Intersex is an umbrella term used to cover a large group of people whose primary and secondary sex characteristics do not match genetic sex.
Also called “hermaphroditism” or “sex ambiguity”, intersex or DSD (Disorders in Sexual Development) is an umbrella term used to cover a large group of people whose primary and secondary sex characteristics (urogenital system) do not match to genetic sex. Often diagnosed in early childhood, these developmental disorders can sometimes reveal themselves during a infertility checkup. More details with our experts.
What does intersex mean?
According to the UN, “Intersex people are born with sexual characteristics that do not fit standard definitions male or female”. In other words, people who, taking into account their chromosomal, gonadal or anatomical sex, do not fall within the classification established by the medical standards of the so-called male and female bodiesdetails the Office of the Commissioner for Human Rights of the Council of Europe. “These specificities manifest themselves, for example, at the level of secondary sexual characteristics (the face shape, muscle mass, body hair…) or primary sex characteristics such as internal and external genitalia and/or chromosomal and hormonal structure (female with 46 chromosomes including 2 XX chromosomesmale with 46 chromosomes including 2 XY chromosomes)” explains Dr. Victor Soulier, urological surgeon and sexologist. Intersex people may have fertility disorders, including infertility.
“Disorders of sexual development have absolutely nothing to do with sexual orientation”
Sometimes the use of hormonal medical treatments is necessary. “Disorders of sexual development have absolutely nothing to do with a person’s sexual orientation or gender identity. The latter can be heterosexual, gay, lesbian, bisexual or asexual, and identify as female, male or non-binary person (neither male nor female)“, adds Julie Condemine, midwife and sexologist. The causes of intersex are still poorly understood. But it is important to note that there are more cases due to better screening. “Many environmental factors are however singled out, such as organic pollutants, pesticides, heavy metals, certain endocrine disruptors (phyto-oestrogens, phthalates, bisphenols, etc.) or the inbreeding, underlines the doctor. Abnormalities are the mostly geneticwith many possible variations, involving the chromosomes and/or genes present on the X and Y chromosomes.”
How many intersex babies are born?
“There is no no complete statistics and reliable on the exact number of births of people with a variation in sexual development, says the doctor. Civil status statistics do not identify so-called “intersex” people. According to the UN, 0.05 to 1.7% of babies who are born each year in the world present intersex sexual characteristics. “We can also mention a study by the Haute Autorité de Santé (HAS) in November 2009, according to which “intersex could reach 2% of births”.According to Claire Nihoul-Fékété, Professor Emeritus of Childhood Surgery, in France, out of an average of 800,000 births per year, there are approximately 200 people with a genetic malformation of sexual development, i.e. one birth in 4,000″. completes Julie Condemine. This figure includes congenital adrenal hyperplasia.
What are the symptoms of intersex?
“The symptoms vary greatly from one person to another; there are many genetic particularities making individual, medical and genetic management sometimes difficult”, recognizes Dr. Soulier. Disorders of sexual development can be detected or suspected at birth (e.g. Congenital Adrenal Hyperplasia), or appear only at pubertyor not be physically apparent at all. “It can range from hormonal abnormality which we will not realize until later during investigations for infertility and which only manifests itself by a lack of hair in a boy for example – until the presence of a penis visible at birth in a little girl.”
What are the consequences for reproduction and fertility?
Intersex people often have fertility problems. “In some cases, they are even infertile, observes the midwife. A medical and genetic diagnosis will make it possible to know the supposed future impact on fertility and the risks of transmission to their offspring.
Intersex is a subject very little discussed in our French society.
Operation and intersex
Intersex is not a pathology in itself but can have short or long term consequences. “The care is multidisciplinary, appealing to gynecologists, pediatricians, surgeons, geneticists, endocrinologists… resumes Julie Condemine. We strive to identify the so-called “genetic” sex, the anatomical particularities in order to offer individualized care. In France, the gender reassignment operations in childhood are the subject of articles in the law of 2 August 2021 relating to the bioethics. In the facts, it does not prohibit surgical interventions on the babies concerned, but insists on the obligation to inform and support the child and his family. A multidisciplinary team should “ensure complete information for the child and his family” and “ensure that they have the necessary time to make an informed choice”, stipulates article L. 2131-6. One “appropriate psychosocial support” must also be provided by this same team. The holders of parental authority must, for example, be informed “the existence of associations specialized in supporting people with a variation in genital development”. “It seems fundamental to also be able to monitor “intersex” people during their lives, both on the medical and psychological levels and in the social and economic field”, in order to know better:
► the medical and psychological consequences of their treatment, depending on the interventions undergone and the age at which they were performed;
► the situations of exclusion, or even discrimination, of which these people may be victims (the report will come back to this point later).
“Biologically there are not only two genders but also a ‘neutral’ gender”
What psychological support for intersex people?
Intersex is a subject very little discussed in our French society which only highlights the taboos related to sexuality. “There is no doubt that it is important to offer benevolent therapeutic support and active listening for intersex people, assures Gwennaëlle Deroost, sex therapist. To provide them with elements of resources for understanding their uniqueness so that they can accept themselves and their bodies. Also deconstruct this idea that they are not in the norms and that they have just as much their place and their legitimacy as a binary person since they also belong to the family of genera. This will allow them to take full confidence that they do not have to choose a genre that does not define them to exist.” According to the sex therapist, the biggest psychological work to be done to support intersex people is above all psychosocial. “How? By informing from an early age that biologically there are not only two genders but also a “neutral” gender as intersex people proclaim. Because even if an intersex person comes to consult to find psychological help and regain a lot confidence in herself, in her body and accepting the fact that she alone can define herself, it cannot constantly arm itself, alone, against everyone’s ignorance.” The information will allow make intersexuality part of our morals and thus allow intersex people to live more peacefully without constantly having to defend themselves or justify their gender or identification with each “curious discussion because it is not usual“. “It’s not up to them to take a step towards us by justifying themselves to be understood and accepted but for the rest of the population to include them by being in an active and inclusive understanding on all existing sexo-biological panels“concludes Gwennaëlle Deroost.
Thanks to Dr. Victor Soulier, urologist surgeon and sexologist in Saint-Etienne, to Mrs. Julie Condemine, midwife and sexologist in Saint-Étienne, and to Gwennaëlle Deroost (Instagram: @sublimation_gwenn), sex therapist in Lille and member of the Psychologist committee. net, for their validations.