BEYOND THE BINARY

In recent months, the definition of sex as biologically male or female has been used in a bid to restrict the rights of trans people. However, as Intersex Ireland explains, sex is not binary, and defining it as such leaves out a significant portion of the population.

Feature Intersex — Activism — Healthcare

We are Intersex Ireland, Ireland’s only intersex-led intersex support and advocacy organisation. As you engage with this article, we invite you to learn about what intersex means, as we are aware there is little public awareness and growing misinformation, which you may have been exposed to during the furore surrounding boxers Imane Khalif and Lin Yu-Ting in last year’s Olympics. Although you might not know a lot about intersex, chances are you have met other intersex people or may even be intersex yourself. We are almost as common as people with red hair or people with green eyes. According to experts, including the United Nations, there may be as many as 90,000 intersex people in Ireland alone.

Intersex is an umbrella term for more than 40 naturally occurring bodily variations that do not fit neatly into strict, binary definitions of what might be considered male or female. Intersex variations affect hormones, chromosomes, gonads and sex organs. They can be discovered at birth, in puberty, or post-mortem.

Someone with Klinefelter syndrome, or 47-XXY, for example, might be assigned male at birth, but because they have an extra X chromosome, it causes them to develop wider hips and larger breasts in puberty. Someone with Swyer syndrome will have XY chromosomes, typically associated with males, streak gonads, a vulva, vagina, uterus and fallopian tubes. Someone with ovotestes will have a testis on one side and an ovary on the other. Hypospadias means the opening to the urethra is located on the underside of the penis somewhere between tip and scrotum rather than at the tip. Congenital Adrenal Hyperplasia, or CAH, is a variation affecting the adrenal glands, resulting in deficient production of cortisol and aldosterone, and higher levels of androgens, causing masculinisation of the genitalia and other parts of the body. CAH can also be associated with life-threatening salt-wasting.

As you might imagine, it can be difficult for intersex children growing up in Ireland and elsewhere. We are often subjected to family rejection, school bullying and workplace discrimination. While some intersex people are also transgender, many are not. In that regard, intersex people are just like the rest of the population, gay, straight, trans, cisgender, etc.

However, because intersex variations can cause bodies and behaviours to clash with societal binary expectations, even cisgender, heterosexual intersex people suffer transphobic violence and discrimination, as shown in research by the European Union, which discovered sharp increases in violence and discrimination against intersex people as well as transgender people.

Here, Sorcha Ní Fhaoláin, one of our members, talks about what it’s like to be intersex in Ireland: “Being a teenager in 1980s Ireland wasn’t easy for anyone, and especially for anyone who existed outside of the male/female binary. To this day, doctors in Ireland still diagnose and attempt to treat the variation, without any consideration for the person behind it. Fear of the medical profession persists, and as an intersex trans woman in their mid-50s, I have more fingers than visits to a doctor in my lifetime. It would be decades later until I discovered the Intersex Ireland community and the wider European Intersex family.

“The medical treatment received by intersex people in Ireland is still well below European standards, but we have a strong community, and a knowledgeable leadership fighting our corner. The recent restrictions and legislative attacks on the trans community also harm intersex people, but rather than trying to express the differences between transgender and intersex, we need to embrace our trans siblings and fight hard for the rights of all vulnerable minorities”.

While the media has been awash for years now with scaremongering about non-consensual sterilisation and genital surgeries performed on transgender children, many intersex people in Ireland and elsewhere are still subjected to actual surgeries in childhood that are designed to give genitals the appearance of typical male or female genitals. These procedures can be accompanied by sterilisation and hormonal treatments, which are performed without consent, with no consideration for our autonomy or personhood. These procedures, many of which are associated with high levels of disability, often conflict with our sexualities and gender identities in adulthood.

Female Genital Mutilation, or FGM, is the surgical alteration of female genitals for social rather than medical reasons. FGM is illegal in Ireland except when it is performed on an intersex child. Operations to shorten the clitoris of intersex children have been associated with lifelong pain, discomfort and theft of the ability to receive sexual pleasure, according to intersex adults who have been subjected to these procedures.

Intersex people in Ireland and elsewhere call for an end to these procedures. In recent years, they have been banned in Malta, and then Iceland, Portugal, Greece, Germany, and parts of Spain, but Ireland remains steadfast in its insistence on mutilating intersex children.

We in Intersex Ireland reached out to Children’s Health Ireland (CHI) to offer the benefit of our experiences of living with the effects of these procedures, declared to be a form of torture by the UN in 2013. Instead of the surgeries we have been subjected to, we advocate for a holistic approach to raising intersex children, involving psychological support and education for parents who may be learning about intersex variations for the first time at the birth of their child.

As people who have struggled through life with the effects of these procedures, often without support or recourse, we feel CHI could greatly benefit from our input. Their refusal to acknowledge or respond to our correspondence, however, speaks volumes about the respect CHI has for intersex people, which helps explain, we think, their comfort in performing invasive, non-consensual, irreversible and harmful procedures that would be illegal in Ireland under any other circumstances.

Dr Adeline Berry of Intersex Ireland says: “I grew up in Tallaght in the ‘70s and ‘80s before emigrating to the US at the age of 21. The arrival of an intersex child brought great shame to my parents, who were even more distressed to find that despite early surgeries, I still acted much more like a girl than a boy in their eyes, incurring abuse of every sort by way of retribution. This was long before I discovered the words transgender or intersex, and long before the birth of the internet.

“At the age of 10, I first discovered I was not alone on this planet, and that there were other people just like me.

“After appearing in the James Bond film For Your Eyes Only, intersex and transgender model and actress Caroline Cossey was outed by the tabloid press.

Construction workers employed by my dad discussed the ways they would murder someone like her if they ever encountered them in person, fully unaware they were in the presence of a transgender and intersex child.

“After returning home to Ireland in 2017 in the wake of Donald Trump’s first presidential election, a well-known and influential psychiatrist my GP referred me to for depression and anxiety, refused to see me simply because I am trans and intersex. His secretary told me to get on the waiting list for the National Gender Service instead. The very same psychiatrist posted on his LinkedIn that same week about how LGBT patients are at a higher risk of suicide. This highlighted for me how intersex and transgender discrimination operated at the highest levels of the medical establishment in Ireland, prompting me to return to school.

“I am still waiting to be seen by the National Gender Service. Last year, I completed my PhD, demonstrating that it can be faster for transgender and intersex people in Ireland to become doctors than to be seen by one.

“My research looked at the life experiences and healthcare needs of older intersex people across Europe. I found high levels of family rejection, school bullying, work discrimination and medical abuse. My research showed that intersex people have urgent mental health needs that are rarely met. Ireland is no exception to any of this. When I volunteered for an Irish suicide line, I spoke to many intersex people experiencing deep shame over their bodies and desperate isolation.

“I fear that after a relatively brief period of a level of LGBTQIA+ awareness and acceptance, rising fascism and intolerance we are seeing everywhere will have harsh repercussions for intersex children in Ireland and elsewhere. In a more right-wing environment, it will be harder to get Irish surgeons and endocrinologists to stop irreversibly harming intersex infants. Parents may be less tolerant and accepting of their intersex child and more worried about what the neighbours think, as my parents were. The intersex child will be more likely to experience school bullying and employment, housing and medical discrimination as they age.

“My research also showed that intersex people are creative. Almost every one of my participants were musicians, writers, sculptors, performers, storytellers and artists. This is the kind of magic we need more of in the world, not less. A world in which intersex people are allowed to survive and flourish is a better world for all of us.”