Dr LUCKY GUPTA
On 26 October, people around the world honour intersex awareness. “Visibility, Inclusion and Empowerment” is the topic that Intersex Awareness Day 2025 will adhere to.
Intersex Terminology and DSD
People whose bodies do not conform to conventional gender norms are considered intersex, according to the UN High Commissioner for Human Rights. “Hermaphrodites” and “congenital eunuchs” are now considered archaic descriptions of intersex people because of how the language surrounding them has changed. Those who identify as LGBTQ+ fall under a broad category that includes many different sexual orientations, romantic partnerships, and gender identities that do not conform to the heterosexual or cisgender binary. All of these communities come together as the LGBTQ+ Movement.
Trans Identity
Trans is a more inclusive term than transgender, according to some. While “trans” is most commonly used to describe transgender people, “trans” plus an asterisk expands the definition to encompass non-binary identities including bigender, genderqueer, agender, two-spirit, and genderless.
Disorders of Sex Development (DSD) is the professional name that has been used since 2006. But because of the pathologising connotations of the name, DSD is still a contentious one. It encompasses a wide range of biological and hormonal characteristics that do not fit neatly into the traditional male or female categories when discussing reproductive or sexual anatomy.
Incidence and Diagnosis
It is believed that between 1.2 and 2.0% of the population experiences intersex variants. An estimated 0.02% to 0.05% of infants are born with genitalia that are not clearly defined. Several tests, including karyotyping, genitourethrogram, hormone evaluations, and imaging procedures (such as ultrasound), are used for diagnosis. It is possible to detect equivocal development during pregnancy in certain situations, such as congenital adrenal hyperplasia.
Psychosocial and Medical Concerns
Intersex and DSD individuals are more likely to have a host of health problems, such as an increased risk of cancer (anal, breast, cervical), STDs, heart disease, and mental health disorders (depression, anxiety, drug misuse, etc.). It is essential to be sensitive and provide psychosocial assistance since discriminatory attitudes make it even more difficult to receive adequate healthcare services. Internalised transphobias and gender incongruence, issues with self-perception and social acceptance, and a fear of rejection are common, especially among adolescents.
Awareness and Education
All communities and healthcare facilities should make raising awareness and providing training a top priority in order to enhance care. Medical and nursing school curricula should include instruction on DSD and the use of inclusive terminology. Creating a comfortable atmosphere for patients is an important responsibility of frontline healthcare workers like paramedics and patient coordinators.
Ethical and Multidisciplinary Care
While dealing with people who have DSD, it is important to take into account their age, risks associated with puberty, family preferences, and sex assignment, among other factors.When making decisions that are crucial, it is important to get the parents’ consent and children’s assent if they are 12 years old or older. When considering surgical procedures, the patient’s functional capacity and health in the long run should be considered more important than short-term cosmetic goals.For comprehensive treatment, a multidisciplinary team consisting of paediatric surgeons, endocrinologists, urologist, surgeons, psychiatrists, psychologist and geneticists.
Medical Management and Surgical
Part of the medical treatment involves hormone therapy and re-establishing electrolyte balances. It is important to only consider surgical procedures like phallus restoration, labioplasty, breast reconstruction or clitoral reduction when they are absolutely necessary from a clinical or functional standpoint after consent.
Conclusion
From the first stages of awareness to acceptance, caring for individuals with intersex and DSD is an ongoing journey that need finesse and a personalised approach. Empathy and open-mindedness are the key methods.Foundational to ethical care is the provision of lifelong psychological support and the assurance of inclusive education.
(The writer is Assistant Professor, Department of Paediatric Surgery)
