Being openly intersex2021-10-23T15:41:28+00:00
Een grote hoeveelheid mensen die in een winkelstraat lopen. De foto is genomen in tegenlicht.

Image: istockphoto.com/nadia_bormotova

Being openly intersex

People often wonder why intersex people are not visible in society. The simple answer is ‘because of stigma and secrecy’. In order to increase the visibility of people with intersex variations, it is important to know how people in general deal with stigma. It is, however, also important to know the ultimate goal of ending stigma and secrecy. This article starts with a theoretical explanation of why intersex people are not visible in society and then addresses the question of what still stands in the way of a ‘coming out’ or being openly intersex.

CONTENT

1. Invisibility as a strategy
2. Position in society
3. Integration or inclusion
4. Coming out and stigma
5. Secrecy and openness
6. Tips for more openness
Consulted literature
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2
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4
5
6
REF

Invisibility as a strategy

Although for most people, their intersex variation is not their only identity (if such a thing exists at all), it is part of what the English social psychologist Henri Tajfel defines as ‘social identity’.1Tajfel defines social identity as “that part of the individuals’ self-concept which derives from their knowledge of their membership of a social group (or groups) together with the value and emotional significance of that membership” (Tajfel 1982). For the visibility of intersex people in society it is not only about belonging to groups, but also about not belonging to a group. What is often called a ‘coming out’ – telling others that you are ‘different’ – also means that the social identity changes: the one who comes out leaves a group and becomes part of another group. But the groups involved are more complex than people who have had ‘no coming out’ or did have a ‘coming out’.

American sociologist-anthropologist Richard Troiden described the phases of the development of a homosexual identity in 1988. Five ‘stigma management strategies’ play a role: capitulation, minstrelization, passing, group alignment and commitment (Troiden 1988).2Earlier, Goffman had described three strategies to neutralize stigma: minstrelization, normification, and militant chauvinism.

Minstrelization: if you feel like you are an outsider, you can magnify the differences between yourself and the dominant group in hopes of being more accepted.

Normification: if you do not want to fight the dominant group, you can try to minimize the differences with the dominant group by emphasizing the similarities and dismissing the differences as unimportant.

Militant chauvinism: role reversal; you make the differences with the dominant group as big as possible – if necessary you exaggerate the differences. At the same time, you frame the differences as superior rather than inferior.

These three strategies correspond in part to what Troiden describes, but Troiden seems to be more in line here with what happens in practice during a coming-out.These strategies can be translated into the strategies that are used when it comes to being intersex. The users of these strategies form distinct social groups:

  • Capitulation – ignoring your intersex variation because you have an internalized stigmatizing view of it.3An example of capitulation is the intersex woman who has great difficulty in having 46,XY DSD, a simplified form of her diagnosis, prominently displayed in her digital medical record. She would prefer that ‘a more neutral form’ such as ‘Androgen Insensitivity Syndrome’ be used, although it is clear from her story that the latter diagnosis may be incorrect. Moreover, she would like the diagnosis to appear in an encrypted part of the digital file.
  • Minstrelization – this involves experiencing your intersex variation in the highly stereotypical way that popular culture dictates. The differences between the stigmatized and the dominant group are deliberately exaggerated. Gender-bending can be an expression of this strategy, but it can also involve discussing the consequences of medical treatment in a harsh, satirical tone.4An American news channel broadcast an item about selling body parts for scientific research in 2015. According to this station, one testis could sell for 35,000 dollars. A woman who had undergone a gonadectomy in her youth responded by saying: “Then my doctor still owes me 70,000 dollars”. This is an example of minstrelization. This does not necessarily mean that the person using this strategy is actually openly intersex.
  • Passing – behaving like someone who is not intersex is probably the most common stigma-evading technique. People who choose ‘passing’ are aware of the fact that they are intersex, but present themselves to colleagues, friends and sometimes even family as ‘typical’ men or women. They lead a double life in which they only share their experiences in an environment where intersex variations are discussable (e.g. close family, hospitals, patient organizations, support groups on the internet) and never in an environment where it is considered not to be discussable (e.g. work, circle of friends, sports organizations).5When choosing ‘passing’, the intersex person adapts as much as possible and will avoid situations where adaptation is not possible. For example, girls take tampons to school even though they never menstruate and boys do not join sports clubs if they risk having to shower together. Sometimes girls behave and dress in an extra feminine manner and boys display strong macho behaviour in order not to deviate from the image that they have of their peers.
  • Group alignment – this strategy is mainly used by ‘newcomers’. People who have only recently found out that they are intersex are looking for the protection of, for example, a patient organization or a support group on the internet to talk about intersex. The feeling of belonging to a group alleviates the pain of the stigma, but outside this group, for example, the passing strategy is used.6This strategy is also often used by parents. They seek affiliation with a patient group because they feel this is the only place where they can talk ‘openly’ about intersex variations. Outside the patient group, they opt for the capitulation strategy. Young people who use group alignment as a strategy often have only recently dealt with the subject and are looking for the strategy they want to use outside the patient group or online support group.
  • Commitment – Strictly speaking, this is not a way of avoiding stigma. It is acceptance. Commitment means that intersex variations are seen as an integral part of life. This has consequences for the person himself or herself, but also for his or her environment.

For the intersex person, entering the commitment phase means accepting that sex is a spectrum with infinite possibilities, rather than the binary ‘male’ and ‘female’. Where a person is on the sex spectrum does not necessarily relate to the position one places on the gender spectrum; intersex people often identify as either a man or a woman.

Arriving in the commitment or acceptance stage means that intersex variations can also become a part of the noticeable personal identity. There are relatively many examples of women with androgen insensitivity syndrome who have expressed their commitment through a tattoo of an orchid – a flower that owes its name to its resemblance to the male internal sex organs, the testes. But commitment can also have an impact in communication with others: the ‘coming out’.7Troiden goes on in his article to discuss different types of commitment. By no means does commitment always result in what Troiden calls conversion; an exuberant coming-out in which the battle with the stigma is fought and social change is pursued. According to Troiden, it is also possible that a choice is made for covering (tone down homosexuality to show ‘respectability’) and blending (gay identity neither announced nor denied). It is not unreasonable to think that intersex people follow such strategies when coming out.

Currently, the majority of intersex people use two main stigma evading strategies: capitulation and passing. This explains why one in 90 people, not an insignificant group, can seem invisible.

Unfortunately these forms of ignorance are not without consequences. Although people who use a stigma-dodging strategy expect to benefit from it, it turns out the opposite is true – they feel less involved with others, often have to deal with exclusion and their environment notices that they are withholding something (Newheiser 2014).

It is therefore necessary to work towards a society in which intersex people can freely tell others about their feelings and experiences.

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Position in society

Intersex people are mostly invisible in society. At first glance, this is a choice they have made for themselves – by choosing a stigma-avoiding strategy. The real cause lies in the reason for the stigma. The short explanation is that for a long time, and sometimes to this day (dependent on the country and the medical policies in hospitals), doctors advise people not to talk about their diagnosis with anyone. Froukje Slijper, a psychologist who was closely involved in medical treatments at the time of the ‘Vinger aan de Pols’-broadcast about intersex variations that is discussed later on this page, afterwards wrote, “For us as therapists, it is also instructive to see the importance of talking openly about this and how your social environment may react. For AISNederland (ed.: a Dutch patient group) it is useful to draw up a policy regarding openness on the basis of this experience.” (Van der Have 2004). The stigma avoiding strategies were part of the treatment plan for intersex people, so to speak.

The fact that doctors supported stigma avoiding strategies can be traced back to research (which was later refuted) by New Zealand psychologist John Money.8This research study is known as ‘the John/Joan Case’. Following a failed circumcision, ‘John’ was left without a penis. His parents were advised by Money to raise the child as a girl: ‘Joan’. Despite the sex change operation and hormone treatment, ‘Joan’ did not feel like a girl and did not connect with girls. As an adolescent, ‘Joan’ was told what had happened and subsequently changed into the man he had always felt he was. Money did not disclose this development and, as a result, doctors worldwide continued to think that ‘nurture’ (upbringing) was more important for the development of gender identity than ‘nature’. According to John Money, keeping the surgery hidden at a very young age was essential for the development of the new gender identity. As a result, long after journalist John Colapinto published the story of David Reimer, ‘John’s’ real name, doctors were still recommending secrecy to intersex people and their families. Money never acknowledged his failure or apologized (Colapinto 1997; Colapinto 2000). David Reimer committed suicide in 2004. But Money’s research is not an explanation of why intersex people are stigmatized – at most, the case study proves that doctors perceive the stigma as so severe that they are willing to take drastic measures. Although cosmetic surgery continues to be performed at a very young age, no research since Money’s has been published that shows that performing surgery at a very young age reduces stigma or improves the position of intersex people in society.

In the Netherlands, talking about intersex variations was almost completely taboo and lead to social exclusion until 2003. The taboo was so extreme that it was often not even discussed within one’s own family. Moreover, many people did not know that they were intersex because their doctor would not tell them their true diagnosis. Patients who asked their doctors if contact with fellow intersex people was possible were told that their diagnosis was so rare that such fellow intersex people did not exist and if they did, they would not want to talk about it (Van der Have 2015). This policy resulted in intersex people being completely excluded from the rest of society.

Nevertheless, intersex people could ultimately still find each other through the rise of the internet (Van der Have 2015), through organizations such as Intersex Society of Northern America (ISNA)9ISNA ceased to exist in 2007. The website www.isna.org has continued to exist, but understandably only contains very outdated information and Bodies Like Ours. The purpose of websites like Bodies Like Ours has been taken over by a large number of pages and groups on Facebook. Most of these groups are closed and secret (invisible to non-members and only accessible after an invitation) or private (visible to everyone and only accessible after approval by an administrator).

The establishment of patient groups for intersex people resulted in people meeting each other as well. For people who are members of a patient group, the taboo is disappearing within the group itself, but even now there is still segregation: the activities of patient groups are often invisible to the rest of society. At most, integration is slowly but surely starting to take place as a number of patient groups (but their members not so much) become more visible in society.

Integration or inclusion

International intersex organizations often focus on the inclusion of intersex people in society. This requires a different approach than the integration and the difference lies mainly in the ‘direction’ of policy development:

When an individual is integrated, it means the person adapts in order to function in society, while inclusion means society adapts so that the person can remain himself/herself/theirself (Thomazet 2009). These two processes lead to a completely different result: integration means the group that integrates remains ‘seperate’ within society; while inclusion means the members of a group can participate independently in society without denying or hiding themselves.

Intersex currently finds itself between segregation and integration: sone intersex people and peer support groups have become partially visible in society and intersex organizations that deal with intersex human rights and the promotion of intersex people are established. The risk of integration is that the group remains ‘separate’ from other people in society.

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Coming out and stigma

Telling people that you have an intersex variation is a coming out that can be compared to the coming out of LGBT people (Preves 2003; Preves 2004) or of someone who has (had) a mental illness (Corrigan 2003) or a physical disability10Carol Gill defines coming out as the integration of how you feel on the inside and how you present yourself (Gill 1997). (Gill 1997). In such situations, you can count on a mainly positive response from your surroundings. There may also be some less pleasant responses. In the case of intersex variations, these negative reactions can be seen as a direct consequence of medicalization, the taboo, the invisibility, and the associated stigmatization.

Exclusion

Research by the Netherlands Institute for Social Research shows that a small majority of people (53%) find it important when meeting someone to know whether this person is a man or a woman. If this is not clear, 18% would rather have no contact with that person. Almost 3 in 10 people believe that there is something wrong with people who do not feel like a man or a woman (Kuyper 2015). 11Similar questions were also asked of the ‘City Panel’ of the municipality of The Hague. 12% of the panel members in The Hague think there is something wrong with people who do not feel like men or women. 6% of the panel members say they would rather not deal with people whose sex is not clear and 35% think it is important to know whether someone is male or female when they meet. These figures deviate favourably from the results of the survey by the Netherlands Institute for Social Research, but the researchers note that due to the methodology of the Hague City Panel, the results are not entirely representative – after all, participants register on a voluntary basis, and especially young people and lower educated residents of The Hague are underrepresented in the panel (Dimensus Policy Research 2015)..

Whether this ‘prefer not to associate’ results in actual discrimination of intersex people is difficult to determine. It is even unclear whether intersex people are implicitly protected by the existing legal framework within the EU for anti-discrimination, which is based on a strict male/female dichotomy (European Commission 2012). 12Waaldijk & Bonini-Baraldi see intersex as something that is on the transgender spectrum and therefore think that the Court of Justice of the European Union could consider discrimination of intersex people as gender discrimination (Waaldijk 2006). However, intersex is not on the transgender spectrum (Richter-Appelt 2013). That means that the discrimination must be specifically directed against someone for being a man or a woman. But what is the legal status of the intersex individual who is excluded from sports competitions because of a testosterone level that is too high? And how does a naturally high testosterone level relate to other perceived advantages, like having long legs? Both are advantages the athlete cannot influence. In the regularly recurring discussion about sports and intersex variations, it appears again and again that intersex variations are significantly more common among top female athletes than among the general population.13 Ferguson-Smith & Ferris (1991), based on 6562 chromatin tests, carried out during various events between 1972 and 1990, arrive at 1 in 504 athletes (Ferguson-Smith 1991). Fenichel, et al (2013) cite an incidence of 1 in 324 as a result of the SRY test among 3384 participants at the 1996 Olympic Games in Atlanta, and 1 in 434 at ‘a recent world championship with 868 participants’ – which is 200 times the estimated incidence among the rest of the population (Fenichel 2013). The mentioned factor of 200 only applies if children with ambiguous genitalia are considered. However, women who are found to be intersex during major sports events usually do not have ambiguous genitalia. It is noteworthy that the chromatin test only checks for the presence of two X chromosomes, which means that men with 47,XXY chromosomes (Klinefelter Syndrome) are considered women, while SRY-tests do not recognize AGS/CAH (the most common intersex variation among women) because the SRY gene is located on the Y chromosome. Most importantly, the vast majority of athletes with an intersex variation will have a disadvantage rather than an advantage because of their abnormal chromosomal pattern or hormonal balance (Fenichel 2013; Ferguson-Smith 1991). It is noteworthy that there is only ever an issue when these women perform better than other women (Buzuvis 2010; Bhowmick 2009; Greer 2009; Preves 2011; Larson 2011; Heggie 2010; Eckert 2010; Klöppel 2009). The arbitrariness of those women then suddenly being called ‘men’ is an example of discrimination.13In 2015, the Court of Arbitration for Sport (CAS) in Lausanne ruled that the maximum testosterone level of 10 nmol/l, set by the IAAF (now World Athletics), is arbitrary and not supported by scientific evidence. Athlete Dutee Chand filed a lawsuit against this, which resulted in her being allowed to compete again. The IAAF was given 2 years to prove that women with naturally high testosterone levels benefit unfairly. Due to the lack of mention of intersex variations in legislation, the protection of intersex people against discrimination is now dependent on scarce (or completely absent) case law.

Medical issue or social issue?

Even if there is no discrimination, it should be taken into account that people do not know how to react to the revealing of a secret (Kelly 1996). But keeping your story a secret may also be extremely difficult, especially since intersex people often experience more psychological problems than other people (Bosinski 2005; Richter-Appelt 2006; Schweizer 2009; Schützmann 2009; Springer 2011). Cohen-Kettenis and Pfäfflin list twelve possible causes for this, which, incidentally, do not always apply, and do not apply to every intersex variation (Cohen-Kettenis 2003):

  1. Need for (genital) surgery
  2. Need for medication
  3. Learning difficulties (language)
  4. Social issues (due to sub-assertiveness, inappropriate social skills, or cross-gender role behaviour)
  5. Premature or delayed puberty
  6. Extremely short or tall physique. (Many women with Turner syndrome say they are bullied because of their height. The fact that this problem is also reported by short people who do not have Turner syndrome is an indication that this is a social issue rather than a clinical one (Sutton 2005))
  7. Absence of menstruation
  8. Need for feminizing or masculinizing hormones
  9. Need for non-surgical treatment of the genitalia (e.g. vaginal dilation)
  10. Infertility
  11. Need for technical aid to engage in sexual contact
  12. Sex reassignment surgery 14NNID objects to the term sex reassignment. In the case of intersex, changing the sex can be seen as returning to the sex that was incorrectly recognized by doctors at birth.

Most of these causes stem from norms that exist in society. Not being able to comply with these norms results in stigma (Goffman 1963; Lee 2006) and feelings of shame (Preves 2003). The shame of not meeting these standards is also a reason why many intersex people do not come out (Aragón 2006).

Byrne does not take the causes of stigma as a starting point, but mentions the experiences that are associated with stigma:

  • Shame
  • Guilt
  • Secrecy
  • The role of “the black sheep of the family”
  • Isolation
  • Social exclusion
  • Stereotypes
  • Discrimination (Byrne 2000)

The experiences mentioned by Byrne cannot be linked one-on-one to the causes mentioned by Cohen-Kettenis and Pfäfflin.15The remark of the mother who says ‘if only my child had ADHD or Aspergers, I would have been able to talk about it with other mothers in the schoolyard’ for instance does fit in Byrne’s list, but does not fit in that of Cohen-Kettenis and Pfäfflin. This is because in the medical approach, the intersex individual is seen as both the cause and the solution of the problem, while the human rights approach assumes that problem and solution are a society’s responsibility. Byrne’s enumeration could be extended to include the experience of an inadequate knowledge of one’s own body and the violated right to self-determination as described by Van Heesch (Van Heesch 2015).

These experiences are recognizable to many intersex people – hence the mission statement of the Intersex Society of North America:

The Intersex Society of North America (ISNA) is devoted to systemic change to end shame, secrecy, and unwanted genital surgeries for people born with an anatomy that someone decided is not standard for male or female. (Intersex Society of North America n.d.)

Openness

Analogous to the coming-out of LGBT people, openness about being intersex to family members, friends and acquaintances seems like a good step. From the many published stories of intersex people on the internet and in magazines, it appears that there is also a desire to come out. Many studies show that coming out leads to less anger, less depression and better self-image among LGBT people (Legate 2012). However, doctors and other medical practitioners still wonder whether sharing information about having an intersex variation has positive or negative consequences for a child, and state that advice about this depends mainly on the personal ideas of the doctor (Sandberg 2012; Hughes 2007). For example, Sandberg, et al:

It is still an open question whether sharing information about the DSD with the wider social environment will have positive or negative consequences for the child. Living a “normal” life with a secret could be harmful, just like living a life without secrets but with an increased risk of stigmatization or rejection. The advice currently given to parents remains largely based on clinicians’ personal opinions on what would be preferable, considering their evaluation of the family, the child, and their wider social and cultural context (Sandberg 2012).

This negative attitude has two possible consequences:

  • Research by Ryan et al. (2015)16Research by Ryan et al. was conducted with funding from National Science Foundation Graduate Research Fellowship and the participants in the study were found through Amazon Mechanical Turk. It would be interesting to see if the study results are replicable using a different method of selecting study participants. shows that negative responses to a coming out of LGB individuals result in feelings of depression and lower self esteem (Ryan 2015). It is not known if this also applies to intersex people, but intersex people definitely already experience pressure because of doctors and their environment to stay ‘in the closet’, so it is likely negative responses would also negatively affect intersex people.
  • Ahrens’ research shows that negative responses to the sharing of sensitive personal information lead to forced silence. She describes three possible routes that victims of rape take 17The comparison with rape is all the more reasonable because numerous publications show that often malpractice rather than medical treatment is involved. Juan É. Mendez, the special rapporteur on torture and other cruel, inhuman or degrading treatment or punishment of the United Nations Human Rights Council has included intersex, for example, in paragraphs 77 and 88 of his report. In paragraph 88 he states: “The special rapporteur calls upon all states to repeal any law allowing intrusive and irreversible treatments, including forced genital-normalizing surgery, involuntary sterilization, unethical experimentation, medical display, “reparative therapies” or “conversion therapies”, when enforced or administered without the free and informed consent of the person concerned. He also calls upon them to outlaw forced or coerced sterilization in all circumstances and provide special protection to individuals belonging to marginalized groups” (Méndez 2013). Similar calls have since been made by the Council of Europe’s Commissioner for Human Rights (Agius 2015) and the European Fundamental Rights Agency (FRA) (European Union Agency for Fundamental Rights 2015). The German state ministers for promotion in their 24th conference equated the unnecessary medical treatment of intersex people with female genital mutilation and the consequences are ‘traumatic, similar to victims of sexual assault’ (GFMK 2014). to not share their story with others: 1) negative responses from professionals make victims doubt whether further sharing of their story is useful, 2) negative responses from friends and family reinforce the feeling of have oneself to blame, and 3) negative responses from both sources reinforce the uncertainty about whether their experiences qualify as rape (Ahrens 2006).

A recent study states that coming out is less successful in an environment that is beyond your control (Legate 2012). The example given is the ‘Don’t ask, don’t tell’ policy that the US Army enacted from 1993 to 2010. Soldiers were not asked what their sexual orientation was, but soldiers who were revealed to be gay, lesbian or bisexual were discharged 18Not only if the soldier told someone him- or herself, but also if ‘reliable information’ showed that he or she was LGBT, the soldier was discharged. Reliable information meant ‘1) A statement by a reliable person that he or she observed or heard a soldier engage in a homosexual act, or state that he or she was a homosexual or bisexual or state that he or she had married or attempted to marry a member of the same sex. 2) A statement by a reliable person that he or she observed or discovered a soldier saying or putting a statement in writing acknowledging a homosexual act or the intent to engage in a homosexual act’..

This is of course also one of the better examples of why visibility is necessary; if really nobody had told anyone anything (and nobody had filed a lawsuit afterwards), the ‘Don’t ask, don’t tell’ policy would still be in effect today. Visibility is also important for the promotion of intersex rights.

In a video19http://stdk.nl/2012/10/vrouwen-met-ais/ Margriet van Heesch says the following about this:

The most important thing I learned from listening to the life stories of intersex people, and there have been forty of them in total, is that there is nothing gained from having a secret. Absolutely nothing at all. And as difficult and scary it may be to tell a secret, to overcome your fear, the fear that people will run away with your story, that they may misunderstand it, that they may pass it on incorrectly, that people will gossip about it… all this is less terrible than having to keep a secret (Van Heesch 2012).

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Secrecy and openness

In 2003, three members of AISNederland (a Dutch patient group, now called DSD Nederland) shared their intersex experiences in the tv show ‘Vinger aan de Pols’ (Dutch TV program). This was the first time that intersex was extensively shown on Dutch television. Both Miriam and Vincenza had had frankly negative experiences disclosing their intersex variations in their personal life. Miriam worked for a fast-growing automation company. When she told the man who had scouted her she was intersex, her contract was not renewed, despite the fact that she had been promised a renewal shortly before. Vincenza told her story to someone she trusted. But at school the story spread and eventually Vincenza was ignored by her classmates (Medical Multi Media/AVRO 2003; Vinger Aan de Pols press release 2003).

The three women who were interviewed in ‘Vinger aan de Pols’ received only positive reactions after the broadcast (Diny 2004; Van der Have 2004). Nienke wrote on the website of AISNederland (now DSD Nederland):

Even in class, people were constantly complimenting me, from teachers to students. I walked around with a big smile on my face the whole day. I couldn’t believe it! The adrenaline was flowing through my body: I WAS FREE! I could be myself from now on! What a wonderful feeling that was… and still is (Barends 2004).

It seems that secrecy creates opportunities for gossip and that openness results in acceptance.

The program ‘Vinger aan de Pols’ also made it clear to health care practitioners that openness is important. Psychologist Froukje Slijper wrote:

For us as therapists, it is also instructive to hear how important it is to be able to talk openly about your form of intersex and what the reaction of those around you can be. Based on this experience, AISNederland (Dutch patient group) should draw up a policy on openness (Van der Have 2004).

The fact that practitioners could learn something from a television program says something about the lack of equivalent communication at the time. Between 2003 and 2013, communication has improved considerably. Nowadays, therapists and patients often work closely together in intersex patient groups. Nevertheless, coming out can still be very difficult, and is still an important issue to speak on. Firstly, (medical) treatments are still a subject of debate. The United Nations, the Council of Europe and the European Parliament have all expressed well-founded criticism and called for a legal ban on unnecessary medical treatments that violate human rights. And secondly, secrecy did not end abruptly in December 2003. Many people under the age of 18 – who are legally children – were also raised without being involved in important decisions about their bodies. Thirdly, ending secrecy is not the same as removing stigma. Stigma stands in the way of real openness. Stigma stands in the way of coming out. To change that, society has to change. Intersex people, their parents and doctors can only contribute to this if they accept that intersex is not a disease.

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Tips for more openness

  • It should be possible to tell people you have some form of intersex variation without fearing the supposed negative consequences, but it should not be an obligation. You must be able to decide for yourself who you come out to and who you do not come out to.
  • An equal treatment act or law that protects intersex people against possible negative consequences of coming out because of discrimination on the basis of expressed gender identity and sex characteristics would help. The explicit protection of these elements would make it easier to report discrimination. It is still unknown if such a law also offers protection in practice. Therefore, the government should communicate widely that discrimination of intersex people is prohibited.
  • Government policies should be geared towards inclusion. Only inclusion will lead to intersex people being visible in society.
  • While society is responsible for the stigma, medical practitioners are responsible for maintaining that stigma when engaging in unnecessary medical interventions without the prior and free informed consent of the person in question, in order to make intersex people appear more ‘male’ or ‘female’.
  • Procastination makes it harder
    A secret requires at least two people. If you wait a long time before coming out, your best friends might say ‘why didn’t you tell us earlier?’ They probably mean that they would have liked to support you much earlier. The longer you wait to come out, the longer the secret remains between you and your friends. And that makes it harder to share your story with people you have known for a long time.
  • It really works… mostly
    People who have spoken publicly about their intersex experiences often say they were surprised that everyone responded positively. Many people experience it as a relief that there is no longer a ‘secret’ that can come out one way or another. People also often feel as if the ‘secret’ stood in the way of friendships. Still, people sometimes react negatively, by staying silent, which harms the friendship. You can of course ask yourself whether such a person was a real friend in the first place. If you have doubts, it is best to talk to people who are already ‘out’. They will confirm to you that the positive effects of openness outweigh any negative reactions or ‘friendships’ that are may end because of your coming out.
  • Tell your own story
    It is your story, someone else cannot advise you on how to tell it. This applies to your family and your friends, but also to professionals whom you ask for help.
  • Seek contact with other intersex people
    Why reinvent the wheel? There are people who have gone through similar experiences and know how you feel. They can help you.
  • Plan your coming out
    Of course, there are those unplanned moments that are perfect for a coming out. You just feel that this is the right moment to tell your story. But such moments are rare. In the vast majority of cases, you will need to plan your coming out. It is best not to do this with an official announcement two weeks in advance – at the very least, your friends will think you are announcing an engagement. Planning a coming out means making sure you have enough time to tell your story, answer some questions and then have a chat. It can be useful to have some written information on hand for people who want to know more about intersex variations. That written information should preferably be about intersex variations and not about you personally. It may also be wise to have someone around you can seek support from afterwards – a coming out can be mentally taxing.
  • Less scary than you think
    Chances are that you will be anxious to come out. Understandably so, because for you coming out is one of the most important days of your life; it is a day you will often think back on later. But for someone else, it is just another Tuesday (or whatever day you choose). Of course, people will be happy to listen to you, but they don’t experience the excitement that you do. So try to relax – it’s just another Tuesday.
  • Practice and start small – your story will become shorter
    A coming out is a bit like a presentation. In a limited amount of time, you try to get your message across to other people in the best possible way. Only if you succeed at this will the people with whom you share your story understand why your coming out is so important to you. Before you share with ‘the whole world’ what it means to be intersex, it is best to start with a small group of people you trust completely. After ‘practising’ like this a few times, you will notice your story getting shorter and shorter. Events that are important to you, but that other people cannot relate to, will be skipped.
  • Set your boundaries
    By practising with good friends, you will find out what you do and do not want to share. Also decide with whom you want to share it. It is often very difficult not to answer questions that push or break those boundaries, especially if the question is asked by someone with whom you have a very good relationship. But even in such a situation, you can say that you do not (yet) want to talk about certain subjects. It may help if you explain that you still need to think about some things yourself or that you have not yet found the right words to tell that part of your story.
  • Your first coming out will not be your last 
    After your first coming-out, many will follow. Each time you meet new people, you will tell your story again. But it will be a story that becomes shorter and shorter, contains less and less emotion, and will be told more and more efficiently. The shortest coming-out text I sometimes use is, ‘Hello, my name is Miriam, I have AIS, you can read more about it on the internet’.
  • Don’t feed the trolls
    In general, it is best to limit your coming out to announcing that you are intersex and answering a few questions. Don’t let yourself get dragged into a discussion. Outright negative responses are unlikely. Sometimes, however, you may be confronted with awkward jokes. Remember that a silly comment only says something about the person making it and nothing about you. Unless you really feel like it, it’s best not to argue with people who make nasty comments: don’t feed the trolls. (Another tip: even if you read the best article on intersex ever on the internet, don’t read the comments – many publications give the trolls free reign).
  • You are still you
    At the end of a coming out, you can explain that you are still you – nothing has changed about you. You have only shared something the other person did not know. It may be good to show that your coming out is a sign of trust to the other person – you are telling your story because the other person has an important place in your life.
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References

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Want to read more?

Want to read more? You might also find the following articles interesting! Like this article, they are aimed at professionals who apply the information in their profession. Looking for an article less detailed and in-depth? Then take a look at the articles written for those who are new to the subject of intersex.

Intersex is not DSD

In 2006, DSD and intersex meant the same thing, but a lot has changed since then. Nowadays DSD stands for the medical aspects and intersex for the social aspects. Are they two mutually exclusive concepts or are they two sides of the same coin?

What do my doctors mean?

Intersex people are in their life often in medical environments. Knowing what your medical professionals mean and what interventions are possible and necessary is extremely important for intersex people and carers of intersex children. More information allows for better protection of themselves or their children.

Healthcare

Intersex is a social concept because intersex people have to deal with the social consequences of living in a society that is set up completely on the idea that there are two types of people: men and women. The reality is much more complex (in both the aspects of gender and sex). Although intersex is a social concept, sometimes intersex people do need some kind of healthcare. Here you will find information on healthcare for intersex people.

United Nations

National governments sometimes receive recommendations under CEDAW, CESCR, UPR, CRC and CaT on the situation of intersex people. But what is that process like? Why is the United Nations allowed to lecture national governments and how does that work?

Social experiences

It is often assumed that little or no data is available on the social consequences of intersex. However, medical publications regularly publish such information.

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Beeld: istockphoto.com/aquatarkus

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