctor explains that a child is intersex, parents may be confused and concerned. Some doctors who are uncomfortable with biological sex ambiguity may order tests to determine the child’s chromosomal count and hormone levels and take measurements of the child’s genitals. They may urge parents to assign a specific gender to the baby and commit to plans for hormonal treatments and surgical interventions to affix that assigned gender to the growing child. Doctors are often taught to present the chosen gender as the “real” underlying sex of the baby, making medical treatment a process of allowing the baby’s “natural” (meaning unambiguous) sex to emerge. This conceptualization of intersex babies as “really” either male or female contradicts the complex mix of male and female traits presented by most intersex bodies (Fausto-Sterling 2000).

Fausto-Sterling disagrees with the practice of immediately affixing a sex to intersex babies through medical interventions. She argues that gender identity emerges in a complex interplay between biology and culture that cannot be assigned or controlled by doctors or parents. In an interview with the New York Times, she explained her position:

The doctors often guess wrong. They might say, “We think this infant should be a female because the sexual organ it has is small.” Then, they go and remove the penis and the testes. Years later, the kid says, “I’m a boy, and that’s what I want to be, and I don’t want to take estrogen, and by the way, give me back my penis.”

I feel we should let the kids tell us what they think is right once they are old enough to know. Till then, parents can talk to the kids in a way that gives them permission to be different, they can give the child a gender-neutral name, they can do a provisional gender assignment. (Fausto-Sterling 2001)

Many intersex people support a ban on what they call intersex genital mutilation, or IGM. In an article for HuffPost, Latinx intersex author and activist Hida Viloria (2017) calls attention to the hundreds of intersex people who have come forward to say that IGM has harmed them. The underlying goal of sexual assignment surgery, Viloria points out, is to create bodies capable of heterosexual sex. Medical ethicist Kevin Behrens (2020) argues that surgical interventions should only be carried out when surgery serves the best medical interests of the child and, in most cases, medical intervention should be delayed until the intersex person is old enough to give informed consent. Behrens also emphasizes that parents and children have the right to know the truth about an intersex child’s diagnosis and the possible consequences of any suggested treatment.

Intersex ambiguity and the rush to hide or eliminate it reveal important lessons about biology and culture. The process of determining what an intersex person was “meant to be” often involves a large set of biological variables, many of them subject to change over time. Those factors vary not only for intersex people but for everyone. Chromosomes alone do not make females and males. Rather, the interactions of genetic factors with hormones and environmental forces produce a complex continuum of gender. Instead of a binary of male and female separated by a hard boundary, many gender scholars recognize gender as a multidimensional spectrum of differences. There is far more biological variation within the cultural categories of male and female than between the two. This is not to deny the existence of biological differences but rather to complicate the concepts of sex and gender, allowing for the normalcy of ambiguity and the tolerance of variation.