According to classical Greek mythology the water nymph Salmacis saw Hermaphroditus, the handsome son of Hermes and Aphrodite, bathing in her spring. She wanted him as her lover, but he was unresponsive so she forcibly embraced him. While Hermaphroditus struggled to free himself, Salmacis hung on tightly and prayed that they would never part. The gods granted her wish, and the two became a single being with both male and female sexual characteristics. From this mythical couple, an artistic character developed generally depicted in statuary and other art as having female breasts and male genitals (a penis and scrotum). There is considerable artistic license in these portrayals; in current times, however, those who used to be called “hermaphrodites,” persons with both male and female biological features, are now called “intersexed individuals” or, clinically, “persons with differences of sex development (DSD).” The penis of intersexed individuals, the male intermittent organ and erotic counterpart of the female clitoris, can, like any other organ, vary greatly in size and shape. Since both the penis and clitoris arise from the same tissue during development, different hormonal and genetic forces can alter their typical distinctive formation. The genitals may be combined in such a variety of ways that, at birth, they are seen as ambiguous: neither clearly male nor female, but intersexed. As a simple immediate designation of male or female is not possible, more details about the individual’s chromosomes, gonads, and other biological features are sought in order to assist in advisement about a gender of rearing. A best diagnosis is possible. In a majority of intersex cases, however, the genitals look typical and do not elicit concern. And, since a full medical analysis can be costly or unavailable, a diagnosis of intersexuality might not occur until puberty or even later in life–or never. In these cases, the male-female intersexual components might be internal; the individual might have one ovary and one testis or a combined ovatestis. Some individuals with internal testes might develop external female-appearing pudenda, with a penis only developing with puberty, and with some persons with internal testes never developing a penis.

The most commonly recognized intersex case at birth is that of a female having an enlarged clitoris appearing as a penis with labia that appear as a scrotum. It is a condition called congenital adrenal hyperplasia (CAH). Another type of intersex condition involves those male-appearing persons who have XXY sex chromosomes and a penis but develop breasts at puberty. This condition is called Klinefelter’s syndrome (KS). It cannot be predicted how, and in which gender, these children would prefer to live. Some females with CAH elect to live as men, and some persons with KS prefer to live as women. Male and female are biological terms, while boy, man, girl, and woman are social terms–biological and social conditions do not always coincide. Until very recently, physicians and parents have often sought to normalize the appearance of ambiguous genitals with cosmetic surgery. In accordance with a mistaken doctrine, males with a penis considered too small were castrated and had their penis removed, and then they were sex reassigned to live as females. Surgeons or parents encouraged mastectomy for those with KS, hampering their desire to live as women. Females with a clitoris considered too large often had it reduced in size. Despite those outmoded practices, professional objections against such cosmetic practice have existed since the late 1980s. In 2012, the United Nations Committee Against Torture (CAT) found nonconsensual cosmetic genital surgeries on children in violation of the Convention Against Torture. Various nongovernmental organizations are now supporting such restrictive recommendations. Increasingly, it is being recognized that every intersexed child, like all other persons, deserves the ability and freedom to make up their own mind in regard to the gender in which they live and the persons they might love.

Back to top