Babies who are intersex may have noticeable differences in their genitalia — but they also may not. Sometimes, intersex traits can involve internal organs or hormone production and are not apparent until puberty or at all.
It can be scary for new parents to hear anything unexpected from a doctor once their baby is born. But intersex traits occur naturally, and it’s not a disease or condition that affects a baby’s physical health.
When a baby is born, they’re assigned a biological sex — either male or female — based on their genitals.
You may have even learned your baby’s sex before birth in a similar way. Nothing between the legs on the ultrasound? “Congratulations — it’s a girl,” you hear. (Unless something is hidden from view, right?)
But it can actually be a bit more complicated than that.
Sometimes, a baby can have genitalia with some male characteristics and some female characteristics. And even deeper than external appearance, some people are born with a mix of male and female biological features (such as a uterus and testicles) that can’t be seen on the outside.
When someone doesn’t fall exactly into the “male” or “female” sex designation, the term “intersex” may be used.
Intersex isn’t new, and it isn’t political in and of itself. It’s just a more widely recognizable term now — though a lot of people still don’t understand it.
This is a popular question to Google, but it may not be the right one to ask.
Keep in mind that people who are intersex are our co-workers, friends, neighbors, and classmates — in other words, you’ve likely interacted with someone who is intersex and had no idea. That’s because they look like anyone else you meet.
Yes, sometimes the genitalia of a baby who has intersex traits is noticeably different. Here are some possibilities:
- a clitoris that’s larger than expected
- a penis that’s smaller than expected
- no vaginal opening
- a penis without a urethra opening at the tip (the opening might instead be on the underside)
- labia that are closed or otherwise resemble a scrotum
- a scrotum that is empty and resembles labia
But the baby’s genitalia may also look completely male or completely female. In other words, they may have male anatomy on the outside but female anatomy on the inside or vice versa.
It could be that a child’s status as intersex doesn’t become obvious until puberty when their body produces more of a hormone that doesn’t match their assigned sex.
Or perhaps certain expected puberty milestones — like a deepening voice or growing breasts — don’t happen. Or maybe the ones that happen are characteristic of what you thought was the “opposite” sex.
In these cases, a person who had more biological male features as a child might look more feminine after puberty, according to a society slow to reject the traditional binary system. Or a person who looked female as a child might start to look more stereotypically male as a teenager.
And sometimes, a person might not learn they have intersex traits until even later, such as if they have difficulty having children and see specialists to learn why. (Note: Not all people with intersex traits have issues with fertility.)
It’s even possible to have intersex traits and never know.
Regardless, a person doesn’t “become” intersex. It’s what they’re born with, whether it’s clear at birth or not until later.
A note about terminology
Opinions differ about the term “intersex” and whether it’s a medical or social designation.
Some people with intersex traits identify as either male or female rather than as intersex. Obviously, this is often true for those who spend their entire lives not knowing about their intersex traits.
The term “intersex” doesn’t describe one particular thing. There are many different varieties — it’s a spectrum. They typically occur naturally.
If you’re a new parent trying to figure all this out, know that there’s nothing that you did or didn’t do to “make” your baby intersex.
For example, you may have learned in sex ed that we’re born with sex chromosomes. Generally, females have a pair of X chromosomes and males have one X and one Y chromosome.
But did you know that there are other variations? For example:
- XXY, or Klinefelter syndrome
- XYY syndrome
- mosaicism, when chromosomes differ by cell (e.g., some cells are XXY and some are XY)
These variations can happen randomly and spontaneously during conception. Sometimes it’s due to egg cells, and sometimes it’s due to sperm cells. The variations can also happen due to other causes.
These chromosomal variations sometimes result in what might be labeled as intersex.
More commonly, though, a baby born with intersex traits does fit into either the XX or XY category. But we now know that biological sex is more complex than our chromosomes.
For example: If a baby is born with female anatomy on the outside and male anatomy on the inside, this is something that happened randomly around the time of conception. They may have XX or XY chromosomes, but that alone doesn’t mean they’re a “girl” or a “boy.”
Intersex isn’t a disease, and it can’t be “cured.” So in that sense, there’s no treatment.
It’s possible to have health conditions that need to be addressed that relate to intersex anatomy. For example, if you have a uterus but no uterine opening, you may have painful menstrual cycles in which the blood doesn’t exit your body. In this case, you may want to have surgery to create an opening.
But this isn’t “treating intersex.” This is treating a closed uterus.
So what about your baby, who may not have typical genitalia?
Do you ‘choose a sex’?
The short answer: Unless there’s also a health condition (like urine not flowing out of the body properly), you don’t need to do anything in terms of medical intervention.
But your doctor may recommend surgery to make the genitalia appear more typically male or typically female. American doctors have been doing this since at least the 1930s — especially performing clitoral surgery when parents intend to raise a baby with a large clitoris as a girl.
There may be social reasons for this recommendation, and your doctor can go over these with you. But it’s essential to also consult non-medical professionals, like counselors.
Currently, in the vast majority of U.S. states, every baby is assigned a binary sex — your baby’s birth certificate will say either male or female. So you may need to choose, at least initially.
However, this practice is changing. A growing number of states are allowing an “X” in place of “M” or “F” on things like ID cards. However, this is still generally something that is changed later, when your child is older — or even an adult — and decides for themselves. And in most places, changing the sex on your birth certificate means changing it from male to female or vice versa.
When it comes to raising your child, there’s good news for babies born with intersex traits — it’s more acceptable to raise kids in a “gender-neutral” way than ever before.
But social stigma and barriers are still very real. Again, this is why many doctors still recommend surgery to make your baby’s genitals match the sex they’re assigned.
This can lead to all sorts of questions, though:
- What if my child later identifies as the opposite sex instead of the one we chose for them?
- What if we have a micropenis removed, only to learn during our child’s puberty that they produce a dominant amount of male hormones?
- What if our child resents our decision and wishes we had left everything as it was when they were born?
- What if we opt not to do surgery, and our child later wishes we had done the “obvious” surgery when it was less complicated/memorable?
All of these questions are more commonly stated as, “What if we chose wrong?” This worry can weigh heavily.
This is why it’s crucial to talk with counselors familiar with intersex, social workers, a variety of medical professionals, trusted friends and family, and people with intersex traits themselves.
Genital surgery that’s done solely for appearance reasons (cosmetic surgery) is never urgent. You can take your time, enjoy your newborn, get to know your child as they grow, and continue an open dialogue with your doctor and others.
For many parents who are told that their baby is intersex, fears about their child’s future acceptance, relationships, and self-esteem are front and center.
You may have questions like, “Will my child be able to go to sleepovers?” and “What if they’re made fun of in high school gym class locker rooms?”
These are natural worries that show your love and concern for your little one. But you don’t have to go it alone. There are resources available that can help.
In addition to a number of firsthand accounts from people who identify as intersex, helpful resources include:
- InterAct, which advocates for intersex youth
- the Dutch government’s guide for supporting your intersex child
- Intersex Initiative
- online support groups on social media platforms like Facebook
- in-person support groups
Ask your doctor to put you in touch with a counselor or social worker who can recommend support groups in your area.
Remember: There is no shame in having a child with intersex traits or in being intersex yourself. Until society is completely aligned with this view, there will be some challenges ahead. But with a strong support system that includes you, your baby can thrive into adolescence and beyond.