Gender identity and sexuality

Although often used interchangeably, there are important distinctions among sex, gender identity, and sexuality.  In this chapter we will be exploring these distinctions to highlight the complexity of one’s biological make-up and expression of his or her gender identity.

An individual’s biological sex may or may not match up with their gender identity.  At birth, babies are typically labeled as either male or female based on external genitalia or other factors, such as chromosomes and hormones.  A child with XX chromosomes and a vulva is labeled as a girl; a child with XY chromosomes and a penis is labeled as a boy.  The terms “assigned female at birth” or “assigned male at birth” reinforce that someone other than the child, typically a doctor, makes this determination for them.  This label is then officially marked as their biological sex on their birth certificate.

In those situations where the sex of the child is unclear, such as with intersex conditions, doctors and parents must discuss what, if any, corrective measures could be taken to better align the child with either male or female characteristics.   Surgery can be performed to either masculinize or feminize the external genitalia of the child, but this decision comes with great uncertainty and complex moral and ethical issues.  If surgery is performed to masculinize ambiguous genitalia and the child later identifies as being male, then there are few issues.  However, if ambiguous genitalia are transformed into a sex that the child later does not identify with, that person’s sense of identity can be complicated.

Before any decisions are made, doctors will often want first to determine the composition of the child’s internal genitalia.