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89-612: The Equality Network is one of Scotland's national organisations working for LGBTI rights and equality. Established by LGBT activists in 1997, it is a registered charity and a company limited by guarantee (no. SC220213), based in Edinburgh . In 2011 it had an income of £374,000. The Equality Network was founded back in 1997 as a national organisation working for LGBT rights and equality in Scotland and 2014 for LGBTI rights and equality in Scotland. The Equality Network has superseded

178-459: A Y chromosome (or more specifically, an SRY gene ). Clinical features include ambiguous genitalia at birth and primary amenhorrhoea with clitoromegaly with inguinal masses. Müllerian structures are not present in the individual. PAIS is one of three types of androgen insensitivity syndrome , which is divided into three categories that are differentiated by the degree of genital masculinization : complete androgen insensitivity syndrome (CAIS)

267-410: A human chorionic gonadotropin (hCG) stimulation test may also provide information helpful in the assessment of virilization capacity. Psychosexual development is influenced by many factors, including the timing, amount, and type of androgen exposure, receptor functionality, and environment, and is thus difficult to predict. Gender identity begins to develop before 3 years of age, although

356-438: A penis with varying degrees of diminished size and hypospadias to a slightly enlarged clitoris . Wolffian structures (the epididymides , vasa deferentia , and seminal vesicles ) are typically partially or fully developed. The prostate is typically small or impalpable. Müllerian remnants are rare, but have been reported. The gonads in individuals with PAIS are testes , regardless of phenotype ; during

445-437: A 'third sex' as superior is overly simplistic, and that "to understand whether a system is more or less oppressive than another we have to understand how it treats its various members, not only its 'thirds'." The Asia Pacific Forum of National Human Rights Institutions states that the legal recognition of intersex people is firstly about access to the same rights as other men and women, when assigned male or female; secondly it

534-463: A birth certificate recording sex as indeterminate, and the first Australian passport with an 'X' sex marker in 2003. On September 26, 2016, California resident Sara Kelly Keenan became the second person in the United States (after Elisa Rae Shupe ) to legally change their gender to 'non-binary'. Keenan cited Shupe's case as inspiration for their petition, "It never occurred to me that this

623-407: A constitutional protection of a right to free development of personality meant that a child's autonomy increases with age, including the development of a gender identity and bodily awareness. It determined that the best interests of the child were protected by allowing the child to determine their own gender identity. The Court determined that genital surgeries should not be conducted on children over

712-409: A definitive diagnosis. Androgen receptor (AR) gene mutations cannot be found in 27% to 72% of individuals with PAIS. As a result, genetic analysis can be used to confirm a diagnosis of PAIS, but it cannot be used to rule out PAIS. Evidence of abnormal androgen binding in a genital skin fibroblast study has long been the gold standard for the diagnosis of PAIS, even when an AR mutation

801-457: A different sex or gender " and "ensur[ing] that sex or gender classifications are amendable through a simple administrative procedure at the request of the individuals concerned." It also advocates for non-binary options and self-identification for all while calling for an end to registering sex on birth certificates. Alex MacFarlane is believed to be the first person in Australia to obtain

890-510: A gender ambiguous phenotype, including a phallic structure that is intermediate between a clitoris and a penis. The urethra typically opens into a common channel with the vagina (i.e. urogenital sinus). Grade 5, the form of PAIS with the greatest degree of androgen insensitivity, presents with a mostly female phenotype, including separate urethral and vaginal orifices , but also shows signs of slight masculinization including mild clitoromegaly and/or partial labial fusion . Previously, it

979-489: A good response to exogenous androgens in neonates is a good predictor of androgen response at puberty. If a mutation in the AR gene is found, it is important to determine whether the mutation is inherited or de novo (i.e. a somatic mutation ); a certain amount of the wild-type androgen receptor will be present in cases of somatic mutation, which can induce virilization at puberty. A genital skin fibroblast study and

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1068-404: A high morbidity . Additional surgeries may be required to correct postsurgical complications such as stenosis of the anastomosis between the native urethra and the graft , urethral fistulas , and posterior displacement of the balanic meatus . Successful masculinizing genitoplasty performed on individuals with grade 3 PAIS often requires multiple surgeries. If feminizing genitoplasty

1157-457: A large portion are assigned female. More recently, the interests of intersex people themselves are being taken into consideration by the medical community. Some parents have pushed their children with intersex variations to display gender normative roles and behaviours, or to engage in hormonal and surgical interventions to make their bodies appear more aesthetically 'normative'. Research based on interviews of people with intersex variations indicate

1246-737: A means of preventing homosexuality and "uppity women." A poll sampled from primarily LGBTQ intersex youth in the US by The Trevor Project found that 55% identified as bisexual / pansexual , 28% gay / lesbian , 12% queer , 2% straight and 3% questioning . Intersex activists and scholars such as Morgan Holmes , Katrina Karkazis and Morgan Carpenter have identified heteronormativity in medical rationales for medical interventions on infants and children with intersex characteristics. Holmes and Carpenter have sometimes talked of intersex bodies as "queer bodies", while Carpenter also stresses inadequacies and "dangerous" consequences from framing intersex as

1335-457: A minority of doctors favored deferring treatment due to lack of evidence and the irreversible nature of the proposed interventions. The Court observed that advocates of surgery were more numerous than opponents, alternatives to surgery were not entirely feasible, and surgeries had improved, “making it less likely that sexual sensitivity would be destroyed; and the medical community was improving communication with parents”. The Court determined that

1424-434: A much higher concentration of testosterone, depending on the degree of androgen insensitivity. Those undergoing high dose androgen therapy should be monitored for safety and efficacy of treatment, possibly including regular breast and prostate examinations. Some individuals with PAIS have a sufficiently high sperm count to father children; at least one case report has been published that describes fertile men who fit

1513-423: A need for more family protection from intervention and more family support. Intersex people who have been involuntarily surgically altered at birth often suffer from depression , anxiety , and gender dysphoria . The World Health Organization (WHO) standard of care is to delay surgery until the child is old enough to participate in informed consent , performing intersex genital surgeries on newborn infants

1602-465: A neovagina, as none of them is ideal. Surgical intervention should be considered only after non-surgical pressure dilation methods have failed to produce a satisfactory result. Neovaginoplasty can be performed using skin grafts , a segment of bowel , ileum , peritoneum , Interceed, buccal mucosa , amnion , or dura mater . Success of such methods should be determined by sexual function , and not by vaginal length alone, as has been done in

1691-527: A partially formed channel from the urethral opening to the glans . Until recently, it was thought that isolated micropenis was not a manifestation of PAIS. However, in 2010, two cases of PAIS manifesting with isolated micropenis were documented. Grade 3, the most common phenotypic form of PAIS, features a predominantly male phenotype that is more severely undermasculinized, and typically presents with micropenis and pseudovaginal perineoscrotal hypospadias with bifid scrotum . Grade 4 presents with

1780-424: A population described by the author as "genetic males." Meyer-Bahlburg also discussed sexual attraction by individuals with partial androgen insensitivity syndrome , 5α-Reductase deficiency and 17β-Hydroxysteroid dehydrogenase III deficiency , stating that sexual attraction towards females in individuals with these conditions was facilitated by "prenatal exposure to and utilization of androgens." He concluded: It

1869-555: A prohibition of discrimination on grounds of sex. Organisation Intersex International Australia successfully lobbied for inclusion of a legal attribute of "intersex status" in anti-discrimination law, stating that protection on grounds of sexual orientation and gender identity was insufficient. Following 2015 legislation in Malta , an attribute of sex characteristics is now more widespread. Multiple organizations have highlighted appeals to LGBT rights recognition that fail to address

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1958-644: A recent Australian study of people born with atypical sex characteristics finding that, while 48% labeled themselves as straight, 52% of respondents labeled themselves as various other categories besides heterosexual. Clinical research on intersex subjects has been used to investigate means of preventing homosexuality. In 1990, Heino Meyer-Bahlburg wrote on a "prenatal hormone theory of sexual orientation." The author discussed research finding higher rates of same sex attraction among women with congenital adrenal hyperplasia, and consistent sexual attraction to men among women with complete androgen insensitivity syndrome -

2047-535: A relatively frequent finding in CAIS and some forms of PAIS, is associated with sexual difficulties including vaginal penetration difficulties and dyspareunia . There are indications that individuals with an intersex condition may be more prone to psychological difficulties, due at least in part to parental attitudes and behaviors, and concludes that preventative long-term psychological counseling for parents as well as for affected individuals should be initiated at

2136-611: A risk of carcinoma , although carcinoma of the neovagina is uncommon. Neither neovaginoplasty nor vaginal dilation should be performed before puberty . Gonadectomy at time of diagnosis is the current recommendation for PAIS if presenting with cryptorchidism . The risk of malignancy when testes are located intrascrotally is unknown; the current recommendation is to biopsy the testes at puberty, allowing investigation of at least 30 seminiferous tubules , with diagnosis preferably based on OCT3/4 immunohistochemistry , followed by regular examinations. Hormone replacement therapy

2225-756: A sexual orientation or gender identity issue. In What Can Queer Theory Do for Intersex? Iain Morland contrasts queer "hedonic activism" with an experience of insensate post-surgical intersex bodies to claim that "queerness is characterized by the sensory interrelation of pleasure and shame." Intersex can also be contrasted with transgender , which describes the condition in which one's gender identity does not match one's assigned sex. Some people are both intersex and transgender. A 2012 clinical review paper reported that between 8.5% and 20% of people with intersex variations experienced gender dysphoria . A report by The Trevor Project on polling intersex youth in

2314-475: A similar presentation and is difficult to distinguish from 5α-reductase type 2 deficiency , especially before puberty. There are differing opinions on whether treatment is necessary. Treatment may include irreversible and far reaching surgical operations such as gonadectomy, as well as hormone replacement therapy, or vaginoplasty if the patient has desire to engage in penetrative sex. A supplemental system of phenotypic grading that uses seven classes instead of

2403-427: A variable degree of labial fusion and clitoromegaly . Ambiguous phenotypic states include a phallic structure that is intermediate between a clitoris and a penis, and a single perineal orifice that connects to both the urethra and the vagina (i.e. urogenital sinus). At birth, it may not be possible to immediately differentiate the external genitalia of individuals with PAIS as being either male or female, although

2492-494: A variety of different opinions have been presented by professionals, self-help groups, and patients over the last few decades. Points of consideration include what conditions justify genitoplasty, the extent and type of genitoplasty that should be employed, when genitoplasty should be performed, and what the goals of genitoplasty should be. Gender assignment itself does not predicate the need for immediate genitoplasty; in some cases, surgical intervention can be delayed to allow

2581-491: Is about access to administrative corrections to legal documents when an original sex assignment is not appropriate; and thirdly it is not about the creation of a third sex or gender classification for intersex people as a population but it is, instead, about self-determination . The relationship of intersex to lesbian, gay, bisexual and trans, and queer communities is complex, but intersex people are often added to LGBT to create an LGBTI community. A 2019 background note by

2670-469: Is an initialism that stands for lesbian , gay , bisexual , and transgender , and others. The initialism has become mainstream as a self-designation; it has been adopted by the majority of sexuality and gender identity-based community centers and media in the United States , as well as many other countries. Another variant is LGBTQIA , which is used, for example, by the "Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual Resource Center" at

2759-453: Is an X linked recessive condition. The partial unresponsiveness of the cell to the presence of androgenic hormones impairs the masculinization of male genitalia in the developing fetus, as well as the development of male secondary sexual characteristics at puberty , but does not significantly impair female genital or sexual development. As such, the insensitivity to androgens is clinically significant only when it occurs in individuals with

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2848-481: Is associated with a 50% risk of germ cell malignancy when the testes are undescended . If the testes are located intrascrotally , there may still be significant risk of germ cell malignancy; studies have not yet been published to assess this risk. Some men with PAIS may experience sexual dysfunction including impotence and anejaculation . A few AR mutations that cause PAIS are also associated with prostate and breast cancers. Vaginal hypoplasia ,

2937-572: Is considered a human rights violation , including by the WHO. Virilization capacity can be assessed by measuring the response to a trial of exogenous androgens ; some studies have measured the growth of the phallus in response to exogenous testosterone or dihydrotestosterone , while others have measured the change in sex hormone binding globulin (SHBG) in response to the artificial androgen stanozolol to assess androgen sensitivity. Some experts have cautioned that it remains to be proved that

3026-441: Is indicated when the external genitalia is that of a typical female, mild androgen insensitivity syndrome (MAIS) is indicated when the external genitalia is that of a typical male, and partial androgen insensitivity syndrome (PAIS) is indicated when the external genitalia is partially, but not fully masculinized. Androgen insensitivity syndrome is the largest single entity that leads to 46,XY undermasculinization . PAIS has

3115-507: Is not present. However, some cases of PAIS, including AR-mutant-positive cases, will show normal androgen binding. A family history consistent with X-linked inheritance is more commonly found in AR-mutant-positive cases than AR-mutant-negative cases. The use of dynamic endocrine tests is particularly helpful in isolating a diagnosis of PAIS. One such test is the human chorionic gonadotropin (hCG) stimulation test. If

3204-418: Is particularly useful when the diagnosis is PAIS. Partial androgen insensitivity syndrome is diagnosed when the degree of androgen insensitivity in an individual with a 46,XY karyotype is great enough to partially prevent the masculinization of the genitalia, but is not great enough to completely prevent genital masculinization . This includes any phenotype resulting from androgen insensitivity where

3293-421: Is performed in infancy, the result will need to be refined at puberty through additional surgery. Procedures include clitoral reduction / recession, labiaplasty, repair of the common urogenital sinus, vaginoplasty, and vaginal dilation through non-surgical pressure methods. Clitoral reduction / recession surgery carries with it the risk of necrosis as well as the risk of impairing the sexual function of

3382-426: Is required after gonadectomy, and should be modulated over time to replicate the hormone levels naturally present in the body during the various stages of puberty . Artificially induced puberty results in the same, normal development of secondary sexual characteristics , growth spurt , and bone mineral accumulation . Women with PAIS may have a tendency towards bone mineralization deficiency, although this increase

3471-481: Is required for genital surgeries in children. The Court ruled in the case of XX, an 8-year old with ambiguous genitalia, androgen insensitivity and XY chromosomes, raised as a girl. Doctors recommended feminizing surgeries , including a gonadectomy , vaginoplasty and clitoroplasty before puberty, but the hospital would not proceed without the consent of the Colombian Institute of Family Welfare and

3560-678: Is the case for CAIS, vaginal dilation using pressure dilation methods should be attempted before the surgical creation of a neovagina is considered, and neither should be performed before puberty. Complications of feminizing genitoplasty can include vaginal stenosis , meatal stenosis, vaginourethral fistula , female hypospadias , urinary tract injuries, and recurrent clitoromegaly. Successful feminizing genitoplasty performed on individuals with grade 3 PAIS often requires multiple surgeries, although more surgeries are typically required for successful masculinizing genitoplasty in this population. Many surgical procedures have been developed to create

3649-521: Is thought to be less than is typically seen in CAIS, and is similarly managed. Testosterone has been used to successfully treat undervirilization in some but not all men with PAIS, despite having supraphysiological levels of testosterone to start with. Treatment options include transdermal gels or patches, oral or injectable testosterone undecanoate , other injectable testosterone esters , testosterone pellets, or buccal testosterone systems. Supraphysiological doses may be required to achieve

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3738-426: Is too early to conclude that there is a pre- or perinatal hormonal contribution to the development of homosexuality, except perhaps in persons with clearcut physical signs of intersexuality. The scientific basis is insufficient to justify the assessment of chromosomes and sex hormones in the fetus, or the prenatal treatment with sex hormones, for the purpose of preventing the development of homosexuality, quite apart from

3827-556: Is used to deconstruct sexes, gender roles, compulsory heterosexuality, and even Western science, rather than addressing medical ethics or other issues that directly impact the lives of intersex people. But perhaps this is an inaccurate way to describe the situation: the truth is not that these discussions are "stuck" prematurely, but that they are starting from a wrong place with a wrong set of priorities". In June 2016, Organisation Intersex International Australia pointed to contradictory statements by Australian governments, suggesting that

3916-841: The Americans with Disabilities Act . In 2013, the Australian Senate published a report on the Involuntary or coerced sterilisation of intersex people in Australia as part of a broader inquiry into the involuntary or coercive sterilization of people with disabilities. In Europe, OII Europe has identified multiple articles of the UN Convention on the Rights of Persons with Disabilities , including on equality and non-discrimination, and freedom from torture, and protecting

4005-847: The Office of the United Nations High Commissioner for Human Rights has stated that intersex persons are a distinct population with concerns about "representation, misrepresentation and resourcing", but who share "common concerns" with LGBT people "due to shared experiences of harm arising from dominant societal sex and gender norms." The paper identifies both how intersex people can suffer human rights violations "before they are able to develop or freely express and identity" and how "stereotypes, fear and stigmatization of LGBT people provide rationales for forced and coercive medical interventions on children with intersex variations." Julius Kaggwa of SIPD Uganda has written that, while

4094-541: The University of California, Davis . The United States National Institutes of Health (NIH) have framed LGBT, others "whose sexual orientation and/or gender identity varies, those who may not self-identify as LGBT" and also intersex populations (as persons with disorders of sex development ) as "sexual and gender minority" (SGM) populations. This has led to the development of an NIH SGM Health Research Strategic Plan. The concept of queer can also be included to form

4183-502: The embryonic stage of development , testes form in an androgen-independent process that occurs due to the influence of the SRY gene on the Y chromosome . Cryptorchidism is common, and carries with it a 50% risk of germ cell malignancy . If the testes are located intrascrotally , there may still be significant risk of germ cell malignancy; studies have not yet been published to assess this risk. Predominantly male phenotypes vary in

4272-595: The politics of Scotland is a stub . You can help Misplaced Pages by expanding it . This article about a lesbian, gay, bisexual, or transgender -related organization is a stub . You can help Misplaced Pages by expanding it . This article about a charitable organisation in the United Kingdom is a stub . You can help Misplaced Pages by expanding it . LGBTI Intersex can be contrasted with homosexuality or same-sex attraction . Numerous studies have shown higher rates of same sex attraction in intersex people, with

4361-681: The Equality Network in 2008. It was also shortlisted for Public Campaign of the Year at the Scottish Politician of the Year Awards 2012. Other national LGBT organisations: Other national organisations with a substantial LGBT remit: Other national equality and human rights organisations: This article about an organisation in Scotland is a stub . You can help Misplaced Pages by expanding it . This article related to

4450-846: The Equality Network. Vic Valentine is manager of the group. Previously, James Morton was manager of Scottish Trans Alliance. Morton is the author of A Scottish History of Trans Equality Activism. The Equality Network won the Campaign of the Year Award at the Herald Society Awards 2012, and Campaign of the Year at the LGBT Youth Scotland Awards 2012, both for the Equal Marriage campaign — the UK's first campaign for same-sex marriage rights, established by

4539-546: The Office of the Public Advocate. The mother brought a case against Institute and Office of the Public Advocate, seeking to provide substitute consent. The mother argued that “the capacity to decide, it would be too late and would prevent normal psychological, physical, and social development”. The Court refused the mother's claim. It questioned the urgency of the case, argued by medical teams. Civil rights advocates and

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4628-682: The US found that 42% identified as cisgender , 32% non-binary , 17% transgender , and 9% questioning , the poll sampled primarily LGBTQ youth. The rate of being transgender/non-binary in the overall US youth population is 5%. Recognition of third sex or gender classifications occurs in several countries. Sociological research in Australia, a country with a third 'X' sex classification, shows that 19% of people born with atypical sex characteristics selected an "X" or "other" option, while 52% are women, 23% men, and 6% unsure. A German law requiring that infants which can be assigned to neither sex have their status left blank on their birth certificate

4717-421: The affected child to reach an age and maturity sufficient to have a role in such decisions. Some studies suggest that early surgeries can still produce satisfactory outcomes, while others suggest it to be unlikely. Even surgeries that are planned as one-stage procedures often require further major surgery. Scarring and tissue loss that result from repeated surgical procedures are of particular concern, due to

4806-456: The child to decide for themselves. According to them, key considerations involved in assigning gender include the appearance of the genitalia , the extent to which the child can virilize at puberty, surgical options and the postoperative sexual function of the genitalia, genitoplasty complexity, potential for fertility , and the projected gender identity of the child. The majority of individuals with PAIS are raised male, although

4895-567: The common predictor of gender reassignment was stigmatization related to having an intersex condition. The outcome of masculinizing genitoplasty is dependent on the amount of erectile tissue and the extent of hypospadias . Procedures include correction of penile curvature and chordee , reconstruction of the urethra , hypospadias correction, orchidopexy , and Müllerian remnant removal to prevent infection and pseudo- incontinence . Erectile prosthesis may be inserted in cases of successful neophalloplasty in adulthood, although it has

4984-1071: The criteria for grade 2 PAIS ( micropenis , penile hypospadias , and gynecomastia ). Several publications have indicated that testosterone treatment can correct low sperm counts in men with MAIS. At least one case report has been published that documents the efficacy of treating a low sperm-count with tamoxifen in an individual with PAIS. Depending on phenotypic features, impotence and other sexual problems such as anejaculation or sexual aversion may be fairly common among individuals with PAIS, but do not necessarily indicate low libido . Support groups for individuals with PAIS may help affected individuals discuss their concerns more comfortably. Some individuals with PAIS may try to avoid intimate relationships out of fear of rejection; individual therapy may help some to overcome social anxiety , and restore focus to interpersonal relationships instead of solely on sexual function and activity. Adults with partial androgen insensitivity syndrome include Australian-Maltese advocate Tony Briffa , considered to be

5073-553: The degree of genital undermasculinization to include micropenis , chordee , bifid scrotum, and/or pseudovaginal perineoscrotal hypospadias . Impotence may be fairly common, depending on phenotypic features; in one study of 15 males with PAIS, 80% of those interviewed indicated that they had some degree of impotence. Anejaculation appears to occur somewhat independently of impotence; some men are still able to ejaculate despite impotence, and others without erectile difficulties cannot. Predominantly female phenotypes include

5162-600: The desired physiological effect, which may be difficult to achieve using non-injectable testosterone preparations. Exogenous testosterone supplementation in unaffected men can produce various unwanted side effects , including prostatic hypertrophy , polycythemia , gynecomastia , hair loss , acne , and the suppression of the hypothalamic-pituitary-gonadal axis , resulting in the reduction of gonadotropins (i.e., luteinizing hormone and follicle-stimulating hormone ) and spermatogenic defect. These effects may not manifest at all in men with AIS, or might only manifest at

5251-540: The dignity and rights of LGBT and intersex people are recognized while, at the same time, harmful practices on intersex children continue. In August 2016, Zwischengeschlecht described actions to promote equality or civil status legislation without action on banning "intersex genital mutilations" as a form of pinkwashing . The organization has previously highlighted evasive government statements to UN Treaty Bodies that conflate intersex, transgender and LGBT issues, instead of addressing harmful practices on infants. LGBT+

5340-407: The earliest age at which it can be reliably assessed has yet to be determined. Approximately 25% of individuals with PAIS are dissatisfied with their assigned gender, regardless of being raised as male or female. One study reports that 46,XY individuals born with micropenis and no hypospadias are better off being raised male, despite the success of some being raised female. Studies involving

5429-435: The ethical issues involved. In 2010, Saroj Nimkarn and Maria New wrote that, "Gender-related behaviors, namely childhood play, peer association, career and leisure time preferences in adolescence and adulthood, maternalism, aggression, and sexual orientation become" masculinized in women with congenital adrenal hyperplasia . Medical intervention to prevent such traits has been likened by Dreger , Feder and Tamar-Mattis to

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5518-845: The gay community "offers us a place of relative safety, it is also oblivious to our specific needs." Mauro Cabral has written that transgender people and organizations "need to stop approaching intersex issues as if they were trans issues" including use of intersex as a means of explaining being transgender; "we can collaborate a lot with the intersex movement by making it clear how wrong that approach is." Pidgeon Pagonis states that adding an I to LGBTQA may or may not help increase representation, and may increase funding opportunities for intersex organizations, but may also be harmful to intersex children due to stigma associated with being LGBTQA. Organisation Intersex International Australia states that some intersex individuals are same sex attracted, and some are heterosexual, but "LGBTI activism has fought for

5607-426: The genitalia is partially, but not completely masculinized . Genital ambiguities are frequently detected during clinical examination at birth, and consequently, a PAIS diagnosis can be made during infancy as part of a differential diagnostic workup . Pubertal undervirilization is common, including gynecomastia , decreased secondary terminal hair , and/or a high pitched voice. The phallic structure ranges from

5696-511: The genitalia, and thus should not be performed for less severe clitoromegaly . Clitoral surgery should be focused on function rather than appearance, with care being taken to spare the erectile function and innervation of the clitoris. If PAIS presents with a common urogenital sinus , the American Academy of Pediatrics currently recommends that surgery to separate the urethra from the vagina be performed at an early age. As

5785-567: The gonads are testes , there will be an increase in the level of serum testosterone in response to the hCG, regardless of testicular descent . The magnitude of the testosterone increase can help differentiate between androgen resistance and gonadal dysgenesis , as does evidence of a uterus on ultrasound examination. Testicular function can also be assessed by measuring serum anti-Müllerian hormone levels, which in turn can further differentiate PAIS from gonadal dysgenesis and bilateral anorchia . Another useful dynamic test involves measuring

5874-603: The initialisms LGBTIQ and LGTBIQ (in Spanish). Kimberly Zieselman of interACT has described how the LGBT community has helped open doors, but how intersex rights are broader: "at its core this is a children's rights issue. It is also about health and reproductive rights, because these operations can lead to infertility." Multiple authors and civil society organizations highlight intersectionalities between intersex people and disability, due to issues of medicalization, and

5963-418: The integrity of the person. Nevertheless, the organization has expressed concern that framings of intersex as disability can reinforce medicalization and lack of human rights, and do not match self-identification. Partial androgen insensitivity syndrome Partial androgen insensitivity syndrome ( PAIS ) is a condition that results in the partial inability of the cell to respond to androgens . It

6052-440: The interim. Grade 7 is indistinguishable from grade 6 until puberty, and is thereafter differentiated by the presence of secondary terminal hair ; grade 6 is indicated when secondary terminal hair is present, whereas grade 7 is indicated when it is absent. The Quigley scale can be used in conjunction with the traditional three classes of AIS to provide additional information regarding the degree of genital masculinization, and

6141-500: The issue of unnecessary "normalising" intersex medical interventions on intersex children, including by using the portmanteau pinkwashing . In a 2001 paper for the (now defunct) Intersex Society of North America , Emi Koyama and Lisa Weasel stating that teaching of intersex issues is "stuck" at talking about intersex as a mean instead of an end: This indeed seems to be a common problem within women's, gender and queer studies: discussions about intersex existence are "stuck" at where it

6230-612: The majority of individuals with PAIS are raised male. Given the wide diversity of phenotypes associated with PAIS, the diagnosis is often further specified by assessing genital masculinization . Grades 2 through 5 of the Quigley scale quantify four degrees of increasingly feminized genitalia that correspond to PAIS. Grade 2, the mildest form of PAIS, presents with a predominantly male phenotype that presents with minor signs of undermasculinized genitalia, such as isolated hypospadias , which can be severe. Hypospadias may manifest with

6319-486: The male participants had a stretched penile length that was below 2.5 standard deviations of the mean, while only 6% of female participants presented with a short vagina in adulthood, and participating physicians gave a lower cosmetic rating to the surgical results of the men than the women. Both male and female participants cited the appearance of their genitalia as being the greatest contributing factor to their dissatisfaction with their body image . In two larger studies,

6408-412: The more ambiguous phenotypic forms of PAIS are less decisive. Homosexuality with respect to assigned gender and atypical gender role behavior are known to occur more frequently in individual with PAIS, and may occur with or without gender dysphoria ; neither should be interpreted as an indication of incorrect gender assignment . If an affected child does express feelings of gender dysphoria,

6497-498: The opportunity to explore such feelings with a psychologist experienced in treating intersex conditions should be accommodated. If feelings of gender dysphoria persist, gender reassignment should be initiated, possibly with the aid of a specialist in the field. Genitoplasty , unlike gender assignment, can be irreversible, and there is no guarantee that adult gender identity will develop as assigned despite surgical intervention. Some aspects of genitoplasty are still being debated;

6586-528: The past 17 years the Equality Network has claimed a number of victories for LGBT equality in Scotland including an equal age of consent, the repeal of Section 28, Civil Partnerships, Gender Recognition, adoption and fertility rights, hate crime laws, and most recently same-sex marriage. The Scottish Trans Alliance ( STA ) is a project within the Equality Network to "improve gender identity and gender reassignment equality, rights and inclusion in Scotland". Scottish Trans Alliance has three full-time staff working for

6675-626: The past. Ileal or cecal segments may be problematic because of a shorter mesentery , which may produce tension on the neovagina, leading to stenosis . The sigmoid neovagina is thought to be self-lubricating, without the excess mucus production associated with segments of small bowel . Vaginoplasty may create scarring at the introitus (the vaginal opening), requiring additional surgery to correct. Vaginal dilators are required postoperatively to prevent vaginal stenosis from scarring. Other complications include bladder and bowel injuries. Yearly exams are required, as neovaginoplasty carries

6764-572: The presumed negative impact on sexual function . While it is thought that feminizing genitoplasty typically requires fewer surgeries to achieve an acceptable result and results in fewer urologic difficulties, there is no evidence that feminizing surgery results in a better psychosocial outcome. In one study, individuals with grade 3 PAIS who were raised male rated their body image and sexual function similarly to those who were raised female, even though they were more likely to have genitalia that were abnormal in size and appearance; more than half of

6853-587: The response in individuals with predominantly male phenotypes overlaps somewhat with the response in normal males. Management of AIS is currently limited to symptomatic management ; methods to correct a malfunctioning androgen receptor protein that result from an AR gene mutation are not currently available. Areas of management include sex assignment , genitoplasty , gonadectomy in relation to tumor risk, hormone replacement therapy , and genetic and psychological counseling . Non-consensual interventions are still often performed, although general awareness on

6942-454: The response to exogenous steroids; individuals with AIS show a decreased response in serum sex hormone binding globulin (SHBG) after a short term administration of anabolic steroids. Two studies indicate that measuring the response in SHBG after the administration of stanozolol could help to differentiate individuals with PAIS from those with other causes of ambiguous genitalia, although

7031-556: The resulting psychological traumatization is rising. The decision of whether to raise an individual with PAIS as a boy or a girl may not be obvious; grades 3 and 4 in particular present with a phenotype that may be difficult to classify as primarily male or female, and some will be incapable of virilization at puberty . Parents of an affected newborn should seek immediate help at a center with an experienced multidisciplinary team, and should avoid gender assignment beforehand. Older guidelines from 2006 advised against waiting for

7120-441: The rhetorical shift remains deeply contentious. Sociological research in Australia, published in 2016, found that 3% of respondents used the term "disorders of sex development" or "DSD" to define their sex characteristics, while 21% use the term when accessing medical services. In contrast, 60% used the term "intersex" in some form to self-describe their sex characteristics. In the United States , intersex persons are protected by

7209-823: The rights of people who fall outside of expected binary sex and gender norms." On July 1, 2020, Russian intersex organizations (Interseks.ru, ARSI, NFP+, Intersex Russia ) issued a statement on the use of LGBTI abbreviation urging not to use it in and about countries with widespread prejudice and violence in attitudes of individuals based on their sexual orientation and gender identity. Emi Koyama describes how inclusion of intersex in LGBTI can fail to address intersex-specific human rights issues, including creating false impressions "that intersex people's rights are protected" by laws protecting LGBT people, and failing to acknowledge that many intersex people are not LGBT. South Africa protects intersex people from discrimination as part of

7298-829: The time of diagnosis. More recent research based on interviews of people with intersex variations indicate a need for more family protection from intervention and more family support. Lifespan is not thought to be affected by AIS. Unfortunately, the number of differentials to consider for PAIS is particularly large. Prompt diagnosis is particularly urgent when a child is born with ambiguous genitalia , as some causes are associated with potentially life-threatening adrenal crises . Determination of testosterone , testosterone precursors and dihydrotestosterone (DHT) at baseline and / or after human chorionic gonadotropin (hCG) stimulation can be used to exclude such defects in androgen biosynthesis . Approximately one half of all 46,XY individuals born with ambiguous genitalia will not receive

7387-455: The traditional three was proposed by pediatric endocrinologist Charmian A. Quigley et al. in 1995. The first six grades of the scale, grades 1 through 6, are differentiated by the degree of genital masculinization ; grade 1 is indicated when the external genitalia is fully masculinized, grade 6 is indicated when the external genitalia is fully feminized, and grades 2 through 5 quantify four degrees of increasingly feminized genitalia that lie in

7476-439: The use of preimplantation genetic diagnosis . In an analysis of the use of preimplantation genetic diagnosis to eliminate intersex traits, Behrmann and Ravitsky state: "Parental choice against intersex may ... conceal biases against same-sex attractedness and gender nonconformity." A 2006 clinical reframing of intersex conditions as disorders of sex development made associations between intersex and disability explicit, but

7565-861: The work of Outright Scotland . It is a registered charity governed by a board of trustees. It has received funding from some of the following organisations: the Equality Unit of the Scottish Government , the Grundtvig programme of the European Commission , the Equality and Human Rights Commission , the Big Lottery Fund and the Awards for All programme. It also raises money from individuals across Scotland. Over

7654-662: The world's first openly intersex mayor and public office-bearer. Briffa served as Deputy Mayor of the City of Hobsons Bay, Victoria, between 2009 and 2011, and Mayor between 2011 and 2012. In history , the Roman sophist and philosopher Favorinus of Arelate has been described as having partial androgen insensitivity syndrome. In Sentencia SU-337/99, of May 12, 1999, the Constitutional Court of Colombia determined that "qualified and persistent" informed consent

7743-440: Was an option, because I thought the gender change laws were strictly for transgender people. I decided to try and use the same framework to have a third gender ." Keenan later obtained a birth certificate with an intersex sex marker. In press reporting of this decision, it became apparent that Ohio had issued a 'hermaphrodite' sex marker in 2012. Intersex scholar Morgan Holmes argues that thinking of societies that incorporate

7832-465: Was criticised by intersex rights groups on the basis that it could encourage parents who see a neutral option as undesirable to have their child undergo genital surgery. In 2013, the third International Intersex Forum made statements for the first time on sex and gender registration in the Malta declaration , advocating for "register[ing] intersex children as females or males, with the awareness that, like all people, they may grow up to identify with

7921-402: Was erroneously thought that individuals with PAIS were always infertile; at least one case report has been published that describes fertile men that fit the criteria for grade 2 PAIS ( micropenis , penile hypospadias , and gynecomastia ). All forms of androgen insensitivity are associated with infertility , though exceptions have been reported for both the mild and partial forms. PAIS

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