The Intersex Child

What sex you are, defines your identity, from what you wear to your psyche, the worldly roles you essay and the expectations that you come to have from life. From applications and forms, voter’s ID, passport, bank accounts and insurance to all the documents in between and the services that lets you be a part of this world, identifies you as either MALE or FEMALE. Even public sanitation comes with branding; MALE or FEMALE. Ever wondered, what kind of life people with Intersex condition get to live? Their existence remains ignored in our society, like some wretched dog on the streets. Opportunities to a life of dignity have eluded them since long. Although one out of every 2000 births is an intersex child, the tradition of secrecy around it, leaves parents unaware and unprepared. Societal expectations can traumatize parents into seeking early surgical interventions to ensure their child leads a ‘normal’ life. In worst cases, such a child gets disowned or even honour killed. Understanding intersex condition is therefore crucial in preventing mindless atrocities and hostile attitudes.

Intersex is a group of conditions that are scientifically recognized as Disorders of Sex Development (DSDs). It is commonplace to call these individuals Hermaphrodites. But calling them so is misleading and insensitive as these individuals do not have all female and all male parts. That is physiologically impossible. A person with an intersex condition has either a discrepancy between the external and internal genitals (the testes and ovaries) or ambiguous genitalia. It is important to note that this condition can happen to any child, just as any other birth disorder. We know humans have 23 pairs of chromosomes- 22 autosomal and 1 pair determining sex; XX for female and XY for male. Intersex individuals have thus far been recognized into four categories:

1.  46 XX Intersex, 46 XX with virilization or commonly Female Pseudohermaphroditism: The person is a female with external genitals that appear male or ambiguous. This results from the female fetus being exposed to excess male hormones before birth leading to hormonal imbalance. This exposure is due to Congenital Adrenal Hyperplasia (Group of autosomal recessive diseases resulting from gene mutations for enzymes mediating the biochemical steps of cortisol production from cholesterol by the adrenal glands. These manifests in either excessive or deficient production of sex steroids ), hormonal medication given to mother during pregnancy or testosterone produced by ovarian tumours in the mother.

2. 46 XY Intersex, 46 XY with undervirilization or commonly Male Pseudohermaphroditism: The person is a male with external genitals that appear female or ambiguous. Reasons leading to the hormonal imbalance seen in XY intersex individuals are inability of testes to produce male hormones, deficiencies in any of the enzymes needed to drive the stepwise process in testosterone formation or inability to use testosterone.  

3. True Gonadal Intersex, commonly True Hermophroditism: Here the person has both ovarian and testicular tissue. This might be in the same gonad (an ovotestis) or the person might have one ovary and one testis. The person may have XX chromosomes, XY chromosomes, or both. The external genitals may be ambiguous or may appear to be female or male. The underlying cause remains unknown, although in some animal studies it has been linked to exposure to common agricultural pesticides.

4. Complex or Undetermined Intersex: These individuals have errors in chromosomal configurations that include 45 XO (only 1 X chromosome), 47 XXY, 47XXX etc. There is no discrepancy between internal and external genitalia, but, imbalance in sex hormonal levels and overall sexual development occurs.

The conditions associated with intersex may become evident at birth or surface gradually towards puberty. Gender identity is thus, a matter of nurture and not nature. Therefore surgical quick fix leading to gender assignment may hardly be the solution as the issue is more complex than assumed. A child medically assigned to be a boy may develop female psyche around puberty or vice versa resulting in Transgenders with emotional discomfort and identity crisis. Parents in particular, need to be educated that having an intersex child is NOT a matter of confusion, grief, shame or fear. Many babies born with intersex conditions are perfectly healthy and do not require any medical intervention other than diagnostic tests. Parents therefore need to press doctors to clarify them on which parts of their child's anatomy involve threats to their child's physical well-being like a blockage to the urinary opening. It is vital to see what the child develops into and wants to be, before medical interventions are made, if they need to be. However, the prospect of a successful surgery at around puberty where gender awareness of the child develops is grim. Therefore doctors need to encourage a middle ground with non-invasive treatments until needed otherwise. Parents need to be talked out of stress and confusion and allowed to focus on the joy of having a beautiful baby. People with intersex condition are no where inferior in aspects of intelligence and talent. The only worry is that they may not be able to propagate, which many of us, ‘normal’ individuals may not do as well, by choice. With the increase in awareness, our understanding of intersex will widen. They are NOT objects of pity as professed by certain traditions. They are our own. A change towards progressive attitude will definitely bring with it the acceptance and empathy, intersex children need. And thus, given opportunities of education and employment, they will thrive like the rest of us and prove to be assets to our society.

Reference: http://www.nlm.nih.gov/medlineplus/ - one of the best sites for health information