also see from sister blog GLBTQJA Wordpress: So You Wanna Know About Hermaphrodite's? and
The words “hermaphrodite” and “pseudo-hermaphrodite” are stigmatizing and misleading words. Unfortunately, some medical personnel still use them to refer to people with certain intersex conditions, because they still subscribe to an outdated nomenclature that uses gonadal anatomy as the basis of sex classification. In a paper titled Changing the Nomenclature/Taxonomy for Intersex: A Scientific and Clinical Rationale, five ISNA-associated experts recommend that all terms based on the root “hermaphrodite” be abandoned because they are scientifically specious and clinically problematic. The terms fail to reflect modern scientific understandings of intersex conditions, confuse clinicians, harm patients, and panic parents. I think it is much better for everyone involved when specific condition names are used in medical research and practice.
To read more about the Victorian origins of the medical terminology of “true” and “pseudo” hermaphroditism, check out chapter 5 of Alice Dreger’s Hermaphrodites and the Medical Invention of Sex which is available at bookshelf, or go to What’s the history behind the intersex rights movement?.
One more thing: While some intersex people seek to reclaim the word “hermaphrodite” with pride to reference themselves (much like the words “dyke” and “queer” have been reclaimed by LBGT people), we’ve learned over the years it is best generally avoided, since the political subtlety is lost on a lot of people.
"Most people in Jamaica are not in favour of homosexual behaviour but rights are not subject to people's feelings, rights are rights and to clarify for the commission the language of the charter doesn't speak to gender, it is a point that has been made over and over again in submissions to other international bodies as well as this one. The new charter of rights says 'The right to freedom from discrimination on the ground of being male or female,' in fact the UN human rights committee pointed out that this language is incompatible with normal standards and leaves people who are hermaphrodite by nature or intersex completely unprotected and leaves room for real challenges, it does not even speak to gender. She continued on the human rights training of the police."
Clearly someone needs to advise spokespersons specially when they are new to the post that when they do go out there to speak on behalf of groups that they apprise themselves of the lexicon that applies. Outdated language/word use at an important meeting as that of the IACHR today can be embarrassing, the more cynical would say if the respective groups do not know the proper terms then it is no wonder we can't see the proper responses on the ground towards the attendant challenges. The same error was made at a recent workshop for LGBT persons as well where the word was used repeatedly corrective steps have since been taken in that regard.
What is intersex?
“Intersex” is a general term used for a variety of conditions in which a person is born with a reproductive or sexual anatomy that doesn’t seem to fit the typical definitions of female or male. For example, a person might be born appearing to be female on the outside, but having mostly male-typical anatomy on the inside. Or a person may be born with genitals that seem to be in-between the usual male and female types—for example, a girl may be born with a noticeably large clitoris, or lacking a vaginal opening, or a boy may be born with a notably small penis, or with a scrotum that is divided so that it has formed more like labia. Or a person may be born with mosaic genetics, so that some of her cells have XX chromosomes and some of them have XY.
Though the experts speak of intersex as an inborn condition, intersex anatomy doesn’t always show up at birth. Sometimes a person isn’t found to have intersex anatomy until she or he reaches the age of puberty, or finds himself an infertile adult, or dies of old age and is autopsied. Some people live and die with intersex anatomy without anyone (including themselves) ever knowing.
Which variations of sexual anatomy count as intersex? In practice, different people have different answers to that question. That’s not surprising, because intersex isn’t a discreet or natural category.
What does this mean? Intersex is a socially constructed category that reflects real biological variation. To better explain this, we can liken the sex spectrum to the colour spectrum. There’s no question that in nature there are different wavelengths that translate into colours most of us see as red, blue, orange, yellow. But the decision to distinguish, say, between orange and red-orange is made only when we need it—like when we’re asking for a particular paint colour. Sometimes social necessity leads us to make colour distinctions that otherwise would seem incorrect or irrational, as, for instance, when we call certain people “black” or “white” when they’re not especially black or white as we would otherwise use the terms.
In the same way, nature presents us with sex anatomy spectrums. Breasts, penises, clitorises, scrotums, labia, gonads—all of these vary in size and shape and morphology. So-called “sex” chromosomes can vary quite a bit, too. But in human cultures, sex categories get simplified into male, female, and sometimes intersex, in order to simplify social interactions, express what we know and feel, and maintain order.
So nature doesn’t decide where the category of “male” ends and the category of “intersex” begins, or where the category of “intersex” ends and the category of “female” begins. Humans decide. Humans (today, typically doctors) decide how small a penis has to be, or how unusual a combination of parts has to be, before it counts as intersex. Humans decide whether a person with XXY chromosomes or XY chromosomes and androgen insensitivity will count as intersex.
In intersex work, it has been found that doctors’ opinions about what should count as “intersex” vary substantially. Some think you have to have “ambiguous genitalia” to count as intersex, even if your inside is mostly of one sex and your outside is mostly of another. Some think your brain has to be exposed to an unusual mix of hormones prenatally to count as intersex—so that even if you’re born with atypical genitalia, you’re not intersex unless your brain experienced atypical development. And some think you have to have both ovarian and testicular tissue to count as intersex.
Rather than trying to play a semantic game that never ends, the ISNA take a pragmatic approach to the question of who counts as intersex. They work to build a world free of shame, secrecy, and unwanted genital surgeries for anyone born with what someone believes to be non-standard sexual anatomy.
By the way, because some forms of intersex signal underlying metabolic concerns, a person who thinks she or he might be intersex should seek a diagnosis and find out if she or he needs professional healthcare not fully available locally but do some reading online where excellent resources abound such as the Intersex Society of North America.
Why get rid of these terms? Because:
These terms are stigmatizing to patients and their families. We should all be working to reduce stigma, not add to it through medical care.
People with intersex are not hermaphrodites, and they are not helped by being labelled this way.
These terms imply a kind of hierarchy of “real” and “fake” intersex people, which is unhelpful and illogical.
These terms attract people with sexual fetishes and fantasies that, frankly, patient advocacy organizations are not interested in hearing from.
The system of labelling intersex people according to the mere presence or absence of certain gonadal tissues (as the “pseudo/true hermaphroditism” system does) pre-dates the modern sciences of genetics and endocrinology. It causes confusion among doctors and patients because it fails to reflect all that we now know matters.
The authors of the JPEM article suggest that new systems of intersex nomenclature and taxonomy be developed to completely replace the old “five sex” model. Specifically they suggest that the replacement taxonomic system:
should enhance, not complicate, the use of medical informatics in research and clinical practice;
should recognize that diagnosis and taxonomy inform, but do not determine, gender assignment and/or gender identity;
should not include the words ‘hermaphrodite’, ‘hermaphroditism’, ‘sex reversal’, or other easily misunderstood terms;
should label the condition rather than the person;
should not confuse physicians and patients;
should make clear that diagnosis does not simply dictate therapy.
The authors end by suggesting that it would be better to use specific etiology-based diagnoses (like AIS, 5-alpha reductase deficiency, etc.) along with an umbrella term. Which umbrella term? In our travels in the last few months, we notice there seems to be an emerging consensus around using disorders of sex development, abbreviated DSDs. This seems to be a term that doctors and many patient advocates can agree encompasses all of the conditions we at ISNA have traditionally labelled intersex.
For the full article, see:
Dreger AD, Chase C, Sousa A, Gruppuso PA, Frader, J. “Changing the Nomenclature/Taxonomy for Intersex: A Scientific and Clinical Rationale.” J Pediatric Endocrinol Metab. 2005 Aug: 18 (8): 729-33.