Understanding intersex bodies: Inclusive sex education for parents

Let’s talk about sex education and intersex, as surprisingly enough, intersex is something we don’t talk about enough.

And although we hear lots of chatter about inclusive sex education, where we teach sex ed in a way that is inclusive for all children, intersex is often forgotten.

This blog post is designed to help parents to have conversations that are inclusive of people with intersex bodies. Talking about intersex variations will help to break stigmas and raise awareness that people with intersex variations exist. It’s a natural variation and conversations about diversity are powerful as they help to break those stigmas.

So…

Regardless of whether you’re the parent of an intersex child, or you’re reading this because you want your child to be inclusive and accepting of diversity, you’ll find the information in this blog posthelpful!

And if you want to learn more about what sex education is all about, then the best place to do that is my Sex Education 101 page.

Let’s get started!

What is intersex?

Intersex is a broad term used to describe people whose reproductive organs, genitals or chromosomes are different to what you’d expect for male or female bodies. 

There are approximately 40 different intersex variations, and many of these variations do not become apparent until well into puberty or adulthood.

So, there are many ways someone can be intersex, as it involves a spectrum of reproductive characteristics. Being intersex is a natural variation in humans, and it does not mean there is something wrong. 

Intersex traits can relate to

• Genitalia
• Internal anatomy
• Hormones
• Chromosome combinations different to XY (male) and XX (female).

Some intersex people have both ovarian and testicular tissue, while others have atypical female or male genitalia or male/female genitalia with variations in their internal organs and/or hormones. Some intersex conditions may be related to underlying concerns that might require medical care, but people who are intersex are generally as healthy as those who are not.

This video provides great information about the experience of intersex people.

Language is changing

Some terms you may hear used to describe people with intersex bodies are:

• Intersex variations
• Differences of (or in) sex development
• Variations of sex characteristics (VSC)
• Disorders of sex development (DSD)

Outdated language like hermaphrodite is no longer used.

Some people will use the name of the condition they’ve been diagnosed with and won’t refer (or think) of themselves as intersex. So, it is about using the language the intersex child (and their parents) prefer.

When do people learn that they are intersex?

Learning that you have an intersex variation can happen at different stages of life, from pregnancy,  birth, childhood, puberty and adulthood.

Sometimes, it is diagnosed during pregnancy, where an ultrasound, pre-natal screening or amniocentesis will show differences in bodies and/or internal organs, a chromosomal variation, or the possibility of a chromosomal variation that is linked to an intersex variation.

Sometimes, it is discovered at birth because the baby has genitals that look different to what you’d expect to see for a male or female body. Not all genital differences mean there is an intersex variation.

Sometimes, it is discovered during late babyhood and early childhood, when medical conditions related to the intersex variation are assessed and managed.

Sometimes, it is discovered during puberty when periods don’t start or bodies don’t change as expected.

Sometimes, it isn’t discovered until adulthood, when they are trying to start their own family, and it doesn’t happen. Or discovered when they develop a cancer on their gonads (testicle or ovary), or they are experiencing muscle weakness.

How is sex assigned? 

When a baby is born, the midwife and/or doctor will look at the genitals of the baby and assign their sex based on what their genitals look like. If the genitals look as expected for a vulva, the assigned sex will be female. And if the genitals look as expected for a penis and scrotum, the assigned sex will be male.

If the genitals don’t look as expected for a male or female, a paediatrician or other specialist is involved, and they will determine (or decide) the sex of the baby based on physical, hormonal and chromosomal characteristics. If the sex cannot be assigned as male or female, it will be indeterminate. 

What gets written on the birth certificate differs worldwide, as each country and or state may document something different.

Keep in mind that intersex is often diagnosed at later stages of life. So, the assigned sex on a birth certificate may be inaccurate in later life. Whether this information is changed or not depends on the parents and the intersex child.

How do genitals develop?

Genital development is fascinating, as we all develop from the same basic structures. 

So when the baby is still a fetus developing in the uterus, the baby’s chromosomes and hormones will start to influence how their internal reproductive organs and genitals develop and grow. The chromosomes and hormones will make the genitals look male, female or somewhere in between (male or female).  This also explains why genitals have a diverse range of appearances, because it is influenced by the amount of hormones in the body at certain times of fetal development. 

Now, I will point you towards some external resources that explain genital development in more detail.

The Intersex Roadshow has a post on how genitals develop, as well as how intersex genitals differ. This resource was created in 2011, but it is still interesting to read.

DSDfamilies in the UK have a printable resource that tells the story of sex development. What I like about this resource is that it emphasises that every vulva and penis looks different, regardless of whether you have an intersex variation (or not). 

Oh Joy Sex Toy has an illustrated post on genital development (graphic novel or cartoon-styled). It has a great illustration that shows how the chromosomes and hormones change the unborn baby’s genitals between 7 and 12 weeks of development. 

Puberty for intersex bodies

Some parents will discover their child has an intersex variation at puberty, when puberty doesn’t happen as expected.  They may not start showing the changes linked with puberty, or they may start puberty but not have periods (or menstruate). 

Puberty can be a challenging time when the body develops differently to their peers, especially if they don’t have a body that is expected for their gender. It’s also a stage of development where they want to fit in with their peers and not be seen as different.

The best resource I’ve found that explains how puberty affects bodies with intersex variations is dsdteens in the UK. They explain how puberty happens inside and outside of the body (including sexual feelings and gender). They emphasise that puberty is unique for everyone,  before pointing them towards information on what puberty will be like for them (by condition). 

How common are intersex bodies?

Statistics vary as intersex is diagnosed at different stages of a person’s life, but it is thought to be as common as red hair. So, between 1 and 2% of babies are born with an intersex variation, with many of these variations not being visible at birth. 

So, if you’ve met someone with red hair, then you’ve met someone with an intersex variation.

Now, It’s important to remember that intersex variations aren’t usually visible, so you can’t tell if someone is intersex by looking at their genitals. Only a small number of babies will have genitals that look different to what you’d expect for a male or female body. Research suggests that one in 2000 babies are born with visible genital differences that require the attention of a specialist.

Most people won’t discover they’re intersex until puberty or adulthood. And some people may never know they have an intersex variation.

Inclusive messaging to share with children

I have managed to find a fantastic resource, Including Intersex: Responding to Issues Affecting the Educational experiences of Intersex Students in Australia,  which includes examples of age and stage appropriate inclusive messaging for sex education. Or you can click here to download it here from DropBox (just in case the link breaks).  

The information below, has been taken from that document, Appendix B: Unpacking what is ‘age and stage appropriate content’. (pages 37-39).

Early years

• All bodies are different and are made up of different parts. 
• Your body has: … (nipples, a vulva, a penis, testicles/testes, a bottom).
• Not all private parts look the same, every penis/vulva etc. looks different.
• Your body is unique and special. 
• It is important to look after your body and private parts.
• No one is allowed to touch your private body parts unless they are a parent/carer who is helping you to stay healthy, or to help you wash/wipe your private parts until you can do this for yourself. 
• Sometimes a doctor may need to check your private body parts to help keep you healthy, or stop them from hurting. It is okay to say no if you do not want this to happen. You should always be with a trusted adult such as a parent or carer when this happens. They can help make sure this is a safe experience for you. 
• Parents/carers and doctors have a responsibility to your health, safety and wellbeing. Their actions and behaviours should always protect and ensure your health and safety and wellbeing.

Late primary

(Including all the information from previous early years)

Body Awareness, Body Differences & Body Changes 

• Our bodies change and grow as we get older.
• Puberty is one of the ways our bodies change as we grow up.
• Not everyone experiences puberty in the same way or at the same time. 
• All changes around puberty are different for each person. You may not experience all changes and you may experience different changes at different times and in different ways to your peers. 
• Some people may experience delayed puberty, or they may start puberty at a very young age.
• Puberty can include a lot of different changes, sometimes these can be unexpected. 
• Sometimes people need to see a doctor to help them start puberty and some people may need extra support around puberty. 
• Not everyone’s genitals look the same (for example, due to genetics, surgery, cultural practices). 
• Some people are intersex. This means that they may have parts of their body, hormones or chromosomes that are different from what we usually expect. 
• Intersex variations are naturally occurring and are a natural part of human diversity.
• Having an intersex variation does not make someone sick or bad. It is not a disease or disorder.
• People have, and develop, different amounts of body hair on different parts of the body. Some common areas include on your face, under your arms, around your genitals and on your arms and legs.
• Some people will have a lot of body hair and some people may have no body hair at all. All body hair is natural and healthy. There is no medical or hygiene reason to remove body hair, however people are free to make their own decisions about keeping or removing their body hair. There are different ways this can be done safely.
• Some people who expect to get a period, may never get a period and that is okay. Sometimes people may not have the organs or hormones that are necessary to have a period. You can always talk to a doctor if you have any concerns about this. 
• Not all people can have babies. There are many reasons that people cannot have biological children. Sometimes an intersex variation or medical treatment may mean that that person is unable to have their own biological children. 
• There are alternative options for people who want to be parents but can’t have their own biological children. This includes reproductive assistance through in vitro fertilisation (IVF) and fertility treatments, adoption and fostering.

Social and emotional

• There are many reasons why we are similar or different from people. Being different is not wrong, bad, or shameful. 
• Consent is necessary before touching another person. This also includes hugging, as people have different boundaries that we may not know or share. 
• No one has the right to touch your body or make you feel like you must give them permission to touch or look at your body. You can always say no to someone who wants to touch or look at your body, even your doctor/s. Sometimes your parents/carers or a healthcare worker (doctor, nurse) will need to look at or touch your body for medical reasons, but they should always be able to explain why they are doing that. When healthcare workers need to touch or look at your body, they there should always be another trusted adult like your parent/carer present (who you also agree can be there) when this is experience for you.
• Peer support is always available if you wish to discuss your experiences with people who have shared experiences with you. Your doctor should be able to recommend a peer support group or community organisation who can point you in the right direction. You can also seek support from the community organisations and health services. 
• Different people can know different bits of information about you. You do not have to tell people anything you do not want them to know. You should be supported by your parents, and family in telling people anything important to you that you would like them to know. 
• Intersex people can have any gender identity or sexuality. Being intersex does not mean that you are part of a ‘3rd’ or ‘other’ sex or gender category. People use all sorts of words to describe and identify themselves, and intersex people are no different. 
• Intersex variations are about biological sex characteristics that people are born with. Being intersex is not the same as being transgender or gender diverse. Most intersex people are cisgender (not transgender) and identify their gender in binary terms.

Secondary and College

(Including all the information from previous years)

Social and emotional

• Self-esteem can affect the way people make and keep friendships, and how they develop their relationships with other people. 
• There are many reasons why people may experience poor self-esteem and feel uncomfortable or shamed for their body, including their weight and body shape, scars, birthmarks, and secondary sex characteristics. This may mean that people have difficulty getting changed with other people around, going swimming, and playing sports or wearing certain clothes. It is important to respect people’s personal boundaries around these things. 
• All touch, including sexual touch, must have consent. All touch, including for healthcare, must have consent. 
• Not having consent respected, especially in sexual situations or healthcare situations, can have big effects for people. They can feel disrespected, scared, ashamed, angry, sad, embarrassed, ignored, and may worry that it will happen again. This can affect the way they interact with others, and whether they trust other people. They may not feel like they can tell anyone about it, especially if the person who did not respect their consent threatened them. Or they may feel that they caused it to happen, especially if the person who did not respect their consent blamed them, or because they needed help when it happened.
• Friends and peers can be very important when someone talks about an experience of not having their consent respected. Friends can say “I believe you,” “it’s not your fault,” and “do you want me to help find out who else can help you?” 

Friends can understand that building trust takes time, and that sometimes people can still have strong feelings and reactions even when the situation has stopped.

Sexual attraction, sexual identity and behaviours

• Not all people experience sexual attraction at the same age, in the same way or at all. Sexual feelings and relationships may feel scary and challenging for some people even when they do experience sexual attraction.
• Feeling attracted to someone can feel exciting, but it can also make people feel nervous, uncomfortable, vulnerable or alone (especially if they don’t know how the other person feels). People can feel worried that the other person will not accept them.
• Intersex is not a sexuality or a gender identity. Intersex people are not automatically LGBTQ+. Most intersex people are heterosexual (straight), and most are cisgender.
• Not all people will feel comfortable and confident in sexual relationships, this can be impacted by negative past experiences and poor self-esteem that can arise from people having negative and wrong ideas about intersex bodies and intersex people.
• Being sexual with another person (whether through sexual intercourse or other sexual behaviours) can be different for different people. People’s boundaries, bodies and preferences vary greatly, and sex may not involve penetration at all. It is important to consider the range of sexual behaviours and the types of sex that are possible and pleasurable for all individuals involved. All sex must have consent. Sometimes there may be physical limitations to what sort of behaviours are possible and enjoyable. 

Biology and diversity

• There are more than 2 sex chromosome patterns (more than just XX and XY). 
• Sex chromosomes alone do not determine a person’s sex or anatomy.
• Biological characteristics do not determine a person’s gender identity. 
• Intersex is not a “third sex”.
• Intersex people are not all the same.

Resources for parents

I have started a list of children’s books about intersex bodies. It’s a small list, but I am actively seeking more books to add to it!

DSDfamilies is a UK site with information for parents about parenting an intersex child. 

ReachOut in Australia has a guide for parents on supporting an intersex teenager.

Don’t forget to jump onto YouTube, as there are quite a few videos made by people with intersex bodies. This video is enlightening as a woman shares her story of learning that she was intersex. Or this animation that talks about intersex. There’s lots more on YouTube, so don’t forget to have a look, as you’ll find videos suitable for both parents and kids.

Resources for children

I haven’t been able to find many resources that have been created for intersex children, let alone resources that educate about intersex bodies.

DSDTeens in the UK has information for 10-14+ year olds to learn about growing up and intersex variations. They break their information into three groups of children: age 10+, age 11+ and age 14+.

Kids Helpline in Australia have an info page for 13 to 17 years olds about understanding people with intersex variations. 

Me & My Body is a 4 minute video that explains differences of sex variation to children. The emphasis is on variety and diversity.

Planned Parenthood in the USA has a short video about how puberty may differ for kids with intersex bodies. 

I hope you find this information helpful!

Happy talking!
❤️ Cath