Some People Don’t Fit Into the Biological Category of ‘Man’ or ‘Woman’

In the Netherlands there are about eighty thousand people who, according to doctors, physically don’t fit in the ‘man’ or ‘woman’ category: people with an intersex condition. You might not know it but you've probably met someone with this condition.

Miriam van der Have has the intersex condition Androgen Insensitivity Syndrome (AIS) and is the head of the Dutch Network Intersex/DSD. She was born with a vagina and got breasts during puberty, but instead of ovaries she had testes and she has XY-chromosomes. Women with AIS neither have a womb, nor ovaries, so they can’t have children. “But it also has advantages," says Miriam, "because women with AIS don’t have any body hair and they never smell of sweat.”

We caught up with Miriam to find out why the letter "I", for intersex, should be placed after "LGBT".

VICE: First, that long name: Intersexcondition/DSD. What is it?
Miriam van der Have: It is a collective term for multiple conditions where people physically don’t completely fit in the ‘man’ or ‘woman’ categories. Doctors speak of DSD, which officially stands for Disorders of Sex Development, but ‘Disorders’ is being replaced by ‘Differences’ nowadays. Human rights organisations use the word Intersex to emphasise the difference with the medical diagnose.

This is different with transgender people, who are physically man or woman, but identify with another gender. To emphasise their gender diversity, they often call themselves transgender. The choice to get operated or not usually has to do with the feeling that the body doesn’t correspond with the inner self. With intersex it's often the other way around. It is determined that the body isn’t obviously biologically man or woman, despite the fact that the person feels completely male or female and refers to him/herself that way. Unlike popular belief, there are few people with an intersex condition who want to change their sex.

And what about hermaphrodites?
That's different. The term "hermaphrodite" indicates ambiguity. A hermaphrodite can both impregnate and give birth. Snails and worms can do this, for instance. Even in the most exceptional case that someone with an intersex condition has both testicular and ovarian tissue, they are not able to both impregnate and give birth.

How can you see that someone has this condition?
That is something doctors struggle with as well, because there are so many conditions that all result in different forms of intersex or DSD. One in 4500 babies aren’t clearly boy or girl, like in the example of the large clitoris or penis. Then an examination of the sex is necessary. It could also be that a girls is born without a womb and a vagina. Sometimes there is a little dimple where the vagina should have been. But it can also be that the problems occur later. For example, a girl who comes to the doctor because she doesn’t start menstruating and turns out to be born without a womb but with XY-chromosomes. There are also boys who have XXY-chromosomes and girls who have only one X-chromosome. Or girls who make too much testosterone, which results in excessive hair and extreme acne.

When so many people have a condition like this, why is it so unfamiliar?
Intersex was a taboo for a very long time. Even doctors didn’t speak about it. A child was born, was examined, got given a sex and had an operation when needed. The child grew as either a boy or a girl. Because it usually isn’t visible from the outside, doctors advised patients to just keep quiet.

But there is a reason to talk about it?
Yes, absolutely. Because the condition has been kept quiet for so long, people who are aware of their condition are overwhelmed by a sense of shame, secrecy and the feeling that something is wrong with them. Often they don’t even dare to get into a relationship. They’d rather be alone than talk about their intersexuality. But in recent years it has become increasingly clear that there isn’t such an obvious distinction between men and women. We see that in the growing acceptance of the LGBT community.

The problem is that in the medical world, when it’s not clear whether a newborn baby is a boy or a girl, it is examined and then the child is operated on and that's too far.

So the problem lies with the medical world?
Yes. People with an intersex condition are still being treated as if they are sick. Those treatments are being done even in the earliest stages of the pregnancy. There are cases of embryo selection where the embryo is aborted because it was visible that the child would have an intersex condition. It's the same discussion as people with Down Syndrome – they differ from the norm, but is that really a reason for exclusion?

What should change?
There should be a bigger awareness that "man" and "woman" is not a dichotomy. Thanks to the LGBT movement in the Netherlands, people see that there are a lot of variations on gender and sexuality. Now people should start realising that even in a biological sense the division between men and women isn’t always clear. When the society accepts that, the medical world won’t immediately choose to treat people to make them fit into the "norm". That process has started, but it can always go faster.

More on gender:

You No Longer Need A Sex Change to Switch Gender in Denmark

Iran Will Subject Female Soccer Players to Random Gender Tests

Is It OK for a Journalist to Reveal the Birth Gender of a Trans Person?