Gender experience and satisfaction with gender allocation in adults with diverse intersex conditions (divergences of sex development, DSD)

Abstract

The aims of this mixed-methods study were to: (1) describe the gender experience and level of satisfaction with gender allocation of intersex persons and (2) explore the spectrum of their gender identities. Of the 69 participants with a number of divergences of sex development (DSD), gender allocation at birth was female in 83% and male in 17%. Seventy-five per cent were satisfied with gender allocation. As adults, 81% lived in the female gender role, 12% in the male role and 7% chose other roles. Nine per cent reported gender change or reallocation. Twenty-four per cent reported an inclusive ‘mixed’ two-gender identity, including both male and female elements, and 3% reported a neither female nor male gender identity. Twenty-six per cent were highly uncertain about belonging to a specific gender, 14% received increased transgender scores on the gender identity questionnaire (GIQ). The dichotomous categorisation of gender fails to capture the gender experiences of a significant proportion of our participants. Uncertainty of belonging to the female or male gender category as well as non-binary identifications highlight the need for alternative gender categories. A reconsideration of the medical approach towards intersexuality, which is currently based on a binary categorisation, is discussed.

Keywords:

• satisfaction with gender allocation
• sex assignment
• gender identity
• gender role
• DSD
• intersex
• psychosexual development

Acknowledgements

We would like to thank all our sponsors for making this study possible: German Research Foundation (Ri 558/2-2), Hamburg Foundation for Science and Culture and University Medical Center Hamburg-Eppendorf. We owe the most to the participants in the study, who have contributed important insights and added impetus to an important learning process. We thank all the cooperating doctors, clinics, teams and departments, in particular Prof. Dr. Paul-Martin Holterhus (Kiel) and Prof. Dr. Olaf Hiort (Lübeck) for their ongoing assistance to our medical queries. Thanks are also due to our colleagues, especially Inga Becker, and everyone who has worked on this project, for their commitment and effort. We would like to thank Katherine Miller and Daniel Turner for their language assistance. Finally, we are grateful to the anonymous reviewers and the editors of this special issue for the improvements to our original paper.

Notes

1. 1. Due to the nature of the German term ‘Geschlecht’ used in the original item, in which the meanings sex and gender are both subsumed, the question could also have been understood to mean: ‘Were you at a later point in time assigned a different sex to that which you had originally been assigned?’.

2. 2. Genital appearance at birth was assessed by the participants’ self-report and their medical records. The self-report was assessed by means of the items ‘Were physical anomalies found to be present within 8 weeks after birth?’ and ‘What was the opinion concerning your genitals with regard to sex directly after birth?’. With regard to the latter item, the categories ‘definitely female’, ‘more likely female’, ‘ambiguous’, ‘definitely male’, ‘more likely male’ and ‘other’ were provided in the original version. The outcomes of these sources were summarised as ‘female’, ‘male’ or ‘ambiguous’.

3. 3. For details see Schönbucher et al. (2012): Stefanie reported having a gonadectomy at the age of 16.

Additional information

Notes on contributors

Katinka Schweizer

Franziska Brunner has academic training in psychology, sexology and criminology at the University of Hamburg. As a member of the gender team at the Department of Sex Research and Forensic Psychiatry (University Medical Center Hamburg-Eppendorf), she is working as a scientific researcher on gender identity, quality of life and sexuality of persons with specific sex developments, e.g. intersex conditions, MRKH syndrome or Kallmann syndrome.

Franziska Brunner

Christina Handford is in the final year of her academic training in psychology and sexology at the University of Hamburg and is involved in research into the gender identity of persons with specific sex developments and treatment approaches and gender identity experiences in sexual minorities at the Department of Sex Research and Forensic Psychiatry (University Medical Center Hamburg-Eppendorf). Her research focus is on conceptions of gender and gender experience amongst people with intersex conditions.

Christina Handford

Hertha Richter-Appelt is Professor of Sex Research at the Medical Faculty of the Hamburg University and co-director of the Department of Sex Research and Forensic Psychiatry (University Medical Center Hamburg-Eppendorf). She is a psychoanalyst and has broad clinical and psychotherapeutic experiences with transsexual, transgender and intersex people. She is principal investigator of several research projects in the field of gender identity disorders, disorders of sex development, etc., a founder member of the European Research Group for Transsexualism and vice-president of the German Society for Sex Research. She has numerous publications in psychotherapy, sex research, gender identity and sexual traumatisation.

Hertha Richter-Appelt

Katinka Schweizer has academic training in psychology and theology. She received her MSc in Social Psychology at the University of Oxford, Master’s Degree in Clinical and Educational Psychology at the University of Hamburg and doctoral degree from the University of Hamburg. She is a certified psychodynamic psychotherapist and works as a researcher and psychotherapist at the University Clinic Hamburg-Eppendorf and in Northern Germany, with special interest in gender identity experiences in sexual minorities, coping processes and psychodynamic psychotherapy.