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Transcript of Living Intersex
By: Tara Farmer
Sexual Phenotype Determination
What is Intersex?
Testosterone and DHT
Estrogen, lack of AMH
Mullerian duct degeneration
Mullerian duct formation
top 1/3 of vagina
Lack of androgens
degeneration of Wollfian ducts
bottom 2/3 vagina
“Intersex” is a general term used for a variety of conditions in which a person is born with a reproductive or sexual anatomy that doesn’t seem to fit the typical definitions of female or male.
A person might be born appearing to be female on the outside, but having mostly male-typical anatomy on the inside
Having ambiguous genetalia
May be born with mosaic genetics, so that some of their cells have XX chromosomes and some of them have XY.
Typically, intersex is due to congenital defects during fetal development.
Androgen Insensitivity Syndrome
occurring in approximately 1 in 20,000 individuals
the body’s cells are unable to respond to androgen
In an individual with complete AIS and karyotype 46 XY, testes develop during gestation
The fetal testes produce mullerian inhibiting hormone (MIH) and testosterone
MIH causes the fetal mullerian ducts to regress, so the fetus lacks uterus, fallopian tubes, and cervix plus upper part of vagina
because cells fail to respond to testosterone, the genitals differentiate in the female, rather than the male pattern, and Wolffian structures (epididymis, vas deferens, and seminal vesicles) are absent.
AIS infant has genitals of normal female appearance, undescended or partially descended testes, and usually a short vagina with no cervix. Occasionally the vagina is nearly absent.
At puberty, the testes are stimulated by the pituitary gland, and produce testosterone. Because testosterone is chemically very similar to estrogen, some of the testosterone converts back to estrogen
This estrogen produces breast growth, though it may be late. Women with AIS do not menstruate, and are not fertile
May have surgical interventions at birth, such as vaginoplasty or removal of undescended testes
Most prevalent cause of intersex among people with XX chromosomes. About 1 in 10,000 to 18,000
Does not cause intersex in XY individuals, but does cause them to go into early puberty; this causes a short stature as an adult and a strong sexual desire during late childhood
the adrenal glands, while trying to make cortisone, may make an unusually high level of other hormones that are “virilizing”. That is, they can make XX embryos have larger than average clitorises, or even a clitoris that looks rather like a penis, or labia that look like a scrotum
ambiguous genitalia, in some females, such that it can be initially difficult to determine sex
early pubic hair and rapid growth in childhood
excessive facial hair, virilization, and/or menstrual irregularity in adolescence
infertility due to anovulation
enlarged clitoris and shallow vagina
The typical female karyotype for females is 46,XX.
have only one X chromosome present and fully functional
female sex characteristics are usually present but underdeveloped compared to the typical female.
Mosaic Turner Syndrome can also occur. This is when some cells have two “sex” chromosomes (XX) but others only have one (X)
short stature, lymphodema (swelling of hands and feet), broad chest and widely spaced nipples, low hairline, low-set ears, and infertility.
When mosaic Turner Syndrome occurs, the person usually doesn’t have all the associated signs of TS, and may have other signs of intersex.
Klinefelter syndrome is a chromosomal condition that affects male physical and cognitive development
Klinefelter syndrome is one of the most common genetic abnormalities affecting 1 in 500 to 1,000 newborn males
Most often, Klinefelter syndrome results from the presence of one extra copy of the X chromosome in each cell (47,XXY). Extra copies of genes on the X chromosome interfere with male sexual development, often preventing the testes from functioning normally and reducing the levels of testosterone.
refers to being born without a penis, in a patient with otherwise typical male anatomy.
means that the clitoris is larger than expected. This is a description, rather than a diagnosis. The most common cause of clitoromegaly is probably CAH
are gonads (sex glands) containing both ovarian and testicular tissue. These are sometimes present in place of one or both ovaries or testes.
How Intersex people view their condition
Intersex is a socially constructed category that reflects real biological variation.
"We can liken the sex spectrum to the color spectrum. There’s no question that in nature there are different wavelengths that translate into colors most of us see as red, blue, orange, yellow. But the decision to distinguish, say, between orange and red-orange is made only when we need it—like when we’re asking for a particular paint color."
"Sometimes social necessity leads us to make color distinctions that otherwise would seem incorrect or irrational, as, for instance, when we call certain people “black” or “white” when they’re not especially black or white as we would otherwise use the terms."
Intersex Society of North America
This is an intersex surgery which involves construction or reconstruction of the vagina. This procedures can be fairly simple or quite complex, depending on the severity of the abnormality.
Uni- or bilateral excision of a gonad, either an ovary or a testis
amputation or removal of most of the clitoris, including glans, erectile tissue, and nerves. This procedure was the most common clitoral surgery performed prior to 1970, but was largely abandoned by 1980 because it usually resulted in loss of clitoral sensation.
is a general term for any reconstruction of the penis itself, especially for more unusual types of injuries, deformities, or birth defects. The principal difficulty is that erectile tissue is not easily constructed and this limits the surgeon's ability to make more than minor size changes.
Is surgery best route?
In many surgical cases, there is scarring and loss of sensitivity.
As recipients grow into adults they feel betrayed by their parents and medical personal. There is a lot of pain and anger because of how their bodies were altered.
In severe cases, one may need surgery in extreme cases. Typically, being intersex is merely cosmetic, not medically threatning.
Intersex advocates suggest raising the child as the nearest gender and allowing them to decide when they get older what they would like to do. Some individuals have no problem with their not-so-normal genetalia.
"Between my legs was a rudimentary phallus" and "fused labio-scrotal folds." They ran their tests, they poked and prodded, and they cut open my belly, removed my gonads, and sent them off to Pathology."
Mosaic, with some cells having the XY genotype and others having XO
Parents raised "Judy" as a female
Grew up as a tomboy
"I quickly came to understand that that tomboy—the gender identity with which I had escaped childhood—was less acceptable in adolescence. "
Took estrogen pills while everyone else had natural puberty. Was told by doctors that she was an "unfinished" girl.
College dropout, runaway, insecure, attempted suicide
Married a man during a time of self loathing
Came across neonatal records while applying for a job, found out her largely embarrassing clitoris was a hideously deformed penis
Divorced,realized she liked women and met Tamara
Transitioned to male in 1996, felt like a cop out, but realized he was more comfortable this way.
Married Tamara in 2000, had a baby using her eggs, much happier living as a male.
Born in New York City in 1968, to recently immigrated Colombian and Venezuelan parents, with what is known as ambiguous genitalia
Father was a physician, knew that there were no serious medical needs
Grew up strict catholic, no talk of sex or nudity-was unaware that her clitoris was larger than other girls
Excelled physically and academically, played basketball and was a cheerleader
During puberty, father asked to take estrogen for breast development
Had no problems with sexual partners and no negative feedback
Went to an intersex conference and was discouraged at all the people who viewed their condition so negatively due to having surgery as an infant. Many intersex boys at birth who, put on estrogen to live as female, but felt as a male. They were left psychologically confused and felt betrayed by parents
Met other women who had clitorectomies and left with little to no sensation
Happy her parents didn't make he have surgery as an infant, lived a normal and happy life
Surgeries and hormone treatments are irreversible
There is no scientific or anecdotal evidence that “normalizing” surgical and/or hormone treatments are beneficial to people with intersex variations
Surgeries and hormone treatments have been shown to be harmful, both physically and psychologically
U.K. in 2003, found that women who had voluntarily undergone clitoral reduction surgery as adults for cosmetic reasons were worse off than those who had not
inorgasmia, severe pain
Health risks secondary to hormone therapy
It is easy for children with intersex variation to grow up without being mocked for their differences.
There's really no locker room showering anymore, people don't generally "stare" at someone's genitalia if there was.
If a parent thinks there is something wrong or inferior about their child’s body, the child will think this too, and having their body “corrected” directly conveys that something is wrong with it
Children’s gender identity and/or sexual orientation is not changed by hormones or surgery, and altering children’s bodies only risks creating deep psychological problems
Even with estrogen people who were originally intersex boys most often grew up to still feel like boys
However good the intentions are for “correcting” intersex variations are, these “treatments” have not been shown to be helpful, but rather, harmful, in achieving their goals
“I was not at all always comfortable with myself or my body. I spent most of my life being in the closet about my intersex status, which is typical of intersex people. I always wondered why the sex ed classes never talked about bodies like mine. Being unsure why my sort of difference was unspeakable made me uncomfortable, and made some things--especially dating/sexuality--awkward. Being treated as an object of curiosity rather than as a person by medical professionals made receiving medical care unpleasant. It took me many years to become comfortable with myself. I know intersex people whose relationships with their parents have been basically destroyed by the family refusing to talk about what was done to the intersex person as a child, and resentment over the parents forcing surgery on their child that left the intersex person without sexual sensation.
I'm almost 50 now, so I've had a lot of time to work on getting comfortable with myself. It was really only when I gender transitioned from the sex I was assigned at birth--which I was not able to do until my 40s--that I stopped keeping my intersexuality a secret. It seemed silly to do so when my sex and gender were issues of everyday speculation, amusement, curiosity and/or distaste anyway (society is not kind to people who are gender transitioning). The whole business was painful, but once I no longer had secrets I was keeping, and was living in my identified gender, I felt much, much better.” -Dr. Cary Gabriel Costello