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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.[13] Such treatments may involve sterilization. Adults, including elite female athletes, have also been subjects of such treatment.[14][15] Increasingly these issues are considered human rights abuses, with statements from international[16][17] and national human rights and ethics institutions.[18][19] Intersex organizations have also issued statements, including joint statements as part of an International Intersex Forum.

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.[20] In April 2015, Malta became the first country to outlaw non-consensual medical interventions to modify sex anatomy, including that of intersex people.[21][22]

Intersex people may have any gender identity.[2][23] Some intersex individuals may be raised as a girl or boy but then identify with another gender identity later in life, while most do not.[3][4][24][25]





In biological terms, sex may be determined by a number of factors present at birth, including:[26]

  • the number and type of sex chromosomes;
  • the type of gonads—ovaries or testicles;
  • the sex hormones;
  • the external genitalia.

People whose characteristics are not either all typically male or all typically female at birth are intersex.[27]



Main article: Intersex in history

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. An early example comes from Sumerian creation myths from more than 4,000 years ago where Ninmah, a mother goddess, fashioned humanity out of clay.[28] 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.[29]


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. Under Roman law, a hermaphrodite had to be classed as either male or female.[30] The 12th-century Decretum Gratiani states that "Whether an hermaphrodite may witness a testament, depends on which sex prevails".[31][32][33] The foundation of common law, the 16th 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."[34][35] Legal cases have been described in Canon law and elsewhere over the centuries.



The term intersexuality was coined by Richard Goldschmidt in 1917.[37] The first suggestion to replace the term 'hermaphrodite' with 'intersex' was made by Cawadias in the 1940s.[38]

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.[39] A now debunked 'optimal gender policy', initially developed by John Money, stated that early intervention helped avoid gender identity confusion.[19] 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.[40]

Dialog 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.[41] 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.[20] In April 2015, Malta became the first country to outlaw non-consensual medical interventions to modify sex anatomy, including that of intersex people.[21] Many civil society organizations and human rights institutions now call for an end to unnecessary "normalizing" interventions.[42][1]

Human rights and legal issues[edit]



Non-consensual medical interventions[edit]

  Legal prohibition of non-consensual medical interventions
  Regulatory suspension of non-consensual medical interventions

This includes "normalising" interventions on intersex persons that are medically unnecessary and the unnecessary pathologisation of variations in sex characteristics. Medical interventions to modify the sex characteristics of intersex people, without the consent of the intersex person have taken place in all countries where the human rights of intersex people have been studied.[43] 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. In April 2015, Malta became the first country to outlaw surgical intervention without consent.[21][22] 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.[21][22][44][45][46] The Chilean government also announced a suspension of non-consensual medical interventions.[47][48]

Anti-discrimination and equal treatment[edit]

  Explicit protection on grounds of sex characteristics
  Explicit protection on grounds of intersex status
  Explicit protection on grounds of intersex within attribute of sex

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.[2][1][49] Several countries have so far explicitly protected intersex people from discrimination, with landmarks including South Africa,[22][50] Australia,[51][52] and, most comprehensively, Malta.[53][54][55][56][57]

Reparations and justice[edit]

Main article: 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.[20][58] A second successful case in Germany, taken by Michaela Raab, was reported in 2015.[59] In the U.S. the "M.C." legal case, advanced by Interact Advocates for Intersex Youth with the Southern Poverty Law Centre is still before the courts.[60][61]

Information and support[edit]

Main article: 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.[18][19][62][63][64][65]

Legal recognition[edit]


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.[3][4][24][25] Recognition of third sex or gender classifications occurs in several countries,[68][69][70][71] however, it is controversial when it becomes assumed or coercive.[72][73][74] 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.[23][75]


Research in the late 20th century has led to a growing medical consensus that diverse intersex bodies are normal, but relatively rare, forms of human biology.[4][76][77][78] Clinician and researcher Milton Diamond stresses the importance of care in the selection of language related to intersex people:


The term 'intersex'[edit]

Some people with intersex traits self-identify as intersex, and some do not.[80][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]

Australian sociological research published in 2016, found that 60% of respondents used the term "intersex" to self-describe their sex characteristics, including people describing themselves as intersex, having an intersex variation or, in smaller numbers, having an intersex condition. Respondents also commonly used diagnostic labels and referred to their sex chromosomes.[23][75]


Main article: 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".[38] The distinctions "male pseudohermaphrodite", "female pseudohermaphrodite" and especially "true hermaphrodite"[85] are vestiges of outdated 19th-century thinking, reflecting histology (microscopic appearance) of the gonads.[86][87][88] Medical terminology has shifted not only due to concerns about language, but also a shift to understandings based on genetics.


Disorders of sex development[edit]



Alternatives to categorizing intersex conditions as "disorders" have been suggested, including "variations of sex development".[11] 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.[93] The UK Intersex Association (UKIA) 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.[94] In May 2016, Interact Advocates for Intersex Youth published a statement opposing pathologizing language to describe people born with intersex traits, recognizing "increasing general understanding and acceptance of the term "intersex"".[95]

LGBT and LGBTI[edit]

The relationship of intersex to lesbian, gay, bisexual and trans, and queer communities is complex,[96] 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.[97] 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."[98][99] 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".[100]

Intersex may be contrasted with transgender,[101] which describes the condition in which one's gender identity does not match one's assigned sex.[101][102][103] Some people are both intersex and transgender.[104] A 2012 clinical review paper found that between 8.5% and 20% of people with intersex variations experienced gender dysphoria.[24]

Intersex can also be contrasted with homosexuality or same-sex attraction. Numerous studies have shown higher rates of same sex attraction in intersex people,[105][106] with a recent Australian study of people born with atypical sex characteristics finding that 52% of respondents were non-heterosexual,[23][75] thus research on intersex subjects has been used to explore means of preventing homosexuality.[105][106]

In an analysis of the use of preimplantation genetic diagnosis to eliminate 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."[107]

Intersex in society[edit]

Kristi Bruce after shooting the documentary XXXY, 2000

Fiction and media[edit]

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

Television works about intersex and films about intersex are scarce. Amongst these, Faking It is notable for providing the first intersex main character in a television show,[108] and television's first intersex character played by an intersex actor.[109]

Civil society institutions[edit]

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.[110] The Androgen Insensitivity Syndrome Support Group (UK) established in 1988.[111] 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.[112]





Intersex Pride flag
Main article: Intersex flag



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.[115] Warne and Raza argue that an association between intersex and hijra people is mostly unfounded but provokes parental fear.[116]




Stanisława Walasiewicz (Stella Walsh) in 1933



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".[14] Intersex advocates regard this intervention as "a clearly coercive process".[121] 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."[122]

Population figures[edit]

There are few firm estimates of the number of intersex people. While human rights institutions have called for the demedicalisation of intersex traits, as far as possible,[18][44][123][124] medical definitions are often still used. The now-defunct Intersex Society of North America stated that:



However, many conditions excluded from Sax's analysis are currently regarded as disorders of sex development. Individuals with those diagnoses may experience stigma and discrimination due to their sex characteristics, including sex "normalizing" interventions, and so those diagnoses and life experiences meet definitions of intersex in use by UN and other bodies. As a result, the statistical analyses by Blackless and Fausto-Sterling have become widely quoted,[44][129] including by other clinicians.[130] The following summarizes those frequency statistics:

Sex Variation Frequency
Klinefelter syndrome (XXY) one in 1,000 births
Turner syndrome (45,X) one in 2,710 births[131]
Androgen insensitivity syndrome one in 13,000 births
Partial androgen insensitivity syndrome one in 130,000 births
Classical congenital adrenal hyperplasia one in 13,000 births
Late onset adrenal hyperplasia one in 1,000 birth.[132]
Vaginal agenesis one in 6,000 births
Ovotestes one in 83,000 births
Idiopathic (no discernable medical cause) one in 110,000 births
5-alpha-reductase deficiency No estimate
Mixed gonadal dysgenesis No estimate
MRKH Syndrome 1 in 4,500-5,000 births
Complete gonadal dysgenesis one in 150,000 births
Epispadias (urethral opening between corona and tip of glans penis) one in 117,000 births[133]


Medical classifications[edit]


Ambiguous genitalia[edit]




Measurement systems[edit]

The Phall-O-Meter satirizes clinical assessments of appropriate clitoris and penis length at birth.


The Phall-O-Meter is a scale, developed by Kiira Triea based on a concept by Suzanne Kessler[136] and later described by Anne Fausto-Sterling in Sexing the Body. It combines assessments of acceptable phallus measurements for boys and girls. For a girl, a medically acceptable clitoris can be no bigger than one centimeter. For a boy, an acceptable penis size must be between 2.5 centimeters and 4.5 centimeters. Surgical interventions may occur if the range between one and 2.5 centimeters.[127]

The Prader scale[137] and Quigley scale are visual rating systems that measure genital virilization or femilization.

Other signs[edit]



Adult (38), Klinefelter's 46,XY/47,XXY mosaic diagnosis (19): gynecomastia


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.[138] 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.[138] Through the seventh week, genetically female and genetically male fetuses appear identical.



Further information: 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.[2] During 2015, the Council of Europe,[44] the European Union Agency for Fundamental Rights[123] and Inter-American Commission on Human Rights[124] 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".[44][123][124]

Medical interventions[edit]

Further information: History of intersex surgery



There remains no clinical consensus about an evidence base, surgical timing, necessity, type of surgical intervention, and degree of difference warranting intervention.[144][145][146] Such surgeries are the subject of significant contention, including community activism,[147] and multiple reports by international human rights[16][44][66][148] and health[65] institutions and national ethics bodies.[19][149]

In the cases where gonads may pose a cancer risk, as in some cases of androgen insensitivity syndrome,[150] concern has been expressed that treatment rationales and decision-making regarding cancer risk may encapsulate decisions around a desire for surgical normalization.[18]


  • Hormone treatment: There is widespread evidence of prenatal testing and hormone treatment to prevent or eliminate intersex traits,[152][153] associated also with the problematization of sexual orientation and gender non-conformity.[152][154]
  • 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.[155] There is widespread evidence of pregnancy terminations arising from prenatal testing, as well 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."[107]
  • 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, using the language of Disorders of Sex Development.[156] This move was criticised by intersex advocacy groups in Australia and New Zealand.[157]
  • Medical photography and display: Photographs of intersex children's genitalia are circulated in medical communities for documentary purposes. Problems associated with medical photography of intersex children have been discussed due to experiences of humiliation and powerlessness by child subjects,[158] along with their ethics, control and usage.[159]


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External video
"Intersexion" documentary, Wikipedia page