As a clinic that treats pelvic health I thought it would be important for us to say something to raise awareness in our community of the importance of honoring our differences. I think the first step is recognizing that variation from a binary system of sexuality is really the norm.
Treating pelvic floor health has been very good for me personally (Sara). I had a very limited view of sexuality from my upbringing and religious training. It was through the medical education I received to help treat pelvic floor function that I realized I didn’t have all the information. The fact is, there is a difference between biology, gender and preference.
Biologically, there is actually a lot of variation in genitalia. “Here’s what we do know: If you ask experts at medical centers how often a child is born so noticeably atypical in terms of genitalia that a specialist in sex differentiation is called in, the number comes out to about 1 in 1500 to 1 in 2000 births. But a lot more people than that are born with subtler forms of sex anatomy variations, some of which won’t show up until later in life.
“Below we provide a summary of statistics drawn from an article by Brown University researcher Anne Fausto-Sterling.2 The basis for that article was an extensive review of the medical literature from 1955 to 1998 aimed at producing numeric estimates for the frequency of sex variations. Note that the frequency of some of these conditions, such as congenital adrenal hyperplasia, differs for different populations. These statistics are approximations.
Not XX and not XY one in 1,666 births
Klinefelter (XXY) one in 1,000 births
Androgen insensitivity syndrome one in 13,000 births
Partial androgen insensitivity syndrome one in 130,000 births
Classical congenital adrenal hyperplasia one in 13,000 births
Late onset adrenal hyperplasia one in 66 individuals
Vaginal agenesis one in 6,000 births
Ovotestes one in 83,000 births
Idiopathic (no discernable medical cause) one in 110,000 births
Iatrogenic (caused by medical treatment, for instance progestin administered to pregnant mother) no estimate
5 alpha reductase deficiency no estimate
Mixed gonadal dysgenesis no estimate
Complete gonadal dysgenesis one in 150,000 births
Hypospadias (urethral opening in perineum or along penile shaft) one in 2,000 births
Hypospadias (urethral opening between corona and tip of glans penis) one in 770 births
Total number of people whose bodies differ from standard male or female one in 100 births
Total number of people receiving surgery to “normalize” genital appearance one or two in 1,000 births”. https://isna.org/faq/frequency/
Gender also varies. We all have a combination of masculine and feminine qualities. This is not determined by our genitalia. Many things influence how we present ourselves or perceive ourselves (culture, upbringing, biology, innate sense….)
“… it also is important to put intersex and LGBT health in a cultural and historical context; he advises clinicians to be aware of the ethnic, religious and cultural values that patients and families bring with them to the clinic.
“I try to stress to patients that the gender norms they are dealing with are societal constructs and are not something that were determined scientifically,” Rosario says. “We have these categories, but practitioners need to help patients and parents recognize that everything doesn’t have to all fit together in one particular way that we conventionally call ‘normal.’ There’s a lot of diversity, and that’s okay.”
This is all the more important because pressure to conform comes with a psychological cost. Those who fall outside of sex and gender norms face stigma, hostility and outright violence. Many endure bullying and rejection that can lead to psychological scars or even suicide. A 2014 study from the Williams Institute at the UCLA School of Law and the American Foundation for Suicide Prevention found that 41 percent of transgender individuals and 10-20 percent of gays and lesbians have attempted suicide. That risk jumps dramatically for those who have faced violence, familial rejection or homelessness.” https://newsroom.ucla.edu/stories/male-or-female
Sexual preference varies and appears to be innate. A boy can prefer boys, girls or both and a girl can, too. And a person can prefer asexuality. https://link.springer.com/article/10.1007/s10508-019-01590-0
Biology, gender and preference in themselves are not perverted. Perversion comes from misusing our sexuality in a way that hurts others, or dissipates our own energy to negatively impact our health or our ability to contributing to the well being of all.
It is very difficult to be different than the majority. Who would purposely choose that?! Please remember to celebrate the people in your life that are “different” than you. We can all use some kindness and support these days.