Hermaphrodite and the Definition of Intersex

Albert the Great (1193-1280) indicates a symbolic hermaphrodite who holds a letter Y
Albert the Great (1193-1280) indicates a symbolic hermaphrodite who holds a letter Y. Fototeca Storica Nazionale/Hulton Archive/Getty Images

A hermaphrodite (her-MAFF-ro-dite) is someone who is born with a discrepancy between their internal genitalia and external genitalia. The term hermaphrodite came from combining the names of the Greek god and goddess Hermes and Aphrodite. For many, the term hermaphrodite is offensive. Instead, the term intersex is preferred.

What Determines Intersex

Usually, the sex of an individual is determined by the internal and external sexual organs, the gonads, and the secondary sexual characteristics that appear at puberty.

Intersex conditions occur when there is a defect in the normal process of sexual maturation that results in abnormalities. How the medical establishment manages these conditions is continually in flux, from how and when to diagnose, and how and when to treat. In addition, why these conditions occur is still unknown. 

Various Terms, Various Conditions

The terms, intersex, third sex, third gender, ambiguous genitalia, pseudohermaphrodite, false hermaphrodite, true hermaphrodite, male pseudohermaphrodite, female pseudohermaphrodite, are also used to describe this condition. Each tends to describe different aspects of this condition. 

For instance, if an individual is born with genitalia that cannot quite be categorized as male or female, but lies somewhere in between, it is known as ambiguous genitalia. However, this person is also considered a false hermaphrodite or pseudohermaphrodite. These last two terms are considered offensive and even confusing.

Therefore, the use of the term disorders of sexual development (DSD) is sometimes preferred.

In cases where both a penis and vagina are present, this individual is considered a true hermaphrodite. But it isn't that simple, DSDs can be classified into three groups:

  • male pseudohermaphrodite, which includes XY females such as women with complete androgen insensitivity syndrome (when a person who is genetically male is resistant to male hormones, called androgens);
  • female pseudohermaphrodite, which includes virilized women such as those with congenital adrenal hyperplasia, which occurs when adrenal glands lack an enzyme needed to make the hormones;
  • and true hermaphrodite. 

What Is a True Hermaphrodite

There have been case studies that conclude that a true hermaphrodite is a normal male phenotype, who has been diagnosed with Sertoli Cell Only Syndrome (SCOS), which is a condition that prevents the sufferer from creating sperm, and that has a testicular mass. Examination of the testes may show that ovarian, fallopian tube, myometrial, endometrial, and epididymal tissue is present. This combination of findings is found in approximately one-third of true hermaphrodites.

Intersex Surgeries

When it comes to the long-term results of procedures that help treat DSD the science is still in its infancy. There are debates about when treatment or gender reassignment should occur. There have been some studies trying to sort this out, though. 

One study out of Brazil found that for making the male to female transition, feminizing genitoplasty consisting of vulvoplasty, clitoroplasty, and Y-V perineal flap produced good cosmetic and functional results in virilized girls with congenital adrenal hyperplasia, with few complications.

In addition, this surgical approach prevented the need for neovaginaplasty.

If a female to male transition is warranted, then a masculinizing genitoplasty, where male genitalia is created, is done. 

Sources

Androgen insensitivity syndrome; US Library of Medicine; MEDLine

Ceci M, Calleja E, Said E, Gatt N. A Case of True Hermaphroditism Presenting as a Testicular Tumour. Case Reports in Urology. 2015;2015:598138. doi:10.1155/2015/598138.

Creighton S. Surgery for intersex. J R Soc Med. 2001 May; 94(5): 218–220. 

Houk CP, Hughes IA, Ahmed SF, Lee PA; Writing Committee for the International Intersex Consensus Conference Participants. Summary of consensus statement on intersex disorders and their management. International Intersex Consensus Conference. Pediatrics. 2006 Aug;118(2):753-7.

Sircili MHP, et al. Anatomical and functional outcomes of feminizing genitoplasty for ambiguous genitalia in patients with virilizing congenital adrenal hyperplasia. Clinics, 2006 June, 61(3), 209-214. 

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