What is intersex? Let's talk about it simply!

You may or may not have heard the term 'Intersex'. Simply put, it means that a person's reproductive system or sexual characteristics do not fit neatly into the usual categories of male or female. This may seem like a complicated topic, but don't worry , we'll break it down into simple terms that you can understand.

What exactly is intersex?

Think about it, we all usually think that we are born either a girl or a boy. However, in the case of intersex, the sex characteristics of a person's body, that is, reproductive organs, chromosomes, hormones, etc., do not belong to this clear division of male and female. Sometimes these characteristics can be visible at birth. But for some people, they can appear during puberty or even later, and sometimes even in adulthood. The strange thing is, sometimes you can't see anything from the outside. Sometimes you only find out about this during surgery or some kind of imaging test.

Is this a disease? Or a sickness?

Many people think that this is some kind of disease or condition. But actually, Intersex is not a disease, illness, or any kind of abnormal "condition". In the past, it was called 'Disorder of Sex Development' (DSD), which means 'a disorder of sexual development'. You can still see it referred to that way in some places. But now doctors and those who are knowledgeable about this matter say that Intersex is not such a 'disorder', but rather a naturally occurring variation in human sexuality . Therefore, having an Intersex condition does not mean that you need any special treatment.

What parts of the body can be affected by intersex conditions?

This condition can affect different parts of your body. Mainly:

• Genitals: That is, the external sexual parts of a man or woman.
• Chromosomes: The tiny things in all of our cells that contain our genetic information.
• Hormones: Like chemical messengers that control various functions in the body.
• Reproductive system: The system of organs involved in producing children.
• Gonads: These are the ovaries in women or the testicles in men.

How common is intersex?

You might think this is a very rare thing, something that is rarely seen. But it's not. In the United States, it's estimated that about one in every 100 people has intersex characteristics. Worldwide, about 2% of the population is said to have intersex characteristics. So, this isn't as rare as we think, is it?

What causes this?

There is no single, definitive cause for intersex. That means it's hard to say exactly why this happens. But scientists and doctors believe that there are several possible causes.

Some intersex traits can be passed down from generation to generation (genetically inherited). Think about it, some traits in our families (like height, skin color) are passed down through genes, that's how it is. But this is a little more complicated.

Other times, it can be caused by hormonal changes during embryo development, the early stages of a baby's development in the womb . It could be a change in the mother's natural hormone levels, or it could be the effect of synthetic hormones from an external medication.

In addition:

• Changes in a gene (receptor gene) related to the hormone androgen: Androgen is a hormone that mainly helps in the development of male characteristics. In order for this hormone to affect the cells of the body, those cells must have a corresponding 'receptor' for it. If there is a change in the gene that makes this receptor, even though the androgen hormone is present, the body cannot use it properly.
• Missing or misplaced part of the sex-determining region Y gene (SRY): The SRY gene, which is normally found on the Y chromosome, is responsible for the development of male characteristics. If there is a problem with this gene, sexual development can be altered.
• Other genetic conditions that can cause abnormal hormone levels that affect the development of sexual organs: Other genetic causes can include deficiencies in the production of hormones needed for sexual development, or overproduction of certain hormones.

How does intersex status manifest itself in my body?

Intersex is a unique condition that manifests itself differently for each person. Just like our fingerprints, everyone's experience of intersex is different. Scientists say that there are approximately 40 different ways that these characteristics can manifest. Therefore, it is impossible to categorize them into one thing: 'This is what intersex means.'

However, let's talk about some of the most common symptoms:

• Chromosome Variations: We all have chromosomes inside the cells of our bodies. These are the ones that carry our genetic information. Typically, a female has XX chromosomes and a male has XY chromosomes. This can be different for someone who is intersex.
• For example, some people may have an XXY chromosome configuration (Klinefelter syndrome) .
• Others may have only one X chromosome (XO - Turner syndrome) (this also affects those classified as female, but can also show intersex characteristics).
• Sometimes, some cells in the body can have XX chromosomes and other cells have XY chromosomes. This is called 'mosaicism' .
• There can be many other types of chromosome combinations like this. These chromosome changes can affect the body's hormone levels and the development of sexual organs.
• Mixed features of external and internal genitalia:
• Some intersex people may look female on the outside, but have male reproductive tissue, such as testicles, on the inside. Or, they may have male genitalia on the outside, but have female reproductive tissue, such as ovaries or a uterus, on the inside.
• In others, both ovarian tissue and testicular tissue may be present, possibly together as 'ovotestes' .
• The external genitalia may be ambiguous , not fully male or female. For example, there may be a larger than normal clitoris or a smaller than normal penis. Or, the location of the vaginal opening may be different.
• Because of these differences, it can sometimes be difficult to immediately tell when a baby is born, 'Is it a girl?'

Does being intersex affect my sexual orientation?

This is a question that many people ask. Being intersex has nothing to do with your sexual orientation. Intersex status does not affect whether you are attracted to people of the opposite sex (straight), gay/lesbian, bisexual, asexual, or have another sexual orientation. An intersex person can be anyone with any sexual orientation.

Is an intersex person a hermaphrodite?

" No, not at all. The term 'hermaphrodite' doesn't actually exist biologically in humans. It's a very old, incorrect word. It means that someone is completely male and completely female at the same time. That's not possible biologically. In fact, many people in the intersex community find that term very disrespectful, offensive, and embarrassing. Therefore, the correct words are Intersex and 'being intersex'."

Do intersex people need surgery or treatment?

"If you are intersex, you usually don't need any surgery – unless you want it. However, in the past, children born with intersex characteristics had surgery to either make their genitals match the sex they were assigned at birth, or to remove reproductive tissue (such as gonadal tissue) that didn't match. This surgery was often done before the child was even 2 years old. At the time, doctors and parents thought it was good for the child's future.

However, recently, intersex community members and activists have been speaking out against these surgeries. They say they are unnecessary because they can affect a child's future sexual function, fertility, and mental health. They argue that parents should allow children to make decisions about their bodies, including whether to have surgery and what kind of treatment they want, until they are old enough to understand .

Many international medical organizations, such as the American Academy of Family Physicians, support the right of intersex people to make decisions about their own bodies. This means waiting until they are old enough to give informed consent . That is, allowing the person to fully understand their condition, the pros and cons of the surgery, and make their own decisions about it.

What are the risks of intersex surgery?

"Surgeries like this, especially those performed at a young age, can have certain risks. Some of them are:

• Decreased sexual sensitivity and function: Surgery can damage nerves.
• Infertility: Due to removal or damage to reproductive tissue.
• Scarring: Can affect both physically and mentally.
• Urinary incontinence or difficulty urinating.
• Frequent occurrence of urinary tract infections (UTIs).
• Psychological effects: Anxiety and anger caused by not being able to make decisions about one's own body.

That's why, unless there is an urgent medical reason, many people are now saying to postpone such surgeries until the person is old enough to understand.

Are there other health problems associated with intersex status?

"Most of the time, people with intersex are completely healthy. However, very rarely, there are several other health problems that can be associated with the intersex condition:

• Bone problems, such as osteopenia and osteoporosis – these can be caused by certain hormonal imbalances.
• There is a small risk of developing certain types of cancer (especially if there is gonadal tissue that has not developed properly in the body).
• Some hormone-related conditions, for example 'Congenital adrenal hyperplasia' or 'Androgen insensitivity syndrome'.
• The urethral opening is on the wrong side of the penis (Hypospadias) or there is no urethral opening.
• Klinefelter syndrome - A condition caused by males having an extra X chromosome.
• Mayer-Rokitansky-Küster-Hauser syndrome - The uterus and vagina do not develop as expected.
• Swyer syndrome - failure to develop sex glands.

"But remember, not all of these diseases affect all intersex people. These are very rare. And, if these conditions exist, they can be treated."

How do I know if I am intersex?

"If you were born with a distinct difference in your genitals, you may not know you are intersex. You may never know it in your life. However, sometimes later in life you may experience things like:

• Puberty not occurring at the expected time. For example, a girl not starting her period at the expected time, or a boy not developing symptoms such as a deepening voice or growing a beard.
• During puberty, changes occur that do not match your registered sex. For example, breast development in a boy, or a deepening of the voice in a girl, or excessive body hair growth.
• Difficulty conceiving children (infertility). Sometimes, people only discover they are intersex when they are trying to have a child.

"If you experience something like this, the best thing to do is to see a doctor and get advice. They can run the necessary tests and give you a clear understanding of this."

Does being intersex affect fertility?

"If you are intersex, whether you can have a child depends on a number of factors. It depends on your specific intersex condition, the development of your reproductive system, and so on. Some intersex people can have children naturally. For others, it may be difficult."

However, many intersex people can have families and raise children. This may require the help of Assisted Reproductive Technology (ART). This may include methods such as in vitro fertilization (IVF), the use of donated eggs, sperm or embryos, or the use of a gestational carrier/surrogate.

The most important thing is, if you are interested in adopting a child, to talk to a doctor about it and find out what options you have.

The most important thing: support and understanding

"Being intersex, especially when you first learn about it, can be a lot of questions. You may feel scared, anxious, or lonely. Intersex people may feel inferior about their appearance or find it difficult to fit in with their peers. Connecting with others who understand these challenges can be very helpful."

It's great to feel like you have someone who understands and listens to you. So, talk to your doctor and find out about support groups and other resources that can help people like you. You can also find information and support groups online.

"Remember, you are not alone. There are many people who understand this situation and can support you. It is very important to talk to someone you trust about your feelings."

Take-Home Message

"Okay then, here are some of the most important things you need to remember from what we've talked about:

• Intersex is not a disease. It is a natural variation of human sexuality.
• This condition can affect things like sex organs, chromosomes, and hormones.
• Intersex characteristics can appear at birth, during adolescence, or later. They may not be visible to the outside world.
• Don't use the word 'hermaphrodite'. It's wrong and offensive. The correct word is Intersex.
• There is a lot of debate about surgery for intersex children. There is a strong opinion that unless there is an urgent medical reason, it is best to wait until the child is old enough to give informed consent .
• Many intersex people live healthy, happy lives, and are able to have families and raise children.
• " If you have questions about this, don't go it alone. Talk to a trusted doctor, a counselor, or an intersex support group. If you need help, don't be afraid to ask for it."

` Intersex, sexual development, reproductive health, chromosomes, hormones, gender identity, DSD