Thank you for the invitation and the opportunity to speak here as the mother of an intersex person. A few comments first of all: my child has a fulfilling job, a large circle of friends and lives in a wonderful partnership. All the fears I had after being told the "diagnosis" have long since dissipated. And about the language used: I use terms that may cause problems for intersex people present or even retraumatise them. I try to avoid this by making an effort to place these terms in the context in which they are used, namely in medicine, and explaining why they are pathologising and what alternatives there are.
Gender is more diverse than some people think: a newborn child has a morphological gender, which we recognise when we look at it naked. So does the midwife, who assigns the child to a gender immediately after birth, also known as the midwife's gender. She may say to the parents of an intersex child: "I can't categorise it as either male or female because of its genitalia." This then leads to the question of the civil status gender, i.e. entry in the civil status register. The parents of this child can now leave the civil status open, but they can also register their child as diverse, male or female - regardless of the gender they choose in everyday life. On a biological level, in addition to morphological sex, there is also genetic, hormonal and gonadal sex - and we will see how diverse and by no means binary these different gender categories are. In addition, we look at social gender - which refers to how we are 'read' by our social environment. And finally, there is gender identity, which I tend to call a child's "gender self-perception", which is still very much characterised by gender assignment from the social environment and only becomes an identity with increasing self-reflection. Incidentally, I always find it interesting that gender identity is not counted as part of biological sex, even though our identity, our self-perception, is based on a biological structure, perhaps even the most important one - our brain.
I will first go into more detail about biological sex: Conventional wisdom has it that the respective sums of genetic, hormonal and morphological characteristics can be clearly delineated between male and female sex. We imagine that both female characteristics and male characteristics naturally exhibit variations in size and shape, but can nevertheless be represented by a Gaussian normal distribution curve and that these normal curves stand separately next to each other. In reality, we have a distribution of gender-typical characteristics that looks like the two norm curves overlap strongly. Most forms of intersexuality can be located in this overlapping area. However, it becomes a little difficult to speak of overlaps when we look at the genetic area. Here, in addition to the chromosome sets 46,XX and 46,XY, we also have the following variants: 45,X0; 47,Triple-X; 47,XXY; 48,Poly-X and their mosaics, and even mosaics of diploid and tetraploid chromosome sets occur. The diversity of chromosomal sexes is high, as are the morphological sexual characteristics.
Variants of the sexual organs
In terms of the development of the organs, the clitoris and penis are homologous, not the penis and vagina. There are numerous transitions between penis and clitoris, but also between scrotum and vulval lips, which are also homologous organs. The possibilities for variations in sexual development are numerous: there are people who have one testicle and one ovary or mixed gonadal tissue on both sides, while others have a penis, testicles and uterus, for example. There are people with a completely female appearance, abdominal testicles and high testosterone levels. There are people with exclusively male primary sexual characteristics and female secondary characteristics. The examples mentioned are only a small selection of the possible variants.
Biological diversity is extremely high and this diversity is logical if you look at embryonic sexual development: It starts with the fertilised egg cell, which has a specific set of chromosomes. By around the eighth week of pregnancy, the reading of genetic information leads to cell proliferation and the first differentiations into various tissues. In this way, paired gonadal systems develop inside the embryo, which are initially neither testicles nor ovaries, and undifferentiated paired sexual ducts (Müllerian ducts and Wolffian ducts). Externally visible sexual tubercles and sexual folds develop.
From the 8th week of pregnancy, the gonads differentiate into testicles or ovaries, which continue to differentiate and produce hormones. During further sexual development, hormones and the corresponding receptors interact in a kind of lock-and-key principle. In cases where the receptor or the hormone are altered, they no longer match. Whether hormones work and how they work naturally depends on this, among other things. The hormone effect on the target cells then leads to the development of physical sexual characteristics. In most boys, testicles develop from the gonadal anlagen, which descend into the scrotum and produce hormones, including testosterone. The Wolffian ducts differentiate into epididymis, vas deferens and ureter. The urethral duct then opens at the tip of the penis in most boys. In most girls, the gonadal anlagen differentiate into ovaries and, under the influence of oestrogens, the Müllerian ducts differentiate into fallopian tubes, uterus and the upper part of the vagina (the lower part forms externally). Also under the influence of hormones, the genital tubercle becomes the penis in boys, the clitoris in girls and the genital folds become vulval lips or scrotum.
This is the so-called "normal" development. Now we come to the variations: In boys, a certain hormone, the so-called anti-Müllerian hormone, prevents the Müllerian ducts from developing into female organs. If this anti-Müllerian hormone is not recognised by receptors or another peculiarity in the hormonal
If a child is male due to external characteristics, it can still have fallopian tubes, a uterus and part of the vagina. The genital tubercle becomes a penis or a clitoris. But if both organs develop from the same embryonic structure, then there must be transitional forms. Because that's how nature works. There are big noses and small noses, big ears and small ears. Why shouldn't there also be differences in size in this organ of all organs? And the decision as to whether we are talking about a clitoris or a penis or whether we are talking about a clitoris that is too large or too small, a so-called "micropenis", is made by medicine. A penis that is smaller than 2 centimetres at birth is considered a micropenis. A clitoris that is larger than 0.5 centimetres at birth is considered a hypertrophic clitoris. However, this categorisation is arbitrary, as both have the same structure: The clitoris also has a shaft and a glans and both have erectile tissue. Even the glands (e.g. the Bartholin's gland and Cowper's gland) are in a comparable location and have a similar function. The idea that the genitals of men and women are built completely differently is therefore simply not true.
This results in numerous transitional forms, such as a child with a penis, testicles, scrotum and uterus, or another with a vagina and vulva, a very large clitoris and testicles in the abdomen. In such cases, the physical sexual characteristics cannot all be assigned to one sex. They are therefore intersex children. How they categorise themselves in terms of gender - i.e. whether they are intersex, male, female or in an individual category - remains to be seen and must then be accepted. The number of intersex people can only be estimated. There are many figures in the literature, most of which vary between 1:100 and 1:2000, depending on the definition.
Pathologisation of the mutation
The cause of variations in sexual development are of course mostly mutations. In my biology degree programme, I was taught that mutations in humans are always considered pathological. But the term mutation is not synonymous with disease or illness. Mutations are often spontaneous changes in the genome, sometimes caused by mutagenic influences, and they are a prerequisite for evolution. Without mutations, we would still be at the stage of microbes today. I don't know if we would want that. When I retired and my colleagues knew that I was very outspoken on the subject of intersexuality, the head of biology presented me with a large bouquet of flowers with the following words: "We wanted to give you something suitable and decided on this: it's all sex organs." And I beamed at him and said: "Yes, and all hermaphrodites*! Wonderful, thank you!" You have to realise that: The flowers that we find so beautiful are almost all hermaphrodites. And we don't find that beautiful in humans. Why not?
This brings me to the cause of the pathologisation of intersexuality that continues to this day. Medicine has the power of interpretation over intersex people and the pathological value of their bodies. It still determines the nomenclature today. Even today, there are still medical institutes with the name "Institute for Genital Malformations". And thus medicine also claims the right to interpret the necessity of medical interventions. This is also shown by the so-called DSD classification, which was defined at the Chicago Consensus Conference (2005). It contains many pathologising terms, such as aberration, syndrome, dysgenesis, regression, hyperplasia. And these terms are still used today when intersex people are told their "diagnosis". And terms from this classification are also used towards parents of intersex children. At the time, it was thought that the term DSD was meaningless, but the long form at the time was "Disorders of Sex Development". Nowadays, some doctors use the long form "Differences of Sex Development" or speak of variants of sex development (VdG). However, on closer inspection, every person has their own variation in sex development - diversity as the norm!
Change in medical assessment
From the 1960s until a few years ago, the medical treatment of intersex children was characterised by the so-called "optimal gender policy". If a child was neither clearly a boy nor clearly a girl, its gender was labelled as ambiguous and this was declared a medical emergency. The assignment of a male or female gender was postulated as a prerequisite for stable personality development and the consequence was the adaptation of the external and internal gender to this assigned, usually female, gender. In other words, attempts were made to create unambiguity through surgery in the sense of curative treatment. For the most part, these gender-changing operations were carried out in infancy. "We do it while the nappies are still on" (quote from a doctor). For example, a very large clitoris was surgically reduced in size - with the risk of damaging the ability to feel. Sometimes there were multiple re-operations, often with corresponding scarring in the genital area. An artificial vagina (neovagina) was inserted in very young children, which then often had to be "bougied" by their own parents over a long period of time. This meant that they had to penetrate their baby's vagina two or three times a week with a finger or rods and dilate it. Functioning gonads were removed, although this is actually prohibited by the castration ban. But here, too, this procedure was declared a curative treatment due to an assumed "risk of degeneration", without taking into account the fact that it entailed lifelong substitution with artificial hormones with sometimes serious side effects. And just a few years ago, we saw that it was recommended to remove a boy's uterus. There was no medical indication for this recommendation, possibly based on the idea that "it's a boy, a uterus doesn't belong in this body". This idea of removing something from a body that didn't belong there was very widespread.
In the meantime, the attitude of many doctors is changing. Here are some quotes from the medical guidelines: "The awareness of the inadequacy of the 'either-or' of bisexuality enables the specialist, together with the person concerned and their relatives, to rediscover and redefine the field of lived gender." (Source: S2k Guideline 174/001: Variants of gender development current status: 07/2016 p. 4) Or: "This multisexuality can also provide existential aspects for the self-image of non-affected persons." (Source: S2k Guideline 174/001: Gender development variants, current status: 07/2016 p. 4) Or - I particularly like to quote this sentence: "Dealing with people with a gender development variant is generally a socio-political problem and must be considered in the context of society as a whole." (Source: S2k Guideline 174/001: Variant gender development current status: 07/2016 p. 4) Intersex is not a medical problem per se. There are only very few forms of intersexuality that require medical intervention.
And I would like to quote another sentence from the guideline: "The UN Convention on the Rights of the Child emphasises that the best interests of the child should be a fundamental concern for parents in their upbringing. A decision in the best interests of the child is only properly possible if the child is listened to." (Source: S2k Guideline 174/001: Variations in gender development current status: 07/2016 p. 4)
The current Civil Status Act offers intersex children the option of simply leaving their gender entry open. If the intersex status is not recognised at birth, but only later, e.g. at puberty, then a change to the gender entry and also a change to the first names can also be made via the Civil Status Act.
The law on the protection of children with gender development variants has been in force since 2021. It prohibits operations on children who are unable to give consent that are solely intended to align them with a standardised gender. However, this law has problems: For example, capacity to consent is not defined. Furthermore, it states "which serve the sole purpose of assimilation without any additional medical reason". (Source: Bundesgesetzblatt Jahrgang 2021 Teil I Nr. 24, issued in Bonn on 21 May 2021, p.1082) It is therefore possible for children to undergo vaginal surgery because there is a common vaginal and urethral excretory duct, but then the clitoris is also reduced in size at the same time, which would not be medically necessary. And the argument "We have to operate on the children so that they don't get bullied at nursery school." is an argument I have personally heard in conversations with doctors. Instead of a medical indication, mental health is then summarily cited as the reason.
in the field.
Intersexuality in the family
The parents' view of intersexuality continues to be characterised by medicine, especially by the linguistic form in which the "diagnosis" is usually communicated: "We have a problem" or "Your child has ... syndrome". I was once told: "Your child looks syndromic." I thought that was terrible - whatever this person meant by that. Sexual development disorders or genital malformations are terms that parents are told. Now imagine the following: You are expecting a baby and are looking forward to the birth. You expect to be told after the birth: "Congratulations, you've had a baby, isn't it lovely?" But then you hear the words: "We have a problem now. Your child is not normal, it has a genital malformation. There is a disorder of sexual development. It's probably the following syndrome ..." And then there may be other, often thoughtless statements. I was told that a midwife in the delivery room exclaimed: "Oh God, a hermaphrodite. How terrible for the parents!"
This naturally prevents the parents from having a normal relationship with the child. And it often creates a conglomerate of negative feelings: There is this fear for the child's happiness in life, sometimes also a sense of shame. And then there's this taboo: "You must never tell anyone that." I know this situation. I was never ashamed of my child, but accepted it as it was right from the start. But I also asked myself: did I do something wrong during the pregnancy? And I was afraid! Afraid that my intersexuality could be discovered, that my child could be ostracised, that it could be bullied at school and that it would be unhappy. And I was also told to keep quiet: "You must never tell anyone, not even your parents and siblings." I didn't fully comply with this requirement, but it took a very long time before I was able to talk about it publicly like I do today.
Intersex children experience bisexuality as the norm in their social environment: games of "boys against girls", "dear pupils", girls' and boys' changing rooms and toilets, sports tables for girls and boys. Intersex is not mentioned in biology lessons and they hear the word "hermaphrodite" used as a swear word in the playground. As a result, they experience permanent marginalisation.
Standards are taught in sex education classes. And many intersex people have described this problem from their childhood and youth: "I felt like a monster, like an alien. I didn't even exist." How are you supposed to develop self-esteem? Inter children experience class teachers and liaison teachers who know nothing or are even afraid to talk about it. And this even affects school psychologists, who often haven't learnt anything about intersex in their training. If you don't know anything about something, you are unsure. Then there is the confusion between intersex children and trans children ... We know that the risk of suicide is high among intersex children and adolescents. This also weighed heavily on me when my child was going through puberty. When I came home from school and my child had finished early, I often went home with the fear: "I hope my child doesn't do something to themselves at some point!" We know people from self-help who have been to adolescent psychiatry due to conspicuous behaviour, where it then turned out that their physical peculiarities or even previous operations were not discussed at home.
Intersexuality is hardly recognised in society and is also confused with trans identity here. The demand for gender-sensitive language is ridiculed as "gender gaga". The work of inter-activists is defamed, I was accused of "early sexualisation" because of my book for kindergarten.
The Catholic Church's approach to intersexuality
In the book When Man and Woman Created by the Congregation for Catholic Education, it says: "In this light, one understands the conclusion of the biological and medical sciences, according to which 'sexual dimorphism' (or the sexual difference between men and women) is confirmed by the sciences - such as genetics, endocrinology and neurology. Moreover, in the case of sexual indeterminacy, it is medicine that intervenes therapeutically. In these particular situations, it is not the parents, and even less society, who can make an arbitrary choice, but it is scientific medicine that intervenes with a therapeutic objective, that is, acting on the basis of objective parameters in a minimally invasive way, with the aim of making the constitutive identity clear." I don't think I need to make anything more clear. This language speaks for itself. I once saw a cartoon that I found very apt. It shows Peter at a desk with a computer. In the background there is a staircase leading up to heaven. Peter calls upwards: Lord, they down there have just made a third generation. And God replies: Not them - I made it."
I would like to conclude my remarks with "to-do lists".
List for medicine:
- Recognising that intersex is not an illness
- Avoidance of pathologising
Handles - Appreciative language towards parents of a child
- Congratulations on your birth
- Recognition that operations on small children are not an adequate treatment for adult anxiety
- Creation of counselling structures
- Mediation of peer counselling
- Realising equality for all people
List for the legislator:
- Enforcement of existing laws to protect children with gender development variants
- Creation of a central register
- Funding for projects and programmes aimed at raising awareness of gender diversity
- Provision of resources for appropriate counselling of families
- Revision of outdated curricular requirements for schools
List for the company:
- Acceptance and appreciation of gender diversity
- Dismantling the taboo of intersexuality
- Dismantling traditional gender roles
- Recognising children's right to self-determination
- Recognising child protection as a shared social responsibility
List for the Catholic Church:
- Recognising gender diversity as part of creation and thus turning away from pathologisation
- Further training for employees in church kindergartens and counselling centres
- Guidelines for a Christian approach to gender diversity in church kindergartens
- Revision of guidelines for teaching religion and ethics
- Critical approach to the Vatican's statement on the topic of 'gender'
I grew up in a Catholic family and was taught a Christian image of God that differs from that of the official church. My image of God is characterised by love and acceptance - also of diversity, but also of non-acceptance of boundaries set by society. Jesus was always a role model for me, because I thought: yes, this was a person who was critical, who rebelled against what was read in society at the time. I learnt this image of God and Christ as a teenager. I think that's where we should go again, that believers should simply say: Christ's mission to me is first and foremost to love my neighbour in addition to loving God. And that's why I'll end with a sentence I heard from a doctor that did me an incredible amount of good: "Never say that my child should have been a boy. Always say that God wanted my child to be the way it is." 
