Health and wellbeing of people with intersex variations Information and resource paper The Victorian Government acknowledges Victorian Aboriginal people as the First Peoples and Traditional Owners and Custodians of the land and water on which we rely. We acknowledge and respect that Aboriginal communities are steeped in traditions and customs built on a disciplined social and cultural order that has sustained 60,000 years of existence. We acknowledge the significant disruptions to social and cultural order and the ongoing hurt caused by colonisation. We acknowledge the ongoing leadership role of Aboriginal communities in addressing and preventing family violence and will continue to work in collaboration with First Peoples to eliminate family violence from all communities. Family Violence Support If you have experienced violence or sexual assault and require immediate or ongoing assistance, contact 1800 RESPECT (1800 737 732) to talk to a counsellor from the National Sexual Assault and Domestic Violence hotline. For confidential support and information, contact Safe Steps’ 24/7 family violence response line on 1800 015 188. If you are concerned for your safety or that of someone else, please contact the police in your state or territory, or call 000 for emergency assistance. To receive this publication in an accessible format, email the Diversity unit <[email protected]> Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne. © State of Victoria, Department of Health and Human Services, March 2019 Victorian Department of Health and Human Services (2018) Health and wellbeing of people with intersex variations: information and resource paper. Initially prepared by T. Jones and W. Leonard; revised and edited J. Rostant on behalf of Department of Health and Human Services 2016–2018 Intersex Expert Advisory Group. Department of Health and Human Services: Melbourne. ISBN 978-1-76069-679-5 (pdf/online/MS word) ISBN 978-1-76069-752-5 (Print) Available at Health of people with intersex variations <https://www2.health.vic.gov.au/about/populations/lgbti-health/health-of-people-with-intersex-variations> Printed by TDC3, Richmond (1810017 cover) Message from the Minister The Victorian Government is committed to equality for all Victorians. It is a key responsibility of the Victorian Government to keep people safe. This includes Victoria's LGBTI communities. The Health and wellbeing of people with intersex variations: information and resource paper is one of the ways in which we are addressing stigma and discrimination for people with intersex variations. This information and resource paper is a critical step toward improving health and wellbeing outcomes of children and adults with intersex variations and their families, with Victoria at the forefront of national efforts in this area. In releasing this paper, the Victorian Government acknowledges that people with intersex variations have had negative experiences in their interactions with health, education, employment and other settings, and confirms its commitment to protecting the right to informed consent and bodily integrity for people with intersex variations. Through issuing this information and resource paper, the Victorian Government confirms its support for the development and implementation of evidence-based policies, programs and services for people with intersex variations. The information and resource paper was developed with the assistance of the Victorian Government Intersex Expert Advisory Group and other community advocates. I would like to thank them for their contribution. Jenny Mikakos MP Minister for Health Contents Message from the Minister .............................................................................................................. 3 Acknowledgements ......................................................................................................................... 6 1. Introduction .................................................................................................................................. 7 1.1 Rationale .............................................................................................................................. 7 1.2 Purpose and audience ......................................................................................................... 8 1.3 Resource development ........................................................................................................ 8 1.4 Emerging framework ............................................................................................................ 9 1.5 Key terminology .................................................................................................................... 9 1.6 Structural outline ................................................................................................................. 10 1.7 Limitations .......................................................................................................................... 10 2. Understanding intersex .............................................................................................................. 11 2.1 What does ‘intersex’ mean? ............................................................................................... 11 2.2 How common are intersex variations? ............................................................................... 12 2.3 Do intersex variations influence sex and gender? ............................................................. 13 2.4 What terminology is appropriate? ....................................................................................... 14 3. Legal and policy contexts .......................................................................................................... 16 3.1 International context ........................................................................................................... 16 3.2 National context .................................................................................................................. 18 3.3 State context ....................................................................................................................... 20 3.4 Health-related service/institutional contexts ....................................................................... 21 4. Health and wellbeing ................................................................................................................. 23 4.1 Physical health and wellbeing ............................................................................................ 23 4.2 Mental health and wellbeing ............................................................................................... 24 4.3 Sexual and reproductive health and wellbeing ................................................................... 25 5. Delivering quality treatment and care ........................................................................................ 27 5.1 The treatment experiences of people with intersex variations ........................................... 27 5.2 Evolving perspectives on treatment and care .................................................................... 28 5.3 Respecting diversity, autonomy and voice ......................................................................... 30 5.4. Supporting individuals and families ................................................................................... 31 5.5 Improving health systems and services ............................................................................. 34 6. An evolving approach for Victoria .............................................................................................. 37 6.1 Putting principles into practice ............................................................................................ 37 6.2 An emerging systems approach: future considerations ..................................................... 38 Appendices .................................................................................................................................... 40 Appendix 1: Basic glossary ...................................................................................................... 40 Appendix 2: Potential health issues for selected intersex variations ....................................... 45 Appendix 3: Support and advocacy services ........................................................................... 49 Appendix 4: Figure description ................................................................................................. 50 References .................................................................................................................................... 52 Acknowledgements The Victorian Department of Health and Human Services recognises the expertise and experiences of people with intersex variations and their families, and the leading efforts of medical, ethical and legal professions involved in the health care of people with intersex variations in Victoria. The department would like to thank all of those who contributed their time and expertise to the development of this and related resources and acknowledge the contribution of Australian and Victorian intersex human rights advocates to the development of improved understanding and practice locally and internationally. In particular, the department thanks those involved in the 2016 project overseen by Gay and Lesbian Health Victoria (GLHV), including project leads Associate