What is intersex?

Intersex is an umbrella term used to refer to a large variety of situations where various aspects of an individual’s physical body do not match what is expected for either a male or a female. In some cases this creates ambiguity about the individual’s biological sex. The term can refer to a huge range of conditions which have varying degrees of impact on the body and on the individual’s experience of life. Medical professionals therefore prefer the term disorders or differences of sexual development (DSDs).

There are various biological factors which can lead to a DSD. Some are chromosomal; rather than the chromosomes expected for male (XY) or female (XX) an individual may have a different chromosomal formation. For example, some people have an extra X chromosome (XXY), a condition known as Klinefelter Syndrome, or a single X chromosome (XO), Turner Syndrome. Other DSDs are related to hormone production and reception. One of the more common conditions is androgen insensitivity syndrome, where male hormones are produced but the body does not respond to them. This can lead to a baby born with XY chromosomes, testes (which remain in the body) and female genitalia. Another common condition is congenital adrenal hyperplasia which causes increased production of male sex hormones. The impact of this on development in the womb can result in a baby with XX chromosomes, a womb and ovaries, and genitalia which look more like those expected of a male baby. Complications in hormone production also lie behind the very rare cases where a child is born with what appear to be female genitals which then develop into a penis when the child reaches puberty. (In these cases, the child was actually born with underdeveloped male genitalia and the surge of testosterone at puberty causes the delayed development.) There are also very rare cases where an individual is born with both ovarian and testicular tissue or where genitals can have a mix of male and female elements.

It is very hard to specify how common intersex conditions are; suggested figures therefore vary hugely. The examples given above are the more extreme cases. There are also many conditions which can be included under the broad term intersex but which have only minor effects on an individual’s body or experience of life. What does seem to be clear is that cases where there is genuine ambiguity about whether an individual is male or female are very rare.¹

The Binary and Intersex

Regardless of how common or not they may be, we cannot deny that intersex conditions exist, and this clearly problematises the idea that we are given the identity of male or female by God and that this is written into our physical bodies. Does this fact undermine the reality of the freedom of the gender binary? If not, how does a biblical worldview help us to understand intersex conditions?

Additional Sexes in the Bible?

When we ask what the Bible might say about intersex, it is worth considering two avenues which have been explored by Megan DeFranza.²

The Bible often talks about eunuchs, and so DeFranza and others have suggested that in the Bible (and in other secular and religious texts from the ancient world) eunuchs were viewed as a third sex, additional to male and female. For example, it is argued that God’s promise of blessing to eunuchs (Isa. 56:4) and Jesus’ acknowledgment of those born as eunuchs (Matt. 19:12) show that the Bible accepts that male and female are not the only expressions of sex difference in creation.

However, there are a few problems with this view. First, while the word ‘eunuch’ appears many times in the Bible (in the Old Testament, the Hebrew word (sāris) occurs 43 times; in the New, the Greek (eunouchos) is used eight times), it does not necessarily always refer to those distinguished by a biological condition. Over time the term became almost synonymous with ‘[high-ranking] official’. It therefore often refers to those who served in royal courts without necessarily saying anything about their bodies (e.g. Potiphar, Gen. 37:36; 39:1; and the cupbearer and baker, Genesis 40:2, 7). In addition, in the Bible, when the term is used to refer to a person in relation to their biology, the understanding seems to be that eunuchs are biological males who are unable to procreate. This would seem to be the case in the key passage, Isaiah 56:3-5. The reference to these eunuchs calling themselves ‘a dry tree’ and receiving something better than ‘sons or daughters’ implies that what was distinctive to them as eunuchs was their inability to father children. In addition, if, as seems likely, Isaiah 56 is alluding back to Deuteronomy 23, where males whose ability to procreate had been lost are excluded from the assembly of the Lord, this further supports the idea that the biblical figure of a eunuch is one who is biologically male but is unable to produce children. There is thus no indication that the Bible sees eunuchs as a third sex.

The second way that the Bible may speak about intersex is by recognising that the mention of male and female in Genesis 1 may not exclude the existence of other sexes. This argument starts from the observation that other pairs in Genesis 1 (e.g. land and seas) don’t exclude the existence of parts of creation which sit between these pairs (e.g. rivers). If it is clear that other binaries in Genesis 1 are not meant to be exclusive, then the same could be true of the male-female binary. Intersex people may therefore not fit within the male-female binary and yet still be part of God’s original plan for creation. In this way, DeFranza suggests, Adam and Eve can be considered the ‘progenitors’ of humanity, but not the ‘paradigms’.

However, I find this an unpersuasive reading of Genesis 1. When God creates the sea creatures, the flying creatures and the land animals they are all created ‘according to their kinds’ (Gen. 1:21, 24, 25). This seems to imply that within these categories of living creatures there are many different, and here unspecified, variations. However, when God creates humanity, they are not created ‘according to their kinds’ but ‘male and female’ (Gen. 1:27). This would seem to suggest that male and female are the ‘kinds’ of humanity. In contrast to the other living creatures, there is no suggestion that there might be lots of kinds of humans, rather there are only two.³

The account in Genesis 2 would seem to support this reading. There are two kinds – male and female - within humanity, the purpose of which is that there might be male-female marriages (Gen. 2:24). Though this paradigmatic statement about marriage doesn’t necessarily exclude the possibility of other sexes in creation, it does explain why there might be within humanity an exclusive binary of male and female and seems to be a weighty argument for an exclusive binary, even if not a conclusive one. In addition, Jesus supports this idea when, in Matthew 19:4-5, he connects Genesis 1:27 (humanity created ‘male and female’) and Genesis 2:24 (‘…the two shall become one flesh’). Obviously, this doesn’t mean that every man and every woman should or will marry (Jesus makes this clear in Matthew 19:11-12), but it does seem to suggest that there is something purposeful about the design of humans as male or female. At very least it provides a logic to explain why the two kinds of humanity are male and female.

We can also note that elsewhere in the Bible, the male-female binary is assumed to be a paradigm for human existence, sometimes even being used as the grounds for various distinctions and instructions (e.g. 1 Cor. 11:3-15; 1 Tim. 2:11-15; 5:1-2; Titus 2:2-6). It is hard to see how the Bible might affirm the existence of a third or other sexes, when it regularly talks only of male and female when dealing with sexed distinctions.

I therefore find it hard to offer a biblical defence of the position which states that intersex conditions might be explained as one or more additional biological sexes which were part of God’s original plan for creation.

A Biblical Theological View

I think a better approach to finding a theological understanding of intersex is to think about it in the context of biblical theology. How might the Bible’s big story help us to understand intersex? When we ask this question, we find a fruitful answer.

The Bible’s big story is uniquely able to explain why the reality we experience now is sometimes different from how God originally intended things to be. We know that our corporate rebellion against God has led to brokenness and imperfections in God’s originally perfect creation (Genesis 3; Romans 8:20-22), and we know that this brokenness extends also to our physical bodies (Romans 8:23). It should therefore not be a surprise to us when our physical bodies, whether from birth or later in life, exhibit divergences from God’s original plan for human embodiment. All of us experience this to a greater or lesser extent at various points in our lives.

It seems to me that the best way to understand intersex conditions is as just some of the many ways the brokenness of creation can be experienced in our physical bodies. In this way, in terms of theological explanation, those born intersex are no different to those born blind or with a limb which is missing or not fully formed. These things are all biological experiences of the brokenness of creation.

Some object to this perspective, seeing it as unloving and dishonouring. However, this need not be. The examples of brokenness which we experience in our physical bodies are non-moral issues. They are not things over which we should feel guilt or shame. Rather, they are reminders of the reality of brokenness, the problem of humanity’s rebellion against God, and the good news of the gospel that Jesus has won the victory over sin such that he has the power and authority to one day put to rights all that is wrong in creation.

With this understanding, we can see how the existence of intersex conditions doesn’t disprove the reality of the gender binary. The gender binary is there as a part of God’s good creation, but it, like all creation, can be marred by the effects of sin.

A Christian Response

A theological explanation only takes us so far. To make a truly Christian response, we also need to think practically. How should Christians respond to those who are intersex and what might it look like for someone who is intersex to follow Jesus?

Intersex and the Image of God

We must start by recognising that intersex people, like all humans, are created in the image of God. An intersex condition does not negate this fact. Bearing the image of God is not predicated on being male or female but on being human, and no outworking of the brokenness of creation that we experience in our physical bodies can change this fact. Every intersex person has unique worth, value and dignity given to them by God and a contribution to bring to society and the church.

This being the case, we must make sure that being intersex is not a reason that people experience guilt and shame. Sadly, it seems that many intersex people, including those who have been involved in churches, have been rejected and ostracised because of being intersex. One intersex Christian who has shared her story recounts that when she opened up to some of her close friends, they told her that she had ‘ruined her testimony’ and that they no longer wanted to talk to her. When she shared with her pastor, he simply recommended that she remain silent about her situation.⁴

As Christians, we must make sure that we are the first to welcome intersex people, to listen to their stories, to acknowledge their pains, and to communicate, through word and action, that they are of equal value to us and to God as those who are clearly biologically male or female. We must work to ensure that having an intersex condition is not something about which individuals need feel ashamed or guilty, just as no one should be caused to feel ashamed or guilty about any aspect of brokenness that they might experience in their physical body.

Intersex and Identity

Intersex is another case where identity is vital. In particular, we must think about ultimate identity so that those whose identity as male or female is not clear, can find peace and security in a more fundamental truth about who they are. We can help intersex people by affirming that even if their identity as a male or female is ambiguous they are still loved by God and valued by him. For Christians who have intersex conditions, we must help them to know and experience that they are a child of God, regardless of any ambiguity about their biological sex. While ambiguity about one area of identity may be present, there need not be any ambiguity about other areas of our God-given identity.

And here there is again a part that we can all play. All of us need to recognise and live out our ultimate identity. Our sexed identity may be given to us by God and may be an important part of who we are, but it is not our ultimate identity. The ultimate identity for a follower of Jesus is as a child of God. This is true for those who are intersex, but it is also true for those of us who are biologically male or female. We need to be sure that our identity as children of God is where we are finding our sense of worth and security, not our biology. Only when those who are biologically male or female do this, can we help those who are intersex to do the same.

The Practical Questions

The practical questions about whether medical treatment and surgery should be sought, and about how intersex people are to live and present themselves in terms of their sexed identity, are too complex to deal with here and I feel underqualified to tackle them. But for a Christian working through these questions, I would offer three thoughts. First, prayer and the guidance of the Holy Spirit must be made central, trusting that God, as a perfect father, will want to answer, and guide and bring peace. Second, local church eldership should be involved. Elders are given to the church as fathers, to look out for us, protect us, encourage and walk alongside us. Such complex and difficult questions shouldn’t be tackled alone; they should be tackled with spiritual fathers alongside. And third, the wisdom of medical professionals should be received. It may need to be weighed against Scripture and the guidance of the Holy Spirit, but medicine is an expression of God’s common grace to humanity and so should not be immediately rejected.

The Binary and Intersex

In theological terms, then, intersex conditions do not undermine the freedom of the gender binary. We know that we live in a world where we are to expect that our embodied experience does not always match up with God’s original intentions. Intersex is just one example where we see this as a reality. For those who are intersex the freedom of the gender binary may be difficult to experience. We must therefore respond with compassion, being those who suffer alongside, and pointing to, as well as living out, a greater identity. Intersex conditions, like so many examples of brokenness we experience in this life, are a reminder to look beyond this age, beyond even the freedom of the gender binary, to a greater freedom looming on the horizon. They are a reminder ‘that the creation itself will be set free from its bondage to corruption and obtain the freedom of the glory of the children of God’ (Romans 8:21).