Intersex: beyond binary sex markers
SPMC J Health Care Serv. 2018;4(1):10 ARK: http://n2t.net/ark:/76951/jhcs6mh5k6
1Commission on Human Rights XI, Trinity II Bldg 8 Quimpo Blvd, Ecoland, Davao City, Philippines
2Hospital Research and Publication Office, Southern Philippines Medical Center, JP Laurel Ave, Davao City, Philippines
Correspondence Michael John T Timajo, michaeljohnt04@gmail.com
Article editor Aileen Grace L Ang
Received 29 August 2018
Accepted 30 August 2018
Cite as Timajo MJT, Española SSB. Intersex: beyond binary sex markers. SPMC J Health Care Serv. 2018;4(1):10. http://n2t.net/ark:/76951/jhcs6mh5k6
Jeff Cagandahan was born and raised as female and was diagnosed to have congenital adrenal hyperplasia early in his 20s. When he was growing up, he developed secondary male characteristics. 1 In 2005, the Regional Trial Court of Laguna granted Jeff his petition to change his given name at birth from Jennifer to Jeff and his recorded sex in legal documents from “female” to “male.” After a Supreme Court ruling in 2008, all his pertinent records, and legal certificates were amended.2 Receiving the Supreme Court ruling was the culmination of Jeff’s long process of navigating through available constructs and practical procedures in our legal and medical systems. At the center of these constructs is the notion that there are only two sexes--male and female.
Sex, usually categorized as male or female, refers to the physical and physiological features of a person, including chromosomes, hormone levels and function, gene expression and sexual anatomy.3 Gender, on the other hand, refers to the “socially constructed characteristics of women and men – such as norms, roles and relationships of and between groups of women and men.”4 Intersex is a distinct term used to describe an individual having physical characteristics that do not fit the typical constructs of either a male or a female body.5 These individuals appear as female or male on the outside with a typical male or female anatomy, respectively, on the inside or are born with genitals that look in between the typical male and female types. There are at least 40 distinct intersex variations, and between 0.5% and 1.7% of the population is born with intersex traits.6
Intersex individuals may be subject to discrimination and abuse when it is known that they are intersex. In many parts of the world, including Australia and Hong Kong, surgeries are performed in the belief that intersex bodies are unhealthy or abnormal, thus should be “fixed.”7 In many instances, these “sex-normalizing procedures” are performed while an intersex person is considered too young to be part of the decision-making process.8 Unfortunately, these procedures may cause pain, incontinence, loss of sexual sensation, permanent infertility, and mental distress, including depression.9
In communities where surgery is not practiced, discrimination comes in other violent forms such as rituals that entail the murder of intersex persons.10 This is prevalent throughout African countries.10 In Malindi, Kenya, a 17-year old boy, born with genitalia of both male and female, identified himself as a man despite being raised as a girl. Because of this, a group of men hired by his uncle drugged him and cut off his penis. The boy died of blood loss.11
Countries are slowly implementing reforms and policies against discrimination of intersex individuals.12 Malta was the first country to legally prohibit painful, high-risk surgeries on intersex children with no proven medical benefits.13 The right to physical integrity is a key human right and is associated with the right to freedom from torture and ill-treatment. “Sex- normalizing procedures,” such as clitoral reduction and gonadectomy, 14 violate the physical integrity of intersex individuals. Directly related to the right to physical integrity of an intersex person is the person’s right to health. In the Philippines, anti-discrimination ordinances for LGBT have been implemented in certain cities, but there are no anti-discrimination legislations in the country for intersex.15
The Universal Declaration of Human Rights, a United Nations (UN) document that states the basic human rights, repeatedly uses “everyone” and “all” in the document to underscore the universality of human rights and their applicability to every human being regardless of biologic make up, cultural differences, or regional particularities.16
The human rights situation of intersex persons has been recently emphasized in the Expert Meeting on ending human rights violations against intersex persons last September 16, 2015 at Geneva.17
From here on, there are still many things that our society can do to uphold the human rights of intersex individuals. Intersex, along with male and female, should be recognized by the state as a sex. Access to reproductive services and special medical programs must be made available to intersex individuals. Efforts to raise the awareness of health care professionals should be made in order to improve the capacity of the health care system to address the special needs of intersex patients. Judicial redress must be available for intersex individuals who underwent “sex-normalizing surgeries” without their consent or against their will. Practitioners involved in non-consensual and unnecessary medical interventions to intersex individuals must be held liable for their actions.
Everyone, sans distinction as to sex, deserves to be free from the travails that are associated with the rigid notions of male and female characteristics. Allowing intersex individuals to go beyond our current binary sex markers ensures protection and promotion of their basic human rights.
Article source
Comissioned
Peer review
Internal
Competing interests
None declared
Access and license
This is an Open Access article licensed under the Creative Commons Attribution-NonCommercial 4.0 International License, which allows others to share and adapt the work, provided that derivative works bear appropriate citation to this original work and are not used for commercial purposes. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc/4.0/
References
1. Republic v. Cagandahan, G.R. No. 166676. 2008 Sep 12.
2. GMA News Online [Internet]. SC ruling: 27-year-old ‘woman’ is ’male’. Manila: GMA News; 2008 September 16 [cited 2018 August 31]. Available from: http://www.gmanetwork.com/news/lifestyle/content/120751/sc-ruling-27-year-old-woman-is-male/story/. Accessed 2018 August 31.
3. Canada Institutes of Health Research [Internet]. Definitons of sex and gender. Ottawa: Canadaian Instituted of Health Research; 2015 June 17 [cited 2018 August 31]. Available from: http://www.cihr-irsc.gc.ca/e/47830.html. Accessed 2018 August 31.
4. World Health Organization [Internet]. Gender. Geneva: World Health Organization [cited 31 August 2018]. Available from: http://www.who.int/gender-equity-rights/understanding/gender-definition/en/. Accessed 2018 August 31.
5. Jones A. Redefining gender. National Geographic. 2017 January; 231(1).
6. Carpenter M. The human rights of intersex people: addressing harmful practices and rhetoric of change. Reproductive Health Matters. 2016; 24(47):74-84.
7. Health Policy Project, Asia Pacific Transgender Network, United Nations Development Programme. Blueprint for the Provision of Comprehensive Care for Trans People and Trans Communities. Washington: Futures Group, Health Policy Project; 2015.
8. Intersex Society of North America [Internet]. What do doctors do now when they encounter a patient with intersex? California: Intersex Society of North America; c1993-2008 [cited 2018 August 31]. Available from: http://www.isna.org/faq/standard_of_care. Accessed 2018 August 31.
9. Free and equal United Nations for LGBT equality. Fact sheet: Intersex. Geneva: United Nations Human Rights Office of the Higher Comissioner for Human Rights [cited 2018 August 31].
10. ILarsson N. Is the world finally waking up to intersex rights? 2016 February 10 [cited 2018 August 31]. In: The Guardian: International edition [Internet]. London: Guardian News and Media Limited. c2018. Available from: https://www.theguardian.com/global-development-professionals-network/2016/feb/10/intersex-human-rights-lgbti-chile-argentina-uganda-costa-rica. Accessed 2018 August 31.
11. Odero J. STATUS UNKNOWN: Intersex in Kenya: Held captive, beaten, hacked. Dead. 2015 Dec 23 [cited 2018 August]. In: Erasing 76 crimes [Internet]. California: 76 Crimes. c2017. Available from: https://76crimes.com/2015/12/23/intersex-in-kenya-held-captive-beaten-hacked-dead/. Accessed 2018 August 31.
12. Human Rights Watch [Internet]. Human rights watch country profiles: Sexual Orientation and Gender Identity. 2017 June 23 [cited 2018 August 31]. Available from: https://www.hrw.org/news/2017/06/23/human-rights-watch-country-profiles-sexual-orientation-and-gender-identity. Accessed 2018 August 31.
13. Transgender Europe [Internet]. Malta adopts ground-breaking trans and intersex law. 2015 April 1 [cited 31 August 2018]. Available from: https://tgeu.org/malta-adopts-ground-breaking-trans-intersex-law/. Accessed 2018 August 31.
14. Human Rights Watch [Internet]. “I want to be like nature made me”: Medically unnecessary surgeries on intersex children in the US. 2017 July 25 [cited 31 August 2018]. Available from: https://www.hrw.org/report/2017/07/25/i-want-be-nature-made-me/medically-unnecessary-surgeries-intersex-children-us. Accessed 2018 August 31.
15. Cayabyab MJ. House OKs LGBT anti-discrimination bill on final reading. 2017 September 20 [cited 2018 August 31]. In: The Philippine Daily Inquirer: News [Internet]. Makati: Inquirer Interactive, Inc. c1997-2018. Available from: http://newsinfo.inquirer.net/932095/house-oks-lgbt-anti-discrimination-bill-on-final-reading-discrimination-house-final-reading-hb-4982. Accessed 2018 August 31.
16.United Nations. Universal Declaration of Human Rights [Internet]. Available from: http://www.un.org/en/universal-declaration-human-rights/. Accessed 2018 August 31.
17. United Nations Human Rights Office of the High Commissioner [Internet]. Opening remarks by Zeid Ra’ad Al Hussein, United Nations High Commissioner for Human Rights at the Expert meeting on ending human rights violations against intersex persons. Geneva: United Nations Human Rights Office of the Higher Comissioner for Human Rights. c1996-2018 [cited 2018 August 31]. Available from: https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=16431. Accessed 2018 August 31.
Copyright © 2018 MJT Timajo, et al.
Published
August 31, 2018
Issue
Volume 4 Issue 1 (2018)
Section
Editorial
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 International License that allows others to share the work for non-commercial purposes with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional, non-commercial contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors grant the journal permission to rewrite, edit, modify, store and/or publish the submission in any medium or format a version or abstract forming part thereof, all associated supplemental materials, and subsequent errata, if necessary, in a publicly available publication or database.
- Authors warrant that the submission is original with the authors and does not infringe or transfer any copyright or violate any other right of any third parties.