For many people, the words “sex” and “gender” are interchangeable. Scientifically, they are very different and much more complex than many people are aware of. Despite what public restrooms would lead us to believe, we simply cannot categorize people into two neat little boxes. A person’s gender and sex may or may not match. And, as we learned with sexual orientation, binaries (though socially ingrained) are much too restrictive for what occurs in reality.
Being aware of the possible variety in sex and gender not only allows us to better understand and express ourselves, but it also helps us to understand and empathize with others. The stories of transgender individuals like Brandon Teena, Tyra Hunter, and Larry King prove to us that confusion, fear, and hatred all too often lead to death. Education on the matter is crucial for our society to live in harmony.
Sex is all about physical and biological characteristics: chromosomes, hormones, genital anatomy, etc. Before a child is even born, the focus is on one question: “Is it a boy or a girl?” Although people may assume that this answer will give them clues as to the gender of the developing child, it’s really a question of sex. We assign individuals with XX sex chromosomes, ovaries, and vulvovaginal genitalia to the female group. Those with XY chromosomes, testes, and a penis comprise the male group. But what happens when determining a person’s sex is not so black and white?
Individuals whose sexual characteristics do not match what our society (and medical professionals) consider “typical” can be described as intersex. According to the Intersex Society of North America (ISNA), approximately 1 in 100 babies are born with bodies that “differ from standard male or female.”1 These differences can be visible at birth, make themselves known at puberty, or go unnoticed for a lifetime. They can be externally visible or internally hidden.
Not everyone agrees on what conditions qualify as “intersex,” but here’s a basic rundown of what sometimes gets included:
Klinefelter Syndrome occurs when a child who exhibits anatomically male traits is born with an extra X chromosome (XXY). This usually becomes noticeable at puberty, as individuals with Klinefelter Syndrome produce less testosterone. Physical traits may include less body or facial hair, less muscle mass, smaller testicles, and increased breast tissue. Infertility or reduced fertility is also likely.
Turner Syndrome occurs when a child who exhibits anatomically female traits is born with only one X chromosome. In addition to a short stature and other physical differences, Turner Syndrome can cause underdeveloped ovaries, resulting in the absence of menstruation and infertility.
Swyer Syndrome occurs when an individual with XY chromosomes has undeveloped gonads, or testes. Unable to produce testosterone and other hormones important for male development, the child is born anatomically female. However, during puberty, the lack of estrogen becomes noticeable in the absence of breast growth and menstruation.
Mayer-Rokitansky-Küster-Hauser Syndrome (MRKH) occurs when the Müllerian duct fails to develop in an XX chromosome fetus. This can lead to the absence of a uterus, cervix, and/or vagina. If a vagina is present, it may be shorter than average and cause painful intercourse. This condition may be noticed during puberty if menstruation doesn’t begin.
Androgen Insensitivity Syndrome (AIS) is when a person’s body is unresponsive to androgens (hormones that are typically considered “male,” such as testosterone). This can occur at mild, partial, or complete levels. In individuals born with XX chromosomes, there is little noticeable difference. However, individuals born with XY chromosomes range in their genital appearance. In complete AIS, an individual externally resembles a female. However, they do not possess a uterus, fallopian tubes, or ovaries. (Their gonads are indeed testes, although they are likely undescended.) Again, this becomes noticeable at puberty with a lack of menstruation.
Congenital Adrenal Hyperplasia (CAH) causes the body to create masculinizing hormones when attempting to create cortisol. In individuals with XX chromosomes, this may lead to an enlarged clitoris (clitoromegaly) and shallow vagina, or in extreme cases, an average-sized penis. Increased facial & body hair, a deeper voice, and trouble with menstruation and fertility are also possible.
There are also external sexual differences for which we do not understand the cause or for which there may be several possible causes. For example, XY individuals can be born with aphallia (the absence of a penis) or what is controversially referred to as a “micropenis” (a penis that is at least 2.5 standard deviations below average). Both XY and XX individuals can also have gonadal tissue which contains properties of both testes and ovaries, for which the external appearance varies widely.
Historically, doctors would rush to perform genital surgery on newborns whose genitalia did not match their male or female ideal. An assigned sex would often be decided without regard to a person’s actual, biological makeup — and the procedure itself would be shrouded in secrecy. For example, a XY newborn with an atypically small penis may undergo complete castration of both the penis and testes. Doctors would advise parents to raise the child as a girl, and not to inform the child of their birth as a boy. (And you thought your teenaged years were confusing.) Today, groups like the ISNA advocate delaying medically unnecessary surgical procedures, so that the individual has the power of choice.