Intersex#Prevalence

There is no clear consensus definition of intersex and no clear delineation of which specific conditions qualify an individual as intersex.{{cite journal |last1=Dreger |first1=A. D. |last2=Herndon |first2=A. M. |title=Progress and Politics in the Intersex Rights Movement: Feminist Theory in Action |journal=GLQ: A Journal of Lesbian and Gay Studies |date=1 January 2009 |volume=15 |issue=2 |pages=199–224 |doi=10.1215/10642684-2008-134 |s2cid=145754009 |quote="In our experience some clinicians have played a sort of moving target game whereby their definition of intersex changes from venue to venue, or moment to moment. We end up spending a remarkable amount of time just trying to agree on which diagnoses (and thus which people) count in the conversation we're trying to have. This does not usually seem to be a purposeful attempt to stall or derail conversation (although that does sometimes result); rather it seems to stem from a lack of systematic consideration of what the term might mean. For example, some want to call intersex only those born with visibly ambiguous genitalia, or only those who have had a particularly unusual mix of prenatal sex hormones."}} The World Health Organization's International Classification of Diseases (ICD), the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), and many medical journals classify intersex traits or conditions among disorders of sex development (DSD).{{cite journal |vauthors=Jordan-Young RM, Sönksen PH, Karkazis K |title=Sex, health, and athletes |journal=BMJ |volume=348 |pages=g2926 |date=April 2014 |pmid=24776640 |doi=10.1136/bmj.g2926 |s2cid=2198650 |url=http://www.bmj.com/content/348/bmj.g2926 |author3-link=Katrina Karkazis |author1-link=Rebecca Jordan-Young |access-date=19 July 2021 |archive-date=11 September 2014 |archive-url=https://web.archive.org/web/20140911063554/http://www.bmj.com/content/348/bmj.g2926 |url-status=live }}

A common adjective for people with disorders of sex development (DSD) is "intersex".{{citation needed|reason=Previously cited to ref 'un-2016', but failed verification. See rev. 1159356782.|date=June 2023}}

File:Hanne Gaby Odiele Photographed by Ed Kavishe for Fashionwirepress.jpg photographed by Ed Kavishe for Fashionwirepress. In 2017, Odiele disclosed having the intersex trait androgen insensitivity syndrome.]]

In 1917, Richard Goldschmidt created the term "intersexuality" to refer to a variety of physical sex ambiguities. However, according to The SAGE Encyclopedia of LGBTQ Studies, it was not until Anne Fausto Sterling published her article "The Five Sexes: Why Male and Female Are Not Enough" in 1993 that the term reached popularity.{{Cite book|last=Goldberg|first=Abbie E.|url=https://books.google.com/books?id=736zDAAAQBAJ&q=Anne+Fausto-Sterling+lgbt&pg=PA614|title=The SAGE Encyclopedia of LGBTQ Studies|date=10 May 2016|publisher=SAGE Publications|isbn=978-1-4833-7129-0|page=614|language=en}}

According to the UN Office of the High Commissioner for Human Rights:

{{blockquote|Intersex people are born with sex characteristics (including genitals, gonads and chromosome patterns) that do not fit typical binary notions of male or female bodies. Intersex is an umbrella term used to describe a wide range of natural bodily variations.{{Cite web |author= |publisher=United Nations Office of the High Commissioner for Human Rights |title=Free & Equal Campaign Fact Sheet: Intersex |date=2015 |url=https://unfe.org/system/unfe-65-Intersex_Factsheet_ENGLISH.pdf |access-date=28 March 2016 |url-status=live |archive-url=https://web.archive.org/web/20160304071043/https://unfe.org/system/unfe-65-Intersex_Factsheet_ENGLISH.pdf |archive-date=4 March 2016 |df=dmy-all }}}}

Some intersex organizations reference "intersex people" and "intersex variations or traits"[http://oii.org.au/19853/welcome/ Welcome to OII Australia – we promote human rights and bodily autonomy for intersex people, and provide information, education and peer support] {{Webarchive|url=https://web.archive.org/web/20141031180738/http://oii.org.au/19853/welcome/|date=31 October 2014}}, Intersex Human Rights Australia, 4 April 2004 while others use more medicalized language such as "people with intersex conditions",[http://www.apa.org/topics/lgbt/intersex.pdf Answers to Your Questions About Individuals With Intersex Conditions] {{Webarchive|url=https://web.archive.org/web/20141031003922/http://www.apa.org/topics/lgbt/intersex.pdf|date=31 October 2014}}, American Psychological Association, 2006. or people "with intersex conditions or DSDs (differences of sex development)" and "children born with variations of sex anatomy".[http://aiclegal.org Advocates for Informed Choice] {{Webarchive|url=https://web.archive.org/web/20110811061747/http://aiclegal.org/|date=11 August 2011}}, Advocates for Informed Choice, undated, retrieved 19 September 2014 In May 2016, interACT published a statement recognizing "increasing general understanding and acceptance of the term 'intersex'".{{Cite web|last=interACT|date=May 2016|title=interACT Statement on Intersex Terminology|url=http://interactadvocates.org/interact-statement-on-intersex-terminology/|url-status=live|archive-url=https://web.archive.org/web/20160608195140/http://interactadvocates.org/interact-statement-on-intersex-terminology/|archive-date=8 June 2016|access-date=30 May 2016|work=Interact Advocates for Intersex Youth}}

Australian sociological research on 272 "people born with atypical sex characteristics", published in 2016, found that 60% of respondents used the term "intersex" to self-describe their sex characteristics, including people identifying themselves as intersex, describing themselves as having an intersex variation or, in smaller numbers, having an intersex condition. Respondents also commonly used diagnostic labels and referred to their sex chromosomes, with word choices depending on audience.

Research on 202 respondents by the Lurie Children's Hospital, Chicago, and the AIS-DSD Support Group (now known as InterConnect Support Group){{Cite web |title=InterConnect Support - Support Embrace Educate Network |url=https://interconnect.support/ |access-date=9 April 2021 |archive-date=19 April 2021 |archive-url=https://web.archive.org/web/20210419224153/https://interconnect.support/ |url-status=live }} published in 2017 found that 80% of Support Group respondents "strongly liked, liked or felt neutral about intersex" as a term, while caregivers were less supportive.{{cite journal |last1=Johnson |first1=Emilie K. |last2=Rosoklija |first2=Ilina |last3=Finlayson |first3=Courtney |last4=Chen |first4=Diane |last5=Yerkes |first5=Elizabeth B. |last6=Madonna |first6=Mary Beth |last7=Holl |first7=Jane L. |last8=Baratz |first8=Arlene B. |last9=Davis |first9=Georgiann |last10=Cheng |first10=Earl Y. |title=Attitudes towards 'disorders of sex development' nomenclature among affected individuals |journal=Journal of Pediatric Urology |date=December 2017 |volume=13 |issue=6 |pages=608.e1–608.e8 |doi=10.1016/j.jpurol.2017.03.035 |pmid=28545802 }} The hospital reported that the use of the term "disorders of sex development" may negatively affect care.{{Cite news|last=Newswise|date=11 May 2017|title=Term "Disorders of Sex Development" May Have Negative Impact|work=Newswise|url=http://www.newswise.com/articles/term-disorders-of-sex-development-may-have-negative-impact|url-status=live|access-date=11 May 2017|archive-url=https://web.archive.org/web/20170515104842/http://www.newswise.com/articles/term-disorders-of-sex-development-may-have-negative-impact|archive-date=15 May 2017}}

Another study by a group of children's hospitals in the United States found that 53% of 133 parent and adolescent participants recruited at five clinics did not like the term "intersex". Participants who were members of support groups were more likely to dislike the term.{{cite journal |last1=D'Oro |first1=Anthony |last2=Rosoklija |first2=Ilina |last3=Jacobson |first3=Deborah L. |last4=Finlayson |first4=Courtney |last5=Chen |first5=Diane |last6=Tu |first6=Duong D. |last7=Austin |first7=Paul F. |last8=Karaviti |first8=Lefkothea P. |last9=Gunn |first9=Sheila K. |last10=Nahata |first10=Leena |last11=Kapa |first11=Hillary M. |last12=Kokorowski |first12=Paul J. |last13=Kim |first13=Mimi S. |last14=Messina |first14=Alyssa C. |last15=Kolon |first15=Thomas F. |last16=Yerkes |first16=Elizabeth B. |last17=Cheng |first17=Earl Y. |last18=Johnson |first18=Emilie K. |title=Patient and Caregiver Attitudes toward Disorders of Sex Development Nomenclature |journal=Journal of Urology |date=October 2020 |volume=204 |issue=4 |pages=835–842 |doi=10.1097/JU.0000000000001076 |pmid=32302259 }} A "dsd-LIFE" study in 2020 found that around 43% of 179 participants thought the term "intersex" was bad, 20% felt neutral about the term, while 37% thought the term was good.{{cite journal |last1=Bennecke |first1=Elena |last2=Köhler |first2=Birgit |last3=Röhle |first3=Robert |last4=Thyen |first4=Ute |last5=Gehrmann |first5=Katharina |last6=Lee |first6=Peter |last7=Nordenström |first7=Anna |last8=Cohen-Kettenis |first8=Peggy |last9=Bouvattier |first9=Clair |last10=Wiesemann |first10=Claudia |title=Disorders or Differences of Sex Development? Views of Affected Individuals on DSD Terminology |journal=The Journal of Sex Research |date=4 May 2021 |volume=58 |issue=4 |pages=522–531 |doi=10.1080/00224499.2019.1703130 |pmid=31985272 }}

{{Main|Hermaphrodite}}

Historically, the term "hermaphrodite" was used in law to refer to people whose sex was in doubt. The 12th century {{Lang|la|Decretum Gratiani}} states that "Whether an hermaphrodite may witness a testament, depends on which sex prevails" ("Hermafroditus an ad testamentum adhiberi possit, qualitas sexus incalescentis ostendit").Decretum Gratiani, C. 4, q. 2 et 3, c. 3{{cite web |url=http://geschichte.digitale-sammlungen.de/decretum-gratiani/kapitel/dc_chapter_1_1585 |title=Decretum Gratiani (Kirchenrechtssammlung) |work=Bayerische StaatsBibliothek (Bavarian State Library) |date=5 February 2009 |url-status=live |archive-url=https://web.archive.org/web/20161220084841/http://geschichte.digitale-sammlungen.de/decretum-gratiani/kapitel/dc_chapter_1_1585 |archive-date=20 December 2016 }} Similarly, the 17th century English jurist and judge Edward Coke (Lord Coke), wrote in his Institutes of the Lawes of England on laws of succession stating, "Every heire is either a male, a female, or an hermaphrodite, that is both male and female. And an hermaphrodite (which is also called Androgynus) shall be heire, either as male or female, according to that type of sexe which doth prevaile."E Coke, The First Part of the Institutes of the Laws of England, Institutes 8.a. (1st Am. Ed. 1812).{{Cite journal |volume=41 |last=Greenberg |first=Julie |title=Defining Male and Female: Intersexuality and the Collision Between Law and Biology |journal=Arizona Law Review |date=1999 |ssrn=896307|pages=277–278}}

During the Victorian era, medical authors attempted to ascertain whether or not humans could be hermaphrodites, adopting a precise biological definition for the term,{{Cite book |publisher=Johns Hopkins University Press |isbn=978-0-8018-9155-7 |last=Reis |first=Elizabeth |title=Bodies in Doubt: An American History of Intersex |location=Baltimore |pages=55–81 |date=2009}} and making distinctions between "male pseudohermaphrodite", "female pseudohermaphrodite" and especially "true hermaphrodite".Molina B Dayal, MD, MPH, Assistant Professor, Fertility and IVF Center, Division of Reproductive Endocrinology and Infertility, Medical Faculty Associates, George Washington University distinguishes what 'true hermaphroditism' encompasses in their study of Ovotestis. Found here: {{cite web|title=Ovotesticular Disorder of Sexual Development|url=http://www.emedicine.com/med/TOPIC1702.HTM|url-status=live|archive-url=https://web.archive.org/web/20071231023651/http://www.emedicine.com/med/topic1702.htm|archive-date=31 December 2007|access-date=2 January 2008}} These terms, which reflected histology (microscopic appearance) of the gonads, are rarely used in the 2020s.W. S. Alexander M.D., O. D. Beresford M.D., M.R.C.P. (1953) wrote extensively about 'female pseudohermaphrodite' origins in utera, in his paper "Masculinization of Ovarian Origin, published An International Journal of Obstetrics and Gynaecology Volume 60 Issue 2 pp. 252–258, April 1953.Am J Psychiatry 164:1499–1505, October 2007: Noted Mayo Clinic researchers J.M. Bostwick, MD, and Kari A Martin MD in A Man's Brain in an Ambiguous Body: A Case of Mistaken Gender wrote of the distinctions in male pseudohermaphrodite condition.{{cite book|author1=Langman, Jan|title=Langman's medical embryology|author2=Thomas Sadler|publisher=Lippincott Williams & Wilkins|year=2006|isbn=978-0-7817-9485-5|location=Hagerstown, MD|page=252}} Until the mid-20th century, "hermaphrodite" was used synonymously with "intersex".Cawadias, A. P. (1943) Hermaphoditus the Human Intersex, London, Heinemann Medical Books Ltd. Medical terminology shifted in the early 21st century, not only due to concerns about language, but also a shift to understandings based on genetics.{{Citation needed|date=June 2021}} The term "hermaphrodite" is also controversial as it implies the existence of someone fully male and fully female.{{cite web|title=Progress and Politics in the intersex rights movement, Feminist theory in action|url=http://www.aisia.org/wp-content/uploads/2016/11/Dreger__Herndon_2009.pdf|author1=Alice D. Dreger|author2=April M. Herndon|access-date=25 April 2023|archive-date=21 June 2023|archive-url=https://web.archive.org/web/20230621132342/http://www.aisia.org/wp-content/uploads/2016/11/Dreger__Herndon_2009.pdf|url-status=live}} As such the term "hermaphrodite" is often seen as degrading and offensive, although many intersex activists use it as a direct form of self empowerment and critique such as in the ISNA's first newsletter Hermaphrodites with Attitude.

The Intersex Society of North America has stated that hermaphrodites should not be confused with intersex people and that using "hermaphrodite" to refer to intersex individuals is considered to be stigmatizing and misleading.{{cite web|title=Is a person who is intersex a hermaphrodite? | Intersex Society of North America|url=http://www.isna.org/faq/hermaphrodite|archive-url=https://web.archive.org/web/20130701061246/http://www.isna.org/faq/hermaphrodite|archive-date=1 July 2013|access-date=5 July 2013|publisher=Isna.org}}

{{More citations needed section|date=June 2024}}

File:Licence to Lie.jpg

Estimates of the number of people who are intersex vary, depending on which conditions are counted as intersex. The now-defunct Intersex Society of North America said:

{{blockquote|If you ask experts at medical centers how often a child is born so noticeably atypical in terms of genitalia that a specialist in sex differentiation is called in, the number comes out to about 1 in 1,500 to 1 in 2,000 births [0.07–0.05%]. But a lot more people than that are born with subtler forms of sex anatomy variations, some of which won't show up until later in life.{{cite web |url=http://www.isna.org/faq/frequency |title=How common is intersex? | Intersex Society of North America |publisher=Isna.org |access-date=21 August 2009 |archive-url=https://web.archive.org/web/20090822212522/http://www.isna.org/faq/frequency/ |archive-date=22 August 2009 |df=dmy-all }}}}

Anne Fausto-Sterling et al., said in 2000 that "[a]dding the estimates of all known causes of nondimorphic sexual development suggests that approximately 1.7% of all live births do not conform to a Platonic ideal of absolute sex chromosome, gonadal, genital, and hormonal dimorphism";{{cite journal |last1=Blackless |first1=Melanie |last2=Charuvastra |first2=Anthony |last3=Derryck |first3=Amanda |last4=Fausto-Sterling |first4=Anne |last5=Lauzanne |first5=Karl |last6=Lee |first6=Ellen |title=How sexually dimorphic are we? Review and synthesis |journal=American Journal of Human Biology |date=March 2000 |volume=12 |issue=2 |pages=151–166 |doi=10.1002/(SICI)1520-6300(200003/04)12:2<151::AID-AJHB1>3.0.CO;2-F |pmid=11534012 |s2cid=453278 }}{{Cite book |publisher=Basic Books |isbn=978-0-465-07714-4 |page=[https://archive.org/details/isbn_9780465077137/page/53 53] |last=Fausto-Sterling |first=Anne |title=Sexing the Body: Gender Politics and the Construction of Sexuality |date=2000 |author-link=Anne Fausto-Sterling |title-link=Sexing the Body}} these publications have been widely quoted by intersex activists.{{cite web |url=https://oii.org.au/16601/intersex-numbers/ |title=On the number of intersex people |date=28 September 2013 |publisher=Organisation Intersex International Australia |access-date=4 July 2015 |archive-url=https://web.archive.org/web/20150704233705/https://oii.org.au/16601/intersex-numbers/ |archive-date=4 July 2015 }}{{cite web |url=http://www.sbs.com.au/news/thefeed/story/intersex-i-lgbti |title=Intersex: the 'I' in 'LGBTI' |last1=Chaleyer |first1=Rani |date=10 March 2015 |publisher=Special Broadcasting Service |access-date=4 July 2015 |url-status=live |archive-url=https://web.archive.org/web/20150705044518/http://www.sbs.com.au/news/thefeed/story/intersex-i-lgbti |archive-date=5 July 2015 }} Of the 1.7%, 1.5% points (88% of those considered "nondimorphic sexual development" in this figure) consist of individuals with late onset congenital adrenal hyperplasia (LOCAH) which may be asymptomatic but can present after puberty and cause infertility.{{cite journal |vauthors=Merke DP, Auchus RJ |title=Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency |journal=The New England Journal of Medicine |volume=383 |issue=13 |pages=1248–1261 |date=September 2020 |pmid=32966723 |doi=10.1056/NEJMra1909786 |s2cid=221884108 }}

Leonard Sax, in response to Fausto-Sterling, estimated that the prevalence of intersex was about 0.018% of the world's population,{{cite journal|url=https://www.jstor.org/stable/3813612|last1=Sax|first1=Leonard|author-link=Leonard Sax|date=August 2002|title=How common is intersex? a response to Anne Fausto-Sterling|journal=Journal of Sex Research|volume=39|issue=3|pages=174–178|doi=10.1080/00224490209552139 |jstor=3813612 |pmid=12476264 |s2cid=33795209}} [https://www.leonardsax.com/how-common-is-intersex-a-response-to-anne-fausto-sterling/ Alt URL] {{Webarchive|url=https://web.archive.org/web/20210228000512/https://www.leonardsax.com/how-common-is-intersex-a-response-to-anne-fausto-sterling/ |date=28 February 2021 }} discounting several conditions included in Fausto-Sterling's estimate that included LOCAH, Klinefelter syndrome (47,XXY), Turner syndrome (45,X), the chromosomal variants of 47,XYY and 47,XXX, and vaginal agenesis. Sax reasons that in these conditions chromosomal sex is consistent with phenotypic sex and phenotype is classifiable as either male or female.

In a 2003 letter to the editor, political scientist Carrie Hull analyzed the data used by Fausto-Sterling and said the estimated intersex rate should instead have been 0.37%, due to many errors.{{cite journal |last1=Hull |first1=Carrie L. |last2=Fausto-Sterling |first2=Anne |title=Letter to the Editor |journal=American Journal of Human Biology |date=January 2003 |volume=15 |issue=1 |pages=112–116 |doi=10.1002/ajhb.10122 |pmid=12552585 }} In a response letter published simultaneously, Fausto-Sterling welcomed the additional analysis and said "I am not invested in a particular final estimate, only that there BE an estimate." A 2018 review reported that the number of births with ambiguous genitals is in the range of 0.02% to 0.05%.

Intersex Human Rights Australia says it maintains 1.7% as its preferred upper limit "despite its flaws", stating both that the estimate "encapsulates the entire population of people who are stigmatized—or risk stigmatization—due to innate sex characteristics", and that Sax's definitions exclude individuals who experience such stigma and who have helped to establish the intersex movement.{{Cite web |url=https://ihra.org.au/16601/intersex-numbers/ |title=Intersex population figures |date=28 September 2013 |access-date=17 April 2021 |archive-date=17 July 2018 |archive-url=https://web.archive.org/web/20180717183724/https://ihra.org.au/16601/intersex-numbers/ |url-status=live }} According to InterACT, a major organization for intersex rights in the US, states that 1.7% of people have some variation of sexual development, 0.5% have atypical genitalia, and 0.05% have mixed/ambiguous genitalia.{{Cite web|url=http://www.healthit.gov/isa/uscdi-data/variation-sex-characteristics|title=Variation in Sex Characteristics|website=www.healthit.gov|access-date=28 July 2023|archive-date=14 May 2023|archive-url=https://web.archive.org/web/20230514193618/https://www.healthit.gov/isa/uscdi-data/variation-sex-characteristics|url-status=dead}}{{Cite journal|url=https://phaenex.uwindsor.ca/index.php/phaenex/article/view/3087|title=From Intersex to DSD: the Disciplining of Sex Development|first=Catherine|last=Clune-Taylor|date=14 May 2010|journal=PhaenEx|volume=5|issue=2|pages=152–178|via=ojs.uwindsor.ca|doi=10.22329/p.v5i2.3087|doi-access=free|access-date=27 July 2023|archive-date=14 May 2023|archive-url=https://web.archive.org/web/20230514193625/https://phaenex.uwindsor.ca/index.php/phaenex/article/view/3087|url-status=live}}{{cite web|url=https://interactadvocates.org/wp-content/uploads/2015/12/BROCHURE-interACT-Friends-final-web.pdf|title=What is intersex?|date=2015|access-date=27 July 2023|archive-date=27 July 2023|archive-url=https://web.archive.org/web/20230727223642/https://interactadvocates.org/wp-content/uploads/2015/12/BROCHURE-interACT-Friends-final-web.pdf|url-status=live}}{{Cite web|url=https://www.americanprogress.org/article/key-issues-facing-people-intersex-traits/|title=Key Issues Facing People With Intersex Traits|date=26 October 2021|work=InterACT|access-date=27 July 2023|archive-date=30 June 2023|archive-url=https://web.archive.org/web/20230630155542/https://www.americanprogress.org/article/key-issues-facing-people-intersex-traits/|url-status=live}}{{efn|Sex within this context refers to the gonads, many individuals with intersex variations have an assigned sex and gender identity that differs from gonadal sex. Individuals with complete androgen insensitivity syndrome are phenotypically female, are assigned female at birth, and usually have a female gender identity but have testis. The definition of biological sex within intersex topics are often arbitrary.{{Cite web|url=https://medlineplus.gov/genetics/condition/androgen-insensitivity-syndrome/|title=Androgen insensitivity syndrome: MedlinePlus Genetics|website=medlineplus.gov|access-date=15 October 2023|archive-date=21 October 2023|archive-url=https://web.archive.org/web/20231021184241/https://medlineplus.gov/genetics/condition/androgen-insensitivity-syndrome/|url-status=live}}{{cite journal |last1=Zucker |first1=Kenneth J |title=Intersexuality and Gender Identity Differentiation |journal=Journal of Pediatric and Adolescent Gynecology |date=February 2002 |volume=15 |issue=1 |pages=3–13 |doi=10.1016/s1083-3188(01)00133-4 |pmid=11888804 }}}} A study relying on a nationally representative survey conducted in Mexico between 2021 and 2022 obtained similar estimates: around 1.6% of individuals aged 15 to 64 reported being born with sex variations.

The following summarizes prevalences of traits that some medical experts consider to be intersex (where sex chromosome anomalies are involved, the karyotype is often summarized by the total number of chromosomes followed by the sex chromosomes present in each cell):

{{Clear}}

Notes:{{notelist-lr|group=intersex-wikitable}}

{{main|Intersex in history|Timeline of intersex history|History of intersex surgery}}

File:Ermafrodito, affresco Romano di Ercolano (1–50 d.C., Museo Archeologico Nazionale di Napoli) - 02.jpg (first half of the 1st century AD)]]

File:(23) Half Male Half Female Androgynous Shiva Gangaikonda Cholapuram Hindu Temple Pragatishwara Tamil Nadu India 2014.jpg statue depicting Ardhanarishvara, a Hermaphroditus form of Shiva. ]]

From early history, societies have been aware of intersex people. Some of the earliest evidence is found in mythology: the Greek historian Diodorus Siculus wrote of the mythological Hermaphroditus in the first century BC, who was "born with a physical body which is a combination of that of a man and that of a woman", and reputedly possessed supernatural properties.{{Cite book |publisher=Harvard University Press |last=Diodorus Siculus |others=C H Oldfather (trans.) |title=Library of History (Book IV) |location=Cambridge, MA |series=Loeb Classical Library Volumes 303 and 340 |date=1935 |url=http://www.theoi.com/Text/DiodorusSiculus4A.html#6 |url-status=live |archive-url=https://web.archive.org/web/20080927074542/http://www.theoi.com/Text/DiodorusSiculus4A.html#6 |archive-date=27 September 2008 }} He also recounted the lives of Diophantus of Abae and Callon of Epidaurus.{{Cite journal|last1=Markantes|first1=Georgios|last2=Deligeoroglou|first2=Efthimios|last3=Armeni|first3=Anastasia|last4=Vasileiou|first4=Vasiliki|last5=Damoulari|first5=Christina|last6=Mandrapilia|first6=Angelina|last7=Kosmopoulou|first7=Fotini|last8=Keramisanou|first8=Varvara|last9=Georgakopoulou|first9=Danai|last10=Creatsas|first10=George|last11=Georgopoulos|first11=Neoklis|date=10 July 2015|title=Callo: The first known case of ambiguous genitalia to be surgically repaired in the history of Medicine, described by Diodorus Siculus|url=http://www.hormones.gr/8581/article/callo:-the-first-known-case-of%E2%80%A6.html|journal=Hormones|volume=14|issue=3|pages=459–461|doi=10.14310/horm.2002.1608|pmid=26188239|doi-access=free|access-date=25 June 2021|archive-date=25 June 2021|archive-url=https://web.archive.org/web/20210625101729/http://www.hormones.gr/8581/article/callo:-the-first-known-case-of%E2%80%A6.html|url-status=live}} Ardhanarishvara, an androgynous composite form of male deity Shiva and female deity Parvati, originated in Kushan culture as far back as the first century AD.{{Cite book|title=Encyclopaedia of the Śaivism|last=Swami.|first=Parmeshwaranand|date=2004|publisher=Sarup & Sons|isbn=978-81-7625-427-4|edition= 1st|location=New Delhi|oclc=54930404}} A statue depicting Ardhanarishvara is included in India's Meenakshi Temple; this statue clearly shows both male and female bodily elements.{{Cite journal|last=Shankar|first=Gopi|date=March–April 2015|title=The Many Genders of Old India|journal=The Gay & Lesbian Review Worldwide|volume=22|pages=24–26|via=ProQuest}}

Hippocrates ({{circa|460}} – {{circa|370}} BC, Greek physician) and Galen (129 – {{circa|200/216}} AD, Roman physician, surgeon, and philosopher) both viewed sex as a spectrum between men and women, with "many shades in between, including hermaphrodites, a perfect balance of male and female".{{Cite journal |doi=10.1057/s41280-018-0080-8 |volume=9 |issue=2 |pages=132–146 |last=DeVun |first=Leah |title=Heavenly hermaphrodites: sexual difference at the beginning and end of time |journal=Postmedieval |date=June 2018 |s2cid=165449144}} Pliny the Elder (AD 23/24–79), a Roman naturalist, described "those who are born of both sexes, whom we call hermaphrodites, at one time androgyni" (from the Greek {{transliteration|el|andr-}}, "man", and {{transliteration|el|gyn-}}, "woman").Pliny, Natural History 7.34: gignuntur et utriusque sexus quos hermaphroditos vocamus, olim androgynos vocatos; Veronique Dasen, "Multiple Births in Graeco-Roman Antiquity", Oxford Journal of Archaeology 16.1 (1997), p. 61. Augustine (354 – 430 AD), the influential Catholic theologian, wrote in The Literal Meaning of Genesis that humans were created in two sexes, despite "as happens in some births, in the case of what we call androgynes".

In medieval and early modern 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.Lynn E. Roller, "The Ideology of the Eunuch Priest", Gender & History 9.3 (1997), p. 558. The 12th century {{lang|la|Decretum Gratiani}} states, "Whether an hermaphrodite may witness a testament, depends on which sex prevails."Decretum Gratiani, C. 4, q. 2 et 3, c. 3{{cite web |url=http://geschichte.digitale-sammlungen.de/decretum-gratiani/kapitel/dc_chapter_1_1585 |title=Decretum Gratiani (Kirchenrechtssammlung) |work=Bayerische StaatsBibliothek (Bavarian State Library) |date=5 February 2009 |url-status=live |archive-url=https://web.archive.org/web/20161220084841/http://geschichte.digitale-sammlungen.de/decretum-gratiani/kapitel/dc_chapter_1_1585 |archive-date=20 December 2016 }}{{cite book |title=A History of Women and Ordination |last1=Raming |first1=Ida |last2=Macy |first2=Gary |last3=Bernard J |first3=Cook |publisher=Scarecrow Press |date=2004 |page=113}} The foundation of common law, the 17th 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".E Coke, The First Part of the Institutes of the Laws of England, Institutes 8.a. (1st Am. Ed. 1812) (16th European ed. 1812). Legal cases have been described in canon law and elsewhere over the centuries.

Some non-European societies have sex or gender systems that recognize more than the two categories of male/man and female/woman. Some of these cultures, for instance the South-Asian Hijra communities, may include intersex people in a third gender category.{{cite web |url=https://www.sapiens.org/body/hijra-india-third-gender/ |title=India's Third Gender Rises Again |publisher=Wenner-Gren Foundation for Anthropological Research |work=Sapiens |date=26 September 2019 |access-date=26 April 2020 |archive-date=29 August 2020 |archive-url=https://web.archive.org/web/20200829030110/https://www.sapiens.org/biology/hijra-india-third-gender/ |url-status=live }}{{cite web |url=https://www.theguardian.com/society/2014/apr/16/india-third-gender-claims-place-in-law |title=Hijra: India's third gender claims its place in law |work=The Guardian |date=16 April 2014 |access-date=26 April 2020 |archive-date=15 April 2017 |archive-url=https://web.archive.org/web/20170415131009/https://www.theguardian.com/society/2014/apr/16/india-third-gender-claims-place-in-law |url-status=live }} Although—according to Morgan Holmes—early Western anthropologists categorized such cultures as "primitive", Holmes has argued that analyses of these cultures have been simplistic or romanticized and fail to take account of the ways that subjects of all categories are treated.{{cite journal |last=Holmes |first=Morgan |author-link=Morgan Holmes |date=July 2004 |title=Locating Third Sexes |url=http://www.transformationsjournal.org/wp-content/uploads/2017/01/Holmes_Transformations08.pdf |journal=Transformations Journal |issue=8 |access-date=28 December 2014 |archive-date=16 April 2017 |archive-url=https://web.archive.org/web/20170416132803/http://www.transformationsjournal.org/wp-content/uploads/2017/01/Holmes_Transformations08.pdf |url-status=live }}

During the Victorian era, medical authors introduced the terms "true hermaphrodite" for an individual who has both ovarian and testicular tissue, "male pseudo-hermaphrodite" for a person with testicular tissue, but either female or ambiguous sexual anatomy, and "female pseudo-hermaphrodite" for a person with ovarian tissue, but either male or ambiguous sexual anatomy. Some later shifts in terminology have reflected advances in genetics, while other shifts are suggested to be due to pejorative associations.

The term "intersexuality" was coined by Richard Goldschmidt in 1917.{{Cite journal |doi=10.1210/endo-1-4-433 |last1=Goldschmidt |first1=R. |year=1917 |title=Intersexuality and the endocrine aspect of sex |journal=Endocrinology |volume=1 |issue=4 |pages=433–456 |url=https://zenodo.org/record/1448726 |access-date=4 July 2019 |archive-date=29 August 2020 |archive-url=https://web.archive.org/web/20200829030112/https://zenodo.org/record/1448726 |url-status=live }} The first suggestion to replace the term "hermaphrodite" with "intersex" was made by Cawadias in the 1940s.

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.{{cite journal|last1=Coran|first1=Arnold G.|last2=Polley|first2=Theodore Z.|title=Surgical management of ambiguous genitalia in the infant and child|journal=Journal of Pediatric Surgery|date=July 1991|volume=26|issue=7|pages=812–820|doi=10.1016/0022-3468(91)90146-K|pmid=1895191|citeseerx=10.1.1.628.4867}} An 'optimal gender policy', initially developed by John Money, stated that early intervention helped avoid gender identity confusion, but this lacks evidence.{{Cite journal|last1=Hughes|first1=I A|last2=Houk|first2=C|last3=Ahmed|first3=S F|last4=Lee|first4=P A|author5=((LWPES1/ESPE2 Consensus Group))|date=June 2005|title=Consensus statement on management of intersex disorders|journal=Archives of Disease in Childhood|volume=91|issue=7|pages=554–563|doi=10.1136/adc.2006.098319 |pmc=2082839|pmid=16624884}} Early interventions have adverse consequences for psychological and physical health.{{Cite book |publisher=Swiss National Advisory Commission on Biomedical Ethics NEK-CNE |title=On the management of differences of sex development. Ethical issues relating to "intersexuality". Opinion No. 20/2012 |location=Berne |date=November 2012 |url=http://www.nek-cne.ch/fileadmin/nek-cne-dateien/Themen/Stellungnahmen/en/NEK_Intersexualitaet_En.pdf |archive-url=https://web.archive.org/web/20150423213245/http://www.nek-cne.ch/fileadmin/nek-cne-dateien/Themen/Stellungnahmen/en/NEK_Intersexualitaet_En.pdf |archive-date=23 April 2015 |access-date=24 July 2018}} 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.{{cite journal |author-link=Alice Dreger |author=Alice Domurat Dreger |title="Ambiguous Sex"—or Ambivalent Medicine? |journal=The Hastings Center Report |date= May 1998 |volume=28 |issue=3 |pages=24–35 |doi=10.2307/3528648|pmid=9669179 |jstor=3528648 }}

Dialogue 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.{{Cite journal |last=Dreger |first=Alice |author-link=Alice Dreger |title=Malta Bans Surgery on Intersex Children |journal=The Stranger SLOG |date=3 April 2015 |url=http://www.thestranger.com/blogs/slog/2015/04/03/22001053/malta-bans-surgery-on-intersex-children |url-status=live |archive-url=https://web.archive.org/web/20150718144253/http://www.thestranger.com/blogs/slog/2015/04/03/22001053/malta-bans-surgery-on-intersex-children |archive-date=18 July 2015 }} 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. In April 2015, Malta became the first country to outlaw non-consensual medical interventions to modify sex anatomy, including that of intersex people. Many civil society organizations and human rights institutions now call for an end to unnecessary "normalizing" interventions, including in the Malta declaration.{{Cite conference |title=Public statement by the third international intersex forum |location=Malta |date=2 December 2013 |url=http://www.ilga-europe.org/resources/news/latest-news/3rd-international-intersex-forum-concluded |url-status=live |archive-url=https://web.archive.org/web/20161124024734/http://www.ilga-europe.org/resources/news/latest-news/3rd-international-intersex-forum-concluded |archive-date=24 November 2016 }}{{citation needed|reason=Previously cited here to ref 'un-2016', but failed verification. See rev. 1159356782.|date=June 2023}}

{{further|Intersex rights by country}}

File:Utrechtpride-intersexboat.jpg Canal Pride in the Netherlands on 16 June 2018]]

Human rights institutions are placing increasing scrutiny on harmful practices and issues of discrimination against intersex people. These issues have been addressed by a rapidly increasing number of international institutions including, in 2015, the Council of Europe, the United Nations Office of the United Nations High Commissioner for Human Rights and the World Health Organization (WHO). In 2024, the United Nations Human Rights Council adopted its first resolution to protect the rights of intersex people.{{cite web |title=UN rights body adopts first resolution to protect rights of intersex people |url=https://www.reuters.com/world/un-rights-body-adopts-first-resolution-protect-rights-intersex-people-2024-04-04/ |website=Reuters |access-date=12 September 2024 |location=Geneva |date=5 April 2024}} These developments have been accompanied by International Intersex Forums and increased cooperation among civil society organizations. However, the implementation, codification, and enforcement of intersex human rights in national legal systems remains slow.

{{Update|map|date=May 2021}}

{{Main|Intersex human rights|Intersex medical interventions}}

[[File:Protection of intersex children from harmful practices.svg|thumb|

{{legend|#002255|Legal prohibition of non-consensual medical interventions}}

{{legend|#0066FF|Regulatory suspension of non-consensual medical interventions}}]]

Stigmatization and discrimination from birth may include infanticide, abandonment, and the stigmatization of families. The birth of an intersex child was often viewed as a curse or a sign of a witch mother, especially in parts of Africa.{{cite web |url=https://www.bbc.com/news/world-africa-39780214 |title=The midwife who saved intersex babies |first1=Helen |last1=Grady |first2=Anne |last2=Soy |work=BBC World Service, Kenya |date=4 May 2017 |url-status=live |archive-url=https://web.archive.org/web/20170515044758/http://www.bbc.com/news/world-africa-39780214 |archive-date=15 May 2017 }} Abandonments and infanticides have been reported in Uganda,{{Cite web |last1=Civil Society Coalition on Human Rights and Constitutional Law |last2=Human Rights Awareness and Promotion Forum |last3=Rainbow Health Foundation |last4=Sexual Minorities Uganda |last5=Support Initiative for Persons with Congenital Disorders |title=Uganda Report of Violations based on Sex Determination, Gender Identity, and Sexual Orientation |date=2014 |url=http://www.hrapf.org/publications/research-papers/uganda-report-violations-based-sex-determination-gender-identity-and |archive-url=https://web.archive.org/web/20150503012642/http://www.hrapf.org/publications/research-papers/uganda-report-violations-based-sex-determination-gender-identity-and |archive-date=3 May 2015 |access-date=15 May 2017}} Kenya,{{Cite web |last=Odero |first=Joseph |title=Intersex in Kenya: Held captive, beaten, hacked. Dead. |work=76 CRIMES |access-date=1 October 2016 |date=23 December 2015 |url=http://76crimes.com/2015/12/23/intersex-in-kenya-held-captive-beaten-hacked-dead/ |archive-url=https://web.archive.org/web/20160425162007/https://76crimes.com/2015/12/23/intersex-in-kenya-held-captive-beaten-hacked-dead/ |archive-date=25 April 2016 }} South Asia,{{Cite journal |doi=10.1007/s11154-008-9084-2 |pmid=18633712 |volume=9 |issue=3 |pages=227–236 |last1=Warne |first1=Garry L. |last2=Raza |first2=Jamal |title=Disorders of sex development (DSDs), their presentation and management in different cultures |journal=Reviews in Endocrine and Metabolic Disorders |date=September 2008 |citeseerx=10.1.1.469.9016 |s2cid=8897416}} and China.{{Cite web |last=Beyond the Boundary – Knowing and Concerns Intersex |title=Intersex report from Hong Kong China, and for the UN Committee Against Torture: the Convention against Torture and Other Cruel Inhuman or Degrading Treatment or Punishment |date=October 2015 |url=http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=INT%2fCAT%2fCSS%2fHKG%2f22156&Lang=en |url-status=live |archive-url=https://web.archive.org/web/20170326052617/http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=INT%2FCAT%2FCSS%2FHKG%2F22156&Lang=en |archive-date=26 March 2017 }}

Infants, children and adolescents also experience "normalising" interventions on intersex people that are medically unnecessary and the pathologisation of variations in sex characteristics. In countries where the human rights of intersex people have been studied, medical interventions to modify the sex characteristics of intersex people have still taken place without the consent of the intersex person.{{Cite book |publisher=Heinrich-Böll-Stiftung |isbn=978-3-86928-107-0 |last1=Ghattas |first1=Dan Christian |author1-link=Dan Christian Ghattas |last2=Heinrich-Böll-Stiftung |author2-link=Heinrich Böll Foundation |title=Human Rights between the Sexes A preliminary study on the life situations of inter*individuals |location=Berlin |date=2013 |url=http://www.boell.de/sites/default/files/endf_human_rights_between_the_sexes.pdf |url-status=live |archive-url=https://web.archive.org/web/20150923223221/http://www.boell.de/sites/default/files/endf_human_rights_between_the_sexes.pdf |archive-date=23 September 2015 }}{{Cite web |url=http://www.radionetherlandsarchives.org/intersex/ |title="Intersex", Radio Netherlands Archives, April 21, 2004 |date=21 April 2004 |access-date=16 April 2019 |archive-date=29 August 2020 |archive-url=https://web.archive.org/web/20200829030112/http://www.radionetherlandsarchives.org/intersex/ |url-status=live }} Interventions have been described by human rights defenders as a violation of many rights, including (but not limited to) bodily integrity, non-discrimination, privacy, and experimentation.{{Cite journal|last=Carpenter|first=Morgan|date=December 2018|title=Intersex Variations, Human Rights, and the International Classification of Diseases|journal=Health and Human Rights|volume=20|issue=2|pages=205–214|pmid=30568414|pmc=6293350}} 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 WHO, other UN bodies such as the Office of the High Commissioner for Human Rights, and an increasing number of regional and national institutions due to their adverse consequences, including trauma, impact on sexual function and sensation, and violation of rights to physical and mental integrity.{{citation needed|reason=Previously cited to ref 'un-2016', but failed verification. See rev. 1159356782.|date=June 2023}} The UN organizations decided that infant intervention should not be allowed, in favor of waiting for the child to mature enough to be a part of the decision-making—this allows for a decision to be made with total consent.{{Cite journal|last=Greenberg|first=Julie A.|date=June 2017|title=Legal, ethical, and human rights considerations for physicians treating children with atypical or ambiguous genitalia|journal=Seminars in Perinatology|volume=41|issue=4|pages=252–255|doi=10.1053/j.semperi.2017.03.012|pmid=28478089}} In April 2015, Malta became the first country to outlaw surgical intervention without consent. 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.{{Cite report |publisher=Council of Europe Commissioner for Human Rights |title=Human rights and intersex people, Issue Paper |date=April 2015 |url=https://wcd.coe.int/ViewDoc.jsp?Ref=CommDH/IssuePaper(2015)1&Language=lanEnglish&Ver=original |archive-url=https://web.archive.org/web/20160106203349/https://wcd.coe.int/ViewDoc.jsp?Ref=CommDH%2FIssuePaper%282015%291&Language=lanEnglish&Ver=original |archive-date=6 January 2016 |access-date=29 August 2020}}

{{Main|Discrimination against intersex people}}

[[File:Inclusion of sex characteristics in anti-discrimination law.svg|thumb|

{{legend|#002255|Explicit protection on grounds of sex characteristics}}

{{legend|#0066FF|Explicit protection on grounds of intersex status}}

{{legend|#9FCFFF|Explicit protection on grounds of intersex within attribute of sex}}]]

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. Researchers have documented significant disparities in mental, physical, and sexual health when comparing intersex individuals to the general population, including higher rates of bullying, stigmatization, harassment, violence, and suicidal intention, as well as substantial barriers in the workplace.

Several countries have so far explicitly protected intersex people from discrimination, with landmarks including South Africa,[http://www.info.gov.za/view/DownloadFileAction?id=67875 Government Gazette] {{Webarchive|url=https://web.archive.org/web/20110609190535/http://www.info.gov.za/view/DownloadFileAction?id=67875 |date=9 June 2011 }}, Republic of South Africa, Vol. 487, Cape Town, 11 January 2006. Australia,[http://www.comlaw.gov.au/Details/C2013A00098 Sex Discrimination Amendment (Sexual Orientation, Gender Identity and Intersex Status) Act 2013, No. 98, 2013] {{Webarchive|url=https://web.archive.org/web/20141006122244/http://www.comlaw.gov.au/Details/C2013A00098 |date=6 October 2014 }}, ComLaw, C2013A00098, 2013.[http://oii.org.au/22713/sex-discrimination-amendment-intersex-status-act/ On the historic passing of the Sex Discrimination Amendment (Sexual Orientation, Gender Identity and Intersex Status) Act 2013] {{Webarchive|url=https://web.archive.org/web/20141006105638/http://oii.org.au/22713/sex-discrimination-amendment-intersex-status-act/ |date=6 October 2014 }}, Organisation Intersex International Australia, 25 June 2013. and, most comprehensively, Malta.{{Cite web |last=Malta |title=Gender Identity, Gender Expression and Sex Characteristics Act: Final version |date=April 2015 |url=http://justiceservices.gov.mt/DownloadDocument.aspx?app=lp&itemid=26805&l=1 |access-date=4 July 2015 |archive-date=5 July 2015 |archive-url=https://web.archive.org/web/20150705045131/http://justiceservices.gov.mt/DownloadDocument.aspx?app=lp&itemid=26805&l=1 |url-status=live}}{{Cite web |last=OII Europe |author-link=OII Europe |title=OII-Europe applauds Malta's Gender Identity, Gender Expression and Sex Characteristics Act. This is a landmark case for intersex rights within European law reform |date=1 April 2015 |url=http://oiieurope.org/press-release-oii-europe-applauds-maltas-gender-identity-gender-expression-and-sex-characteristics-act/ |access-date=3 July 2015 |archive-url=https://web.archive.org/web/20150522051313/http://oiieurope.org/press-release-oii-europe-applauds-maltas-gender-identity-gender-expression-and-sex-characteristics-act/ |archive-date=22 May 2015 }}{{Cite conference |last=Transgender Europe |title=Malta Adopts Ground-breaking Trans and Intersex Law – TGEU Press Release |date=1 April 2015 |url=http://tgeu.org/malta-adopts-ground-breaking-trans-intersex-law/ |archive-url=https://web.archive.org/web/20161103161043/http://tgeu.org/malta-adopts-ground-breaking-trans-intersex-law/ |archive-date=3 November 2016 |access-date=4 July 2015}}

{{Main|Intersex human rights}}

Claims for compensation and remedies for human rights abuses include the 2011 case of Christiane Völling in Germany.{{Cite web |last=International Commission of Jurists |title=In re Völling, Regional Court Cologne, Germany (6 February 2008) |access-date=27 December 2015 |url=http://www.icj.org/sogicasebook/in-re-volling-regional-court-cologne-germany-6-february-2008/ |url-status=live |archive-url=https://web.archive.org/web/20160105074337/http://www.icj.org/sogicasebook/in-re-volling-regional-court-cologne-germany-6-february-2008/ |archive-date=5 January 2016 }}{{cite web |url=http://zwischengeschlecht.org/pages/Hermaphrodite-wins-damage-claim |title=Christiane Völling: Hermaphrodite wins damage claim over removal of reproductive organs |last1=Zwischengeschlecht |date=12 August 2009 |access-date=20 July 2015 |url-status=live |archive-url=https://web.archive.org/web/20150705201148/http://zwischengeschlecht.org/pages/Hermaphrodite-wins-damage-claim |archive-date=5 July 2015 |author1-link=Zwischengeschlecht }} A second case was adjudicated in Chile in 2012, involving a child and his parents.{{cite web|title=Condenan al H. de Talca por error al determinar sexo de bebé|url=http://diario.latercera.com/2012/11/24/01/contenido/pais/31-123780-9-condenan-al-h-de-talca--por-error-al-determinar-sexo-de-bebe.shtml|website=diario.latercera.com|access-date=15 February 2017|language=es|url-status=live|archive-url=https://web.archive.org/web/20170215210929/http://diario.latercera.com/2012/11/24/01/contenido/pais/31-123780-9-condenan-al-h-de-talca--por-error-al-determinar-sexo-de-bebe.shtml|archive-date=15 February 2017}}{{cite web|last=García|first=Gabriela|title=Identidad forzada|url=http://www.paula.cl/reportajes-y-entrevistas/reportajes/identidad-forzada/|website=www.paula.cl|language=es|url-status=live|archive-url=https://web.archive.org/web/20170215212801/http://www.paula.cl/reportajes-y-entrevistas/reportajes/identidad-forzada/|archive-date=15 February 2017|date=20 June 2013}} A further successful case in Germany, taken by Michaela Raab, was reported in 2015.{{Cite web |last=Zwischengeschlecht |title=Nuremberg Hermaphrodite Lawsuit: Michaela "Micha" Raab Wins Damages and Compensation for Intersex Genital Mutilations! |access-date=21 December 2015 |date=17 December 2015 |url=http://stop.genitalmutilation.org/post/Nuremberg-Hermaphrodite-Lawsuit-Damages-and-Compensation-for-Intersex-Genital-Mutilations |url-status=live |archive-url=https://archive.today/20160511101133/http://stop.genitalmutilation.org/post/Nuremberg-Hermaphrodite-Lawsuit-Damages-and-Compensation-for-Intersex-Genital-Mutilations |archive-date=11 May 2016 }} In the United States, the Minor Child (M.C. v Aaronson) lawsuit was "a medical malpractice case related to the informed consent for a surgery performed on the Crawford's adopted child (known as M.C.) at [Medical University of South Carolina] in April 2006".{{cite web |title=M.C. V. AARONSON |url=https://www.splcenter.org/seeking-justice/case-docket/mc-v-aaronson |access-date=1 August 2019 |archive-date=29 August 2020 |archive-url=https://web.archive.org/web/20200829030124/https://www.splcenter.org/seeking-justice/case-docket/mc-v-aaronson |url-status=live }} The case was one of the first lawsuit of its type to challenge "legal, ethical, and medical issues regarding genital-normalizing surgery" in minors, and was eventually settled out of court by the Medical University of South Carolina for $440,000 in 2017.{{Cite book |last1=Dutta|first1=Anatol |editor1=Jens M. Scherpe |editor2=Anatol Dutta |editor3=Tobias Helms |chapter=Private International Law Aspects of Intersex |date=12 September 2018 |title=The Legal Status of Intersex Persons |pages=415–426 |publisher=Intersentia |isbn=978-1-78068-770-4 |last2=Pintens |first2=Walter |doi=10.1017/9781780687704.026 |s2cid=158683664}}

{{Main|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.{{cite web |last=Holmes |first=Morgan |author-link=Morgan Holmes |title=Is Growing up in Silence Better Than Growing up Different? |work=Intersex Society of North America |url=http://www.isna.org/node/743 |url-status=live |archive-url=https://web.archive.org/web/20160305055336/http://www.isna.org/node/743 |archive-date=5 March 2016 }}{{cite web |last=Intersex Society of North America |title=What's wrong with the way intersex has traditionally been treated? |url=http://www.isna.org/faq/concealment#fn2 |url-status=live |archive-url=https://web.archive.org/web/20140626004731/http://www.isna.org/faq/concealment#fn2 |archive-date=26 June 2014 }}{{Cite book |publisher=World Health Organization |isbn=978-92-4-156498-4 |last=World Health Organization |title=Sexual health, human rights and the law |location=Geneva |date=2015}}

{{Main|Legal recognition of intersex people}}

The Asia Pacific Forum of National Human Rights Institutions states that legal recognition is firstly "about intersex people who have been issued a male or a female birth certificate being able to enjoy the same legal rights as other men and women".{{Cite book |author-link=Asia Pacific Forum |isbn=978-0-9942513-7-4 |last=Asia Pacific Forum of National Human Rights Institutions |title=Promoting and Protecting Human Rights in relation to Sexual Orientation, Gender Identity and Sex Characteristics |date=June 2016 |url=http://www.asiapacificforum.net/resources/manual-sogi-and-sex-charactersitics/ |url-status=live |archive-url=https://web.archive.org/web/20170115144950/http://www.asiapacificforum.net/resources/manual-sogi-and-sex-charactersitics/ |archive-date=15 January 2017 }} In some regions, obtaining any form of birth certification may be an issue. A Kenyan court case in 2014 established the right of an intersex boy, "Baby A", to a birth certificate.{{cite news|url=https://www.reuters.com/article/us-kenya-intersex-idUSKCN0JJ1M120141205|title=Kenya takes step toward recognizing intersex people in landmark ruling|newspaper=Reuters|url-status=live|archive-url=https://web.archive.org/web/20150924211232/http://www.reuters.com/article/2014/12/05/us-kenya-intersex-idUSKCN0JJ1M120141205|archive-date=24 September 2015|date=5 December 2014}}

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.{{cite book|last=Money|first=John|url=https://archive.org/details/manwomanboygirl00mone|title=Man & Woman Boy & Girl. Differentiation and dimorphism of gender identity from conception to maturity|author2=Ehrhardt, Anke A.|publisher=The Johns Hopkins University Press|year=1972|isbn=978-0-8018-1405-1|location=US|author-link1=John Money|url-access=registration}}{{cite journal |author=Furtado P. S. |year=2012 |title=Gender dysphoria associated with disorders of sex development |journal=Nat. Rev. Urol. |volume=9 |issue=11 |pages=620–627 |doi=10.1038/nrurol.2012.182 |display-authors=etal |pmid=23045263 |s2cid=22294512 }}{{cite book |last=Marañón |first=Gregorio |title=Los estados intersexuales en la especie humana |year=1929 |publisher=Morata |location=Madrid }} Recognition of third sex or gender classifications occurs in several countries,{{cite web|url=http://www.ag.gov.au/Publications/Pages/AustralianGovernmentGuidelinesontheRecognitionofSexandGender.aspx|title=Australian Government Guidelines on the Recognition of Sex and Gender, 30 May 2013|access-date=6 October 2014|url-status=live|archive-url=https://web.archive.org/web/20150701084543/http://www.ag.gov.au/Publications/Pages/AustralianGovernmentGuidelinesontheRecognitionofSexandGender.aspx|archive-date=1 July 2015}}{{Cite journal|first=Ingrid|last=Holme|title=Hearing People's Own Stories|journal=Science as Culture|volume=17|issue=3|pages=341–344|doi=10.1080/09505430802280784|year=2008|s2cid=143528047}}{{cite web|url=http://www.passports.govt.nz/Transgender-applicants|title=New Zealand Passports - Information about Changing Sex / Gender Identity|access-date=6 October 2014|url-status=live|archive-url=https://web.archive.org/web/20140923055123/http://www.passports.govt.nz/Transgender-applicants|archive-date=23 September 2014}}[http://www.dw.de/third-sex-option-on-birth-certificates/a-17193869 Third sex option on birth certificates] {{Webarchive|url=https://web.archive.org/web/20141010184218/http://www.dw.de/third-sex-option-on-birth-certificates/a-17193869 |date=10 October 2014 }}, Deutsche Welle, 1 November 2013. however, it is controversial when it becomes assumed or coercive, as is the case with some German infants.{{cite web |url=https://stopigm.org/Intersex-3rd-gender-in-Germany-Silly-season-fantasies-vs-reality-of-genital-mutilations/ |title="Intersex: Third Gender in Germany" (Spiegel, Huff Post, Guardian, …): Silly Season Fantasies vs. Reality of Genital Mutilations |date=1 November 2013 |website=Stop IGM |access-date=15 March 2021 |archive-date=11 March 2021 |archive-url=https://web.archive.org/web/20210311090429/https://stopigm.org/Intersex-3rd-gender-in-Germany-Silly-season-fantasies-vs-reality-of-genital-mutilations/ |url-status=live }}[http://oiieurope.org/bluff-package-for-inter-leaving-sex-entry-open-is-not-an-option/ Sham package for Intersex: Leaving sex entry open is not an option] {{Webarchive|url=https://web.archive.org/web/20140829115843/http://oiieurope.org/bluff-package-for-inter-leaving-sex-entry-open-is-not-an-option/ |date=29 August 2014 }}, OII Europe, 15 February 2013 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 75% of survey respondents self-described as male or female (52% as women, 23% as men), and 6% as unsure.{{Cite book|publisher=Open Book Publishers |isbn=978-1-78374-208-0 |last1=Jones |first1=Tiffany |last2=Hart |first2=Bonnie |last3=Carpenter |first3=Morgan |last4=Ansara |first4=Gavi |last5=Leonard |first5=William |last6=Lucke |first6=Jayne |title=Intersex: Stories and Statistics from Australia |location=Cambridge, UK |date=2016 |access-date=2 February 2016 |url=http://oii.org.au/wp-content/uploads/key/Intersex-Stories-Statistics-Australia.pdf |archive-url=https://web.archive.org/web/20160914152729/http://oii.org.au/wp-content/uploads/key/Intersex-Stories-Statistics-Australia.pdf |archive-date=14 September 2016 }}

On January 20, 2025, US president Donald Trump signed Executive Order 14168, entitled "Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government". This executive order asserts that it is the policy of the United States that there are only two sexes, male and female, and that these sexes are immutable throughout a person's life, starting at conception.{{cite web |title=Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government |url=https://www.whitehouse.gov/presidential-actions/2025/01/defending-women-from-gender-ideology-extremism-and-restoring-biological-truth-to-the-federal-government/ |url-status=live |archive-url=https://web.archive.org/web/20250121214116/https://www.whitehouse.gov/presidential-actions/2025/01/defending-women-from-gender-ideology-extremism-and-restoring-biological-truth-to-the-federal-government/ |archive-date=21 January 2025 |website=White House|date=21 January 2025 }} The executive order does not acknowledge the existence of, or make provision for, intersex people. According to intersex advocate Alicia Roth Weigel, this order "attempts to negate our very existence".{{cite web|url=https://time.com/7209300/trumps-biological-truth-executive-order-is-not-true/|title=Trump's 'Biological Truth' Executive Order is Not Based in Biology or Truth|author=Alicia Roth Weigle|publisher=Time|date=January 23, 2025}}

{{main|Intersex and LGBT}}

File:ILGA conference 2018 Intersex Awareness Day group photo.jpg]]

File:Pidgeon Pagonis.jpg]]

Intersex conditions can be contrasted with transgender gender identities and the attached gender dysphoria a transgender person may feel, wherein their gender identity does not match their assigned sex.{{cite web |url=http://www.assembly.coe.int/nw/xml/XRef/Xref-XML2HTML-en.asp?fileid=20057&lang=en |title=Children's right to physical integrity |last=Rupprecht |first=Marlene |publisher=Parliamentary Assembly of the Council of Europe |date=6 September 2013 |access-date=1 January 2021 |url-status=live |archive-url=https://web.archive.org/web/20131226081751/http://assembly.coe.int/nw/xml/XRef/Xref-XML2HTML-en.asp?fileid=20057&lang=en |archive-date=26 December 2013}}{{cite web |url=http://interactyouth.org/post/100048044990/laverne-cox-is-on-this-weeks-faking-it-in-honor |title=Trans? Intersex? Explained! |publisher=interACT |access-date=1 January 2021 |url-status=usurped |archive-url=https://web.archive.org/web/20141018091459/http://interactyouth.org/post/100048044990/laverne-cox-is-on-this-weeks-faking-it-in-honor |archive-date=18 October 2014 }}{{cite web |url=https://oii.org.au/18194/differences-intersex-trans/ |title=Basic differences between intersex and trans |publisher=Organisation Intersex International Australia |access-date=10 July 2013 |archive-url=https://web.archive.org/web/20140904081530/http://oii.org.au/18194/differences-intersex-trans/ |archive-date=4 September 2014 |date=3 June 2011 }} However, some people are both intersex and transgender; although intersex people by definition have variable sex characteristics that do not align with either typically male or female, this may be considered separate to an individual's assigned gender, the way they are raised and perceived, and their internal gender identity.{{cite web |url=http://intersexday.org/en/mauro-cabral-marks-bodies/ |title=The marks on our bodies |date=25 October 2015 |website=Intersex Day |access-date=1 January 2021 |url-status=live |archive-url=https://web.archive.org/web/20160405220557/http://intersexday.org/en/mauro-cabral-marks-bodies/ |archive-date=5 April 2016 }} A 2012 clinical review paper found that between 8.5% and 20% of people with intersex variations experienced gender dysphoria. In an analysis of the use of preimplantation genetic diagnosis to eliminate intersex traits, Behrmann and Ravitsky state: "Parental choice against intersex may ... conceal biases against same-sex attractedness and gender nonconformity."{{Cite journal |doi=10.1080/15265161.2013.828131 |pmid=24024805 |volume=13 |issue=10 |pages=39–41 |last1=Behrmann |first1=Jason |last2=Ravitsky |first2=Vardit |title=Queer Liberation, Not Elimination: Why Selecting Against Intersex is Not "Straight" Forward |journal=The American Journal of Bioethics |date=October 2013 |s2cid=27065247}}

The relationship of intersex people and communities to LGBTQ communities is complex,{{cite web |last=Dreger |first=Alice |title=Reasons to Add and Reasons NOT to Add "I" (Intersex) to LGBT in Healthcare |date=4 May 2015 |url=https://www.aamc.org/download/431576/data/reasonsdeck.pdf |publisher=Association of American Medical Colleges |access-date=18 May 2016 |url-status=live |archive-url=https://web.archive.org/web/20160609230211/https://www.aamc.org/download/431576/data/reasonsdeck.pdf |archive-date=9 June 2016 }} but intersex people are often added to the LGBT acronym, resulting in the acronym LGBTI (or when also including asexual people, LGBTQIA+{{Cite news |last=Gold |first=Michael |date=21 June 2018 |title=The ABCs of L.G.B.T.Q.I.A.+ |language=en-US |work=The New York Times |url=https://www.nytimes.com/2018/06/21/style/lgbtq-gender-language.html |access-date=27 July 2023 |archive-date=18 April 2021 |archive-url=https://web.archive.org/web/20210418235156/https://www.nytimes.com/2018/06/21/style/lgbtq-gender-language.html |url-status=live }}). 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.{{Cite web |last=Koyama |first=Emi |title=Adding the "I": Does Intersex Belong in the LGBT Movement? |work=Intersex Initiative |url=http://www.intersexinitiative.org/articles/lgbti.html |access-date=18 May 2016 |url-status=live |archive-url=https://web.archive.org/web/20160517075057/http://www.intersexinitiative.org/articles/lgbti.html |archive-date=17 May 2016 }} Organisation Intersex International Australia states that some intersex individuals are homosexual, and some are heterosexual, but "LGBTI activism has fought for the rights of people who fall outside of expected binary sex and gender norms."{{cite web |title=Intersex for allies |url=http://oii.org.au/allies |date=21 November 2012 |access-date=18 May 2016 |archive-url=https://web.archive.org/web/20160607042937/http://oii.org.au/allies/ |archive-date=7 June 2016 }}{{cite web |url=http://gaynewsnetwork.com.au/news/oii-releases-new-resource-on-intersex-issues-13999.html |title=OII Releases New Resource on Intersex Issues |last=Busby |first=Cec |publisher=Intersex Human Rights Australia |date=1 June 2014 |access-date=1 January 2021 |archive-url=https://web.archive.org/web/20140606202143/http://gaynewsnetwork.com.au/news/oii-releases-new-resource-on-intersex-issues-13999.html |archive-date=6 June 2014}} 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".{{Cite news |last=Kaggwa |first=Julius |title=I'm an intersex Ugandan – life has never felt more dangerous |work=The Guardian |access-date=3 October 2016 |date=19 September 2016 |url=https://www.theguardian.com/world/2016/sep/16/intersex-ugandan-lgbt-gay-rights-life-never-felt-more-dangerous |url-status=live |archive-url=https://web.archive.org/web/20161006015137/https://www.theguardian.com/world/2016/sep/16/intersex-ugandan-lgbt-gay-rights-life-never-felt-more-dangerous |archive-date=6 October 2016 }} Mauro Cabral has written that transgender people and organizations "need to stop approaching intersex issues as if they were trans issues", including use of intersex conditions and people as a means of explaining being transgender; "we can collaborate a lot with the intersex movement by making it clear how wrong that approach is."{{cite web |title=IAD2016: A Message from Mauro Cabral |publisher=Global Action for Trans Equality |access-date=1 January 2021 |date=26 October 2016 |url=https://transactivists.org/2016/10/26/iad2016-a-message-from-mauro-cabral/ |archive-url=https://web.archive.org/web/20161103133403/https://transactivists.org/2016/10/26/iad2016-a-message-from-mauro-cabral/ |archive-date=3 November 2016 }}

{{main|Literature about intersex|Intersex characters in fiction}}

File:XXX Kristi Bruce San Francisco 2000.jpg, 2000]]

Heinlein's acclaimed 1959 "'—All You Zombies—'" is an early intersex science fiction story, based on time-travel.

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

The memoir, Born Both: An Intersex Life (Hachette Books, 2017), by intersex author and activist Hida Viloria, received strong praise from The New York Times Book Review, The Washington Post, Rolling Stone, People Magazine, and Psychology Today, was one of School Library Journal{{'s}} 2017 Top Ten Adult Books for Teens, and was a 2018 Lambda Literary Award nominee.

Television works about intersex and films about intersex are scarce. The Spanish-language film XXY won the Critics' Week grand prize at the 2007 Cannes Film Festival and the ACID/CCAS Support Award.{{cite web|last1=Leffler |first1=Rebecca |title=Critics Week grand prize to 'XXY' |url=https://www.hollywoodreporter.com/hr/content_display/awards_festivals/cannes/news/e3id97fddd8a9cc782ed64893105887c4fc |website=The Hollywood Reporter |access-date=12 February 2017 |date=26 May 2007 |archive-url=https://web.archive.org/web/20070930222336/http://www.hollywoodreporter.com/hr/content_display/awards_festivals/cannes/news/e3id97fddd8a9cc782ed64893105887c4fc |archive-date=30 September 2007 }} Faking It is notable for providing both the first intersex main character in a television show,{{cite news |url=https://www.buzzfeed.com/louispeitzman/meet-televisions-groundbreaking-intersex-character |title=Meet television's groundbreaking intersex character |last=Peitzman |first=Louis |publisher=BuzzFeed News |date=23 September 2014 |access-date=1 January 2021 |url-status=live |archive-url=https://web.archive.org/web/20160529020917/https://www.buzzfeed.com/louispeitzman/meet-televisions-groundbreaking-intersex-character |archive-date=29 May 2016 }} and television's first intersex character played by an intersex actor.{{cite web |url=http://www.newnownext.com/faking-it-intersex/04/2016/ |title="Faking It" Breaks New Ground With First Intersex Actor To Play Intersex Character On TV |last=Avery |first=Dan |publisher=Logo TV |date=1 April 2016 |website=NewNowNext |access-date=1 January 2021 |url-status=live |archive-url=https://web.archive.org/web/20160405070107/http://www.newnownext.com/faking-it-intersex/04/2016/ |archive-date=5 April 2016 }}

{{main|Intersex civil society organizations}}

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.{{Cite web |last1=Androgen Insensitivity Syndrome Support Group Australia |last2=Briffa |first2=Anthony |author-link2=Tony Briffa (politician) |title=Discrimination against People affected by Intersex Conditions: Submission to NSW Government |url=http://www.antidiscrimination.justice.nsw.gov.au/Documents/submission%20about%20intersex%20discrimination%20in%20nsw.pdf |date=22 January 2003 |access-date=16 May 2016 |url-status=live |archive-url=https://web.archive.org/web/20160311131348/http://www.antidiscrimination.justice.nsw.gov.au/Documents/submission%20about%20intersex%20discrimination%20in%20nsw.pdf |archive-date=11 March 2016 }} The Androgen Insensitivity Syndrome Support Group (UK) was established in 1988.{{cite web |url=http://www.aissg.org/INDEX.HTM |title=Androgen Insensitivity Syndrome Support Group (AISSG) |access-date=16 May 2016 |archive-url=https://web.archive.org/web/20160121050955/http://www.aissg.org/INDEX.HTM |archive-date=21 January 2016 }} 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.{{cite web |title=Dear ISNA Friends and Supporters |url=http://www.isna.org |date=2008 |access-date=16 May 2016 |archive-url=https://web.archive.org/web/20160519013103/http://www.isna.org/ |archive-date=19 May 2016 }}

{{main|Intersex Awareness Day|Intersex Day of Remembrance}}

Intersex Awareness Day is an internationally observed civil awareness day designed to highlight the challenges faced by intersex people, occurring annually on 26 October. It marks the first public demonstration by intersex people, which took place in Boston on 26 October 1996, outside a venue where the American Academy of Pediatrics was holding its annual conference.{{cite web |url=http://intersexday.org/en/max-beck-morgan-holmes-boston-1996/ |title=When Max Beck and Morgan Holmes went to Boston |date=17 October 2015 |website=Intersex Day |access-date=1 January 2021 |url-status=live |archive-url=https://web.archive.org/web/20151020004238/http://intersexday.org/en/max-beck-morgan-holmes-boston-1996/ |archive-date=20 October 2015 }}

Intersex Day of Remembrance, also known as Intersex Solidarity Day, is an internationally observed civil awareness day designed to highlight issues faced by intersex people, occurring annually on 8 November. It marks the birthday of {{lang|fr|Herculine Barbin|italic=no}}, a French intersex person whose memoirs were later published by Michel Foucault in Herculine Barbin: Being the Recently Discovered Memoirs of a Nineteenth-century French Hermaphrodite.

{{main|Intersex flag}}

File:Intersex Pride Flag.svg|The intersex flag created in July 2013 by Morgan Carpenter of Intersex Human Rights Australia

File:Intersex-inclusive pride flag.svg|The Progress Pride Flag flag with the intersex flag, created in 2021 by Valentino Vecchietti of Intersex Equality Rights UK

File:Cattleya lueddemanniana costera.JPG|upright|An orchid flower

The intersex flag was created in July 2013 by Morgan Carpenter of Intersex Human Rights Australia to create a flag "that is not derivative, but is yet firmly grounded in meaning". The circle is described as "unbroken and unornamented, symbolising wholeness and completeness, and our potentialities. We are still fighting for bodily autonomy and genital integrity, and this symbolises the right to be who and how we want to be."[http://ihra.org.au/22773/an-intersex-flag/ An intersex flag] {{Webarchive|url=https://web.archive.org/web/20180709150738/https://ihra.org.au/22773/an-intersex-flag/ |date=9 July 2018 }}, Intersex Human Rights Australia, 5 July 2013

In 2021, Valentino Vecchietti of Intersex Equality Rights UK redesigned the Progress Pride Flag to incorporate the intersex flag.{{cite web|last1=Parsons|first1=Vic|date=June 7, 2021|title=Progress Pride flag gets 2021 redesign to better represent intersex people|url=https://www.pinknews.co.uk/2021/06/07/progress-pride-flag-intersex-flag/|access-date=June 10, 2021|website=PinkNews}} This design added a yellow triangle with a purple circle in it to the chevron of the Progress Pride flag. It also changed the color of green to a lighter shade without adding new symbolism. Intersex Equality Rights UK posted the new flag on Instagram and Twitter.{{Cite web|date=June 8, 2021|title=The Progress Pride Flag Is Getting an Intersex-Inclusive Makeover|url=https://www.them.us/story/progress-pride-flag-intersex-inclusive-makeover|url-status=live|archive-url=https://web.archive.org/web/20210710210201/https://www.them.us/story/progress-pride-flag-intersex-inclusive-makeover|archive-date=July 10, 2021|access-date=August 3, 2021|website=them.us|language=en-US}}{{Cite instagram|user=intersex_equality_rights_uk|postid=CPwvT3glwtw|title=Slide 1. Happy Pride 2021! For our Intersex Inclusion Campaign we'd like to share with you our new intersex inclusive Pride Progress…|date=June 5, 2021|author=Intersex Equality Rights UK}}

Because the word "orchid" comes from the Greek word for testicle, and the orchiectomy is a common surgery performed on intersex infants, the orchid flower is a symbol of being intersex and of opposition to non-consensual genital surgery.{{Cite web |last=Carpenter |first=Morgan |date=2013-10-26 |title=Symbols |url=https://intersexday.org/en/symbols/ |access-date=2025-04-13 |website=Intersex Day |language=en}}

{{main|Intersex people and religion}}

In Judaism, the Talmud contains extensive discussion concerning the status of two types of intersex people in Jewish law; namely, the androgynous, who exhibit both male and female external sexual organs, and the {{transliteration|he|tumtum}}, who exhibit neither. In the 1970s and 1980s, the treatment of intersex babies started to be discussed in Orthodox Jewish medical halacha by prominent rabbinic leaders, such as Eliezer Waldenberg and Moshe Feinstein.{{cite news |url=http://www.jweekly.com/article/full/72653/the-space-between-stanford-prof-talmudic-rabbis-were-into-analyzing-sexuali/ |title=Stanford prof: Talmudic rabbis were into analyzing sexuality |last=Schifrin |first=Dan |date=19 September 2014 |newspaper=J |access-date=1 January 2021 |url-status=live |archive-url=https://web.archive.org/web/20141010140948/http://www.jweekly.com/article/full/72653/the-space-between-stanford-prof-talmudic-rabbis-were-into-analyzing-sexuali/ |archive-date=10 October 2014 }}

{{main|Sex verification in sports}}

File:Stanisława Walasiewicz z nagrodami.jpg, an athlete posthumously diagnosed with Turner syndrome in 1980, photographed in 1933]]

Erik Schinegger, Foekje Dillema, Maria José Martínez-Patiño and Santhi Soundarajan were subject to adverse sex verification testing resulting in ineligibility to compete in organised competitive competition. Stanisława Walasiewicz, an athlete diagnosed posthumously with Turner syndrome was posthumously ruled ineligible to have competed.{{cite journal|author=Klaudia Snochowska-Gonzales|title=Walasiewicz była kobietą (Walasiewicz Was a Woman)|journal=Gazeta Wyborcza|volume=190|issue=14 August 2004|page=8|url=http://szukaj.gazeta.pl/archiwum/1,0,4144041.html?wyr=Walasiewicz%2B%2B%2B|access-date=31 May 2006|language=pl|archive-date=14 May 2020|archive-url=https://web.archive.org/web/20200514085621/http://www.archiwum.wyborcza.pl/Archiwum/1,0,4144041.html?wyr=Walasiewicz+++|url-status=live}}

The South African middle-distance runner Caster Semenya won 3 World Championships gold medals and 2 Olympic gold medals in the women's 800 metres. When Semenya won gold at the 2009 World Championships, the International Association of Athletics Federations (IAAF) requested sex verification tests on the very same day. The results were not released, and Semenya was ruled eligible to compete.{{cite journal|last=Cooky|first=Cheryl|author2=Shari L. Dworkin|title=Policing the Boundaries of Sex: A Critical Examination of Gender Verification and the Caster Semenya Controversy|journal=Journal of Sex Research|date=Feb 2013|volume=50|issue=2|pages=103–111|doi=10.1080/00224499.2012.725488|pmid=23320629|s2cid=1353785}} In 2019, new IAAF rules came into force for athletes like Semenya with certain disorders of sex development (DSDs) requiring medication to suppress testosterone levels in order to participate in 400m, 800m, and 1500m women's events. Semenya objected to undergoing the treatment which is now mandatory. She has filed a series of legal cases to restore her ability to compete in these events without testosterone suppression, arguing that the World Athletics rules are discriminatory.{{Cite web |date=2023-11-02 |title=Caster Semenya Opens Up About Discrimination Battle Against World Athletics |url=https://marathonhandbook.com/caster-semenya-discrimination/ |access-date=2024-08-05 |language=en-US}}

Katrina Karkazis, Rebecca Jordan-Young, Georgiann Davis and Silvia Camporesi have claimed that IAAF policies on "hyperandrogenism" in female athletes are "significantly flawed", arguing that the policy does not protect against breaches of privacy, requires athletes to undergo unnecessary treatment in order to compete, and intensifies "gender policing", and recommended that athletes be able to compete in accordance with their legally-recognised gender.{{Cite journal |doi=10.1080/15265161.2012.680533 |pmid=22694023 |volume=12 |issue=7 |pages=3–16 |last1=Karkazis |first1=Katrina |last2=Jordan-Young |first2=Rebecca |last3=Davis |first3=Georgiann |last4=Camporesi |first4=Silvia |author-link1= Katrina Karkazis |author-link2= Rebecca Jordan-Young |author-link3= Georgiann Davis |title=Out of Bounds? A Critique of the New Policies on Hyperandrogenism in Elite Female Athletes |journal=The American Journal of Bioethics |date=July 2012 |pmc=5152729}}

In April 2014, the BMJ reported that four elite women athletes with XY chromosomes and 5α-reductase 2 deficiency were subjected to sterilization and "partial clitoridectomies" in order to compete in sport. The authors noted that partial clitoridectomy was "not medically indicated" and "does not relate to real or perceived athletic 'advantage'".{{Cite journal |doi=10.1136/bmj.g2926 |volume=348 |issue=apr28 9 |pages=–2926–g2926 |last1=Jordan-Young |first1=R. M. |last2=Sonksen |first2=P. H. |last3=Karkazis |first3=K. |author-link1=Rebecca Jordan-Young |author-link3=Katrina Karkazis |title=Sex, health, and athletes |journal=BMJ |date=April 2014 |pmid=24776640 |s2cid=2198650 }} Intersex advocates{{who|date=January 2021}} regarded this intervention as "a clearly coercive process".{{cite web|url=http://oii.org.au/27745/un-human-rights-council-side-event-the-time-has-come/|title=UN Human Rights Council: resolution, statement and side event, "The time has come"|publisher=Organisation Intersex International Australia|access-date=28 September 2014|archive-url=https://web.archive.org/web/20140930082248/http://oii.org.au/27745/un-human-rights-council-side-event-the-time-has-come/|archive-date=30 September 2014|date=11 September 2014}} 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."{{Cite report |last2=Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health |title=Sport and healthy lifestyles and the right to health. Report A/HRC/32/33 |last1=Pūras |first1=Dainius |publisher=United Nations |date=4 April 2016 |url=http://ap.ohchr.org/documents/dpage_e.aspx?si=A/HRC/32/33 |url-status=live |archive-url=https://web.archive.org/web/20161215111551/http://ap.ohchr.org/documents/dpage_e.aspx?si=A%2FHRC%2F32%2F33 |archive-date=15 December 2016 }}

{{Main|Intersex (biology)}}

The notion of intersex individuals can be understood in the context of sexual system biology that varies across different types of organisms. Most animal species (~95%, including humans) are gonochoric, in which individuals are of either a female or male sex.{{cite book |doi=10.1016/B978-0-12-800049-6.00320-6 |chapter=Mating Systems in Plants, Genome Evolution and |title=Encyclopedia of Evolutionary Biology |date=2016 |pages=480–492 |isbn=978-0-12-800426-5 | vauthors = Muyle A, Marais G }} Hermaphroditic species (some animals and most flowering plants{{cite journal |last1=Christopher |first1=Dorothy A. |last2=Mitchell |first2=Randall J. |last3=Trapnell |first3=Dorset W. |last4=Smallwood |first4=Patrick A. |last5=Semski |first5=Wendy R. |last6=Karron |first6=Jeffrey D. |title=Hermaphroditism promotes mate diversity in flowering plants |journal=American Journal of Botany |date=August 2019 |volume=106 |issue=8 |pages=1131–1136 |doi=10.1002/ajb2.1336|pmid=31403705 |pmc=6852098 }}) are represented by individuals that can express both sexes simultaneously or sequentially during their lifetimes.{{cite book |doi=10.1016/B978-0-12-800049-6.00149-9 |chapter=Sex and Recombination in Snails |title=Encyclopedia of Evolutionary Biology |date=2016 |pages=49–60 |isbn=978-0-12-800426-5 | vauthors = Auld J, Jarne P }} Intersex individuals in a number of gonochoric species, who express both female and male phenotypic characters to some degree,{{cite book |last1=Fusco |first1=Giuseppe |last2=Minelli |first2=Alessandro |title=The Biology of Reproduction |date=10 October 2019 |publisher=Cambridge University Press |isbn=978-1-108-49985-9 |url=https://books.google.com/books?id=AKGsDwAAQBAJ&q=intersex&pg=PA116|language=en|page=116}} are known to exist at very low prevalences.

Although "hermaphrodite" and "intersex" have been used synonymously in humans,{{cite book |last1=Dreger |first1=Alice Domurat |title=Hermaphrodites and the medical invention of sex |date=1998 |publisher=Harvard University Press |location=Cambridge, Mass. |isbn=978-0-674-00189-3}}{{Pages needed|date=July 2021|reason=Cite the page numbers}} a hermaphrodite is specifically an individual capable of producing female and male gametes.{{cite book |doi=10.1016/B978-0-12-800049-6.00146-3 |chapter=Sex Determination |title=Encyclopedia of Evolutionary Biology |date=2016 |pages=81–88 |isbn=978-0-12-800426-5 | vauthors = Ross L, Blackmon H }} While there are reports of individuals that seemed to have the potential to produce both types of gamete,{{cite journal |last1=Krob |first1=G. |last2=Braun |first2=A. |last3=Kuhnle |first3=U. |title=True hermaphroditism: Geographical distribution, clinical findings, chromosomes and gonadal histology |journal=European Journal of Pediatrics |date=January 1994 |volume=153 |issue=1 |pages=2–10 |doi=10.1007/BF02000779|pmid=8313919 |s2cid=1931001 }} in more recent years the term hermaphrodite as applied to humans has fallen out of favor, since female and male reproductive functions have not been observed together in the same individual.{{Cite encyclopedia |last=Rosenfield|first=Kevin A.|title=Hermaphrodite |entry=Hermaphrodite|date=2018|encyclopedia=Encyclopedia of Animal Cognition and Behavior|pages=1–2|editor-last=Vonk|editor-first=Jennifer|location=Cham|publisher=Springer International |doi=10.1007/978-3-319-47829-6_329-1|isbn=978-3-319-47829-6 |editor2-last=Shackelford|editor2-first=Todd}}{{Blockquote|text=The term "hermaphrodite" has sometimes been used to refer to humans whose biological sex is ambiguous. This usage has fallen out of favor and in any case was technically incorrect. The essential characteristic of hermaphrodites is the ability to reproduce as both male and female. No such case has been identified in any human}}

{{see also|Definitions of intersex}}

Research in the late 20th century led to a growing medical consensus that diverse intersex bodies are normal, but relatively rare, forms of human biology.{{cite book|last=Zderic|first=Stephen|title=Pediatric gender assignment: a critical reappraisal; [proceedings from a conference ... in Dallas in the spring of 1999 which was entitled "pediatric gender assignment – a critical reappraisal"]|publisher=Kluwer Acad. / Plenum Publ.|year=2002|isbn=978-0-306-46759-2|location=New York, NY [u.a.]}}{{cite journal|last1=Frader|first1=J.|last2=Alderson|first2=P.|last3=Asch|first3=A.|last4=Aspinall|first4=C.|last5=Davis|first5=D.|last6=Dreger|first6=A.|last7=Edwards|first7=J.|last8=Feder|first8=E. K.|last9=Frank|first9=A.|last10=Hedley|first10=L. A.|last11=Kittay|first11=E.|date=May 2004|title=Health care professionals and intersex conditions|journal=Arch. Pediatr. Adolesc. Med.|volume=158|issue=5|pages=426–8|citeseerx=10.1.1.572.1572|doi=10.1001/archpedi.158.5.426|pmid=15123472|first15=H.|last16=Parens|last12=Marsh|last15=Nelson|first14=W.|last14=Mouradian|first13=P. S.|last13=Miller|first12=J.|first16=E.}}{{cite journal |last1=Wiesemann |first1=Claudia |last2=Ude-Koeller |first2=Susanne |last3=Sinnecker |first3=Gernot H. G. |last4=Thyen |first4=Ute |title=Ethical principles and recommendations for the medical management of differences of sex development (DSD)/intersex in children and adolescents |journal=European Journal of Pediatrics |date=June 2010 |volume=169 |issue=6 |pages=671–679 |doi=10.1007/s00431-009-1086-x |pmid=19841941 |pmc=2859219 }} Clinician and researcher Milton Diamond stresses the importance of care in the selection of language related to intersex people:

{{blockquote|Foremost, we advocate use of the terms "typical", "usual", or "most frequent" where it is more common to use the term "normal". When possible avoid expressions such as maldeveloped or undeveloped, errors of development, defective genitals, abnormal, or mistakes of nature. Emphasize that all of these conditions are biologically understandable while they are statistically uncommon.{{cite journal |last=Diamond |first=Milton |author-link=Milton Diamond |author2=H. Keith Sigmundson |title=Management of intersexuality: Guidelines for dealing with individuals with ambiguous genitalia |journal=Archives of Pediatrics and Adolescent Medicine |volume=June |year=1997 |url=http://www.hawaii.edu/PCSS/online_artcls/intersex/apam.html |access-date=8 April 2007 |archive-url=https://web.archive.org/web/20070208121451/http://www.hawaii.edu/PCSS/online_artcls/intersex/apam.html |archive-date=8 February 2007 |df=dmy-all }}}}

{{Main|Sexual differentiation}}

The common pathway of sexual differentiation, where a productive human female has an XX chromosome pair, and a productive male has an XY pair, is relevant to the development of intersex conditions.

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. 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.{{Cite book|last1=Kolodny|first1=Robert C.|url=https://archive.org/details/textbookofsexual00kolo|title=Textbook of Sexual Medicine|last2=Masters|first2=William H.|last3=Johnson|first3=Virginia E.|publisher=Little, Brown and Company|year=1979|isbn=978-0-316-50154-5|edition=1st|location=Boston|author2-link=William Masters|author3-link=Virginia E. Johnson|url-access=registration}} Up until and including the seventh week, genetically female and genetically male fetuses appear identical.

At around eight weeks of gestation, the gonads of an XY embryo differentiate into functional testes, secreting testosterone. Ovarian differentiation, for XX embryos, does not occur until approximately week 12 of gestation. In typical female differentiation, the Müllerian duct system develops into the uterus, fallopian tubes, and inner third of the vagina.

In males, the Müllerian duct-inhibiting hormone AMH causes this duct system to regress. Next, androgens cause the development of the Wolffian duct system, which develops into the vas deferens, seminal vesicles, and ejaculatory ducts.

By birth, the typical fetus has been completely sexed male or female, meaning that the genetic sex (XY-male or XX-female) corresponds with the phenotypical sex; that is to say, genetic sex corresponds with internal and external gonads, and external appearance of the genitals.

There are a variety of symptoms that can occur. Ambiguous genitalia is the most common sign. There can be micropenis, clitoromegaly, partial labial fusion, electrolyte abnormalities, delayed or absent puberty, unexpected changes at puberty, hypospadias, labial or inguinal (groin) masses (which may turn out to be testes) in girls and undescended testes (which may turn out to be ovaries) in boys.

Ambiguous genitalia may appear as a large clitoris or as a small penis.

File:Quigley scale for androgen insensitivity syndrome.jpg is a method for describing genital development in AIS.]]

Because there is variation in all of the processes of the development of the sex organs, a child can be born with a sexual anatomy that is typically female or feminine in appearance with a larger-than-average clitoris (clitoral hypertrophy) or typically male or masculine in appearance with a smaller-than-average penis that is open along the underside. The appearance may be quite ambiguous, describable as female genitals (a vulva) with a very large clitoris and partially fused labia, or as male genitals with a very small penis, completely open along the midline ("hypospadic"), and empty scrotum. Fertility is variable.{{Citation needed|date=April 2021}}

The orchidometer is a medical instrument to measure the volume of the testicles. It was developed by Swiss pediatric endocrinologist Andrea Prader. The Prader scale{{Cite news |last1=Diamond |first1=Milton |last2=Linda |first2=Watson |author-link1=Milton Diamond |title=Androgen insensitivity syndrome and Klinefelter's syndrome: sex and gender considerations |periodical=Child Adolesc Psychiatric Clin N Am |year=2004 |issue=13 |pages=623–640 |url=http://www.hawaii.edu/PCSS/biblio/articles/2000to2004/2004-ais-and-klinefelters.html |url-status=live |archive-url=https://web.archive.org/web/20130701141723/http://www.hawaii.edu/PCSS/biblio/articles/2000to2004/2004-ais-and-klinefelters.html |archive-date=1 July 2013 |df =dmy-all}} and Quigley scale are visual rating systems that measure genital appearance. These measurement systems were satirized in the Phall-O-Meter, created by the (now defunct) Intersex Society of North America.{{cite journal |last=Forrester |first=John |title=The psychology of the sexual–reproductive–gender system |issue=42 |journal=Wellcome History |date=2009 |pages=13–15 |url=http://eprints.whiterose.ac.uk/64236/1/Wellcome_History_42_Winter_2009_.pdf |access-date=26 June 2018 |archive-date=29 August 2020 |archive-url=https://web.archive.org/web/20200829030148/http://eprints.whiterose.ac.uk/64236/1/Wellcome_History_42_Winter_2009_.pdf |url-status=live }}{{Cite journal |doi=10.1558/tse.v16i2.163 |volume=16 |issue=2 |pages=163–182 |last=Marchal |first=Joseph |title=Bodies Bound for Circumcision and Baptism: An Intersex Critique and the Interpretation of Galatians |journal=Theology & Sexuality |date=3 July 2010 |s2cid=143514837}}{{cite journal |last1=López |first1=Daniel J. García |title=La intersexualidad en el discurso médico-jurídico |journal=Eunomía |date=25 February 2015 |issue=8 |pages=54–70 |url=https://e-revistas.uc3m.es/index.php/eunom/article/view/2476 |language=es }}

In order to help in classification, methods other than a genitalia inspection can be performed. For instance, a karyotype display of a tissue sample may determine which of the causes of intersex is prevalent in the case. Additionally, electrolyte tests, endoscopic exam, ultrasound and hormone stimulation tests can be done.{{Cite book|url=https://books.google.com/books?id=82PGmX_eM8sC&q=intersex+treatment&pg=PA476|title=Health Care Ethics in Canada|last1=Baylis|first1=Françoise|last2=Borgerson|first2=Kirstin|last3=Hoffmaster|first3=Barry|last4=Sherwin|first4=Susan|date=6 October 2011|publisher=Cengage Learning|isbn=978-0-17-650464-9|access-date=28 May 2020|archive-date=29 August 2020|archive-url=https://web.archive.org/web/20200829030154/https://books.google.com/books?id=82PGmX_eM8sC&pg=PA476|url-status=live}}

Intersex can be divided into four categories which are: 46, XX intersex; 46, XY intersex; true gonadal intersex; and complex or undetermined intersex.

This condition used to be called "female pseudohermaphroditism". People with this condition have female internal genitalia and karyotype (XX) and various degree of external genitalia virilization.{{Cite journal|last1=Kamijo|first1=H.|last2=Narita|first2=O.|date=November 1997|title=[Female pseudohermaphroditism]|journal=Nihon Rinsho. Japanese Journal of Clinical Medicine|volume=55|issue=11|pages=2925–2929 |pmid=9396289}} External genitalia is masculinized congenitally when female fetus is exposed to excess androgenic environment.{{Cite web|url=https://medlineplus.gov/ency/article/001669.htm|title=Intersex: MedlinePlus Medical Encyclopedia|website=medlineplus.gov|access-date=25 March 2019|archive-date=29 August 2020|archive-url=https://web.archive.org/web/20200829030155/https://medlineplus.gov/ency/article/001669.htm|url-status=live}} Hence, the chromosome of the person is of a female, the ovaries of a female, but external genitals that appear like a male. The labia fuse, and the clitoris enlarges to appear like a penis. The causes of this can be male hormones taken during pregnancy, congenital adrenal hyperplasia, male-hormone-producing tumors in the mother and aromatase deficiency.

This condition used to be called "male pseudohermaphroditism". This is defined as incomplete masculinization of the external genitalia.{{Cite journal|last=Migeon|first=C. J.|date=July 1980|title=Male pseudohermaphroditism|journal=Annales d'Endocrinologie|volume=41|issue=4|pages=311–343 |pmid=7011168}} Thus, the person has male chromosomes, but the external genitals are incompletely formed, ambiguous, or clearly female.{{Cite journal|last1=Fernández-Cancio|first1=Mónica|last2=Camats|first2=Núria|last3=Flück|first3=Christa E.|last4=Zalewski|first4=Adam|last5=Dick|first5=Bernhard|last6=Frey|first6=Brigitte M.|last7=Monné|first7=Raquel|last8=Torán|first8=Núria|last9=Audí|first9=Laura|date=29 April 2018|title=Mechanism of the Dual Activities of Human CYP17A1 and Binding to Anti-Prostate Cancer Drug Abiraterone Revealed by a Novel V366M Mutation Causing 17,20 Lyase Deficiency|journal=Pharmaceuticals|volume=11|issue=2|page=37|doi=10.3390/ph11020037|pmid=29710837|pmc=6027421|doi-access=free}} This condition is also called 46, XY with undervirilization. 46, XY intersex has many possible causes, which can be problems with the testes and testosterone formation. Also, there can be problems with using testosterone. Some people lack the enzyme needed to convert testosterone to dihydrotestosterone, which is a cause of 5-alpha-reductase deficiency. Androgen insensitivity syndrome is the most common cause of 46, XY intersex.

This condition used to be called "true hermaphroditism". This is defined as having asymmetrical gonads with ovarian and testicular differentiation on either sides separately or combined as ovotestis.{{Cite journal|last1=Iqbal|first1=Muhammad Zafar|last2=Jam|first2=Mazhar Rafee|last3=Saleem|first3=Muhammad|last4=Ahmad|first4=Mushtaq|date=30 July 2011|title=True Hermaphrodite: A Case Report|journal=APSP Journal of Case Reports|volume=2|issue=2|page=16 |pmc=3418019|pmid=22953283}} In most cases, the cause of this condition is unknown.

This is the condition of having any chromosome configurations rather than 46, XX or 46, XY intersex. This condition does not result in an imbalance between internal and external genitalia. However, there may be problems with sex hormone levels, overall sexual development, and altered numbers of sex chromosomes.

{{further|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. During 2015, the Council of Europe, the European Union Agency for Fundamental Rights and Inter-American Commission on Human Rights 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."{{Cite web |last=European Union Agency for Fundamental Rights |title=The fundamental rights situation of intersex people |date=April 2015 |url=http://fra.europa.eu/sites/default/files/fra-2015-focus-04-intersex.pdf |archive-url=https://web.archive.org/web/20160305072423/http://fra.europa.eu/sites/default/files/fra-2015-focus-04-intersex.pdf |archive-date=5 March 2016 |access-date=3 January 2016}}{{Cite web |publisher=Comisión Interamericana de Derechos Humanos |last=Comisión Interamericana de Derechos Humanos |title=Violencia contra Personas Lesbianas, Gays, Bisexuales, Trans e Intersex en América |date=12 November 2015 |url=http://www.oas.org/es/cidh/informes/pdfs/ViolenciaPersonasLGBTI.pdf |language=es |url-status=live |archive-url=https://web.archive.org/web/20160107143635/http://www.oas.org/es/cidh/informes/pdfs/ViolenciaPersonasLGBTI.pdf |archive-date=7 January 2016 }}

{{main|Intersex medical interventions}}

{{further|History of intersex surgery}}

File:Small Ela Luk.jpg]]

Medical interventions take place to address physical health concerns and psychosocial risks. Both types of rationale are the subject of debate, particularly as the consequences of surgical (and many hormonal) interventions are lifelong and irreversible. Questions regarding physical health include accurately assessing risk levels, necessity, and timing. Psychosocial rationales are particularly susceptible to questions of necessity as they reflect social and cultural concerns.{{citation needed|date=July 2023}}

There remains no clinical consensus about an evidence base, surgical timing, necessity, type of surgical intervention, and degree of difference warranting intervention.{{Cite journal |doi=10.1159/000442975 |pmid=26820577 |volume=85 |issue=3 |last1=Lee |first1=Peter A. |last2=Nordenström |first2=Anna |last3=Houk |first3=Christopher P. |last4=Ahmed |first4=S. Faisal |last5=Auchus |first5=Richard |last6=Baratz |first6=Arlene |last7=Baratz Dalke |first7=Katharine |last8=Liao |first8=Lih-Mei |last9=Lin-Su |first9=Karen |last10=Looijenga |first10=Leendert H.J. |last11=Mazur |first11=Tom |last12=Meyer-Bahlburg |first12=Heino F.L. |last13=Mouriquand |first13=Pierre |last14=Quigley |first14=Charmian A. |last15=Sandberg |first15=David E. |last16=Vilain |first16=Eric |last17=Witchel |first17=Selma |last18=and the Global DSD Update Consortium |title=Global Disorders of Sex Development Update since 2006: Perceptions, Approach and Care |journal=Hormone Research in Paediatrics |date=28 January 2016 |pages=158–180 |doi-access=free}}{{Cite journal |doi=10.1016/j.jpurol.2016.04.001 |pmid=27132944 |last1=Mouriquand |first1=Pierre D. E. |last2=Gorduza |first2=Daniela Brindusa |last3=Gay |first3=Claire-Lise |last4=Meyer-Bahlburg |first4=Heino F. L. |last5=Baker |first5=Linda |last6=Baskin |first6=Laurence S. |last7=Bouvattier |first7=Claire |last8=Braga |first8=Luis H. |last9=Caldamone |first9=Anthony C. |last10=Duranteau |first10=Lise |last11=El Ghoneimi |first11=Alaa |last12=Hensle |first12=Terry W. |last13=Hoebeke |first13=Piet |last14=Kaefer |first14=Martin |last15=Kalfa |first15=Nicolas |last16=Kolon |first16=Thomas F. |last17=Manzoni |first17=Gianantonio |last18=Mure |first18=Pierre-Yves |last19=Nordenskjöld |first19=Agneta |last20=Pippi Salle |first20=J. L. |last21=Poppas |first21=Dix Phillip |last22=Ransley |first22=Philip G. |last23=Rink |first23=Richard C. |last24=Rodrigo |first24=Romao |last25=Sann |first25=Léon |last26=Schober |first26=Justine |last27=Sibai |first27=Hisham |last28=Wisniewski |first28=Amy |last29=Wolffenbuttel |first29=Katja P. |last30=Lee |first30=Peter |title=Surgery in disorders of sex development (DSD) with a gender issue: If (why), when, and how? |journal=Journal of Pediatric Urology |volume=12 |issue=3 |pages=139–149 |year=2016 |doi-access=free}}{{Cite journal |doi=10.1080/19419899.2013.831214 |volume=5 |issue=1 |pages=34–43 |last1=Creighton |first1=Sarah M. |last2=Michala |first2=Lina |last3=Mushtaq |first3=Imran |last4=Yaron |first4=Michal |title=Childhood surgery for ambiguous genitalia: glimpses of practice changes or more of the same? |journal=Psychology and Sexuality |date=2 January 2014 |s2cid=89605693 |url=http://discovery.ucl.ac.uk/1415959/1/Creighton_Childhood_surgery.pdf |access-date=13 January 2019 |archive-date=19 July 2018 |archive-url=https://web.archive.org/web/20180719102451/http://discovery.ucl.ac.uk/1415959/1/Creighton_Childhood_surgery.pdf |url-status=live |doi-access=free}} Such surgeries are the subject of significant contention due to consequences that include trauma, impact on sexual function and sensation, and violation of rights to physical and mental integrity.{{citation needed|reason=Previously cited to ref 'un-2016', but failed verification. See rev. 1159356782.|date=June 2023}} This includes community activism,{{Cite book |editor-link1=Mauro Cabral |editor-first1=Mauro |editor-last1=Cabral |editor-link2=Morgan Carpenter |editor-first2=Morgan |editor-last2=Carpenter |publisher=Intersex Day |title=Intersex Issues in the International Classification of Diseases: a revision |date=2014 |url=http://intersexday.org/wp-content/uploads/2015/10/intersex_issues_in_the_international_classification_of_diseases-cabral-carpenter-2014.pdf |url-status=live |archive-url=https://web.archive.org/web/20160811041824/http://intersexday.org/wp-content/uploads/2015/10/intersex_issues_in_the_international_classification_of_diseases-cabral-carpenter-2014.pdf |archive-date=11 August 2016 }} and multiple reports by international human rights{{Cite web |publisher=Comisión Interamericana de Derechos Humanos |last=Comisión Interamericana de Derechos Humanos |title=Violencia contra Personas Lesbianas, Gays, Bisexuales, Trans e Intersex en América |date=12 November 2015 |url=http://www.oas.org/es/cidh/informes/pdfs/ViolenciaPersonasLGBTI.pdf |url-status=live |archive-url=https://web.archive.org/web/20160107143635/http://www.oas.org/es/cidh/informes/pdfs/ViolenciaPersonasLGBTI.pdf |archive-date=7 January 2016 }} and health institutions and national ethics bodies.{{Cite book |isbn=978-3-941957-50-3 |last=German Ethics Council |title=Intersexuality, Opinion |date=February 2012 |url=http://www.ethikrat.org/publications/opinions/intersexuality |archive-url=https://web.archive.org/web/20170421134819/http://www.ethikrat.org/publications/opinions/intersexuality |archive-date=21 April 2017 |access-date=25 January 2020}}

In the cases where gonads may pose a cancer risk, as in some cases of androgen insensitivity syndrome,{{cite journal|last=Cools|first=Martine|author2=Koen van Aerde|author3=Anne-Marie Kersemaekers|author4=Marjan Boter|author5=Stenvert L. S Drop|author6=Katja P. Wolffenbuttel|author7=Ewout W. Steyerberg|author8=J. Wolter Oosterhuis|author9=Leendert H. J. Looijenga|title=Morphological and Immunohistochemical Differences between Gonadal Maturation Delay and Early Germ Cell Neoplasia in Patients with Undervirilization Syndromes|journal=J. Clin. Endocrinol. Metab.|date=September 2005|volume=90|issue=9|pages=5295–5303|doi=10.1210/jc.2005-0139|pmid=15998778|doi-access=free|hdl=1854/LU-848324|hdl-access=free}} concern has been expressed that treatment rationales and decision-making regarding cancer risk may encapsulate decisions around a desire for surgical "normalization".

• Feminizing and masculinizing surgeries: Surgical procedures depend on the diagnosis, and there is often a concern as to whether surgery should be performed at all. Typically, surgery is performed shortly after birth. Defenders of the practice argue that individuals must be clearly identified as male or female for them to function socially and develop "normally". Psychosocial reasons are often stated. This is criticised by many human rights institutions, and authors. Unlike other aesthetic surgical procedures performed on infants, such as corrective surgery for a cleft lip, genital surgery may lead to negative consequences for sexual functioning in later life, or feelings of freakishness and unacceptability.Intersex Society of North America (24 May 2006). [http://www.isna.org/faq/healthy What evidence is there that you can grow up psychologically healthy with intersex genitals (without "normalizing" surgeries)?] {{Webarchive|url=https://web.archive.org/web/20061208214540/http://www.isna.org/faq/healthy |date=8 December 2006 }}. Retrieved 25 November 2006.
• Hormone treatment: There is widespread evidence of prenatal testing and hormone treatment to prevent or eliminate intersex traits,[http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=4754 Bioethics Forum blog – Preventing Homosexuality (and Uppity Women) in the Womb?] {{Webarchive|url=https://web.archive.org/web/20160402051942/http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=4754 |date=2 April 2016 }}, Alice Dreger, Ellen K. Feder, Anne Tamar-Mattis (2010), at Hastings Center Bioethics Blog, retrieved 18 May 2012. associated also with the problematization of sexual orientation and gender non-conformity.{{cite journal|last=Meyer-Bahlburg |first= HFL |author-link=Heino Meyer-Bahlburg |date=1990 |title= Will prenatal hormone treatment prevent homosexuality?|journal=Journal of Child and Adolescent Psychopharmacology|volume=1|number=4|pages=279–283 |doi=10.1089/cap.1990.1.279}}
• Psychosocial support: All stakeholders support psychosocial support. A joint international statement by participants at the Third International Intersex Forum in 2013 sought, among other demands: "Recognition that medicalization and stigmatisation of intersex people result in significant trauma and mental health concerns. In view of ensuring the bodily integrity and well-being of intersex people, autonomous non-pathologising psycho-social and peer support be available to intersex people throughout their life (as self-required), as well as to parents and/or care providers."{{cite web | url = http://www.kaleidoscopeaustralia.com/about-us/intersex-inclusion-policy/ | title = Intersex Inclusion Policy | work = Kaleidoscope Australia Human Rights Foundation | access-date = 2017-02-02 | archive-url = https://web.archive.org/web/20170203164353/http://www.kaleidoscopeaustralia.com/about-us/intersex-inclusion-policy/ | archive-date = 2017-02-03 | url-status = dead | at=Appendix A (Malta Declaration) }}
• 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.{{cite web|url=http://www.bioethics.net/journals/ajob-volume-13-number-10/|title=American Journal of Bioethics, 13:10, 51–53. Retrieved 11 September 2013|date=October 2013 |access-date=6 October 2014|url-status=live|archive-url=https://web.archive.org/web/20141011225351/http://www.bioethics.net/journals/ajob-volume-13-number-10/|archive-date=11 October 2014}} There is widespread evidence of pregnancy terminations arising from prenatal testing, as well as 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."
• Medical display. Photographs of intersex children's genitalia are circulated in medical communities for documentary purposes, and individuals with intersex traits may be subjected to repeated genital examinations and display to medical teams. Problems associated with experiences of medical photography of intersex children have been discussed{{Cite book |last=Preves |first=Sharon |title=Intersex and Identity, the Contested Self |year=2003 |publisher=Rutgers |isbn=0-8135-3229-9

}} p. 72. along with their ethics, control and usage.{{Cite journal |doi=10.1353/pbm.2000.0002 |pmid=10804583 |volume=43 |issue=2 |pages=161–172 |last=Dreger |first=Alice Domurat |author-link=Alice Dreger |title=Jarring Bodies: Thoughts on the Display of Unusual Anatomies |journal=Perspectives in Biology and Medicine |date=2000 |s2cid=34463546 }} "The experience of being photographed has exemplified for many people with intersex conditions the powerlessness and humiliation felt during medical investigations and interventions."{{Cite journal |last1=Creighton |first1=Sarah |last2=Alderson |first2=J |last3=Brown |first3=S |last4=Minto |first4=Cathy |year=2002 |title=Medical photography: ethics, consent and the intersex patient |periodical=BJU International |volume=89 |issue=1 |pages=67–71 |doi=10.1046/j.1464-410X.2002.02558.x |pmid=11849163 |s2cid=26513690 |doi-access=free}}

p. 70.

• 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 and experience clinically significant distress or impairment, using the language of disorders of sex development.{{Cite journal |doi=10.1007/s10508-015-0550-0 |pmid=25944182 |last=Kraus |first=Cynthia |title=Classifying Intersex in DSM-5: Critical Reflections on Gender Dysphoria |journal=Archives of Sexual Behavior |date=May 2015 |volume=44 |issue=5 |pages=1147–1163 |s2cid=24390697 }}

• Intersex Awareness Day
• Intersex people and military service
• Sexual differentiation in humans
• Intersex healthcare
• Gynandromorphism
• Endosex
• True hermaphroditism
• Androgyny
• 46,XX/46,XY

{{Notelist}}

{{Reflist}}

{{further|Intersex human rights reports}}

• {{Cite book |author-link=Asia Pacific Forum |isbn=978-0-9942513-7-4 |last=Asia Pacific Forum of National Human Rights Institutions |title=Promoting and Protecting Human Rights in relation to Sexual Orientation, Gender Identity and Sex Characteristics |date=June 2016 |url=http://www.asiapacificforum.net/resources/manual-sogi-and-sex-charactersitics/ |access-date=29 August 2016 |archive-date=15 January 2017 |archive-url=https://web.archive.org/web/20170115144950/http://www.asiapacificforum.net/resources/manual-sogi-and-sex-charactersitics/ |url-status=dead }}
• {{Cite journal |title=How sexually dimorphic are we? Review and synthesis|journal=Am J Hum Biol |volume=12 |issue=2 |pages=151–166 |year=2000 |pmid=11534012 |doi=10.1002/(SICI)1520-6300(200003/04)12:2<151::AID-AJHB1>3.0.CO;2-F |first1=Melanie |last1=Blackless |first2=Anthony |last2=Charuvastra |first3=Amanda |last3=Derryck |first4=Anne |last4=Fausto-Sterling |first5=Karl |last5=Lauzanne |first6=Ellen |last6=Lee|s2cid=453278 }}
• {{Cite web |last1=Council of Europe |last2=Commissioner for Human Rights |author1-link=Council of Europe |author2-link=Commissioner for Human Rights |title=Human rights and intersex people, Issue Paper |date=April 2015 |url=https://wcd.coe.int/ViewDoc.jsp?Ref=CommDH/IssuePaper(2015)1&Language=lanEnglish&Ver=original|ref=none}}
• {{Cite book |publisher=NYU Press |isbn=978-1-4798-3786-1 |last=Davis |first=Georgiann |author-link=Georgiann Davis |title=Contesting Intersex, The Dubious Diagnosis |location=New York |date=2015 |url=http://nyupress.org/books/9781479887040/}}
• {{Cite web |publisher=Palm Center |last1=Elders |first1=M Joycelyn |last2=Satcher |first2=David |last3=Carmona |first3=Richard |author1-link=Joycelyn Elders |author2-link=David Satcher |author3-link=Richard Carmona |title=Re-Thinking Genital Surgeries on Intersex Infants |date=June 2017 |url=http://www.palmcenter.org/wp-content/uploads/2017/06/Re-Thinking-Genital-Surgeries-1.pdf}}
• {{Cite book |publisher=Basic Books |isbn=978-0-465-07714-4 |last=Fausto-Sterling |first=Anne |title=Sexing the Body: Gender Politics and the Construction of Sexuality |date=2000 |author-link=Anne Fausto-Sterling |title-link=Sexing the Body}}
• {{Cite book |publisher=Heinrich-Böll-Stiftung |isbn=978-3-86928-107-0 |last1=Ghattas |first1=Dan Christian |author1-link=Dan Christian Ghattas |last2=Heinrich-Böll-Stiftung |author2-link=Heinrich Böll Foundation |title=Human Rights between the Sexes: A preliminary study on the life situations of inter*individuals |location=Berlin |date=2013 |title-link=Human Rights between the Sexes }}
• {{Cite book |publisher=Ashgate Publishing |isbn=978-0-7546-7311-8 |editor-last=Holmes |editor-first=Morgan |editor-link=Morgan Holmes |title=Critical intersex |location=Burlington, VT |series=Queer interventions |date=2009}}
• {{Cite journal |doi=10.1136/adc.2006.098319 |pmid=16624884 |pmc=2082839 |volume=91 |issue=7 |pages=554–563 |last1=Hughes |first1=I A |last2=Houk |first2=C |last3=Ahmed |first3=S F |last4=Lee |first4=P A |author5=((LWPES1/ESPE2 Consensus Group)) |title=Consensus statement on management of intersex disorders |journal=Archives of Disease in Childhood |date=June 2005 }}
• {{Cite book |author=Marcus de María Arana |publisher=Human Rights Commission of the City and County of San Francisco |last2=de María Arana |first2=Marcus |title=A Human Rights Investigation Into The Medical "Normalization" Of Intersex People |date=2005 |url =http://www.aph.gov.au/DocumentStore.ashx?id=2bbf04f0-66c8-4dd9-9c20-2cdb1c936f79}}
• {{Cite book |isbn=978-1-62313-502-7 |last1=Human Rights Watch |author1-link=Human Rights Watch |last2=interACT |author2-link=Interact Advocates for Intersex Youth |title=I Want to Be Like Nature Made Me |date=July 2017 |publisher=Human Rights Watch |url=https://www.hrw.org/report/2017/07/25/i-want-be-nature-made-me/medically-unnecessary-surgeries-intersex-children-us}}
• {{Cite book |publisher=Open Book Publishers |isbn=978-1-78374-208-0 |last1=Jones |first1=Tiffany |last2=Hart |first2=Bonnie |last3=Carpenter |first3=Morgan |last4=Ansara |first4=Gavi |last5=Leonard |first5=William |last6=Lucke |first6=Jayne |title=Intersex: Stories and Statistics from Australia |location=Cambridge, UK |date=2016 |access-date=2 February 2016 |url=https://interactadvocates.org/wp-content/uploads/2016/01/Intersex-Stories-Statistics-Australia.pdf |archive-url=https://web.archive.org/web/20180527202242/https://interactadvocates.org/wp-content/uploads/2016/01/Intersex-Stories-Statistics-Australia.pdf |archive-date=27 May 2018 }}
• {{Cite journal |title=Intersex Studies: A Systematic Review of International Health Literature|journal=SAGE Open |volume=2018 |issue=1 |pages=1–22 |year=2018 |doi=10.1177/2158244017745577 |first=Tiffany |last=Jones |doi-access=free }}
• {{Cite book |publisher=Duke University Press |isbn=978-0-8223-4318-9 |last=Karkazis |first=Katrina |author-link=Katrina Karkazis |title=Fixing Sex: Intersex, Medical Authority, and Lived Experience |date=2008 |title-link=Fixing Sex}}
• {{Cite journal |doi=10.1159/000442975 |pmid=26820577 |volume=85 |issue=3 |last1=Lee |first1=Peter A. |last2=Nordenström |first2=Anna |last3=Houk |first3=Christopher P. |last4=Ahmed |first4=S. Faisal |last5=Auchus |first5=Richard |last6=Baratz |first6=Arlene |last7=Baratz Dalke |first7=Katharine |last8=Liao |first8=Lih-Mei |last9=Lin-Su |first9=Karen |last10=Looijenga |first10=Leendert H.J. |last11=Mazur |first11=Tom |last12=Meyer-Bahlburg |first12=Heino F.L. |last13=Mouriquand |first13=Pierre |last14=Quigley |first14=Charmian A. |last15=Sandberg |first15=David E. |last16=Vilain |first16=Eric |last17=Witchel |first17=Selma |last18=and the Global DSD Update Consortium |title=Global Disorders of Sex Development Update since 2006: Perceptions, Approach and Care |journal=Hormone Research in Paediatrics |date=28 January 2016 |pages=158–180 |doi-access=free}}
• {{Cite web |last1=Organisation Intersex International Australia |author-link1=Organisation Intersex International Australia |last2=Carpenter |first2=Morgan |author-link2=Morgan Carpenter |title=Submission on the Review of Part B of the Ethical Guidelines for the Use of Assisted Reproductive Technology in Clinical Practice and Research, 2007 |location=Sydney |date=April 2014 |url=http://oii.org.au/25621/submission-ethics-genetic-selection-intersex-traits/ |access-date=6 May 2014 |archive-date=6 October 2014 |archive-url=https://web.archive.org/web/20141006114348/http://oii.org.au/25621/submission-ethics-genetic-selection-intersex-traits/ }}
• {{Cite web |last=Regmi |first=Esan |title=Stories of Intersex People from Nepal |url=https://oii.org.au/wp-content/uploads/2016/04/Intersex-Stories-in-Nepal.pdf |date=2016 |archive-date=3 May 2016 |archive-url=https://web.archive.org/web/20160503161547/https://oii.org.au/wp-content/uploads/2016/04/Intersex-Stories-in-Nepal.pdf}}
• {{Cite book |pages=91–104 |publisher=Washington College of Law Center for Human Rights & Humanitarian Law |last=Tamar-Mattis |first=Anne |author-link=Anne Tamar-Mattis |title=Torture in Healthcare Settings: Reflections on the Special Rapporteur on Torture's 2013 Thematic Report |chapter=Medical Treatment of People with Intersex Conditions as Torture and Cruel, Inhuman, or Degrading Treatment or Punishment |location=Washington, DC |date=2014 |url=http://antitorture.org/wp-content/uploads/2014/03/PDF_Torture_in_Healthcare_Publication.pdf |archive-url=https://web.archive.org/web/20140327061454/http://antitorture.org/wp-content/uploads/2014/03/PDF_Torture_in_Healthcare_Publication.pdf |archive-date=27 March 2014 |url-status=dead}}
• {{Cite web |last=United Nations Office of the High Commissioner for Human Rights |author-link=Office of the High Commissioner for Human Rights |title=Free & Equal Campaign Fact Sheet: Intersex |date=2015 |url=https://unfe.org/system/unfe-65-Intersex_Factsheet_ENGLISH.pdf }}
• {{Cite web |last1=UN Committee against Torture |author1-link=United Nations Convention against Torture#Committee against Torture |last2=UN Committee on the Rights of the Child |author2-link=Committee on the Rights of the Child |last3=UN Committee on the Rights of People with Disabilities |author3-link=Committee on the Rights of Persons with Disabilities |last4=UN Subcommittee on Prevention of Torture and other Cruel, Inhuman or Degrading Treatment or Punishment |last5=Juan Méndez |author5-link=Juan E. Méndez |last6=Dainius Pūras |last7=Dubravka Šimonoviæ |last8=Marta Santos Pais |last9 =African Commission on Human and Peoples' Rights |author9-link=African Commission on Human and Peoples' Rights |last10=Council of Europe Commissioner for Human Rights |author10-link=Commissioner for Human Rights |last11=Inter-American Commission on Human Rights |author11-link=Inter-American Commission on Human Rights |work=Office of the High Commissioner for Human Rights |title=Intersex Awareness Day – Wednesday 26 October. End violence and harmful medical practices on intersex children and adults, UN and regional experts urge |date=24 October 2016 |url=http://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=20739&LangID=E |ref=none}}
• {{Cite book |isbn=978-92-4-150732-5 |last1=World Health Organization |last2=OHCHR |last3=UN Women |last4=UNAIDS |last5=UNDP |last6=UNFPA |last7=UNICEF |title=Eliminating forced, coercive and otherwise involuntary sterilization, An interagency statement |date=2014 |url=http://apps.who.int/iris/bitstream/10665/112848/1/9789241507325_eng.pdf?ua=1|author1-link= World Health Organization |author2-link=Office of the High Commissioner for Human Rights }}
• {{cite book |author-link=Zwischengeschlecht |last=Zwischengeschlecht |date=March 2014 |chapter-url=http://intersex.shadowreport.org/public/2014-CRC-Swiss-NGO-Zwischengeschlecht-Intersex-IGM_v2.pdf |chapter=IGM – Historical Overview. Hermaphrodites in the 'Developed World': From Legal Self-Determination to IGM, Supplement 1 |title=NGO Report to the 2nd, 3rd and 4th Periodic Report of Switzerland on the Convention on the Rights of the Child (CRC) |edition=2 |pages=49–62}}

{{external media | width=210px | float=right | | video1=[https://www.buzzfeed.com/lizzwarner/what-its-like-to-be-intersex " What It's Like To Be Intersex"], Lizz Warner, BuzzFeed}}

• {{Commons category-inline|Intersex}}
• {{Wikiquote-inline|Intersex}}

{{Intersex}}

{{Sex}}

{{Sex (biology)|state=collapsed}}

{{Reproductive health |state=collapsed}}

{{Congenital malformations of genital organs}}

{{LGBTQ}}

{{Authority control}}

Category:Intersex topics

Category:Sex

Category:Medical controversies