Why I have changed my thinking about intersex.

Towards the end of his life Augustine of Hippo produced a work called The Retractions. At the beginning of the Prologue to this work he writes:

‘For a long time I have been thinking about and planning to do something which I , with God’s assistance, am now undertaking because I do not think it should be postponed: with a kind of judicial severity, I am reviewing my works – books, letters and sermons – and, as it were, with the pen of a censor, I am indicating what dissatisfies me.’ [1]

In undertaking this task Augustine is setting an example which all theologians should be willing to follow. All theologians write things which, in retrospect, they see were mistaken and they need to be prepared to admit this fact and correct their own work in order that others may not be misled by their errors.

In this blog I want to follow Augustine’s good example by taking the pen of a censor to what I have previously written about the phenomenon commonly known as ‘intersex.’

In  order to begin to think about this phenomenon we need first to understand that the physical sexual differentiation between men and women is a matter of differences in what are known as the ‘genotype’ and the ‘phenotype.’ As I explain in my book Glorify God in your Body:

‘The genotype is the genetic constitution of human beings. The phenotype is the observable physical characteristics of a human being, including their appearance, development and behaviour. The phenotype results from the interaction of a person’s genetic makeup and their environment. At the level of the genotype every human being has 46 chromosomes (thread like structures in human cells which transmit inherited genetic information) arranged in 23 pairs.

What determines a person’s sex are the X and Y chromosomes, which are present in the foetus from the moment of conception. Most women are 46XX and most men are 46XY. The existence of this chromosomal difference leads to the observable physical differences between men and women that exist at the level of the phenotype (differences in genitalia, body shape, the sound of the voice, etc.) and it is what is ultimately responsible for the ability of human beings to have children by means of sexual reproduction.’[2]

There are some people who possess bodies that differ from what is typical for male or female human bodies at the level of either their genotype or their phenotype or both and the term ‘intersex’ is commonly used to describe them. Thus, when the label LGBTQI, or some variant thereof, is used, the ‘I’ stands for ‘intersex.’  

Although I want to stand by most of what I wrote about those who are ‘intersex’ in Glorify God in your Body, there are two things I would now like to correct as a result of having read the excellent book The Genesis of Gender by the American Catholic writer Abigail Favele.

The first is my use of the term ‘intersex’ itself. The term carries the implication that the people concerned are a separate category of people who are neither male nor female. They are ‘inter’ sex in the sense of standing between the two sexes of male and female rather than belonging to them.[3] This implication is misleading because in fact no such category exists.

The reason this is the case is because the fundamental distinction between men and women in terms of their biological sex lies in the type of gametes they produce. To quote Favele, what the science of sex tells us is that God has so created the human race that:

‘Human bodies are teleologically organised according to our distinct role in reproducing the species. The structure of our bodies is arranged to produce either large sex cells or small sex cells. These sex cells are called gametes. Large gametes are ova, and small gametes are sperm. A physiology arranged to produce ova is female, and a physiology arranged to produce sperm is male. This twofold distinction between large and small gametes is stable and universal, not only throughout the human species, but also among all plant and animal species that reproduce sexually.

There is no such thing as a third gamete or a spectrum of possible gametes. This invariable feature of our humanity ties us intimately to the rest of creation. When the gametes combine, they can create a new member of the species. The sex binary, then, is the necessary foundation for the continued transmission of human existence.’ [4]

If someone was genuinely intersex they would have a body which was hermaphrodite in the sense of being able to produce both ova and sperm, and which could thus take on both the male and female roles in sexual reproduction. However, there does not seem to be any evidence that anyone fits into this category. As Favele notes, there are very rare cases in which ‘an individual can develop both ovarian and testicular tissue, but even in this case, he or she will produce one gamete or the other, not both.’[5]  As she goes on to write: ‘there is no direct evidence in the literature of a hermaphroditic human being, someone able to produce both small and large gametes.’ [6]

What all this means is that we should stop using the word ‘intersex’ and start using some other, more accurate, term instead. The term Favele suggests, and which I think is helpful, is ‘Congenital conditions of sexual development’ (CCSDs). This term is helpful because unlike ‘intersex’ it does not carry the implication that the person concerned is other than male or female,’ and because its neutrality avoids the stigmatizing implications which some people find present in the alternative  term ‘disorders of sexual development’ (DSDs). We can observe that an unusual congenital condition of sexual implication is present without suggesting that the condition (or the person who has it) is in some way defective.

The second thing I would like to correct is my tentative suggestion that in the rare cases where the genotype has both XX and XY chromosomes and the phenotype has both male and female characteristics (for example both a penis and a vagina) the person concerned should bear witness to the God given sex binary, and God’s general call to human beings to live as male or female,  by choosing to live as either one sex or the other.

The reason I want to retract this suggestion is because if Favele is right, then even in these rare cases the person concerned will have a body that is ordered to produce either sperm or ova and is thus actually male or female. They do not have to choose. God has made the choice for them as he has for all other people.

As Favele argues:

‘The most humanizing and precise way to view CCSDs is to understand these conditions not as exceptions from the sex binary, but as variations within the binary. We need to make room within the boxes of male and female for a diverse range of body types and personalities.’[7]

To put it another way, we need to develop a more inclusive view of what it means to male or female, rather than suggesting that someone is not either male or female because their sexual development has resulted in an unusual form of genotype or phenotype. Because of their belief in the God given sexual binary Christians should be advocating for this more inclusive approach.

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[1] Augustine,  The Retractions ( Washington DC: Catholic University of America Press, 1968), p.3.  

[2] Martin Davie, Glorify God in you Body (London: CEEC, 2018), pp.112-113.

[3] Thus Susannah Cornwall writes, ‘intersex people’s bodies don’t fit into either box’ (Intersex Conditions (DSDs):a Guide for Christians (Manchester: Lincoln Theological Institute, N.D.), p.4).

[4] Abigail Favele, The Genesis of Gender (San Francisco: Ignatius Press, 2022), pp. 123-124.

[5] Favele, p.129.  

[6] Favele, p.129 referring to Meltem Ozdemir et al, ‘Ovotesticular disorder of sex development: An unusual presentation,’ Journal of Clinical Imaging Science, 9, no.34 (2019).  

[7] Favele, p.135.

• Intersex