What does it mean to say someone is intersex?
The [International Association of Athletics Federations] will not drug me or stop me from being who I am.
Caster Semenya, South African intersex athlete and two-time Olympic gold medalist
Defining the Issue
A Disorder of Sexual Development (DSD), a term first developed in 2006, is a condition in which someone may be born with the DNA of one sex, but their body looks like the other sex.1
DSDs are a diverse group of conditions associated with atypical development of internal and external genitalia. DSDs can be difficult to understand because they involve genes, hormones, and reproductive organs (both internally and externally).
Having a DSD means the person doesn’t develop the same way other people do. Because their genitals don’t match their genetics, their anatomy doesn’t always neatly fit into the category of male or female. Some of the more widely discussed DSDs include Congenital Adrenal Hyperplasia, Androgen Insensitivity Syndrome, and 5-alpha reductase deficiency.
The word intersex is preferred to DSD by some who think the word disorder is stigmatising.2 Others prefer the term differences of sexual development.3 By defining themselves as intersex, people are asserting that they don’t have a disorder; they’re just different. In contrast, others contend the term DSD is merely descriptive and directs attention to the fact that sexual development has not proceeded as normal.
How many people are born with a DSD? The answer depends to a large degree on what gets classified as a DSD. Planned Parenthood’s claim that “1 in 100 people born in the U. S. is intersex”4 is absurdly high and inaccurate.5
Here’s what is clear: The very extreme forms of DSDs in which a child is born with genitals that do not match his or her genetics are rare (e.g., XY child with a vagina; XX child with a penis). Cases where the child has both testes and ovaries are rarer still. Minor differences like a urethral opening in a different place are more common, but such problems don’t really cause any confusion about a child’s sex.
Biblical Ethical Principles
Having a DSD does not detract from the fact that a person is made in the image of God (Genesis 1:26–28). All of us struggle with the effects of the fall in that our bodies get sick, decay, grow old, and eventually die.
Those with DSDs simply face the effects of the fall on the human body at an earlier age and in more profound ways. Having a DSD does not mean the child is cursed or that God is angry at the family. God loves children born with a DSD.
Christian anthropology insists on the goodness of the two genders of male and female (Genesis 1:27). At the same time, we show mercy and compassion for people who face unusual and rare challenges connected with DSDs.
Suggested Moral Stance
In John 9, Jesus showed mercy to a man born blind. In the same way, we should show mercy to children born with a DSD as Jesus’s followers. That means we walk with their families through the many difficult questions of childhood and puberty, showing great patience as the children move into adulthood. We help the children embrace the gender that best fits their own unique situation and encourage them to live in accordance with biblical sexual ethics.
The existence of DSDs does not mean gender is merely a social construction or that a person is free to choose whichever gender they prefer. The existence of DSDs as rare exceptions actually proves the standard that there are only two genders.
For example, if I tell my students, “Over fall break, you will not be required to submit your weekly homework,” I am reasserting the rule that usually their homework is due weekly, but there is an exception during fall break. Likewise, when we encounter a case in which a child’s genitalia do not appear clearly to be male or female, we are asserting that normally the genders of male and female are easily identifiable.
What does modern medicine say about treating DSDs? Debates about surgical management of DSDs are quite contentious, with different stakeholders often holding conflicting opinions. In the past, the standard opinion was that the earlier the surgical reconstruction of the genitals is done, the better. But some people who had such corrective surgery as children were unhappy with the results as adults.6
The European Society of Pediatric Urology and the Society for Pediatric Urology summarise some of the concerns involved and say, “Atypically developed genitalia can affect not only physical appearance and body image, but also function of the urinary tract, kidneys, gonads, and the psychological and psychosexual development of the individual.”7
The immediate concern for DSD babies is to ensure a good urinary tract and colorectal function while sometimes waiting until a child is older for surgical genital reconstruction, if any is done at all.8
These decisions must be made with great care on a case-by-case basis with the best advice of trained surgeons and in collaboration with a team of experts. The primary concern is always to see that a child is healthy and thriving.
DSDs and a transgender identity are not the same things (see chapter 45 for a discussion of the latter). A DSD is diagnosable by objective criteria. Transgenderism is based on the subjective experience of someone who claims to feel trapped in the wrong body. While not denying the subjective feelings of someone who has such an experience, one cannot test for transgender identity in the same way one can test for an intersex condition. There is no objective test of one’s DNA or hormone levels that can prove a person is transgender. But with DSDs, most are clearly observable or diagnosable by objective medical tests.
1 See I. A. Hughes et al., “Consensus Statement on Management of Intersex Disorders,” Pediatrics 118, no. 2 (August 2006): 755, https://doi.org/10.1542/peds.2006-0738.
DSD Disorders of Sex Development
DSD Disorders of Sex Development
DSD Disorders of Sex Development
DSD Disorders of Sex Development
DSD Disorders of Sex Development
2 “InterACT Statement on Intersex Terminology,” InterACT: Advocates for Intersex Youth, https://interactadvocates.org/interact-statement-on-intersex-terminology/.
3 See “Differences in Sex Development,” National Health Service, August 15, 2019, https://www.nhs.uk/conditions/differences-in-sex-development/.
DSD Disorders of Sex Development
DSD Disorders of Sex Development
DSD Disorders of Sex Development
4 “What’s Intersex,” Planned Parenthood, https://www.plannedparenthood.org/learn/gender-identity/sex-gender-identity/whats-intersex.
5 For example, Congenital Adrenal Hyperplasia occurs in perhaps a ratio of 1:14,000 children in its classical form and 1:1,000 in its non-classical form. Karen Lin-Su, Saroj Nimkarn, and Maria I. New, “Diagnosis and Management of Congenital Adrenal Hyperplasia,” Pediatric, Adolescent, & Young Adult Gynecology, ed. Albert Altchek and Liane Deligdisch, eds. (Chichester: Wiley-Blackwell, 2009), 25. Estimates of children born with Complete Androgen Insensitivity Syndrome vary widely from 1:20,000 to 1:64,000. Angeliki Galani et al., “Androgen Insensitivity Syndrome: Clinical Features and Molecular Defects,” Hormones 7, no. 3 (2008): 219. See also Angelo Poletti, Paola Negri-Cesi, and Luciano Martini, “Reflections on the Diseases Linked to Mutations of the Androgen Receptor,” Endocrine 28, no. 3 (December 2005): 243–62. These authors actually suggest 1:20,400 births, but it is difficult to know if they mean AIS in general or CAIS in particular.
6 Naomi S. Crouch et al., “Sexual function and genital sensitivity following feminizing genitoplasty for congenital adrenal hyperplasia,” The Journal of Urology 179, no. 2 (February 2008): 634–38.
7 P. Mouriquand et. al, “The ESPU/SPU standpoint on the surgical management of Disorders of Sex Development (DSD),” Journal of Pediatric Urology 10 (2014): 9.
DSD Disorders of Sex Development
8 Hughes et al., “Consensus Statement.” The Consensus Statement on Intersex Disorders says, “Adverse outcomes have led to recommendations to delay unnecessary genital surgery to an age of patient informed consent, although relative risks and benefits are unknown.”
Branch, J. A. (2021). 50 Ethical Questions: Biblical Wisdom for Confusing Times (pp. 217–221). Lexham Press.
