The first question asked by grandparents after a baby is born is ‘is it a boy or girl’. This is often determined by looking at the genitalia. Intersex is a condition where the sex of the child could not be determined looking at the genitalia.

What are the causes of intersex?

The causes of intersex are many however it can be simplified as follows

• A Hypervirilised Girl: chromosome is XX but genitals are masculanised due to exposure to male hormones
• A Undervirilised Boy: Chromosome is XY but the genitals are not well masculanised due to deficiency or failure of action of male hormones
• Mixture of problems: This can be at various levels; both XX and XY chromosomes or both testicular and ovarian tissues or multiple patterns

How to deal with this at birth?

It is essential to do the tests like chromosomes and harmonal tests soon after the birth to identify the problem. It is also essential not to name or fix gender for the baby before diagnosis. Once the problem is assessed doctors and parents should sit together and decide what is the best sex of rearing for the baby. If the sex is assigned by appearances without proper testing, it becomes socially very difficult to change gender once the child becomes old.

Can the appearance be improved by an operation?

Corrective surgery for intersex (to make them look more like a girl or to look more like a boy) is a complex procedure. Often the social implications and the social stigma of bringing up a child with abnormal genital force the parent to seek operation.

However it should involve a lot of thinking as they are irreversible and may involve altering sensation to the area. Although the sex assignment is done with the best interest by the parents and doctors, one should understand that the children may feel the other way and choose an opposite gender when they grow in to an adult.