Intersex conditions

An estimated 1.7 per cent of babies are born with intersex conditions, although many variations are not apparent at birth. About one in 2,000 newborns have genital differences that involve a sex differentiation specialist being consulted. Others are identified later in life, sometimes not until puberty or adulthood.

Intersex traits can vary considerably and have a complex range of causes. Most are random but some are genetic. Chromosome variations can happen randomly and spontaneously during conception due to egg cells or sperm cells. This means a child may not have the typically male (XY) or female (XX) chromosomes and instead have a combination such as XXY or XYY. Some intersex people do fit into either the XX or XY category but develop female anatomy on the outside and male anatomy on the inside. In many cases, the cause is not determined.

There are three categories, including

• 46, XX intersex: Female chromosomes and ovaries but external genitals appear male. This can be caused by exposure to excess male hormones before birth.
• 46, XY intersex: Male chromosomes but external genitals are incompletely formed, ambiguous or female. Testes may be normal, malformed, or absent. May be caused by testosterone issues and other foetal development variations.
• Sex chromosome intersex: Can involve a range of chromosomal variations that affect sex development. They don’t cause a discrepancy between internal and external genitalia but possible problems with sex hormone levels and overall sexual development.

Gender identity refers to a fundamental sense of belonging and self-identification of being female, male, both, or something other than female or male. It does not necessarily correspond to the sex assigned or presumed at birth.

Sexual orientation is the sex of the person to whom one is sexually attracted. It may include heterosexual, bisexual, homosexual, pan-sexual, or asexual.

Being intersex is not the same as being transgender, which is when a person does not identify with their biological sex.

Historically, medical research aimed to explain why people were intersex and how it could be ‘fixed’. A baby with intersex traits was usually assigned male or female, which often resulted in surgery or medication. It is now more widely understood that such difference does not mean physical makeup needs to be changed.

More people believe that those born with intersex traits should not face unnecessary surgery or medical treatment and later decide for themselves how they would like to identify – intersex, male, female or otherwise. Not all people with intersex conditions have genital differences and some do not know they are intersex until their body does not develop as expected at puberty, or when they want to have children.

Unless they have a related medical condition, babies born with intersex conditions are natural and healthy. Their long-term medical outlook is no different than it is for other children. Some people with intersex conditions may require early surgery, if for example they cannot urinate, but many don’t.

Some trait variations result in medical issues such as problems making or regulating hormones, development issues during puberty and possibly increased cancer risk due to undeveloped tissue.

Early surgery to assign a sex may affect hormone levels later, and those born without various sex organs may need hormone replacement therapy.

Having intersex traits can also affect fertility. An intersex person with a uterus may be able to carry a pregnancy. Some intersex people have ovaries, a uterus, and a vagina, and may be able to become pregnant.