Journal of ISSN: 2373-6445JPCPY

Psychology & Clinical Psychiatry
Research Article
Volume 6 Issue 7 - 2016
Gender Identity: Intersex Individuals
Ilhame Khabar*
San Jose State University, USA
Received: October 12, 2016 | Published: December 21, 2016
*Corresponding author: Ilhame Khabar, San Jose State University, USA, Email:
Citation: Khabar I (2016) Gender Identity: Intersex Individuals. J Psychol Clin Psychiatry 6(7): 00406. DOI: 10.15406/jpcpy.2016.06.00406


According to past beliefs and social norms, society has been taught that their has only been two types of biological structures regarding the ideal male and female. The majority of society has also believed that gender identity was specific only to those structures, as most have had a very fixed perspective of men and women and the sexual organs that are associated. In today's society, there has been an observed increase of many variations in sexual orientation, gender identity, gender expression, and sex anatomy. Awareness has been subtle, yet growing on gender identity and intersex individuals; however, some studies and popular media stories have also shown that many of these individuals have experienced trauma and hardship due to their ambiguous genitalia and how it has affected their gender identity.

Keywords: Intersex; Identity; Gender; Sexuality


The world we live in is full of diverse communities that have to go through many struggles in order to be accepted within a society. There have been variations in social classes, sexuality, ethnic backgrounds, and in gender rolls. There have been many studies and sociological theories that have made claims and determined the foundations, in which produce specific ideologies about all of these groups, yet we still underrepresent a very important group of society. This group may have been the most unique and misunderstood community to date.

We have known that we are introduced to specific social beliefs and social-inheritance when we develop. We have also known that our environmental influences suggest specific behaviors and ways to identify according to acceptable norms. When we were children, we were tough right and wrong; normal and abnormal; and what respectable gentlemen and graceful ladies were suppose to act like. What about individuals who are born with variation in sex anatomy? How do they identify?

In this paper, I will review the literature regarding intersex individuals and the way they chose to identify. I will explore a collection of articles and studies regarding gender identity, medical treatment, social stigmas, and the influences of gender identity among this particular community.

Intersex Defined

According to the Intersex Society of North America (ISNA), Intersex was a recently coined term and a general description used to describe the different developments and unique structures that occurred in some individuals at birth. The variations typically occurred in sexual reproductive systems and sexual developments. In other words, intersex individuals developed entirety different in terms of their sexual organs. This may have consisted of developing a contradictory sexual organ, two variant sexual organs, or unusual structures that resulted in ambiguous indications of sexual anatomy. To further elaborate, a man is typically born with a penis and a women has been born with a vagina. This has been the common way we identified men and women. In the intersex community, this is not the case. Intersex individuals may have been born with a vigina, a penis, or both sexual organs. Another way these individuals may have been born could have been shown in the size of their sexual organ. The penis or clitoris may have been abnormally small or large in size. Individuals who were born with mosaic genetics, which meant that some of their cells have XX chromosomes and others have XY, also qualified as intersex. Other types of variations exist among this community as well.

The variations and ambiguous structures correlated with having intersex anatomy, were not always immediately identified at birth. In some cases, they have been reported to show up later in developmental stages such as adolescence and adulthood. Some cases were even reported after an individual died and had an autopsy. All of which, supports the realization that intersex individuals are not entirely that uncommon. In fact, the ISNA (2008) also claims that the frequency of individuals who were born without a fixed distinction between XX or XY, occurred in every 1,600 births. Others with Klinefelter, which means they had a combination of XXY chromosomes, occurred in every 1,000 births. They also stated that 1 of every 1,000 births involve a surgical procedure with the objective of resulting in a normal genital appearance.

The most interesting factor of some intersex individuals, was that there was no real indication between male or female. In other words, nature was not the absolute indicator of these individuals were. In society, the decision of female and male was typically determined by doctors. The decision of what the appropriate size for a sex organ was determined by professionals and biological experts, before individuals were officially considered as intersex. Another way of deciding this, was by society and the humans within it. They were the essential deciders of what was appropriate and unusual. Humans decide whether a person with XXY chromosomes or XY chromosomes and androgen insensitivity counted as intersex.

The ISNA (2009) also stated that in their work, they experience firsthand that the decisions made about intersex individuals by medical professionals were not always consistent or parallel. They found that doctors frequently disagreed on the appropriate conditions operating under the in intersex term. Some required or believed that intersex individuals must have met the standards condition of having ambiguous genitalia, regardless of physiological and physical indications. Others believed that the brain was exposed to unusual combinations of hormones, which have essentially influenced the development of one's sex during the prenatal stages, which entails that individuals may not be intersex unless they have experienced atypical development. Other professionals thought that an individual must have had both sexual organs physically developed in order to be considered an intersex.

Historical Background and Biological Contexts

Hermaphrodite was the term used to describe people with atypical sex anatomy for hundreds of years, as described by Feder and Karkazis [1] in the Hasting Center Report in 2008. The terminology was divided into three categories, in which determined an individual's true sex. Male pseudo hermaphroditism, female pseudo hermaphroditism, and true hermaphroditism. Generally, individuals who displayed sex organs that may have contradicted their physical appearance were considered as some forms of pseudo hermaphroditism. Others, who may have reported having two sex organs, were considered to be true hermaphrodites. To further elaborate, male pseudo hermaphroditism refereed to an individual having some form of testicles, yet resembling the appearance of a female. On the other hand, a female pseudo hermaphrodite, was someone who displayed physical traits of a male, yet had some form of a clitoris. Finally, the term true hermaphrodites, represented individuals who embodied some form of both testes and a clitoris at the same time. Feder and Karkazis [1], also insisted that hermaphroditism was considered to be something that was a disorder and was viewed as difficult and challenging. Unlike today's externalized opinions on the matter, which display a controversial view.

In even more recent years, the term intersex has been used to describe even wider categories of individuals with ambiguity displayed in gender identity, physiological development, and sexual development. The infliction of this term being used as an alternative to hermaphrodite was inflicted by activists and criticized practices over the years. The transition in terminology was also expanded for reasons having to do with the limitation and stigmas associated with the previous term. Essentially, society has received the message, in which entails: I am a person, not a disorder [1].

Intersex, as a terminology, was developed in recent discoveries. It was used to describe individuals with sexual ambiguity. That being said, it was still not used as a medical term for conducting diagnosis for patients. Clinicians have been hesitant in using it and have only displayed its significance when describing it in a non-official manner to refer to individuals with variations in sexual anatomy. Nevertheless, it is still considered to be the umbrella term, as if has brought comfort to individuals experiencing variations in sex anatomy. This was, interestingly, due to lack of understanding, more than the experience in itself. Dr. Katrina Karkazis [2] clarified this in her clinical conference in the American Journal of Psychiatry in 2008. She was also referenced by her peers, Dr. Micheal Bostwick and Dr. Karla Martin, in their reply to the same conference in 2008. They further conveyed that, as an intersex individual who displayed mixed-gonadal dysgenesis, Dr. KarkaZis was diagnosed later on in her adult life, unlike newborns who are immediately diagnosed and, in some cases, treated. Bostwick and Martin [3] also emphasized that Dr. KarkaZis learned of her diagnoses at the age of 48. This lead to the observation that her interpersonal hardship resulted less from her sexual anatomy and more from her need to understand her gender identity, in relation to her intersex position.

Gender Identity

According to the American Psychological Association (2006), the definition of gender identity was as follows: Gender identity refers to one’s sense of oneself as male, female, or transgender, when one’s gender identity and biological sex are not congruent, the individual may identify as transsexual or as another transgender category. This meant that gender identity was not based specifically on whether an individual had a penis or a vagina, rather, it is based on how the individual identifies, in accordance with their understanding of gender roles, as well as, conflictions of gender roles. Confliction, used respectfully, to describe transgendered individuals. Furthermore, a way of understanding gender identity is simply reflecting on the fact that regardless of whether we were male or female, our gender was not based on our sex organs; rather, it was determined by our conditioning and our social beliefs; our social influences and our behavior; and our individual traits and personal structures. An example of this may be depicted in our behavior as men and women within our society the way we speak, act, and think, may be the general factors in determining gender identity.

Once these definitions have been considered. The stereotypes within particular cultures must have also been considered. This is because culture has had a significant influence on gender and the way in which people have chosen to identify. The social structure of the ideal family involved a masculine male who performed particular functions outside the home, as well as, a feminine mother who may have performed her role at the home of raising the children. These individuals were typically heterosexual and had a typical physical, physiological, and sexual development.

Another view has also been considered in regards to gender being based on stereotypes has been considered when think of geographical regions and what it means to be male or female within those regions. A particular effort has been made in viewing the American culture and how we have constructed gender by color_ we have made association with the color pink to affirm feminine traits in individuals we believed will identify as females and have associated the color blue to verify the masculinity of those we believed were male. [4]. This type of association has also been done with toys and specific symbols used in society. for example: We have always given female dolls to children dressed in dresses with piggytales. This was also applied to infants and children identified by their society as boy; however, in this case, we have given them objects and toys that stimulate a masculine association.

As an adition to clothing, medical terminology, and cultural beliefs, the idiology of gender has also been based on attitudes, physical appearance, personal gestures, and patterns of speech and as well as vocal tones. additionals beiefs about gender identity have also included technological factors and advancement in socety. This could have meant global influences amongst societies or exposure to more stereotypes associated with implicating gender, McGrath [5] has refereed to this as law's evolution.

Another view McGrath [5] made about gender identity and gender in general, was in respects to the constant association of gender with sex in legal matters and cases. He mentioned the case of Ruth Bader Ginsburg as an example. She used the terms of gender and sex to describe interchangeable views in her arguments during sex discrimination cases. Justice Ginsburg's secretary made the necessary recommendation that G that she use the word gender as an alternative to the term sex, as it made her appear too assertive.

Unfortunately, the legal terminologies and usage of the concepts of sex and gender have not been completely altered according to the proper consideration of intersex individuals. the results have yet to change, regardless of variation in individuals and how they may choose to identify. This has included the consideration of men, women, transgendered, homosexuals, and other individuals who may identify differently. An emphasized view of these communities lacking simple rights, such as common ways to simply identify and keep their individuality has been made quite difficult. These minorities have truly tolerated mistreatment in their rights and part of miss the understandings considering their gender-identities are related to the media and the exploitation of these individuals, as well the shared fascination, which makes them quite popular. This was an essential result of mainstream television and influential cinema, which delayed shocking depictions of Transsexuals, transvestites, and drag queens and drag kings, who have stepped of the shadows.

Another essential point that was emphasized in McGrath's [5], Article is regarding the fact that even though the majority of society has been becoming quite educated on gender and have comprehended that there are many ways to identify, some individuals still believe that it is fixed and absolute. In other words, many individuals still believe that if you are born a man you will identify as a man and if you are born female you will identify as a woman. This community disregarded the fact that there are variations in sex anatomy and that regardless of which, some people may recognize themselves as man or female, regardless of their own sexual organs or physical appearance.

Intersex individuals and gender identity

The most popular case of an individual with variation in sex anatomy was the case study of in conducted by A psychologist who may have been too eager, and may have severely traumatized his patient. This individual was born with a male reproductive system, and was also an identical twin. This is significant because it provides the perfect factors for a study on Gender Identity. Two males, who share the same DNA, and have the same parents. They also have very comparable, if not parallel, social environments, which influence their conditioning. That being said, David did experience a traumatic injury to his sexual organ, due to an unanticipated incident during a basic procedure. Therefore, his parents had to make the difficult decision of raising David, who was Bruce prior to the accident, as Brenda who is now a considered a girl.

The research doctor that followed this case was, a psychologist specializing in sexual identity and gender biology. His hypotheses stated that most, human, individuals are completely sexually neutral during the first 2 years of their development. He also claimed that nurture was superior to nature, in the context of gender identity. With this in mind, David's parent's followed Dr. Money's instruction on removing David's testicles and adjusting him to live and be recognized as a girl. As some have speculated "the Reimer's came in with a boy, and left with a girl".

The results of the case study, showed tremendous controversy. David, who was Brenda at the time, continued to display masculine traits. This was, clearly, displayed in his behavior during interaction video sessions. Some examples of these behaviors consisted of: wanting to play with masculine toys, as appose to barbies, which is considered to be normal behavior for little girls. He also displayed much confusion and aggression through his lack of, essential, differentiation between being a girl or a boy. Another perspective that was considered, was the approach that Dr. Money used to assess and influence David and his brother. It may be described as: extremely unethical from many points of views, and some would even argue that it crosses moral and legal boundaries, in regards to sexual exploitation and exposure.

Others have definitely questioned the concept of gender identity after Dr. Money and the Case Study of David Reimer. The results show a consistent pattern of Intersex individuals developing more masculine traits than those who develop feminine traits. The consistent patterns also show that the correlation between nature and nurture has no emphasis on one to be superior to the other. Another discovery I have found is that, most individuals who are part of the intersex community, regardless of how they identify, tend to have severe mental, personal, and emotional disorders, as a direct result of their sexual anatomy, and the need to develop their identity [6-9].


  1. Feder EK, Karkazis K (2008) What's in a Name? The Controversy over Disorders of Sex Development. Hastings Cent Rep 38(5): 33-36.
  2. Karkazis K (2008) Disorders of sex development: Improving care for affected persons and their families. The American Journal of Psychiatry 165(2): 265-266.
  3. Bostwick JM, Martin KA (2008) Disorders of sex development: Improving care for affected persons and their families: Drs. Bostwick and Martin reply. The American Journal of Psychiatry 165(2): 265-266.
  6. MacKenzie D, Huntington A, Gilmour JA (2009) The experiences of people with an intersex condition: A journey from silence to voice. J Clin Nurs 18(12): 1775-1783.
  7. Morland I (2008) II. Intimate violations: Intersex and the ethics of bodily integrity. Feminism & Psychology 18(3): 425-430.
  8. Karkazis K (2008) Disorders of sex development: Improving care for affected persons and their families. Am J Psychiatry 165(2): 265-266.
  9. MacLaughlin DT, Donahoe PK (2004) Sex Determination and Differentiation. The New England Journal Of Medicine 350(4): 367-378.
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