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There is a misguided thought that everyone is born neatly fitting into the box of either male or female. Creating a human is complicated as fuck, and sexual differentiation involves complex interactions between hormones, chromosomes, reproductive organs, and genitals. There is a lot of individual variety in the development of a person. About 1.7% of people are born intersex, which means that they don’t have the anatomy fitting the typical definition of male or female.

Part of the reason that this happens is that males and females start with very similar systems, they just develop differently. In school I remember learning that girls produce estrogen, and boys produce testosterone. Only once I became a sex educator did I learn that men also produce estrogen, women also produce testosterone, and how much of each hormone each person releases depends on the person. For example, I have cysts on my ovaries which make me produce more testosterone than most women. This is not harmful, but it makes me have slightly more body hair than some women. Although this condition does not make me intersex, it shows that there is a lot of individual variety even among those that are born male or female.

Being intersex includes a variety of conditions where the person has anatomy that combines what is traditionally thought of as male and female biology. Here are three examples of conditions.

Persistent Müllerian Duct Syndrome is when an (XY) male is born with a uterus. The male usually has a normally functioning penis and often the uterus is only discovered when they have an MRI or pelvic ultrasound later in life. Many that have this condition will never know, although most with this condition are infertile.

Congenital Adrenal Hyperplasia (CAH) is when an individual has trouble making cortisone in the adrenal glands. When this happens an XX female may develop a larger clitoris, and have a large amount of body hair, a receding hairline and a deeper voice.

Androgen insensitivity syndrome is when an XY male is unable to respond to typically “male” hormones. As a result a newborn has a typical female appearance but often has a short vagina with no cervix and lacks a uterus and fallopian tubes. They also often have undescended testicals, which are often surgically removed.

What to doctors do when they see that a patient is intersex?

It is often not immediately visible that a baby is intersex. Sometimes it is not until puberty or until a person tries to conceive that they notice that something is different. Unfortunately, we live in a society where when babies are born obviously intersex, doctors often surgically alter them so that they have what looks like a penis or a vagina. The problem with this is that it often decreases the babies ability to experience pleasure when they get older. Also, often doctors alter a baby to make a penis or vagina based on what their genitals like, without considering their chromosomes, hormones and internal genitalia. The problem with this is that often intersex folk don’t feel like they are the gender that they look like, and this can lead to serious identity issues.

Is being intersex a disorder?

Not at all. The reason it is often difficult for intersex people is because we live in a society that puts a lot of emphasis on categorizing people as male or female, and we don’t have a lot of systems in place to support those that don’t neatly fit into one box. Intersex is an identity and a community and many are proud to be intersex, that is why an I was added to the LGBTQI movement.

How do you know if someone is intersex?

It depends. Sometimes when a baby is born you can see that they don’t have something that looks like a typical penis or vulva. However, sometimes it is not until puberty or until a person tries to conceive that they notice that something is different.

What about the term hermaphrodite? It’s best not to ever use it unless someone who is intersex tells you that is what they want to be called. Although some intersex folks have reclaimed this term, for most it is thought of as a slur.

How do you interact with someone who’s intersex online?

There are all kinds of shapes and sizes of genitals, and it is perfectly alright to have your sexual preferences. What you should never do is make someone feel shame for the way that they look.

Intersex people may have their own vocabulary that they like to use to refer to their genitals. Instead of taking your best guess, I suggest asking them what words they like to use.

As with everything, communication is the most important. Ask them what turns them on and what type of stimulation feels good, as they may experience pleasure differently.

Intersex people are sometimes fetishized, instead of doing that, and only talking about their genitals, ask them what their fantasies are and think of them as the complete humans that they are. Often life is very hard for intersex people because of our culture around gender, instead of perpetuating the status quo, be open, be curious and be nonjudgemental.