Sex goes way beyond male or female

Many folks think humans come in two sexual flavors -- male and female -- and that's about the end of the story. Pull down their pants and you can know what sex they are.

The truth, as with almost everything about humans, is a lot more complex. We've seen this recently, as 18-year-old South African runner Castor Semenya was required to take a set of gender tests in August after her rapid rise in world standings.

Human sexual traits aren't one-or-the-other, though. They're more like a spectrum. Many people have well-developed genitals (penis or clitoris, vagina and breasts) and matching well-developed reproductive organs (testes or ovaries and uterus). Even within this group, as we know, some people's genitals are bigger or smaller, some more or less sensitive, and there are other variations.

But some people have less-developed genitals, and some don't have matching reproductive organs. This is why it's a spectrum. Some folks might have well-developed genitals but less-developed reproductive organs. Or the genitals might be the opposite sex of the reproductive organs. People with a vagina and breasts might not have ovaries -- or they might have testes inside, instead.

A whole host of different medical variations are the cause. Some people's bodies don't use testosterone or estrogen the same way as other people, leading to this diversity of sexual traits. Some of these medical variations can have serious effects, and medical intervention is suggested in some cases.

More often, though, people are told the options -- in many cases, the parents are told right after birth -- and allowed to decide. When genitals are significantly less-developed or formed quite differently, doctors often recommend parents have surgery to make them more "normal." These surgeries have become more controversial in recent years, as a growing number of people think of their sex at birth as natural, even if it's a minority. Some activists say we ought to broaden our understanding of human sexuality, rather than be trapped by the false "either-or" standard. Other people worry about a social stigma, and look to surgery as an answer.

So what are the numbers? How "normal" or not is sexual ambiguity? According to the Intersex Society of North America, 1-in-100 live births have some sexual ambiguity. Some of these are very mild and might not gain the attention of doctors until later in life. The number of live births where sexual ambiguity is so severe that doctors call in a sex-differentiation specialist is often said to be 1-in-1,500.

Either way, many people all around you are not just "either-or." They might be complicated, but all humans are.

For the International Association of Athletics Federation, the governing body that asked Semenya to take the gender tests, the question becomes, "What is a woman?" The IAAF's own rules don't mention requirements to compete as one sex or the other, and its policy document on gender verification says there is no test required to compete, and contains no definition of what a "female" competitor is. Instead, if someone's sex is questioned, the IAAF rules focus on whether the different sexual traits would give an athlete an advantage over other female athletes.

Early media reports (as reported here on NowPublic) have said Semenya has no ovaries or uterus and has internal testes. One report mentioned that the IAAF will recommend medical treatment to her because she is at risk. I assume she has female genitalia, or it seems unlikely that her family and doctors would keep insisting she's a woman. All of these factors might suggest she has androgen insensitivity syndrome or gonadal dysgenesis.

Both of these medical variations often occur when a person has XY chromosomes -- usually considered a "male" -- but both are allowed under the IAAF policy as "conditions that accord no advantage over other females." The BBC has reported that it is not expected Semenya will be stripped of the gold medal she won in August.

It will be interesting to see what the IAAF decides at its November meeting. Despite the early press reports, the IAAF released the following statement on Semenya on Sep. 11:


No matter how the Semenya case turns out, there will always be lots of people who don't fit neatly into either the "male" or "female" category. The more information we have, the better we will be able to deal with this sexual variation all around us. And more information is crucial for people with sexual ambiguities, so they can make the health care decisions that help them to become happy individuals.

For further reading, visit:
Organisation Internationale des Intersexues (advocacy group)
Accord Alliance (health care support)
Intersex Society of North America (archive site)
Intersex, breaking the taboo (Channel 4)
Intersexuality (Wikipedia)