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Intersexuality/DSD In North America & Europe

Sexual/gender variations. Work by Anne Fausto-
Sterling & John Money. Intersex/DSD support groups

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Sexual and gender variation:

Western society has traditionally oppressed sexual minorities. Every child is expected to be conceived with either XX or XY chromosomes, grow up identifying themselves as either a woman or a man, to have internal and external sexual organs which are clearly male or female, and to be sexually attracted to members of the "opposite" sex when they mature. For reasons of ignorance, religious teaching, and/or fear, we have tended to force people into the traditional heterosexual male or female role. But, as in so many sexually related topics, a two-mode "either/or" model is insufficient. Consider:

bullet Homosexuals: male or female adults who are attracted to members of the same gender; about 5% of the population.

bullet Bisexuals: male or female adults who are attracted to persons of both/all genders; about 5% of the population.

bullet Transgender persons: adults who appear like a typical male or female, but who do not accept their birth-assigned general. Some are convinced that nature has played a terrible trick on them. They feel that they are a woman in a man's body, or vice versa. Others do not identify themselves as either male or female. Others switch. They are rare; their numbers are unknown. Estimates vary widely.

bullet Transsexuals: transgender adults who have undergone hormone therapy and/or surgical procedures in order to make their body more closely resemble the sex that they identify themselves as.

bullet Intersexuals: individuals with a Disorder of Sexual Development (DSD) who are born with anatomy or physiology which differ from cultural ideals of male and female." 1

About Anne Fausto-Sterling:

Anne Fausto-Sterling attempted to categorize intersexuality in a 1993 article. 2 She introduced three sexes in addition to male and female:

bullet Herm refers to "true hermaphrodite" -- an intersex person born with both ovarian and testicular tissues and internal reproductive organs.

bullet Merm is an intersex person with their sex chromosomes following a XY (nominally male) karyotype.

bullet Ferm is an intersex person with a XX (nominally female) karyotype.

These categories have not been well received by most intersex people.

She has written of her vision of a more accepting future:

"At birth, instead of hearing the inevitable pronouncement of "boy" or "girl" new parents might excitedly await a much expanded range of possibilities. Herms, ferms, and merms, being the rarer birth events might come to be seen as especially blessed or lucky, having as they do the best of all possible worlds, sexually speaking. Herms, merms and ferms might become the most desirable of all possible mates able as they are to pleasure their partners in a variety of ways. Furthermore, the existence of three additional sexes would open up possibilities for the rest of us. It would become difficult to maintain a clear conceptualization of homosexuality, for example, and perhaps its current contentious status would fade from view. If we envision the world in fives instead of twos, it would also be more difficult to hold onto rigid constructions of male and female sex roles. ...Should we have only two sexes? -- my answer would be a resounding no."

About Dr. John Money:

John William Money (1921-2006) was a psychologist and sexologist at Johns Hopkins University in Baltimore, MD. According to Wikipedia, he was:

"... well-known for his research into sexual identity and biology of gender. Money identified several influential concepts and terms during his career, including gender identity, gender role, gender-identity/role, and lovemap." 3

He was very highly regarded as a world-class expert in his field. He received many international awards.

One of his early specialties was intersexuality. He developed the concept that a person's gender is not simply defined by their genitalia, but also by one's self-awareness and social assignment. He taught that gender among very young children is plastic, and only becomes rigid later in life. In a very famous case, in 1965, he persuaded a family to have one of their twin sons castrated and raised as a girl.

Infant genital surgery:

Partly as a result of Money's research, many physicians began recommending that the ambiguous external genitals of intersex infants be surgically modified so that the child will grow up appearing to be a "normal" male or female. Sometimes, the infant have an enlarged or protruding clitoris; others are born with a "micropenis".

In about 90% of past cases, intersex infants have undergone genital surgery to make them appear as a "normal" female. One surgeon explained: "You can make a hole, but you can't build a pole." 4 Surgery involves removal and remolding genital structures, and may involve the addition of parts taken from elsewhere on the body.

Physicians now attempt to preserve structures that have concentrations of nerves, so that sexual feeling will remain. But they cannot guarantee that their patients will ever be able to have orgasms in later life. Such care was not always taken in the past.

These operations are usually performed shortly after birth, at the age of 6 weeks to 15 months. 5 They are sometimes done later, during childhood or teen years.

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Intersex activist groups:

There is increasing opposition to these operations. Several activist and support groups by and for intersex individuals have been formed. 1,6,7 They generally oppose genital surgery on intersex people, particularly when it is done at an age where the person cannot make an informed choice. Nathalie Angier 5 has written:

"The debate raises difficult questions about who has the right to decide what ranks as esthetically acceptable genitalia, whose interests are being served by surgical intervention and whether one's sexual identity is so entwined with the appearance of one's genitals that it is worth subjecting infants to a major operation to assure visual concordance between one and the other."

The Federal Prohibition of Female Genital Mutilation Act does permit genital surgery if it is "necessary to the health of the person on whom it is performed." Activists have tried to modify the law, so that it cannot be performed without the informed consent of the individual. This would effectively eliminate the possibility of genital surgery on intersexual newborns and infants who cannot give consent.

Cheryl Chase, founder of the Intersex Society of North America commented: 1

"[North] Africans have their cultural reasons for trimming girls' clitorises, and we have our cultural reasons for trimming girls' clitorises. It's a lot easier to see what's irrational in another culture than it is to see it in our own."

With regard to the proposed change in the law, she commented:

"That would break the pediatricians' argument that they do this to prevent psychological and mental trauma for the child...We don't expect this to be finished up in six months, but we're not going to go away, and we have more passion than they do."

Some pediatricians defend the practice of infant genital surgery. Dr. Anthony A. Caldamone, head of pediatric urology at Hasbro Children's Hospital in Providence, RI said:

"I don't think it's an option for nothing to be done. I don't think parents can be told, this is a normal girl, and then have to be faced with what looks like an enlarged clitoris, or a penis, every time they change the diaper. We try to normalize the genitals to the gender to reduce psychosocial and functional problems later in life."

Dr. Justine M. Schober, a pediatric urologist at Hamot Medical Center in Erie, Pa. has said:

"The truth is, genital surgery is being done, but we don't know what the outcome of it is, sexually or otherwise. We don't have any long-term studies."

Advocacy groups begun to have a significant impact on the medical community early in the 21st century. Such groups are now taking part in medical international conferences

David Thomas, a pediatric urologist at St. James's University Hospital and Infirmary in Leeds, UK conducted a scouting study. It involved only about a dozen intersexual individuals aged 11 to 15 who had been subjected to genital surgery. Results were not encouraging. 8 Dr. Thomas reports: "

"Every girl required some additional vaginal surgery...The results are indifferent and frankly disappointing."

Estimates on the number of intersex persons in North America range from 1 in 50 to 1 in 2000. Intersexuality is sometimes caused by their DNA, sometimes by rare hormonal levels during pregnancy, and sometimes by unknown causes. More details.

References used:

The following information sources were used to prepare and update the above essay. The hyperlinks are not necessarily still active today.

  1. The Intersex Society of North America closed their office in 2008. They maintain their web site unchanged at: They have a FAQ which described their newsletter and other materials on intersexuality. A new non-profit organization, Accord Alliance, composed of health care and advocacy professionals, opened its doors in 2008-MAR. It will continue to lead natoional efforts to improve health care and outcomes for intersexual persons.
  2. Anne Fausto-Sterling, "The Five Sexes: Why Male and Female are not enough", The Sciences, 1993-MAR/APR, 1993:20-24. Responses were printed in the JUL/AUG issue. The article was reprinted on the New York Times Op-ed page on 1993-MAR-12.
  3. "John Money," Wikipedia, 2009-JAN-07, at:
  4. Melissa Hendricks, "Is it a Boy or a Girl?", Johns Hopkins Magazine, 1993-NOV-10 to 16.
  5. Nathalie Angier, New Debate Over Surgery on Genitals, New York Times, New York NY, 1997-MAY-13
  6. Intersex Voices was a Web site supporting intersexual persons and their families. See: [Apparently offline]
  7. Genital Mutilation Survivors' Support Network (GMSSN) has a German and English web site at: {Apparently offline]
  8. Anne Scheck, "Early Vaginal Reconstruction for All Intersex Girls?," Urology Times of Canada, 1997-APR. Available at:

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Copyright 1998 to 2015 by Ontario Consultants on Religious Tolerance
Originally published: 1998-MAR-16

Last updated on 2015-JUN-14
Author: Bruce A Robinson
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