A Systematic Review of the Health and Healthcare Inequalities for People with Intersex Variance.

Laetitia Zeeman,Kay Aranda

doi:10.3390/ijerph17186533

Abstract

Extensive research documents the health inequalities LGBTI people experience, however far less is known for people with intersex variation. This paper presents a review of intersex health and healthcare inequalities by evaluating research published from 2012 to 2019. In total 9181 citations were identified with 74 records screened of which 16 were included. A synthesis of results spans nine quantitative, five qualitative and two narrative reviews. Literature was searched in Medline, Web of Science, Cochrane, PsycInfo and CINAHL. People with intersex variance experience a higher incidence of anxiety, depression and psychological distress compared to the general population linked to stigma and discrimination. Progressive healthcare treatment, including support to question normative binaries of sex and gender, aids understand of somatic intersex variance and non-binary gender identity, especially when invasive treatment options are avoided or delayed until individuals are able to self-identify or provide consent to treatment. Findings support rethinking sex and gender to reflect greater diversity within a more nuanced sex-gender spectrum, although gaps in research remain around the general health profile and the healthcare experiences of people with intersex variance. More large-scale research is needed, co-produced with peers who have lived experience of intersex variation to ensure policy, education and healthcare advances with greater inclusivity and ethical accountability.

Highlights

The twenty first century is marked by an increasing awareness of gender, sex and sexual plurality with recognition of how these factors may impact on health and wellbeing
Research reporting on intersex health and healthcare is limited and often small-scale, ranging from one participant in Hughes [38], to 123 in Berglund et al [36], and 329 in Bennecke et al [35]
‘disorders of sex development’ (n = 43) including Androgen insensitivity syndrome (AIS), complete gonadal dysgenesis (GD), 5α-reductase deficiency and Leydig cell hypoplasia, found higher rates of psychological distress including depression and anxiety in women with intersex variance amongst study participants compared to the general population [37]

Summary

Introduction

The twenty first century is marked by an increasing awareness of gender, sex and sexual plurality with recognition of how these factors may impact on health and wellbeing. Large scale international reviews collating these research findings include studies of LGBTI health inequalities [1,2], the disease burden in gender and sexual minorities [3], intersex health [4], the global health burden and needs of transgender populations [5], the health profile of sexual minority women [6], and more recently, loneliness and social support in older LGB communities [7]. These studies share a common denominator of an increasing concern over how diverse identities and bodies intersect and experience health inequalities in LGBTI populations. Practitioners working in health and social care settings are tasked with understanding the specific needs of LGBTI people in a context of evolving practice, changing terminology and emerging policy directives [9]

Methods

Results

Discussion

Conclusion