The term ‘intersex’ covers a range of people born with a reproductive or sexual anatomy that doesn’t fit typical definitions of ‘male’ and ‘female’. There are about 15 conditions that fit the definition of ‘intersex’. The one most commonly understood is a child born with genitalia that are not easily categorised as male or female. People may go through all or some of their lives without knowing they have an intersex condition. Those who do know typically identify themselves as either female or male – only a small proportion actually see themselves as intersex.
Mani Bruce Mitchell was born in 1953 with both a vagina and a small penis, and named Bruce. Her penis was surgically removed when she was eight years old. She lives as a woman, but acknowledges the male aspect of her identity by allowing her facial hair to remain. In 2003 a documentary based on her life, Yellow for hermaphrodites: Mani’s story, was screened on New Zealand television. Since then she has been the public face of intersex awareness, and in the 2010s was the executive director of the Intersex Trust Aotearoa New Zealand.
Numbers of intersex people
The proportion of intersex people in the population depends on which conditions are included, and whether the particular condition is noticed, but conservative estimates are one in 5,000. If all conditions are taken into account, the incidence could be as high as one in 100. Intersex Awareness New Zealand suggested that there were approximately 2,000 intersex people in New Zealand in the 2010s.
The history of treatment
In the 1950s specialists at Johns Hopkins University in Baltimore, US, suggested that the psychological wellbeing of a child depended upon a stable gender identity, which should be fixed by 18 months of age. It was also assumed that the child’s body should fit with their gender. Those born with ‘ambiguous’ genitalia were given surgery so that their genitals more closely resembled those of a ‘true’ male or female – often without the parents being fully informed. In most instances the surgery was not medically necessary. Many people now argue that the surgery should have been delayed until the individual was old enough to decide themselves whether or not they wanted it. In some instances, surgical procedures on babies resulted in many follow-up surgeries being needed.
Outcomes for corrective surgery
Research has shown that children who grow up with ambiguous genitalia, or who make their own decisions about surgery later in life do not, on average, fare worse than any other children. However, those who were subjected to early surgery and not informed about their condition often experience difficulties in later life. For example, some aspects of physical development may not occur as expected. Someone raised as a girl may not develop breasts as expected because their hormone levels are not typically female. While most support groups recommend raising an intersex child as one gender or the other, it is recognised that many may decide later in life that this gender is not right for them.
Boy or girl?
Congenital adrenal hyperplasia (CAH) can ‘virilise’ girl babies in the womb, so their genitalia appear male. When one New Zealand woman gave birth in the late 1970s, a delivery-room staff member announced, ‘It’s a boy!’, and then another said, ‘It’s a girl!’ ‘And then they went quiet,’ recalled the mother. ‘I had a look and said, “Is it a boy or a girl?”, and my doctor just said, “I don’t know.”’1 Tests showed that her baby was female, with CAH. The woman later had another baby who appeared clearly male, but was also found to be a girl with CAH. Both girls had surgery on their genitals to make them appear more female, while they were still babies.
The New Zealand-born psychologist and sexologist John Money pioneered theories of intersex identity and treatment during a career at Johns Hopkins University. He gained an international reputation for his work on intersexuality and invented the now widely used terms ‘gender identity’ and ‘gender role’. He became a highly controversial figure after one of his patients, whose penis was irreparably damaged during a medical procedure at the age of eight months, was raised as a girl on Money’s advice. The patient later committed suicide, and Money was accused of falsely reporting the case. However, some colleagues have said he made the best possible decision based on the available knowledge at that time.