Intersex is a term that refers to individuals that were born with genitalia, chromosomes, or hormonal imbalances that fit outside of the sexual binary of male and female. For example, an individual may have genitals that are associated with being female, but at the same time have an internal reproductive system or hormones associated with being male, such as hidden testes and testosterone. They may also have variations in chromosomes, such as XXY (as opposed to the male XY and female XX), or a mix of XY and XX throughout cells, or just one X chromosome. Intersexuality does not always present at birth, and may show during puberty, adulthood, or sometimes not at all.

Patient Care

Around 2% of the worldwide population is intersex, yet there remains very little comprehensive and well-informed healthcare for intersex individuals. This lack of support may lead to detrimental mental health issues over time. For example, up until recently, nonconsensual surgeries at infancy were the main form of care for intersex individuals. Surgical procedures typically removed or hid certain genitalia to align with the sex binary. Sometimes these can lead to further sexual health complications down the line, such as sexual dysfunction and infertility.

Current healthcare for intersex adults is practically nonexistent, despite unique needs directly related to intersex complications and those that result from surgeries or hormone therapies. Additionally, residual stigma and discrimination still influence the quality of treatment and care that intersex individuals receive. This lack of adequate care or effort to try to change care quality likely negatively impacts existing problems with low self-esteem, self-concept, and isolation.

A study of intersex adults in the US found that 53.6% out of 198 participants reported fair to poor mental health, with younger populations reporting worse mental health. Of this group, 61.1% reported depression, 62.6% anxiety, 40.9% PTSD, and 31.8% had attempted suicide. Additionally, they found that discovering one’s intersexuality at an older age can lead to psychological difficulties. Researchers believe this may be due to the shame, stigma, low self-esteem, and low satisfaction with healthcare that comes with being intersex. All of which are also associated in the study with clinically significant symptoms of depression.

Societal Influences

Societal pressures also impact mental health and well-being. Part of this is a feeling of not having a community or not belonging to one group. Because many intersex individuals are told to keep their intersexuality secret or present as one specific sex, they may feel isolated in their environment or feel a lack of control over their body. Especially if they had received a nonconsensual surgical intervention at a young age.

In a study of Puerto Rican intersex adults, researchers found that 83.3% out of 12 participants reported discrimination. Of these reports, 50% reported harassment, sexual abuse, or being followed, and 33.3% reported being beaten or robbed. The fear of this kind of discrimination and harassment can lead to heightened levels of anxiety, sometimes cripplingly so.

Researchers suggest it may be more difficult to fully integrate into society. Because most intersex individuals go unnoticed or are told to hide the fact that they are intersex, gaining support comes down to direct disclosure with others. Intersex individuals have commented in open-ended surveys that it can be difficult to know who to trust in these scenarios, taking into account the stigma placed on them from a young age and misunderstanding from some healthcare professionals.

Conclusion

Intersex individuals are widely misunderstood, despite recent movements to provide more informative healthcare and prevent nonconsensual surgeries at infancy. This stigma and discrimination in both societal and healthcare settings can be extremely discouraging and may lead to worsened mental health and quality of life, influencing depression, anxiety, low self-esteem, and more.

References:

• Esteban, C., Ortiz-Rodz, D. I., Muñiz-Pérez, Y. I., Ramírez-Vega, L., Jiménez-Ricaurte, C., Mattei-Torres, E., & Finkel-Aguilar, V. (2023). Quality of life and psychosocial well-being among intersex-identifying individuals in Puerto Rico: An exploratory study. International Journal of Environmental Research and Public Health, 20(4), 2899. https://doi.org/10.3390/ijerph20042899
• Intersex: What is intersex, Intersex surgery. Cleveland Clinic. (2022, July 19). https://my.clevelandclinic.org/health/articles/16324-intersex
• Marinus, M. A., & Cense, M. (2024). A life course perspective on the sexual development of Young Intersex People. Healthcare, 12(2), 239. https://doi.org/10.3390/healthcare12020239
• Rosenwohl-Mack, A., Tamar-Mattis, S., Baratz, A. B., Dalke, K. B., Ittelson, A., Zieselman, K., & Flatt, J. D. (2020). A national study on the physical and mental health of intersex adults in the U.S. PLOS ONE, 15(10). https://doi.org/10.1371/journal.pone.0240088