Intersex Individuals Research Articles

Fair Competition and Inclusion in Sport: Avoiding the Marginalisation of Intersex and Trans Women Athletes

Despite the reality of intersex individuals whose biological markers do not necessarily all point towards a traditional binary understanding of either male or female, the vast majority of sports divide competition into categories based on a binary notion of biological sex and develop policies and regulations to police the divide. In so doing, sports governing bodies (SGBs) adopt an imperfect model of biological sex in order to serve their particular purposes, which, typically, will include protecting the fundamental sporting value of fair competition. Yet, one potential consequence of enforcing such an approach would seem to be the exclusion or marginalization of individuals whose biological development does not fit within the binary model, whether due to genetics or through a choice to undergo medical intervention to better represent a chosen gender identity. Any such exclusion or marginalization will inevitably tend to undermine another fundamental value of sport, that of inclusivity. In the context of those with differences of sex development, SGBs appear to be faced with a difficult problem: dealing with a conflict between two fundamental values of sport. Different approaches to this problem have been suggested, with some academics proposing that sports organisations, in general, ought to prioritise fairness above, while others suggest the need to ‘balance’ competing values or even to prioritise inclusion over fairness. However, it is argued that any of these approaches are, in principle, justifiable as any sport should be free to prioritise or balance its own values. What seems more important for any SGB is the need for a rational and transparent justification of regulations that pursue fair competition at the expense of inclusivity. Furthermore, where fair competition and inclusivity are fundamental values, any such justification would seem to demand adherence to some basic norms. First, the regulations should be built on (and articulate) a consistent and principled basis of what ‘fair competition’ means in a particular sport. Second, any regulations should only exclude or restrict participation to the minimum degree necessary to achieve the sense of fair competition so articulated. Third, SGBs should be transparent about what their values are and where their priorities lie so that participants and other stakeholders are able to make an informed choice as to whether they wish to participate in, support, or be associated with a particular sport. With reference to the adoption of the Eligibility Regulations for Athletes with Differences of Sex Development (the ‘DSD Regulations’) by the International Association of Athletic Federations (IAAF), this article seeks to evaluate whether the approach of the IAAF satisfied these basic requirements.

Analyzing Jameson’s Double Consciousness in the Novel “Confessions of a Teenage Hermaphrodite”

Intersex individuals are grieved with elimination and deprivation. It has been a general observation that they are destined to remain unknown or low-caste. The societies do not provide them the opportunities to fulfill their basic needs, but rather add to their miseries and despairs. The present study tends to analyze the role of other people in the growth of double consciousness of intersex through the application of Du Bois’ (1903) theory of Double Consciousness on the intersex character of Jameson from the novel “Confessions of a Teen Age Hermaphrodite”. By adopting the qualitative approach and through textual analysis, the study interestingly highlighted that not only harsh, rigid, and degrading attitudes but sometimes care and affection of people also cause double consciousness of intersex. Moreover, it was also noted that some people do not deliberately become the source of intersex’ double consciousness, it is done unintentionally. Keywords: Double Consciousness, Intersex, Confessions of a Teen Age Hermaphrodite

Differences in infection and prevention of HIV and other sexually transmitted infections among older adults in Columbus, Ohio.

In the United States, rates of sexually transmitted infections (STIs) have increased year after year for the past six consecutive years. Even so, the majority of research has focused on younger populations with little work examining infections and prevention methods among older adults. Data come from the Columbus Health Aging Project (N = 794). This study was designed to assess several domains of health among adults aged 50 years and older in Columbus, Ohio with a particular focus on addressing disparities based on sexual and gender identity. Multivariable logistic regression models were used to examine the association between sociodemographic factors and risk of STI acquisition, HIV diagnosis, and several common prevention methods, adjusting for known confounders. Key results suggest that cisgender women, intersex individuals, and transgender women are less likely to use condoms relative to cisgender men. Meanwhile, white individuals were least likely to use condoms while bisexual individuals were most likely. Transgender women and those living with family/roommates were most likely to use PrEP/PEP relative to cisgender men and those living with a spouse or partner. Cisgender women, compared to cisgender men, were most likely to report not using any prevention method. This study highlights the need for better research among older adults in order to ascertain how interventions may be targeted to specific populations. Future research should aim to educate individuals differently based on their specific needs rather than treating older adults as a homogenous population or ignoring their sexually active nature entirely.

Intersex Interventions as Human Rights Violations: The European Court of Human Rights Sets Out Guiding Principles in M v France

In 2022, the European Court of Human Rights, for the first time, signalled that it regards non‐consensual interventions on intersex individuals which are not motivated by medical necessity as human rights violations. This case note argues that the admissibility decision in question, M v France, albeit ruled inadmissible on procedural grounds, constitutes an important step towards binding supranational human rights standards, particularly regarding torture and ill‐treatment. While M v France could inspire intersex people to further their claims as strategic litigation, the note reflects on the central questions invoked by the Court's decision and some of the legal hurdles that intersex people may face when approaching courts with claims for recognition and redress.

Quality of Life and Psychosocial Well-Being among Intersex-Identifying Individuals in Puerto Rico: An Exploratory Study.

Intersex is an umbrella term used to describe the diversity or differences in the characteristics of physical sexual development. Approximately 1.7% of the population are born intersex, and 1 in every 2000 babies at birth presents genital variation. Unfortunately, there is a lack of research on the health of intersex-identifying persons in Latin America. This study aimed to document experiences of discrimination and violence among self-identifying intersex individuals in Puerto Rico and to determine if there is a significant difference in the quality of life, psychological well-being, and social well-being between intersex-identifying and endosex individuals. This was a quantitative method pilot study with a cross-sectional approach and exploratory comparative group design. An online survey was used, where a total of 12 self-identifying intersex adult participants were recruited, and 126 endosex adult participants served as a comparative group. The findings show that 83% of the participants reported experiences of discrimination and different types of violence due to their intersexuality. There was a significant difference between the intersex-identifying and endosex groups in psychological well-being, including in three of its dimensions (positives relations, autonomy, and environmental mastery). However, there were no significant differences between the groups in quality of life or social well-being. The findings of this study provide a preliminary understanding of the health disparities of intersex-identifying individuals in Puerto Rico and suggest the need for more profound research, especially the inclusion of other Caribbean and Hispanic countries. The findings also preliminarily imply the need for local and global interventions to reduce physical and mental health disparities and to improve health, quality of life, and well-being among intersex-identifying individuals.

Narrative Therapy with Intersex Individual: A Clinical Case Study

Aim of Study. In the realm of family counselling, narrative counselling is gaining traction as a cutting-edge treatment option. In the present study the use of story counselling in working with intersex males has received special attention. The purpose of the current research was to provide a framework of narrative counselling and to investigate how intersex males' tales are influenced by cultural norms, worldviews, power, and privilege, and how this affects their emotional happiness. Methodology. The present investigation used single case study research design and collect data from a male individual with intersex problem. The data was collected through semi-structure interview and different stories writeup from the client. Result. The sources of the numerous themes and subthemes were investigated using thematic analysis in this qualitative study. Through semi-structured interviews, numerous themes, such as hopelessness, pessimism, self-blame, victimization, and learned helplessness, were found. Conclusions. According to the findings of the present study, there is a significant need to comprehend the difficulties and psychological pressures that affect individuals with intersex illnesses and to give narrative therapy to reduce their suffering. This study was undertaken not only for intersex individuals, but also for mental health professionals, in order to increase knowledge of sexual issues in Pakistani society and culture and to provide insight into them.

Transgender and Intersex Individuals and Religious Life

Societal views of the place of transgender and intersex individuals and the right of such individuals to participate in activities and institutions previously made unavailable to them based on sex are changing rapidly. While many institutions are allowing such people to engage in activities previously reserved for the sex opposite from their biological sex, the Catholic church must stand firm in its fidelity to the truth of human sexuality. However, groups within the Church have expressed differing views; namely, the German Synod and its recent text titled, “Dealing with Gender Diversity.” This paper seeks to examine the synod’s conclusions and refutes them using appeals to Orthodox Catholic teaching.

Effect of dosage of orally administered 17α-methyltestosterone on sex reversion of the yellowtail tetra Astyanax lacustris (Lütken, 1875).

The females of yellowtail tetra (Astyanax lacustris), known as the freshwater sardine, are approximately 1.33 times larger than males, and thus, all-female monosex culture would increase production and reduce size variability. The present work aimed to identify the optimal dose of 17α-methyltestosterone (MT) to be used in the masculinization of A. lacustris for indirect sex reversal. Three different concentrations of MT (20, 40, and 60 mg/kg of feed in the diet) were fed to the fry for 30 days. Thirty adult individuals from each treatment, including the control (0 mg MT/kg), were evaluated for gonadal development, morphological and histological sexual identification, zootechnical performance, and the possible genotoxic effect caused by prolonged exposure to MT. MT significantly (P<0.01) affected the differentiation of the gonads, with the presence of possible inhibitory effects in all treatments. Intersex individuals were present in the 20 and 60 mg MT/kg treatments. All treatments were able to masculinize A. lacustris and the treatment with the lowest hormone concentration produced the highest percentage of males 76.7%, while the control had 46.7% males. The presence of erythrocyte nuclear alterations indicated a possible cytotoxic effect of MT in treatments 40 and 60 mg MT/kg, however, the use of the hormone did not affect the growth and the survival of the individuals. Thus, the use of MT is a viable option for obtaining neomales as a first step into the production of all-female progenies.

Challenges accessing physical activity from a transgender perspective: A systematic review

The gender-diverse community faces numerous barriers that make physical activity difficult to access, meaning they are less physically active than their cisgender counterparts, compounding the existing health and wellbeing inequalities experienced by this group. The current study conducted a systematic review of sporadic literature relating to trans, non-binary and intersex people’s experience of physical activity with the aim of understanding how individuals negotiate and experience physical activity environments. A systematic searching of 8 databases and screening highlighted 30 academic papers for review. A narrative synthesis of the experiences of trans, non-binary and intersex individuals formed a three-layer model of influence. The first layer encapsulated the systemic and systemic influences such as transphobia and trans-moral panic. The second layer included external influences such as others’ behaviour, gendered spaces and exclusionary policies. The third layer was made up of internal influences such as internalised transphobia and gender concealment. The focus on fitting gender non-conforming individuals into a binary system through gendered spaces, pressures to switch teams and provide ‘proof’ of gender conformity set a dangerous precedent of the physical activity space as an unwelcoming and unsafe place for those who do not conform to the gender binary. If there should be a hope to address the health inequalities faced by the trans, non-binary and intersex community, the focus must move away from conformity and the debate of ‘fairness’ towards true inclusion and creating an environment where gender minorities can feel safe to engage with physical activity.

The Squamate Clitoris: A Review and Directions for Future Research.

The clitoris is a part of the genitalia of female amniotes that typically functions to stimulate sensory arousal. It usually consists of a small organ that is dimorphic and homologous to the penis. The developing amniote embryo forms a genital tubule, then sex hormones initiate a developmental cascade to form either a penis or clitoris. In squamates (lizards and snakes) the genital tubule develops into a paired hemiphallus structure called the "hemiclitores" in the female and the "hemipenes" in the male. The complex evolution of squamate hemipenes has been extensively researched since early discoveries in the 1800's, and this has uncovered huge diversity in hemipenis size, shape, and ornamentation (e.g., protrusions of spines, hooks, chalices, cups). In contrast, the squamate hemiclitoris has been conspicuously under investigated, and the studies that describe this anatomy are fraught with inconsistences. This paper aims to clarify the current state of knowledge of the squamate hemiclitoris, providing a foundation for further research on its morphology and functional role. We show that while several studies have described the gross anatomy of hemiclitores in lizards, comparative information is entirely lacking for snakes. Several papers cite earlier authors as having reported discoveries of the snake hemiclitores in vipers and colubrid snakes. However, our examination of this reveals only erroneous reports of hemiclitores in snakes and shows that these stem from misinterpretations of the true anatomy or species involved. An especially problematic source of confusion is the presence of intersex individuals in some snake populations; these form reproductively functional ovaries and a single hemipenis, with the latter sometimes mistaken for a hemiclitoris (the intersex hemipenis is usually smaller and less spinous than the male hemipenis). Further research is recommended to identify the defining anatomical features of the squamate hemiclitores. Such studies will form a vital basis of future comparative analyses of variation in female genitalia in squamates and other amniotes.

Movement pattern and population structure of Clibanarius antillensis Stimpson, 1859 in south Brazil

AbstractHermit crabs have soft abdomens and therefore must use empty gastropod shells as protection. Shell choices do not occur at random, and the animals often occupy shells with the best fit among the available ones. To live in intertidal and sublittoral zones, regions subjected to daily variations in abiotic factors, hermit crabs present a locomotory circadian rhythm. Clibanarius antillensis has been the object of several studies in Brazil's south-east, so this study was aimed at describing its population in the south of Brazil and its movement activity under laboratory conditions during night-time and daytime, while using two different shells. The animals were sampled from the Sepultura and Lagoinha beaches, in the state of Santa Catarina through free diving. Sex ratio was skewed for males, with ovigerous females present during the whole year but with a spring peak. Males were more abundant than females, ovigerous females and intersex individuals, being predominant in all size-classes analysed. The hermit crabs occupied mainly two gastropod shells: Cerithium atratum and Agathistoma viridulum, and ovigerous females used only the first. Clibanarius antillensis showed nocturnal activity and the animals using C. atratum shells were more active than those using A. viridulum. Cerithium atratum shells are lighter and less bulky than A. viridulum, implying that there might be a tradeoff in which the hermit crabs use lighter shells, that provide less protection in order to expend less energy and be more active.

Normalizing intersex children through genital surgery: the medical perspective and the experience reported by intersex adults

This paper explores the conceptions of specialized physicians regarding intersex child surgery, and contrasts them with the experiences of intersex adults. The gap between the views of health personnel—who affirm that they are “doing their best”—and those of intersex persons—who report the adverse consequences of surgery—highlights the need to stop unnecessary normalization surgeries in children. The findings of this study suggest that bridging the gap between the medical perspective and the experience of intersex people requires opening direct channels of communication among all those involved in the clinical process, incorporating intersex individuals into bioethics committees, encouraging contact with the parents of intersex children, implementing regulations that unambiguously delay or prohibit unnecessary interventions, promoting a debate on relevant ethical principles and human rights to protect the interests of all intersex people, and disseminating the contents of such a debate.

Ensuring equitable, inclusive and meaningful gender identity- and sexual orientation-related data collection in the healthcare sector: insights from a critical, pragmatic systematic review of the literature

In several countries, no gender identity- and sexual orientation-related data is routinely collected, if not for specific health or administrative/social purposes. Implementing and ensuring equitable and inclusive socio-demographic data collection is of paramount importance, given that the LGBTI community suffers from a disproportionate burden in terms of both communicable and non-communicable diseases. To the best of the authors’ knowledge, there exists no systematic review addressing the methods that can be implemented in capturing gender identity- and sexual orientation-related data in the healthcare sector. A systematic literature review was conducted for filling in this gap of knowledge. Twenty-three articles were retained and analysed: two focussed on self-reported data, two on structured/semi-structured data, seven on text-mining, natural language processing, and other emerging artificial intelligence-based techniques, two on challenges in capturing sexual and gender-diverse populations, eight on the willingness to disclose gender identity and sexual orientation, and, finally, two on integrating structured and unstructured data. Our systematic literature review found that, despite the importance of collecting gender identity- and sexual orientation-related data and its increasing societal acceptance from the LGBTI community, several issues have to be addressed yet. Transgender, non-binary identities, and also intersex individuals remain often invisible and marginalized. In the last decades, there has been an increasing adoption of structured data. However, exploiting unstructured data seems to overperform in identifying LGBTI members, especially integrating structured and unstructured data. Self-declared/self-perceived/self-disclosed definitions, while being respectful of one’s perception, may not completely be aligned with sexual behaviours and activities. Incorporating different levels of information (biological, socio-demographic, behavioural, and clinical) would enable overcoming this pitfall. A shift from a rigid/static nomenclature towards a more nuanced, dynamic, ‘fuzzy’ concept of a ‘computable phenotype’ has been proposed in the literature to capture the complexity of sexual identities and trajectories. On the other hand, excessive fragmentation has to be avoided considering that: (i) a full list of options including all gender identities and sexual orientations will never be available; (ii) these options should be easily understood by the general population, and (iii) these options should be consistent in such a way that can be compared among various studies and surveys. Only in this way, data collection can be clinically meaningful: that is to say, to impact clinical outcomes at the individual and population level, and to promote further research in the field.

Characteristics, barriers, and career intentions of a national cohort of LGBTQ+\u2009MD/PhD and DO/PhD trainees

BackgroundLesbian, gay, bisexual, transgender, queer, non-binary, intersex, and/or asexual (LGBTQ+) individuals continue to suffer worse health outcomes compared to the general population. Data on LGBTQ+ individuals in medicine, particularly in medical training, remain sparse. National studies of LGBTQ+ students in MD/PhD and DO/PhD training programs have not been reported.MethodsTrainees pursuing MD, DO, MD/PhD, and DO/PhD degrees at 32 nationally representative institutions completed a 70-item survey about their future career and anticipated challenges using an online survey tool from September 2012 to December 2014. There were 4,433 respondents to the survey. Of those, 2,837 completed the gender identity questions and 2,849 completed the sexual orientation questions. Completion of these questions was required for inclusion. Survey results were analyzed to examine differences between LGBTQ+ and non-LGBTQ+ medical and dual degree trainees.ResultsLGBTQ+ students were underrepresented among MD/PhD and DO/PhD trainees (8.70%) compared to the US population, though their representation was higher than among MD and DO trainees (5.20%). LGBTQ+ dual degree trainees endorsed the greatest interest in pursuing careers involving academic medicine, with varying career focuses including research, clinical duties, education, and advocacy. LGBTQ+ dual degree trainees prioritized opportunities in patient care, work-life balance, and research as the most important factors for their career selection. Importantly, a higher percentage of LGBTQ+ dual degree trainees (15.50%) identified sexual harassment as a past barrier to career advancement compared to their non-LGBTQ+ peers (8.27%). LGBTQ+ dual degree trainees were more likely to report having a mentor who advocated for them.ConclusionsLGBTQ+ physician scientist trainees remain under-represented and under-studied. It is vital that medical institutions devote more time and resources towards identifying and addressing the unique needs of this group in training. Training programs should be aware of the current and prior challenges faced by their LGBTQ+ dual degree trainees, work to overcome the unique barriers they face, highlight the strengths and unique perspectives they bring, and foster their professional growth and goals during and beyond their training.

Is intersexuality a mere difference or disorder?

Is intersexuality a mere difference or disorder? Since the 2006 Chicago consensus statement's disorder of sexual development (DSD) nomenclature, intersex scholars have criticized and repudiated the use of "disorder" by arguing that it is medically inaccurate, yields unwarranted surgical implications, unnecessarily pathologizes intersex individuals, and that, most importantly, intersex individuals do not prefer it. They argue for linguistic alternatives such as "difference" and other similar alternatives, for example, "variation," "divergence," and so forth. These criticisms of "disorder" have had significant uptake by scholars writing on intersexuality. While the motivation(s) for using "mere difference" is doubtless rooted in beneficence for intersex persons, medically inaccurate intersex terminology compromises optimal clinical care and should consequently be either abandoned or revised. This focus paper argues (moderately) for the thesis that some cases of intersex are disorders, and some mere differences. The upshot of my proposal is not only that it conceptually disambiguates disorder and mere difference, but by failing to generalize unique intersex individuals their care is prioritized.

A Queer Heavenly Family: Expanding Godhood Beyond a Heterosexual, Cisgender Couple

A Queer Heavenly Family: Expanding Godhood Beyond a Heterosexual, Cisgender Couple

Hormônios naturais e sintéticos impactam as características zootécnicas e morfológicas da tilápia do Nilo (Oreochromis niloticus)

ABSTRACT This work aimed to investigate the effects of the endocrine disruptors 17β-estradiol (E2) and 17α-ethinylestradiol (EE2) on Nile tilapia (Oreochromis niloticus) development, emphasizing the zootechnical and morphological aspects. The concentrations of E2 and EE2 tested were 250, 500, and 1,000 μg·L−1. The evaluated compounds were capable of producing intersex individuals and causing zootechnical damage in Nile tilapia, with a significant decrease in the condition factor as the concentrations increased. Besides, these concentrations were also able to induce the development of morphological anomalies without any significant difference between them. E2 and EE2 exposure were shown to be lethal for Nile tilapia larvae, having no effect on the incubation time and the percentage of larvae hatching. Morphological anomalies such as head shape malformation, oral malformation, operculum malformation, belly retraction, distended abdomen with fluid accumulation (ascites), exophthalmos, signs of bleeding in the belly, and curved pectoral fin radii, were also observed, which impaired the fish development.

Sports Medicine Research Practices for Categorizing Transgender and/or Intersex Participants.

Approximately 1 to 1.4 million individuals (0.58% of the population) in the United States identify as transgender, yet no literature could be found regarding how researchers should adapt clinical research studies when intersex or transgender individuals volunteer as participants. Therefore, the objective was to determine if there is a consensus among recently published researchers in 3 athletic training and sports medicine journals regarding procedures used to categorize participants and data of transgender or intersex individuals in a research study. The authors developed a 14-item survey using Qualtrics XM to assess how researchers categorize individuals and their data when intersex or transgender individuals volunteer to participate in clinical research studies that are not intended to focus on intersex or transgender individuals. The survey was sent to 378 individuals in athletic training and related fields who recently published research manuscripts from 2018 to 2020 in one or more of 3 leading journals in the field including the Journal of Athletic Training, the Journal of Sport Rehabilitation, and the Athletic Training and Sports Health Care Journal. A total of 82 respondents completed the survey, yielding a response rate of 21.69%. When categorizing research participants who were not using hormones or surgery to transition, several respondents were unsure how to categorize transgender individuals (n = 14, 17.1%) or intersex individuals (n = 35, 42.7%). If the research participant was using hormones and/or surgery to transition, many respondents were unsure how to categorize the sex of the individual (n = 27, 32.9%). Only 5 (6.1%) respondents indicated that their organization has policies that guide their inclusion of transgender and/or intersex individuals in research studies. There does not appear to be consensus among researchers who recently published in athletic training and sports medicine journals regarding how to categorize transgender and intersex individuals who volunteer to participate in research studies.

An exploratory study of the retrospective educational experiences of young intersex adults

AimWhile there is increasing awareness of best practice in LGBT-inclusive education, little is known about the specific educational issues facing intersex individuals, and how the education system could be improved for this marginalised group.MethodThis paper reports an empirical study involving semi-structured interviews with two young intersex adults, to understand their retrospective, lived educational experiences and ascertain their views on improving educational practice around intersex issues.FindingsRelevant themes identified were knowledge and understanding, impact of diagnosis, information sharing, journey of identity acceptance, protective factors, and wellbeing.ImplicationsRecommendations are made regarding how schools and professionals might support intersex children and young people during their education.

A discriminational attitude and behavior in the healthcare field: Homophobia level in healthcare professionals working in primary health services and the affecting factors.

To investigate the homophobia level among the healthcare professionals working in primary healthcare services and the affecting factors. This descriptive and cross-sectional study conducted between November 2018 and April 2019, included 184 healthcare professionals. The mean total score of the Hudson and Ricketts Homophobia Scale was 103.55 ± 30.47. There was a statistically significant difference between the marital status of the healthcare professionals, what they felt during the care/treatment of lesbian, gay, bisexual, transgender, and intersex (LGBTI) individuals, level of knowledge about such individuals, willingness to know more about them, and the status of having LGBTI acquaintances and the median homophobia score. The results will be beneficial for LGBTI individuals, who have problems in communicating with primary healthcare personnel, to benefit from the services effectively.