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Following the publication of my last article “Intersex Is Not as Common as Red Hair,” some debates have broken out on social media regarding the distinction between so-called “differences of sexual development,” or DSDs, and “intersex” conditions. In my article I drew a distinction between these two terms, stating that “while all intersex conditions may be considered DSDs, not all DSDs are necessarily intersex conditions.” Simply put, I view intersex to be a subset of DSDs.
But not everyone agrees on how to define intersex. As I mentioned in my previous article, Anne Fausto-Sterling, professor of biology and gender studies at Brown University, coauthored a review paper that broadly defines an intersex person as “an individual who deviates from the Platonic ideal of physical dimorphism at the chromosomal, genital, gonadal, or hormonal levels.” Using this extremely broad definition they conclude that approximately 1.7% of individuals are intersex, and perhaps even 2.27% if the criteria are loosened even more.
Many prominent intersex organizations also have their own definitions that vary widely. For instance here’s how the intersex organization InterACT defines intersex:
Intersex is an umbrella term for differences in sex traits or reproductive anatomy. Intersex people are born with these differences or develop them in childhood. There are many possible differences in genitalia, hormones, internal anatomy, or chromosomes, compared to the usual two ways that human bodies develop.
And the Intersex Society of North America defines intersex a bit more narrowly:
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.
So, why do I use a much narrower definition than those used by Fausto-Sterling and many intersex organizations? Am I just trying to make intersex seem as rare as possible (<0.02%), whereas activists and scientists like Fausto-Sterling are trying to do the exact opposite by quoting the much broader 1-2% statistic? Are we all then equally guilty of letting our biases pull us in opposite directions? No, and here’s why.
My view—that intersex is a subset of DSDs—comes from a paper by Leonard Sax, a psychologist and physician, where he defined intersex as “those conditions in which chromosomal sex is inconsistent with phenotypic sex, or in which the phenotype is not classifiable as either male or female.” Sax favored this definition because of its clinical relevance; that is, it simply made no clinical (or logical) sense to place individuals with Klinefelter syndrome or Turner syndrome (whose sex is unambiguous) within the same umbrella category as individuals with conditions resulting in some degree of sexual ambiguity. Thus, Sax’s definition provides more nuance and greater conceptual clarity regarding the actual phenomena one may wish to consider.
Many activists, on the other hand, rely on there being a disparity between what the 1-2% statistic they frequently quote actually refers to and what they’re hoping people interpret “intersex” to mean. For example, they use the existence of intersex people to argue that sex is a spectrum, and so it is clear that they want people to view intersex conditions as occupying some intermediate or ambiguous space between males and females (i.e. Sax’s narrow definition of intersex). However, they then engage in rhetorical sleight of hand when they quote the prevalence of intersex conditions as being “as common as red hair,” or between 1-2% according to Fausto-Sterling’s criteria, which includes 99 people who are not in any way sexually ambiguous for every one that is. Thus, activists are actively misleading people into believing the prevalence of sexual ambiguity in humans is two orders of magnitude higher than it actually is (~2% vs 0.02%).
Activists are trying to have it both ways. They want a definition of intersex that communicates sexual ambiguity for the purposes of undermining the sex binary in favor of a spectrum model, but they also want to portray intersex as being astonishingly common. To achieve this they dishonestly (or perhaps ignorantly) couple Sax’s narrow concept of intersex (sexual ambiguity) with Fausto-Sterling’s extremely broad intersex statistic (1-2%). This is how the Social Justice sausage is made.
Sax’s definition is robust because it adds more clarity to the conversation by separating out different concepts—sex ambiguity vs any difference of sex development—yet I have no issue with people using other definitions or even using “intersex” and “DSD” interchangeably. All that really matters is that, whichever definition one chooses to use, people are very clear about what phenomena they are referring to when they use these terms. Failing to do so results in people talking past one another or endless semantic bickering about the “true” definition of intersex, instead of engaging with the actual concepts that are necessary for a clear and productive conversation to take root.
There is no “true” definition of intersex. Rather, we have definitions that are more or less useful depending on what information is trying to be honestly conveyed.
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I worked in clinical nursing (pediatrics) for 20 years, so the clinical definition resonates well with me, where we saw children born w ambiguous genitalia along with Klinefelter and Turner syndrome. Good post!
Thank you for this but I remain at least a little confused. How can or should the 0.0X% sexually ambiguous people be classified? Male? Female? Neither? Both?