Male or Female or What Sex- Understanding Intersex or DSD




A young woman, age 22, is about to marry. During an exam, she tells the nurse that she never had a period. On further examination, she learns she has a condition they called testicular feminization syndrome. As the story unfolds, viewers learn about what we now call Differences of Sex Development or DSD. It's also been called intersex.

I won’t spoil the show for you! 

As usual, the series tastefully deals with difficult subjects. Different characters display different emotional responses as the story unfolds. The care is provided by the Christian sisters serving women and their families in one of London’s poor areas (Poplar). If you want to see the show, it is Episode 5 of Season 8.

INTERSEX or Disorders (Differences/Diverse) of Sex Development (DSD)

Currently, scientists refer to the woman’s condition in the episode as a type of intersex or DSD condition called Androgen Insensitivity Syndrome (AIS). People with this AIS condition are genetically male (XY) but resistant to the male hormones (androgens). Thus, the person has many physical traits of a woman but has a man’s genetic presentation. There can be variations from partial to complete AIS.

Intersex is a somewhat older term for a broader category of people with atypical sex conditions, which includes people whose sexual anatomy does not fit the usual appearance of male or female. In 2005, a name for a broad category of atypical sex conditions was created as Disorders of Sex Development or DSD. External genitalia can vary as can internal sex organs. The observable sexual characteristics can differ from the chromosomes (XY, XX, XXY). Some conditions are evident at birth and some are evident at puberty (Read more in this article from Pediatrics).

In case you are tempted to think there are three, four or five sexes, let’s be clear that mismatches between chromosomes and sexual anatomy can vary and be complex. As one example, some people are mosaics—having a mix of different chromosomes where some cells in the body have the female (XX) and others the male (XY). For more information on advances in the scientific understanding of variations in gene variations leading to differences in sex development, see Conway (2014).

You might wonder how many people are born with such a condition. So far, the data do not reveal a clear number because different conditions have been identified as being a part of DSD. The conditions are not frequent (see e.g., NYT). Media reports picked up on the writings of Fausto-Sterling, which suggested intersex conditions were more common than we might think, but Leonard Sax challenged her data and notes the problem of who ought to be included in a category when attempting to estimate the number of children born with a condition that could be identified as intersex. 

Based on his analysis and definition of intersex, human sexuality remains a dichotomy for almost all humans with the birth of a child with intersex occurring less than 2 out of every 10,000 births (See Leonard Sax, 2002).

Current medical practice focuses on people with DSD, which includes conditions of Turner and Kleinfelter syndromes and the hypospadias. 

When all the DSD conditions are part of the definition of a sexual difference, the number of children born with a sex difference is about 1 in 100 live births (Sandberg, Pasterski, & Callens, 2017). 

So, you can do the math to appreciate how many people in your school, place of worship, organization, or business have a DSD condition. Every child with a condition necessarily involves one or more adults, but knowing the numbers does not predict how many will need what type of medical and psychological care and support. Perhaps the numbers do allow us to be more sensitive to the way we write and speak about human nature and sexuality.

The word “Disorders” in DSD is understandably unacceptable to some. On the one hand, an identifiable medical condition is part of the cultural process to obtain care paid for by health insurance. On the other hand, those who wish to avoid stigma would prefer a term such as Differences of Sex Development or Diverse Sex Development

Another term in use by the US National Institute of Health is SGM, which refers to Sexual and Gender Minorities and thereby includes those who identify as lesbian, gay, bisexual and transgender as well as those with nontraditional sex development or DSD.

Some people classified with DSD live their lives not knowing of their condition. Some parents and families have made surgical changes (gender assignment surgery). Others postpone surgery until the child is old enough to understand their gender identity. 

Adjustment to conditions varies with the individuals and the parents as well as the specific biological condition. A study by Davis (2014) provides examples of how different people with a DSD condition respond to diagnostic terminology.

RELIGION and CULTURE

Religious texts and traditions historically treated sex as binary (created male or female). Christian women have used the text to advocate for equality with men as males and females were created in the image of God:

So God created mankind in his own image,
in the image of God he created them;
male and female he created them.
Genesis 1: 27 NIV

Unfortunately, this oft quoted text leaves out people born with mixed sexual anatomy.

While differences in external sex anatomy may be seen, the study of internal differences and chromosomal differences has been relatively recent. The idea that humans had 46 chromosomes was established in the 1950s (nature). Anyway, as it turns out, when it comes to sexual anatomy and genetic conditions, some people are mixed and not simply "created male or female" (See APA topic on intersex conditions for more detail).

When it comes to moral and social implications of being one sex or the other, some people refer to the male and female binary division as a premise in one argument or another. I’ll leave it to the religious scholars to help the faithful integrate science and faith. Frankly, it isn't easy and there are many claims to methods of integration.

Many won’t see any conflict. Others won’t be interested unless a family member is involved. And others may truly experience a spiritual struggle when interpretations of sacred texts are used to condemn some aspect of one’s identity, which in the current discussion means the lack of a distinct male or female biologically-based identity.

For religious parents of intersex (or DSD) children and individuals with an intersex (or DSD) condition, the emotional distress and emotional responses depicted in the aforementioned Call the Midwife episode can be real. 

Healthcare professionals, mental health workers, policy makers, and religious leaders would do well to be appraised of the medical facts and lived realities of people who do not neatly fit familiar patterns. In short, despite the role of diagnoses in obtaining medical care, including psychological care, the diagnosis does not directly lead to identifying how individuals and their parents experience the reality.

And it might be helpful, if those so certain about human nature and the causes of various conditions, could imbibe a dose of humility when it comes to faith and science. 

On the one hand, the religious binary sex enthusiasts ought to consider medical realities. 

On the other hand, the statistically challenged crusaders tempted to inflate low frequency conditions ought to consider a rigorous approach to defining conditions and obtaining frequency data.

Cite this post (APA style)


Sutton, G. (2019, April 29). Male or Female or What Sex Understanding Intersex. [Blog post].  
      Retrieved from https://dividedchristians.blogspot.com/2019/04/
      male-or-female-or-what-sex.html



References

Conway, G. S. (2014). Disorders of sex development (DSD): An overview of recent scientific advances. Psychology & Sexuality5(1), 28–33. https://doi.org/10.1080/19419899.2013.831213

Davis, G. (2014). The power in a name: Diagnostic terminology and diverse experiences. Psychology & Sexuality5(1), 15–27. https://doi.org/10.1080/19419899.2013.831212

Sandberg, D. E., Pasterski, V., & Callens, N. (2017). Introduction to the special section: Disorders of sex development. Journal of Pediatric Psychology42(5), 487–495. https://doi.org/10.1093/jpepsy/jsx065


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Intersex and An American War Hero

Smithsonian Magazine examines the possibility that the "father" of the U.S. Cavalry was intersex based on his skeleton.

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