search engine by freefind advanced

Intersex Sex-Assignment Surgery: My Body, My Choice

Part I 20/20 Intersex

Part ll 20/20 Intersex



The medical definition of intersex is a Hermaphrodite; a person with a full set of both male and female sex organs and hormones.


However, many people do not fit the strict physical sex binary presented by the medical model of male and female. A lot of us have some degree of anatomical or physiological intersex traits.


Some intersex people enjoy their physicality and sexuality just as it is, taking pride in their unique identity. Others feel identified with a specific sex and want to become more physically a female or a male, and may undertake sexual reassignment surgery and/or hormonal therapy to change.


If surgery without consent was performed during infancy, intersex people should always grow up with full knowledge of their surgery and an understanding of the potential conflict and confusion it may cause. 


Childhood SAS and Hormonal Treatment Disclosure is Important

Being subjected to sex assignment surgery (SAS)during infancy because of ambiguous or mixed sex traits can cause intersex people a great deal of confusion, suffering and trauma. Any sex assignment surgery should be chosen by the intersex individual based on their own feelings and choices rather a doctor's assessment of which physical sex characteristics appear dominant, because nonconsensual surgery may tragically lock a person into the wrong anatomical sex, or force them into a lifestyle that ignores aspects of their intersex nature.


The Anatomical and Physiological Development of Sex and Intersex   

The term “sex” literally refers to the anatomical and physiological definitions of “male” or “female”. This is how sex develops:


All of the eggs in a woman’s ovaries are the female sex, signified as X. When the fathers’ sperm enters the mothers’ egg during fertilization, it contributes a second sex chromosome to the egg. If the chromosome is another X, the XX combination will mean that the fertilized egg, or zygote, becomes the female sex, and female sex characteristics will develop during embryonic development. If the fathers’ chromosome is Y, the combined XY pattern means the zygote becomes the male sex and will develop male sex characteristics during embryonic development. But other normal chromosomal combinations occur as well: XXY, female-female-male; XYY, male-female-female; and XO, female-no sex, are common examples. These can contribute to intersex development.


The implanted zygote becomes an embryo with two sets of reproductive and sex systems; the Mullerien ducts and the Wolffian ducts. In the XX embryo, female sex hormones cause the Mullerian duct system to transform into the female reproductive system. Without male sex hormones to stimulate it, the Wolffian system shrinks away to nearly nothing. If the embryo has a Y chromosome, it develops testicles which produce a substance around the eighth week which blocks the development of the Mullerian system and shrinks it to almost nothing. The testicles also begin producing the hormone testosterone, which stimulates the development of the Wolffian ducts into the male reproductive and sexual system.


The sex organ cells, or gonads, are initially sex undifferentiated.  As they develop into sex organs, the female and male gonads follow the growth same curve until about the sixth week, when the gonads in embryos carrying the Y chromosomes begin to form into testicles. If no Y chromosome is present, the gonadal cells begin to develop into ovaries. As the embryo develops, the gonads travel from their original locale into new positions; the ovaries move into the lower abdominal region on the sides of the uterus, and the testicles move out of the abdomen into the scrotal sack. People with intersex anatomy and physiology may develop combinations of these sexual and reproductive systems.


Phases of hormones released in the body during pregnancy and after birth also influence sex factors. They contribute to the formation of sex traits in the womb, and the intense hormones released during puberty effect not only adult genital and reproductive maturation, but many other features associated with sex: facial, pubic and body hair, voice pitch, breast development, and muscle mass, among others. Variations on these hormonal release patterns can contribute to the anatomical and physiological development of intersex characteristics.


(From Amazing Anatomy: Know Your Body)


Some people are born with a combination of female and male sexual and reproductive anatomy and physiology. This is a normal variation in the human chromosomal structure. They may identify with one sex to varying degrees, or with both sexes. They may opt not identify with the concept of gender at all, but choose simply to see themselves as the unique human being they are. Any of these perceptions are completely valid.


Intersex genitalia

Breast development in Klinefelter's Syndrome

Neck development in Turner's Syndrome


Individuals medically classified as intersex are called hermaphrodites - people born with a full set of both female and male sex organs. People born as full hermaphrodites often have difficulty with fertility, although there are exceptions.


Other intersex people are born with varying degrees of mixed sex chromosomal and hormonal variations.


Examples of Chromosomal Variations:


Klinefelter's Syndrome

Men with Klinefelter's syndrome have 47 chromosomes rather than 46, with a double XX sex chromosome. This gives them the chromosomal pattern 47XXY. Approximately one in every 400 to 700 men has some degree of Klinefelter's syndrome.


Frequently men with Klinefelter's show no outward evidence of its effects, but in some cases Klinefelter's can have a pronounced effect on sexual development, causing small testicles, growth of breast tissue, and sparse beard growth. Men with Klinefelter’s may produce less testosterone than other men, and will probably not

produce sperm.


For young men at puberty whose appearance is impacted by Klinefelter's in a manner that makes them uncomfortable, testosterone injections may be an option. These shots can help "masculinize” appearances by increasing body hair and other male sex traits, as well as increasing sexual interest and erectile ability. Testosterone injections will not make the testicles produce sperm.


Turner's Syndrome

Women with Turner's syndrome have 45 chromosomes, rather than 46. The absent chromosome is one of the female X sex chromosomes, giving them the chromosomal pattern45X or 45X0. About one in every 2500 women have Turner's syndrome.


Women with Turner's syndrome frequently lack one or both ovaries, or have only streaks of ovarian tissue, and can rarely produce eggs or female hormones. Without ovaries or eggs, pregnancy is not possible. Women with Turner's also may not develop breasts, or begin their menstrual cycle, unless they take the hormones estrogen and progestin. Many, but not all, are of short stature, and some may have defects of the heart, kidney, or ears that require medical attention.


Speck Syndrome

Men with Speck syndrome have an extra Y chromosome, giving them the chromosomal pattern 47XYY. Some men with Speck syndrome have low sperm production and, more rarely, malformation of the testicles, but many are fertile. Physical findings also indicate that some men with Speck syndrome may be taller than average.


AIS and 5ARD

AIS (Androgen Insensitivity Syndrome) and 5ARD (five-alpha-reductase deficiency) occur when a 46XY person’s body does not respond to androgens, the hormones responsible for “masculinizing” sex traits.


There are two types of AIS: Complete AIS (CASI) and Partial AIS (PAIS). People with CIAS do not respond to androgens at all. They often have testes with external female genitals. People with PIAS respond partially to androgens, in varying degrees. They have testes and a range of body types, and genitals that may differ in look and function from the typical XX or XY genitals.



A Special Note to Intersex People:


It is important that you read our page on how to give yourself self-examinations.


Knowing your body is the key to your sexual wellness. It is crucial that you pursue comprehensive knowledge about your particular intersex anatomy and physiology, and give yourself a thorough monthly self-exam, as well as attending an annual exam with a doctor who is informed about your unique body. You will need to perform a self-exam of your specific sex-traits. Know what they are, inside and out. Demand thoroughness from yourself; knowledge is constructive power.


Jean Marc: "My partner and I are both physically intersex. We don’t call ourselves by any label: we’re just two people who love each other.

We both grew up feeling different and weird about having multiple sex organs. We hid whenever situations arose calling for nudity; locker rooms, changing rooms, sleepovers, etc. Neither of us felt comfortable or safe exploring sex with other people, although we tried.

Our relationship has been stupendously freeing. We aren’t limited by a ‘disability’; we’re blessed with an enhanced sexual capacity and an enlarged empathy for all "sexes.”

Lee: "I was born intersex. My parents elected to have my sex organs surgically altered to make me appear entirely female when I was an infant, and without knowing it I received female hormones through puberty (I thought I was taking vitamin shots).

When I was fourteen I fell in love with a guy and had really strong erotic fantasies about having sex with him in a man’s body. The desire to penetrate him with a penis that wasn’t there was unbearably acute, unbearably painful. I didn’t know how to reconcile my body with my needs.

On a hunch I started asking my doctors’ nurse about the content of my “vitamin” shots”. He confessed that I had been misinformed and was actually being administered a regime of estrogen and progestin.

Talk about a silent explosion. I heard that information and the earth shook. Why didn’t they tell me? How can I be expected to make a life for myself without knowing who I am?

That day I began a journey towards defining my own identity, based on my own feelings and choices. That should be an inalienable right from birth for all people."


Q&A with Sex Educator Shain Stodt

My Daughter Has Been Diagnosed With Turners Syndrome

Q. My nine year old daughter has been diagnosed with an abnormal condition called Turners Syndrome. Will she be able to have children and lead a normal life? Should she have corrective surgery? 

A. Women with Turners Syndrome can seldom produce children, although there are exceptions. From our Intersex Page above:

Women with Turner's syndrome frequently lack one or both ovaries, or have only streaks of ovarian tissue, and can rarely produce eggs or female hormones. Without ovaries or eggs, pregnancy is not possible. Women with Turner's also may not develop breasts, or begin their menstrual cycle, unless they take the hormones estrogen and progestin. Many, but not all, are of short stature, and some may have defects of the heart, kidney, or ears that require medical attention. 

Being Intersex is less common than having XY or XX chromosomes, but it isn’t abnormal; many people are Intersex to some degree or another. Two things are very important: 

1. That you support her identity and identity choices as she develops them. Love her for exactly who she is. That is not defined by fertility or motherhood or breasts or ovaries; that is defined by who she is as a human being, and what makes her happy. Normal is overrated: happiness isn’t. 

2. That she receives enlightened, specialized medical attention so that her anatomic and physiologic condition is clearly understood, and any health needs she may have are met. 

PLEASE review this page in regard to sex assignment surgery. This is a sensitive issue about which any decisions are usually best left to the Intersex individual. Quite a lot of identity confusion and misery can result in forced, uninformed, or involuntary surgery. Love her, nurture her unique soul, and have faith in her ability to make the right choice for herself when she’s ready, if any choice must be made -she may be perfectly happy just as she is.

   ~ Shain 


Copyright© 2015. All Rights Reserved.