The social meanings attached to variations in sex characteristics have shifted since ancient times in line with the prevailing knowledge-producing systems (including religion, philosophy, science and medicine). Social meanings also vary across geographical and cultural contexts. In some historical and cultural contexts, people with variations in sex characteristics have been accepted as being able to make a valid choice between living as men or women, for example. By the mid-1800s in European contexts, people with variations in sex characteristics (then called “hermaphrodites” were conceptualized as people whose bodies deceptively hide their ‘real’ identities, their ‘true’ sex, which the expertise of doctors could uncover.
The now discredited 1950s advice of gynaecologist John Morris (suggesting that people with CAIS could not cope with truthful disclosure) and psychologist John Money (proposing that genital surgery, usually feminizing, would have a successful outcome if done early enough and if the medical history is withheld from the patient) held sway until challenged by intersex patient activism from the mid-1990s. In the 21st century, increased acceptance of the idea that people should be told about their own diagnosis and treatment opens up for new ways of interpreting variations in sex characteristics. When health professionals talk with people about their variations, this might be framed in terms of diagnosis or it might be framed in less pathologizing terms and is often contingent upon the professional’s training, clinical role and cultural lens.
Social scientists, intersex advocates, and patient representatives now question the cultural conceptions of intersex that have led to shaming, silencing, and inhibiting patient autonomy and choice in treatment. Such cultural conceptions have been upheld in medicine and psychology, with detrimental effects on the psychological well-being of people with variations in sex characteristics. Depathologising and affirming ways of understanding variations in sex characteristics are at the heart of PSI-International’s work.