Historical/cultural aspects

The social meanings attached to genital differences -- between men and women, and between those who are intersexed and those who are not -- have varied since ancient times in line with the prevailing knowledge-producing systems (religion, philosophy, science, medicine) and between geographical and cultural loci (anthropological, sociological). For several centuries so-called hermaphrodites were accepted as people in whom a combination of sex characteristics could be found, and who might therefore be allowed to choose what they wanted to be. But by the mid-1800s they had become people whose bodies deceptively hide their 'real' identities, their 'true' sex, which the expertise of doctors could uncover.

The year 1852 has been given as the date of the first published report of sex-'corrective' surgery in the US, alongside an increasing reference to homosexuality in medical journals. By the mid-20th century physicians understood the scientific importance of chromosomes and hormones in sex differentiation and development. However, the external genital morphology became the single most important criterion for the social act of assigning gender, and 'corrective' genital surgery became the gold standard that preserved our binary system.

The now discredited 1950s advice of gynaecologist John Morris (that women with Androgen Insensitivity Syndrome would not handle truthful diagnostic disclosure) and of psychologist John Money (that gender reinforcement surgery in other intersex/dsd conditions would be unproblematic if done early and if the patient is kept uninformed) held sway until challenged by intersex patient activism from the mid-1990s.

Scientific advances have provided more effective treatments for the medical problems associated with some intersex/dsd conditions. However, interventions to align the anatomy to the assigned gender constitute a societal practice, with significant physical and psychological repercussions for the individual and suspect implications for society.

Social scientists and patient advocates question unhelpful cultural conceptions of variations in sex anatomy, and the way in which these have been upheld in medicine and psychology, with detrimental effects on the psychological well-being of people born differently sexed. Positive responses to atypical sex characteristics associated with intersex/dsd are at the heart of EuroPSI.