3: Variation in Sex, Gender, and Sexuality

Sex

The existence of sex variations fundamentally challenges the notion of a binary biological sex – that sex is either “female” or “male.” Intersex describes individuals with sex characteristics that do not fit cultural definitions of what is considered “male” or “female,” or variation in sex characteristics such as chromosomes, gonads, sex hormones, or genitals. The bodies of “intersex” people, like those of “female” and “male” people, is a socially constructed category that humans have created to label bodies that they view as different from those they would classify as distinctly “female” or “male.” The term is slightly misleading because it may suggest that people have complete sets of what would be called “male” and “female” reproductive systems, but those kinds of human bodies do not actually exist; “intersex” really refers to biological variation. The dated and derogatory term “hermaphrodite” is inappropriate for referring to intersex people, and should be avoided.

There are a number of specific biological sex variations. For example, having one Y and more than one X chromosome is called Kleinfelter Syndrome. Does the presence of more than one X mean that the XXY person is female? Does the presence of a Y mean that the XXY person is male? These individuals are neither clearly chromosomally male or female; they are chromosomally intersex. Some people have genitalia that others consider ambiguous. This is not as uncommon as you might think, though accurately estimating the intersex population is complicated due to the varied measurements and definitions of “intersex” and lack of tracking requirements. Intersex advocacy organization InterACT explains, based on the work of Dr. Anne Fausto-Sterling, that approximately 1.7% of individuals are born intersex and that 0.05% of individuals (1 in 2,000) are born with ambiguous genitalia of which the doctor may suggest unnecessary surgeries to correct (InterACT 2021). So, why is this knowledge not commonly known? Many individuals born with genitalia not easily classified as “male” or “female” are subject to genital surgeries during infancy, childhood, and/or adulthood which aim to change this visible ambiguity. Surgeons alter the size of the genitals of infants they want to make look more typically “female” or “male.” For instance, in infants with genital appendages smaller than 2.5 centimeters doctors reduce the size and assign them as “female” (Dreger 1998). In each instance, surgeons literally construct and reconstruct individuals’ bodies to fit into the dominant, binary sex system. While parents and doctors justify this practice as in “the best interest of the child,” many people experience these surgeries and their social treatment as traumatic, as they are typically performed without patients’ knowledge of their sex variation or their consent. Individuals often discover their chromosomal makeup, surgical records, and/or intersex status in their medical records as adults, after years of physicians hiding this information from them. The surgeries do not necessarily make bodies appear “natural,” due to scar tissue and at times, disfigurement, and/or medical problems and chronic infection. The surgeries can also result in psychological distress. In addition, many of these surgeries involve sterilization, which can be understood as part of eugenics projects, which aim to eliminate intersex people. Therefore, there has been a degree of shame, secrecy, and betrayal surround the surgeries.

Intersex activists began organizing in North America in the 1990s to stop these nonconsensual surgical practices and to fight for patient-centered intersex health care. Broader international efforts emerged next, and Europe has seen more success than the first wave of mobilizations. In 2008, Christiane Völling of Germany was the first person in the world to successfully sue the surgeon who removed her internal reproductive organs without her knowledge or consent (International Commission of Jurists, 2008). In 2015, Malta became the first country to implement a law to make these kinds of surgeries illegal and protect people with sex variations as well as gender variations (Cabral & Eisfeld, 2015). Accord Alliance is the most prominent intersex focused organization in the U.S.; they offer information and recommendations to physicians and families, but they focus primarily on improving standards of care rather than advocating for legal change. Due to the efforts of intersex activists, the practice of performing surgeries on children is becoming less common in favor of waiting and allowing children to make their own decisions about their bodies. However, there is little research on how regularly nonconsensual surgeries are still performed in the U.S., and as Accord Alliance’s standards of care have yet to be fully implemented by a single institution, we can expect that the surgeries are still being performed.

Scholars have identified how sex is not static or unchanging, as we might expect. For instance, Anne Fausto-Sterling (2000) proposed dynamic systems theory, which conceptualizes sex as potentially fluid, as bodies, organs, and sex characteristics can be influenced by physical and social environments. Fluidity in this sense refers to the capacity for change, such as changes in sex characteristics, gender identity or expression, and sexual identity or attraction. As with the existence of intersex people, fluidity in bodily and sex characteristics challenges binary notions of sex as strictly “female” or “male.”

Gender

A binary gender perspective assumes that only women and men exist, obscuring gender diversity and erasing the existence of people who do not identify as men or women. A gendered assumption in our culture is that someone assigned female at birth will identify as a woman and that all women were assigned female at birth. While this is true for cisgender (or “cis”) individuals—people who identify in accordance with their gender assignment—it is not the case for everyone. Some people assigned male at birth identify as women, some people assigned female identify as men, and some people identify as neither women nor men. This illustrates the difference between, sex assignment, which doctors place on infants (and fetuses) based on the appearance of genitalia and other biological markers, and gender identity, which one discerns about oneself. The existence of transgender people, or individuals who do not identify with the gender they were assigned at birth, challenges the very idea of a single sex/gender identity. For example, trans women, those who were assigned male and are women, show us that not all women are born with female-assigned bodies. The fact that trans people exist contests the biological determinist argument that biological sex predicts gender identity. Transgender people may or may not have surgeries or hormone therapies to change their physical bodies, but in many cases they experience a change in their social gender identities. Nonbinary people – an umbrella term for those who do not identify within the binary of woman or man – may use specific identities such as nonbinary, genderfluid, or genderqueer. Genderfluid is a specific identity which denotes the capacity for fluidity in gender identity and/or expression, though individuals who experience gender fluidity may not identify specifically with that term and instead select the identity that best suits them at the time. Some nonbinary individuals may use gender-neutral pronouns, such as they/them or ze/hir, rather than the gendered pronouns she/her or he/his. As pronouns and gender identities are not visible on the body, trans communities have created procedures for communicating gender pronouns, which consists of verbally asking and stating one’s pronouns (Nordmarken, 2013). Though estimates vary, a recent Pew study suggests that 1.6% of the U.S. population and over five percent of U.S. young adults identify as transgender or nonbinary (Brown 2022).

The concepts of transgender and intersex are easy to confuse, but these terms refer to very different identities. To review, transgender people are those who identify with a gender other than that assigned at birth, while intersex people are those who have biological characteristics that do not fit neatly within the dominant sex/gender system. One term refers to gender (transgender) and one term refers to biological sex (intersex); however, some people may also use intersex as a social or gender identity. While transgender people challenge our binary ideas of gender (woman/man), intersex people challenge our binary ideas of biological sex (female/male). Gender theorists, such as Judith Butler and Gayle Rubin, have challenged the very notion that there is an underlying “sex” to a person, arguing that sex, like gender, is socially constructed. This is revealed in different definitions of “sex” throughout history in law and medicine. For instance: Is sex composed of genitalia? Is it simply genetic make-up? A combination of the two? Various social institutions, including courts, have not come to a consistent or conclusive way to define sex, and the term “sex” has been differentially defined throughout the history of law in the United States. In this way, we can understand the biological designations of “male” and “female” as social constructions that reinforce the binary construction of men and women.

Sexuality

Sexuality, too, was socially constructed as a binary of “gay” and “straight,” though those are contemporary terms. Since the invention of the concepts “heterosexuality” and “homosexuality” in the 1800s, and subsequent adoption of heterosexual and homosexual as sexual identities, sexual categories have proliferated to include bisexual, pansexual, asexual, queer, fluid, and more. This variation has created challenges for researchers attempting to count the LGBTQ+ population. For instance, studies that ask whether or not people identify as “lesbian, gay, bisexual, or transgender” exclude all the other sexual identities, and lump gender identity (transgender) in with sexual identities (lesbian, gay, and bisexual). Additionally, survey respondents may not publicly or openly identify as such even if they have attractions or internal identities that may classify them as LGBTQ+. Thus, survey data may underreport the proportion of LGBTQ+ populations. A recent Gallup poll suggests that that 7.6% of the U.S. adult population identifies as LGBTQ+, with most of those individuals identifying as bisexual (Jones 2024).

A recent Gallup poll indicates that 7.6% of U.S. adults identify as lesbian, gay, bisexual, transgender, queer or some other sexual orientation besides heterosexual, an increase from prior years. The poll also found that more than one in five adults in the Gen Z generation identify as LGBTQ+.

See a chart showing the percent increase from 2012 to 2023 and the news report LGBTQ+ Identification in U.S. Now at 7.6% here <https://news.gallup.com/poll/611864/lgbtq-identification.aspx>.

Jones, Jeffrey. 2024. “LGBTQ+ Identification in U.S. Now at 7.6%.” Gallup. Retrieved from https://www.pewresearch.org/2023/05/08/asian-identity-in-the-us/ on August 20, 2024.

Finally, studies can fail to differentiate between gender and sexuality in measuring the LGBTQ+ population. Transgender and nonbinary people can be queer by way of both gender or sexuality, or by only gender if they identify sexually as straight. A common misconception is that all trans people are sexually queer. This error may stem from the “LGBTQ+” acronym that lists trans (T) people along with lesbians, gay men, bisexuals, and other queer people (LGBQ). A trans man who previously identified as a lesbian may still be attracted to women and thus may identify as straight, or may identify as queer. Another trans man may be attracted to other men and thus identify as gay or queer. This multiplicity suggests that the culturally dominant binary model fails to accurately encapsulate the wide variety of sexual and gender lived experiences.

The identity queer also complicates our understanding of sexuality. Whereas other identities point to specific attractions (e.g., lesbian refers to attraction to women, pansexual refers to attraction to any gender), queer is ambiguous and inclusive of the possibility of fluidity (see below). Those who identify as queer may do so for a variety of reasons such as to be intentionally vague, to avoid being boxed into specific attractions, or to be inclusive of trans and nonbinary individuals. Cultural understandings of sexuality as inherently static and tied to romance are also challenged by flexible and romantic identities. For instance, people may use “homoflexible,” “lesbiflexble,” and “heteroflexible” to denote that they have a primary sexual attraction but are open to other experiences or sometimes have other attractions, and the identities “aromantic,” “panromantic,” or “heteroromantic,” point specifically to romance or relationships and are used to differentiate sexual attraction and romantic attraction.

Sexuality cannot be simply reduced to whether people are straight, gay, lesbian, pan, queer, and so on. Sexuality also includes other identities, desires, and behaviors including how we have sexual encounters, negotiations around sexual encounters, power dynamics with sexual partners, and much more.

Online sex educators at Scarleteen highlight several components or ‘circles’ of sexuality:

• Sensuality
• Intimacy
• Sexual orientation and gender identity
• Sexual and reproductive health
• Sexual behaviors and practices
• Power and agency

See the image "Circles of Sexuality" and the article Sexuality: WTF Is It, Anyway? here <https://www.scarleteen.com/read/sexuality-wtf-it-anyway>.

Corinna, Heather. 2024. Sexuality: WTF Is It, Anyway?. Scarleteen: Queer Sex Ed for All. Retrieved from https://www.scarleteen.com/read/sexuality-wtf-it-anyway on August 20, 2024.

Other sexual communities include kink/BDSM (bondage/discipline, dominance/submission, sadism/masochism), lifestyle or swinging, and polyamorous communities, and many individuals are part of multiple sexual communities. As with sex and gender, sexuality can involve any degree of fluidity. For instance, a person’s sexual attractions might change over their life course such that they may identify first as straight, then lesbian, then pansexual, or a person’s sexual interests could develop after being introduced to a particular sexual community or after thinking critically about their own needs and desires.

As you can see, sex, gender, and sexuality are not as clear cut as the culture teaches many of us to believe. There is enormous variation in sex characteristics and bodies, gender identities and expressions, and sexual identities and attractions. None can be reduced to a simple binary, as they were socially constructed. We will revisit the concepts of binary systems and social construction in future chapters.