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Changing the Nomenclature/Taxonomy for Intersex: A Scientific and Clinical Rationale
Journal of Pediatric Endocrinology and Metabolism
Abstract
We explain here why the standard division of many intersex types into true hermaphroditism, male pseudohermaphroditism, and female pseudohermaphroditism is scientifically specious and clinically problematic. First we provide the history of this tripartite taxonomy and note how the taxonomy predates and largely ignores the modern sciences of genetics and endocrinology. We then note the numerous ways that the existing taxonomy confuses and sometimes harms clinicians, researchers, patients, and parents. Finally, we make six specific suggestions regarding what a replacement taxonomy and nomenclature for intersex should do and not do, and we call for the abandonment of all terms based on the root "hermaphrodite".
... 26,27 A clinical shift in this century, from the traditional term 'hermaphrodite' to 'disorders of sex development', was framed as a way of escaping pejorative and old-fashioned beliefs. 28 Around the same time, the term intersex was abandoned in clinical settings, with the stated intention to distinguish questions of 'identity' from clinical disorders and head off reinterpretations of the meaning of variations of sex characteristics in the context of LGBTQ activism. 28,29 However, nomenclature shifts in clinical settings have not addressed the substance behind those beliefs; that is, they have not addressed underlying clinical and social misconceptions, stigmatisation and harm. ...
... 28 Around the same time, the term intersex was abandoned in clinical settings, with the stated intention to distinguish questions of 'identity' from clinical disorders and head off reinterpretations of the meaning of variations of sex characteristics in the context of LGBTQ activism. 28,29 However, nomenclature shifts in clinical settings have not addressed the substance behind those beliefs; that is, they have not addressed underlying clinical and social misconceptions, stigmatisation and harm. Indeed, harmful preconceptions that intertwine ideas about bodies and identities remain evident, including in clinical settings. ...
Children with innate variations of sex characteristics (also termed differences of sex development or intersex traits) are routinely subjected to medical interventions that aim to make their bodies appear or function more typically female or male. Many such interventions lack clear evidence of benefit, they have been challenged for thirty years, and they are now understood to violate children’s rights to bodily autonomy and bodily integrity. In this paper I argue that these persist in part due to epistemic injustices and biomedical authority. Epistemic injustices include limited disclosure of current practices, the systemic marginalisation of community voices and psychosocial professionals, and attempts to discredit or mis- represent testimony. Bioethics has largely failed to change medical practice, and sometimes plays a role in perpetuating epistemic injustices. I find that the development of an intersex movement provides opportunities for epistemic justice and liberation by engaging with other disciplines and promoting oversight of medical decision-making. The paper draws particularly on Australian sources, including internationally influential ethical principles.
The field of intersex studies is advancing and requires scholars to update their knowledge and representation of people with intersex variations. To examine how psychology students are taught about people with intersex variations, we reviewed best-selling USA psychology textbooks in introductory psychology (n = 8), psychology of women and gender (n = 5), human sexuality (n = 4), and biological psychology (n = 3). All textbooks indexed intersex or cognate terms, with alternative terms (e.g., disorders of sex development) indexed less frequently. Intersex variations were described as emerging during the stages of sex development, and as challenging binary categories for sex. Several specific variations were commonly described as syndromes with little reference to psychological research or lived experiences. Women and girls with congenital adrenal hyperplasia (CAH) were most clearly framed as “natural experiments” about how nature and nurture intersect. Diverse sex development involving 46 XY genotypes tended to be described as difference from norms for male endosex development. However, two textbooks included lengthy narratives of people’s lived experiences as intersex, and photographs of intersex-identified individuals were common. Photo images of the South African athlete Caster Semenya depicted more of her body than did the photo images of other intersex-identified individuals. The textbooks generally included critical reflection on the assumptions of a gender binary, and on the attribution of ambiguity to others’ bodies, genetic determinism, the medical gaze, and the sex testing of athletes. We consider how information in these textbooks can shape the representation of intersex among psychology students, and how it may be used to develop more humanizing representations of intersex across all psychology textbooks.
A ciência hegemônica considera que existem apenas dois corpos sexuados: o masculino e o feminino, o que denomina-se de “dimorfismo sexual”. Contudo, as evidências revelam que os corpos de homens e mulheres variam imensamente. O presente artigo pretende problematizar o discurso científico hegemônico, o qual estabelece apenas o corpo masculino típico e o corpo feminino típico como normais e, com isso, enquadra todos os corpos que fogem aos modelos típicos como errados ou patológicos. A pesquisa realizada foi bibliográfica e documental. O artigo foi dividido em três tópicos: o primeiro apresenta uma breve história da construção das noções hegemônicas sobre os corpos sexuados; o segundo tópico apresenta como os corpos atípicos são remodelados pelo discurso científico a fim considerá-los errados e patológicos, ao invés de variações da natureza; e, por fim, o terceiro apresenta uma nova forma de olhar todos os corpos sexuados.
The article presents a clinical observation of an extremely rare in gynecological practice androgen insensitivity syndrome (AIS). The authors give data on the pathogenesis of the disease, modern classification and terminology of various forms of this pathology. The phenotypic manifestations of the disease, the results of clinical and instrumental studies and surgical treatment are described.
The results of the study show the possibility of clinical diagnosis of AIS and timely surgical treatment of patients with this pathology, due to the high risk of gonadal malignancy.
Introduction:
Intersectionality refers to the interconnectedness of various social locations creating unique experiences for individuals and groups, in the context of systems of privilege and oppression. As part of immunization coverage research, intersectionality allows healthcare professionals and policymakers to become aware of the constellation of characteristics contributing to low vaccine uptake. The objective of this study was to examine the application of intersectionality theory or concepts, and the appropriate use of sex and gender terminology, in Canadian immunization coverage research.
Materials and methods:
The eligibility criteria for this scoping review included English or French language studies on immunization coverage among Canadians of all ages. Six research databases were searched without date restrictions. We searched provincial and federal websites, as well as the Proquest Dissertations and Theses Global database for grey literature.
Results:
Of 4725 studies identified in the search, 78 were included in the review. Of these, 20 studies included intersectionality concepts, specifically intersections of individual-level characteristics influencing vaccine uptake. However, no studies explicitly used an intersectionality framework to guide their research. Of the 19 studies that mentioned "gender", 18 had misused this term, conflating it with "sex".
Conclusions:
Based on our findings, there is an evident lack of intersectionality framework utilization in immunization coverage research in Canada, as well as misuse of the terms "gender" and "sex". Rather than only focusing on discrete characteristics, research should explore the interaction between numerous characteristics to better understand the barriers to immunization uptake in Canada.
Supported by about eight hundred scientific references, mainly from the fields of biology, psychology, psychiatry, and sociology, this bibliotherapeutic work reveals surprising information about the first stage of human existence: in utero. It is aimed both at the general population, to raise awareness of intrauterine psychic life, and at health professionals, to whom the authors propose the inclusion of a new concept—Idealized Sex Projection—into their theoretical rationales, to enable more incisive and effective practices.
As a result of about twenty years of research, the authors discuss in this book the parental preference for the sex of their children by illustrating fifty clinical cases that were worked with Family Constellations (FC) as a classical psychotherapy and subjected to exploratory research based on hermeneutic phenomenological reflection. Numerous insights and new perspectives arise from this systemic-phenomenological practice, such as those on patriarchy, sex-selective abortion, female foeticide, female neglect, feminicide, the fraternal birth order effect, non-heterosexuality, and intra-familial incest.
Information is also given here on rarer topics in the FC literature, such as the phenomenological stance, schemas about being-with-the-other, types of attachment styles, psychic crypts, systemic ghosts, invisible loyalties, and cognitive heuristics.
The authors also propose to add some new concepts to the scientific literature on general psychotherapy, such as homeostatically oriented sentences, psychic protoschema, archaic fault, fictive attachment, systemic-phantom-member, three-dimensional obscurity of trauma, imperceptible trauma, macrosystemic psychopathology, specular phantomization, feminine-social-political negligence, politically imposed sociopsychosis, and the central theme of this work, the ISP, or idealized sex projection.
Members of the ancient Mesopotamian cult of Ištar have been subjected to various interpretations by scholars despite only a small number of textual references. In scholarly literature, assinnu have been described as everything from cultic prostitutes, to castrates, to “playboys” and “festival people.” This paper will discuss attestations of assinnu in ancient textual sources that have been deployed for various interpretations and translations relating to gender and sexuality. The deepest focus is on the issues of sex assignment at birth, castration, sexuality, prostitution, and transvestism. The incorporation of modern gender theory will aid with deconstructing long-held interpretive traditions within Assyriological scholarship and make space for a new analysis of assinnu as performing a non-normative or non-binary gender. This new, minimal interpretation of assinnu is less dependent on rigid categorization and instead allows room for ambiguity in the ancient texts and modern descriptions of assinnu.
Focusing on the Italian legal scenario, the paper examines medical practices that impose cosmetic surgeries on intersex children. Carried out with the aim of adjusting their genitalia to a perfect male or female body, these practices infringe upon the fundamental rights of the children subjected to them and demand new ways of protection. The paper explores the legal approaches that could be adopted to challenge them and to ensure the protection of children’s rights.
ResearchGate has not been able to resolve any references for this publication.