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Home , Intersex, Intersex and LGBT

TIPS FOR WORKING WITH PEOPLE for your own curiosity or from judgement. Refer to information from intersex-led organisations to • Most intersex people will identify as a or a assist you to work in respectful, client-directed , and some will identify as non-binary or use ways. a self-designated descriptor. Be aware that intersex people are not an homogenous ‘third ’. • As with any client, it is intrusive to ask about intimate details such as genitals or sex and • Human anatomical and physiological variations reproductive organs. Most people, including intersex do not in themselves constitute medical problems. people consider their physical characteristics as Medical language, (such as using ‘disorders’, or personal information that would not be disclosed in ‘conditions’ for normal variations), can alter or general conversation. undermine people’s informed consent to medical treatment. • Many intersex people may have only discussed their intersex experiences and bodies in medical contexts. • People with intersex variations may describe Speaking of these experiences in counselling themselves as intersex, but may also use other INTERSEX settings may be useful for later sharing in other terms. It is preferable to use the term ‘intersex’ settings and relationships, and may help individuals unless asked otherwise. Avoid leading with to develop non-medical ways of discussing being terms such as ‘’, or ‘disorders of intersex. Be affirming about intersex as a natural A QLIFE GUIDE sex development’ which can convey negative variation. connotations about intersex people. FOR HEALTH • If a person learns of their intersex status later in PROFESSIONALS • Intersex is about physical sex characteristics, life,they may need support to help understand so avoid language that confuses intersex with their variation, as well as how it relates to , or with sexuality. For example, avoid their past, to current relationships and to People are born with referring to someone’s intersex status as their their understanding of themself. many kinds of bodies, and gender. Terms like ‘diverse gender and sexuality’ natural differences in sex • Some people may have health needs do not include intersex. Talk about ‘intersex’ and characteristics are far more ‘bodily diversity’ specifically. arising from their intersex variation or medical interventions. These can common than might be widely • With appropriate timing and manner, you could include developmental delays, pain, recognised. Intersex is an ask ‘how do you see yourself, what language do you trauma and bone health issues umbrella term for a wide range prefer?’ Be guided by the language the person uses, relating to medical interventions. of natural variations, including including use or non-use of pronouns. Ask privately genetic, hormonal or physical whenever possible, and ensure you are asking for • In working with sex and intimacy, sound reasons, and in context. be aware that intersex related sex characteristics. surgeries and treatments may • Avoid using terms that are often used to describe have affected sexual function and Intersex people are born with LGB people’s sexuality, such as ‘’. Most sensation. This can have effects on physical sex characteristics intersex people do not have the type of experiences self esteem, sexual wellbeing and that don’t fit medical and often associated with LGB people’s coming out. relationships. Intersex people are often informed by parents social norms for or male or medical professionals who may have held (or • Families and carers of intersex bodies. withheld) this information for some time, rather infants, children and adolescents than a coming out process of self discovery. also need affirmative support, and may also benefit from counselling. • Inform yourself, and while creating openness to talk Access to peers and adults with about many aspects of being intersex, be careful intersex variations can help families and not to place the onus of your education upon the individuals to make better, more informed, people you are supporting. Be aware of the context choices about health needs. of asking questions to ensure you are not asking

CONTACT QLIFE Health Professionals wanting to know more can contact us at [email protected] QLife is open 365 days a year, 3pm - midnight. P 1800 184 527 | www.qlife.org.au VERSION 1.0 APRIL 2017 people do not have to conform to prevalent norms about bodies or sex classifications, nor restrictive norms INTERSEX STATUS AND AUSTRALIAN LAW about sexuality and gender.

People with intersex characteristics have had a long It is important to use a person centred approach and to struggle to claim human . However, things actively work against shame and stigma when working have begun to change. From 1st August 2013, the Sex with intersex people. This approach affirms intersex Act (, bodies as naturally occurring, including openness about and Intersex Status) provided the first federal protection the diversity of bodies, and sexualities for all INTERSEX in Australia from discrimination on the basis of gender people including intersex people. When facing choices identity and intersex status. The Act recognises the about medical intervention, intersex people should distinction between sex, gender identity and intersex first introduced from 2002. In some cases, initial sex be supported to make informed decisions. Informed DEFINING INTERSEX status. Australia also was the first country in the world assignment can be incorrect. This can be particularly consent should include access to peer support and to conduct a parliamentary inquiry into involuntary or Up to 1 to 2% of people may have an intersex variation, damaging where an original was accurate information about the possible and likely coerced medical interventions on intersex people (2013). and intersex people exist in all cultures and throughout surgically reinforced during infancy or childhood. outcomes of medical interventions and their alternatives history. Intersex people are born with genetic and other (including non-intervention). All work with intersex variations related, for example, to genitals, Gender and gender identity can be understood as “The Darlington Statement” (2017) people should be underpinned by the intent to support and chromosomal patterns. There may be 40 or more socially constructed, and may include assigned gender rights to bodily autonomy and self-determination. distinct intersex variations, each with a different genetic or legal sex (at birth) and self-determined gender. is a joint consensus statement by or other basis. While intersex variations are naturally intersex organisations in Australia Sexuality for intersex people, as for everyone, is not occurring, they remain associated with stigma and THE ‘I’ IN LGBTI secrecy in medical, social and family settings. This determined by physical sex characteristics or gender and Aotearoa/New Zealand and identity. Intersex people may be heterosexual, and some stigma contributes to a lack of accurate population In Australia, there has been growing inclusion of ‘I’ for may be same-sex attracted. Some may identity as , independent activists. It outlines legal figures about people with intersex characteristics and a intersex in LGBT-focussed spaces, as seen in the use of , bisexual, or asexual. lack of reporting on the number of medical interventions reform, access to affirmative health LGBTI. While Intersex is not specifically about sexuality carried out in infancy or childhood. THE IMPACT OF MEDICALISATION care and the importance of peer and gender diversity in the way that LGB and T are, there is common ground for intersex and LGBT people due While intersex variations can be apparent prenatally The birth of an intersex child is often treated by health support for the wellbeing of intersex to stigma related to not ‘fitting’ and (such as via IVF or amniocentesis) or at birth, some professionals as a psycho-social emergency and there gender norms. Discrimination towards intersex people variations may not be recognised until or into may be a sense of urgency conveyed for parents to people. can occur based on fixed, narrow notions of gender adulthood. Some people learn of intersex variations consent to medical interventions. Often, limited avenues and sexuality, regardless of an intersex person’s gender when seeking medical advice, such as when becoming of support and information are available to parents or identity or sexual orientation. sexually active or trying to conceive, or due to other children themselves and there may not be referral to WORKING WITH PEOPLE WITH INTERSEX related or unrelated health matters. It is not uncommon support outside of the medical system, such as from CHARACTERISTICS As with all the separate, intersecting populations in for intersex people themselves to remain unaware of intersex-led organisations. These processes can result in L,G,B,T and I, it is important to use each letter with having intersex traits until told by parents or medical decisions for surgeries during infancy or early childhood Many intersex people have experienced trauma from care; for example, if speaking about LGBTI people and practitioners into late childhood or adulthood. For being made without a full understanding of the long- medical procedures and examinations, often in the communities ensuring that the context is relevant for people learning later of their intersex status, it can term physical and psychological implications, or without developmental stages of childhood or in adolescence. Intersex people, or whether it may be about a different be difficult to gain accurate information about past information about the options to delay decisions until a This can include surgeries, medical photography, being population eg: sexuality related to LGB, or sexuality and medical history and interventions, due to stigma and child can consent themselves. subjected to teaching situations, and being talked about gender related to LGBT. poor medical records systems. in intimate and pathologising ways. Because of this, Surgical procedures and other interventions are based intersex people may be reluctant to ask for psychological BODIES, GENDER AND SEXUALITY on an intention to ‘normalise’ intersex people’s bodies; help and other forms of support due to feelings of to have appearances that are more in line with male mistrust, anger, shame and/or embarrassment. Some Intersex people, as any people, have diversity of gender, or female norms. Some surgeries are presented as people with intersex bodies report that intrusive gender identity and sexual orientation. These may be preventative for future risks despite evidence that these examinations combined with stigma and secrecy informed by a person’s intersex characteristics, but are decisions could in most cases be safely delayed until a within the family left them vulnerable to distinct from being intersex. child can consent. as children, with added impact on mental health and willingness to trust others. To avoid misunderstandings about people’s intersex The prioritisation of physical appearance over the status, it is necessary to understand the differences risks to intervention reflects an adherence to sex and It is essential that medical and psychological support between ‘sex characteristics’ and ‘gender’ or ‘gender gender norms, and an over-valuing of societal norms ensures that intersex people are listened to and able to identity’, as well as sexuality and sexual orientation. about genital appearance, as though nonconformity make decisions about their own body. When working and natural variations carry more risks to wellbeing with intersex people of all ages, it is critical that they Sex characteristics relate to an individual’s physical, than intervention. Evidence shows that most decisions and any loved ones involved in their care are assured bodily characteristics and traits. In Australia, most could be delayed until a child is old enough to consent, that intersex bodies are a natural human intersex people describe their sex as male or female, but interventions continue in Australia today, despite variation and that intersex some as non-binary, and some in other ways. A person’s avoidable physical and psychological effects and legal sex classification can appear on legal documents concerns about ethics. including birth certificates and passports and this is usually based on assigned sex at birth. In Australia, federal gender classifications include ‘female’, ‘male’, and ‘X’, a third legal option

QLIFE GUIDE FOR HEALTH PROFESSIONALS | INTERSEX