This paper was updated in September 2013, with a new final “impact” section that reflects the discontinuation of “SGD” and “DSG” terminology by the National LGBTI Health Alliance and many other organisations.

Summary

In late 2012 and early 2013, OII Australia determined that the terms “sex and gender diversity” (“SGD”) and “diverse sex and gender” (“DSG”) were confusing the media, policy makers, and the public about intersex and intersex people. This paper outlines those reasons, provides evidence from press reports and policy submissions, and proposes alternative usages.

We believe “SDG”/”DSG” terminology was confusing because the terms are euphemistic, abstracted, conflate identities and biology, and lack legibility. We believe that misconceptions are partly generated and perpetuated through the poor use of umbrella terms, often by third parties. They are misused in ways that elide differences between intersex and trans groups.

We believe that a move away from obscure innovative terms would make information more intelligible to a general audience, and an international audience. We believe that consistency and clarity in terminology would help us to talk more effectively about intersex, and more easily help us work together on areas of common concern with trans and other communities.

The purpose of this discussion paper is to illuminate some of the issues, and help to agree a way forward that promotes clarity, simplicity, and consistency, in a way that helps achieve positive change.

The paper suggests an umbrella term, and establishes that the term “intersex” should always be used to refer to intersex people and issues.

It concludes with a brief update assessing the impact of the paper since initially published in January 2013, noting that usage of “SGD” and “DSG” has diminished, and awareness of intersex issues has also increased. It is possible that a shift in terminology has contributed to that process.

Evidence of confusion about “SGD”

Evidence of confusion about the nature of “SGD” and “DSG” is widespread, and is not limited to OII Australia. Peter Hyndal said, at the launch of the National LGBTI Health Alliance’s DSG Health Report:

There’s been all this talk of “sex and gender diversity” this evening. It seems to me that very few people really understand what that term actually means. “Sex and Gender Diversity” is a term that describes two different groups of people.

The first are intersex…
Being intersex is a biological reality.
It has nothing to do with a person’s gender identity. And It has nothing to do with a person’s sexuality.

The second group of people we refer to as part of the term “Sex and Gender Diverse”, are people whose gender identity happens to be different from cultural assumptions of ‘normality’. This includes (but certainly isn’t limited to) people like me – who were born female, but who identify and present in the world as male… [1]

The focus of that launch event was on trans issues, with trans speakers and non-trans policy makers. Particularly egregious examples of a lack of understanding can be seen in the press coverage of that launch. The SX/GNN report referred to intersex twice, in opening and closing the article (our emphasis):

The Diversity in Health: Improving the health and well-being of transgender, intersex and other sex and gender diverse Australians report was launched at Parliament House in Canberra on Tuesday, November 27 at an event sponsored by the convenors of the Federal Parliamentary LGBTI Friends Group
Alliance Chair, Susan Ditter, said… “The recommendations … provide a solid foundation … to improve the health of transgender, intersex and other sex and gender diverse Australians.” [2]

The bulk of the article was given to two interviews of trans people, and a summary statement by the Alliance Chair.

The publisher identified the report’s key concerns:

It recommends reforms and greater protections for DSG people in five key areas, including health, education and community services, identity recognition, health care, legal protection as well as greater research and evidence about the issues commonly faced by those in the community.

One of the major recommendations is for the Commonwealth to direct Medicare to remove the gendering of medical procedures and rebates, so that people can gain access to rebates for procedures which are appropriate for their bodies, regardless of their gender. According to the report such coverage should include, but not be limited to, medically necessary transition processes. [2]

The Star Observer titled its coverage “Trans issues back on national agenda”. The word intersex was mentioned twice:

Top transgender and intersex advocates refreshed their lobbying efforts in Canberra…

The National LGBTI Health Alliance organised the roundtable with transgender, intersex, queer and Indigenous sister girls from most states and territories.

The issues that the press coverage expanded upon were solely based on an interview with Sally Goldner [3]:

“I feel like we are at a cusp but I think public understanding of what transgender is certainly increasing all the time.”
Goldner said Australian transgender people were still missing out because they faced a “shortage of social justice” despite increasing public awareness around gender diverse issues.
“Going back to last year when the passports improvements were announced there was barely a backlash,” Goldner said.
In September 2011, the Australian Government announced new guidelines for transgender people applying for passports. Before the change, transgender people were forced to undergo sex reassignment surgery before their gender could be changed on their passport which severely limited travel overseas.
The government relaxed the standards by allowing transgender people to present a statement from a medical practitioner supporting their gender. [3]

Both press reports presumed the existence of an homogeneous “DSG people”, or “DSG community” of interest, and the issues expanded upon are about transition, which strongly implies that transition is a “DSG” issue, rather than primarily a trans issue. Some of the issues mentioned in the interview with Sally coincided with changes to guidelines for intersex people, but that was omitted.

An uninformed reader of both articles would likely assume that trans, intersex and “DSG” are synonymous. A little informed reader would likely assume that transition is a, perhaps the, intersex issue [4].

Outside the LGBTI communities, the Australian Human Rights Commission published the Sex Files report in 2009, as part of a “sex and gender diversity project”:

The biological definition of sex is based on whether a person is male or female. However, there are also people who are born not exclusively male or female and are intersex. The phrase sex diversity as a term recognises the complete spectrum of sex identity.
For people who define sex as biologically determined, gender is viewed as socially constructed. From this perspective, gender can be determined by how a person looks, dresses or acts. People can express a gender identity that is masculine, feminine or something else. Gender identity does not necessarily match with sex. [5]

The use of “sex diversity” appears to be an unnecessary case of mirroring the use of “gender diversity”. The document establishes a reasoning for discussion of “sex identity” that appears dated and inaccurate. Further, the Sex Files report did not take account of existing practices in some States whereby intersex people can obtain identity documentation on the basis of administrative correction to birth registration details [6].

In its submission on the Human Rights and Anti-Discrimination Bill Exposure Draft, in December 2012, the AHRC has found it necessary to use more explicit language around intersex, in an effort to ensure our inclusion in the proposed bill:

Recommendation 6: The Commission recommends that, in addition to protection against discrimination based on gender identity, the Bill also provide protection more directly against discrimination on the basis of a person is sex characteristics, intersex status, or gender expression. [7]

Mixing identity terms and biological terms

The dovetailing of identity terms with a biological term is unhelpful, and it results in presumptions that intersex is also an identity term.

An example of this is the HRAD submission by A Gender Agenda, Canberra which states:

A Gender Agenda works with the sex and gender diverse community which includes transsexuals, transgender people, intersex people, cross-dressers and other sex or gender variant or gender non-conforming people as well as their partners and other family members. [14]

In this particular case, intersex is sandwiched between transgender people and cross-dressers, both forms of gender diversity. We believe that this placement of the term intersex should be discouraged as it contradicts A Gender Agenda’s assertion that sex and gender diversity refers to two distinct groups. The ANU College of Law “Equality Project” makes a number of erroneous assertions regarding the utility of the term “gender identity” to include intersex, which appear misguided in the wake of the passing of the Sex Discrimination Amendment, and which also conflate identity and bodily experiences:

Under international law the phrase used is “gender identity”,14 and there is no policy reason to depart from that term. It is the understanding of the Equality Project that this is also the preferred term in the opinion of transgender and intersex people and groups who lobby on their behalf…

Gender Identity refers to:

  • the gender related identity of a person, (for example, being a transgender person, being a transsexual person, being an intersex person, being a person who does not identify as either male or female), [8]

The ANU college of Law “Equality Project” submission goes on to make the erroneous assertions both that intersex is an identity category, and that it is positioned within a “gender-diverse community”:

The Equality Project also submits that it is important to use terms such as ‘transgender’ and ‘intersex’ in the legislative definition by way of explicit example. This is because it makes it easier for people to understand that they are included under the definition and because these identity categories are important to many in the gender-diverse community. [8]

Some of these issues go beyond the scope of a document examining the use of “SGD” or DSG” as descriptors, however, they demonstrate a lack of clarity originating in the misguided belief that intersex is a gender identity term.

Self-descriptions of intersex within intersex communities

When intersex groups self organise, or speak, the terminology of “sex and gender diversity” is never used. It is clear that “SGD” or “DSG” are terms used by others to include us, not terms that we use ourselves.

This is demonstrated in the seven demands of the second International Intersex Forum, held in Stockholm in December 2012. These demands also show what are actual intersex issues:

Between 9-11 December 2012, the second International Intersex Forum took place in Stockholm. This event brought together 37 activists representing 33 intersex organisations and supportive institutions from all continents.

The Forum agreed to affirm the principles of the first International Intersex Forum and extended the demands aiming to end discrimination against intersex people and to ensure the right of bodily integrity and self-determination:


  1. To put an end to mutilating and ‘normalising’ practices such as genital surgeries, psychological and other medical treatments, including infanticide and selective abortion (on the grounds of intersex).
  2. To ensure that the personal, free, prior, and fully informed consent of the intersex individual is a compulsory requirement in all medical practices and protocols.
  3. Creating and facilitating supportive, safe and celebratory environments for intersex people, their families and surroundings.
  4. In view of ensuring the bodily integrity and health of the intersex child, psycho-social support and non-pathologising peer support be provided to parents and/or care providers and the child`s immediate family instead of surgical or other medical treatment unless such interventions are live-saving.
  5. The provision of all human rights and citizenship rights to intersex people.
  6. The provision of access to one`s own medical records and any documentation, and the affirmation of the intersex person`s right to truth.
  7. The acknowledgement and redress of the suffering and injustice caused in the past. [9]

Actual terminology in use by intersex people can also be seen in the open letter on intersex to the UN High Commissioner for Human Rights, signed by Australians Gina Wilson and Tony Briffa. It begins:

We are writing to discuss the grave situation of human rights abuses of intersex people worldwide. We are concerned about the specific uses of prenatal Dexamethasone (DEX), nonconsensual medically unnecessary surgeries on infants and minors, the gross mistreatment of Pinki Pramanik, and the recent addition of intersex people under the language of “DSD” (Disorders of Sex Development) to the DSM-V. [10]

Further examples are provided in the submissions on the Human Rights and Anti-Discrimination Bill (HRAD), Exposure Draft, by OII Australia [11], AISSGA [12], and Tony Briffa [13]. OII Australia state, in the first paragraph:

OII Australia is a national body by and for intersex people. We promote the human rights of intersex people in Australia, and provide information, education and peer support. OII Australia is a not-for-profit company, recognised by the Australian Taxation Office as a charitable institution. We are not publicly-funded; we rely on the contributions of our members.

The AISSGA state in their first paragraph:

The Androgen Insensitivity Syndrome (AIS) Support Group Australia Inc. (A0041398U) is a peer support, information and advocacy group for people affected by AIS and/or related intersex conditions, and their families.

Tony Briffa states:

Thank you for the opportunity to provide feedback on the exposure draft of the Human Rights and Anti-Discrimination Bill 2012 (Cth). I am particularly pleased the Bill aims to include people born biologically both male and female; otherwise known as intersex. I am one such person.

The terms “SGD” and “DSG” are not in general use on the websites for OII Australia or AISSGA, except where quoting or critiquing works using those terms.

Nevertheless, while all submissions by intersex people and organisations to the HRAD use the same language, “intersex”, the terminology has historically been contentious. This makes the current standardisation on intersex significant.

Historically, the term hermaphrodite was used in educated western contexts. That term now has a specific meaning in biology to indicate biological entities that have all of what, in mammals, are sexually dimorphic reproductive parts. The term intersex has been used since the early 20th century. Since 2006, medical discourse has used a term that most intersex groups in most countries find problematic and contentious: “Disorders of Sex Development” or “DSD”. Some overseas groups have attempted to ameliorate the medicalisation inherent in “DSD” by referring to “DSD” euphemistically as “Differences of Sex Development”.

Disputes around language in intersex communities focus on the use of intersex rather than “DSD”, the validity of the term hermaphrodite, and differing perspectives on the use of the medicalised language, such as the word “condition”. No self organised intersex groups in Australia use “SGD” or “DSG”.

Intersex is an umbrella term

“SGD” or “DSG” are often described as umbrella terms, for example:

Sex and gender diversity is an “umbrella term” that describes two different groups of people – intersex people and gender diverse people. [14]

It is rarely recognised that intersex is an umbrella term, just like trans, or gender diversity. It is an umbrella term for a broad range of very different medical diagnoses, and what medicine currently calls “disorders of sex development”.

A good demonstration of how Intersex is an umbrella term or abstraction, is given in the AIS Support Group HRAD submission:

The Androgen Insensitivity Syndrome (AIS) Support Group Australia Inc. (A0041398U) is a peer support, information and advocacy group for people affected by AIS and/or related intersex conditions, and their families… We also provide support to those with related intersex conditions like Partial and Complete / Gonadal Dysgenesis, MRKH (also known as Vaginal Agenesis), 5a-Reductase Deficiency, 3b-Hydroxysteroid Dehydrogenase Deficiency, 17-Ketosteroid Reductase Deficiency and 17b-Hydroxysteroid Deficiency. (The previous name for AIS was Testicular Feminisation Syndrome).

Because intersex is an umbrella term, it is already an abstraction. It should not be abstracted further into “sex diversity”, and then further into “sex and gender diversity”.

Trans as an umbrella term

The search for new terminology appears to come from within the trans community, and is seen in the desire to acknowledge the inclusion of transgender people, transsexual people, genderqueer, sistergirls and other identities. Terms used to refer to the broader trans community include “gender diverse” and “trans*”. The 2012 Queensland Transgender Sistergirl and Gender Diverse Conference, for example, gave the following acknowledgement:

We welcome people from the trans, sistergirl, brotherboy, transsexual, transgender, gender diverse, trans man, trans woman, intersex, genderqueer, genderfluid, bigendered, agendered, androgyne, grrl, boi, MTF, FTM, transvestite, crossdresser, pre-op, post-op, female, and male community [15]

In practice, reporting of the Diversity in Health report launch also demonstrates that “sex and gender diversity” is typically represented in the LGBT/LGBTI media as a new term for trans.

It is essential that trans and other gender diverse people feel included in terms that are designed to include them. Nevertheless, intersex people should not need to be drawn into a debate about terminology to describe trans.

Legibility to third parties

The word intersex is not commonly understood. There are multiple reasons for this, including:

  • lack of resourcing for any intersex-specific organisations or communities, affecting public awareness [16].
  • a pathologising medical environment.
  • deliberate obfuscation by some trans groups who define trans as intersex for political objectives [17].
  • increasing societal familiarity with trans issues, and a tendency to see intersex through that perspective.

In this context, consistency and clarity are critical to ensure that intersex voices are heard. Linguistically mashing intersex with trans, sex and gender diversity does not do this.

In an international context, “Trans” and “Intersex” are the terms that are most commonly recognised, even in documents where both distinct groups are discussed. A model report showing how the two distinct groups can both be discussed in a report without obfuscating intersex issues can be seen in the European Commission report “Discrimination against trans and intersex people on the grounds of sex, gender identity and gender expression” [18]:

European societies are based on norms derived from the simplistic idea of a dichotomy of two mutually exclusive and biologically defined sexes to whom different roles and behaviour are traditionally ascribed (the binary gender model). People who do not easily fit these norms, such as trans and intersex people, encounter numerous difficulties, both at the practical level of everyday life and at the legal level. Obviously, this is not acceptable in a legal union such as the European Union whose founding Treaty, according to Art. 2 TEU, is founded on respect for human dignity and human rights, including the rights of persons belonging to minorities…

With the present report, the European Commission’s Network of Legal Experts in the Non-discrimination Field wishes to contribute to the European Union’s efforts to combat the disadvantage suffered by trans and intersex people. The report examines the legal treatment of discrimination against trans and intersex people on the grounds of sex, gender identity and gender expression, in particular in EU law, against the background of the difficult position of trans and intersex people in our societies. [18]

New terminology: objectives and suggestions

We believe that it is ok not to require a single, fixed umbrella term. Given that trans and intersex are already both umbrella terms, it is ok to talk, for example, about intersex people, and trans/gender diverse people.

In terms of naming a common joint actions, such as an LGBTI Health Alliance working group, proposed terminology should:

  • Recognise that intersex and trans are two distinct communities and avoid presumptions of a homogeneous commonality of interest and needs.
  • Not erase the needs and issues of one community, but promote visibility and understanding of both communities.
  • Promote clarity about what it means and who it refers to.
  • Be legible to a broad audience, including Australian but also internationally.
  • Be concise.
  • Be easy to disambiguate.
  • Avoid abbreviation in ways that imply a homogeneous community of interest.
  • Not necessarily be a single fixed phrase: terminology could vary, both in the order of words to describe intersex and trans communities, and even in descriptors for trans communities.

Most importantly terminology should:

  • Reflect usage within the communities it refers to. In the case of intersex communities and organisations, this will involve clear use of the word “intersex”.

The impact of new terminology

The National LGBTI Health Alliance led in the adoption of new terminology by its working group, now a “Intersex, Trans and Gender Diversity Working Group”. The terminology was adopted in advance of the national Health in Difference conference in April 2013.

We believe that it is not coincidental that the Health in Difference saw major advances in awareness of intersex issues, and action on issues around medical treatment; evidence was made available to members of the Health in Difference Working Party; immediately after the event, OII Australia also remarked on the extent of good inclusion of intersex issues [19]. Content on intersex health issues presented to the conference was later included in an LGBTI Health Alliance newsletter, and a speech on intersex health issues was selected for broadcast on Joy 94.9 [20].

It is likely that increased awareness of distinct intersex health issues prompted the LGBTI Health Alliance to prioritise submissions to the Senate Inquiry on involuntary or coerced sterilisation of people with disabilities, when such issues received no significant attention at the 2012 “DSG” round table meeting, and minimal inclusion in the subsequent report launched in November 2012 (e.g. an infantilising final recommendation in a lengthy list of health care items). The specific intersex issue has now become an Alliance priority, one of 7 key proposals for action over coming years in LGBTI Health 2013: people profiles and perspectives [21].

Similarly, media discussions around intersex, and trans and gender diversity issues are now more likely to correctly identify the scope of issues affecting our communities [22].

A key impact of the use of improved terminology can be seen in the federal guidelines on the recognition of sex and gender, published in June 2013. Between the publication of a public draft and the publication of the final document, the shift away from “SGD” is apparent. This document, which is mentioned in the Explanatory Memorandum to the Sex Discrimination Amendment [23], will help to drive usages of inclusive terminology elsewhere.

Up until this point, OII Australia drove concern about “SGD” language [24]; following publication of the final document, we have a benchmark and authoritative government document that can clarify terminology for the broader community.

Collaborative actions between trans, intersex and lesbian and gay organisations has also led to the separation of intersex from trans and gender diverse issues in some cases – such as in the drafting of a survey of major parties in advance of the 2013 federal election [25].

Nevertheless, the period since the change in Alliance terminology has seen continued use of “SGD” terminology by some Alliance members, such as A Gender Agenda, which used the language in a sole submission by a trans group to the Senate Inquiry on involuntary or coerced sterilisation [26]. It is not clear if the submission added value to existing submissions by other organisations, and the usage of vague and problematic terminology may be partly responsible for that.

The same period has also seen intersex presumed to be part of an homogeneous “intersex, trans and gender diversity” category, as evident in the choice of a trans activist without experience of intersex issues as the presenter of a general overview on all these issues at the Geelong Healthcare Pathways conference in October [27].

We are, nevertheless, aware that the adoption of new language has led some people to use terms like “WWCOTW” or “Whatever We’re Calling Ourselves This Week” [28], a statement that assumes “we” are a “we”. In this regard, we hope that a degree of stability can be made with lead organisations in the field maintaining use of the new terminology.

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References

[1] Peter Hyndal speech to Parliamentary Friends of LGBTI, 27 November 2012, supplied by author.
[2] SX News, 3 December 2012, Report sheds light on how to improve DSG health, http://gaynewsnetwork.com.au/news/national/9866-report-leads-to-hopes-for-change-for-diverse-sex-gender-community.html
[3] Star Observer, 27 November 2012, Trans issues back on national agenda, http://www.starobserver.com.au/news/2012/11/27/trans-issues-back-on-national-agenda/90110
[4] We’re aware that some intersex people, including OII members, change gender documentation, but transition is not an intersex issue, as can be seen from the demands of the second International Intersex Forum, following.
[5] Australian Human Rights Commission, 2009, http://humanrights.gov.au/genderdiversity/sex_files2009.html
[6] See OII Australia, “Intersex and the Sex Files: good for trans*, bad for intersex”, http://oii.org.au/13524/sex-files-good-trans-not-good-intersex/ and also “On administrative correction of NSW intersex birth registrations, http://oii.org.au/4856/on-birth-registrations/
[7] Australian Human Rights Commission HRAD submission, https://senate.aph.gov.au/submissions/comittees/viewdocument.aspx?id=6c5b537d-5f1b-4032-88b3-2676906599d9
[8] See the HRAD submission by the ANU College of Law “Equality Project” direct link https://senate.aph.gov.au/submissions/comittees/viewdocument.aspx?id=91a173b8-0238-4d67-83d0-d5c9bd8a307a
[9] ILGA Europe, 12 December 2012, The Second International Intersex Forum concluded, http://www.ilga-europe.org/home/news/for_media/media_releases/intersex_forum_2012_media_release
[10] Hida Viloria et al, 20 December 2012, Open Letter on Intersex to the UN High Commissioner for Human Rights, http://oii.org.au/21442/open-letter-un-high-commissioner-human-rights/
[11] OII Australia submission, direct link: https://senate.aph.gov.au/submissions/comittees/viewdocument.aspx?id=3954ffb3-5e39-4b64-a490-a05cbf045294
[12] AISSGA submission, direct link: https://senate.aph.gov.au/submissions/comittees/viewdocument.aspx?id=6bd0e894-f22d-410d-b680-7d1992695893
[13] Submission by Councillor Tony Briffa JP, direct link: https://senate.aph.gov.au/submissions/comittees/viewdocument.aspx?id=26df272d-4f77-492f-80c6-aa81c9734a1e
[14] A Gender Agenda, HRAD submission, direct link, https://senate.aph.gov.au/submissions/comittees/viewdocument.aspx?id=c1aa64fb-0cdf-4cca-b65a-72c68f14d479
[15] See http://www.transconference.org.au
[16] See, for example, http://oii.org.au/19853/welcome/
[17] See “Trans as intersex, crossing the line” by Tracie O’Keefe, http://www.thescavenger.net/isgd/trans-as-intersex-crossing-the-line-56934-369.html, and the rebuttal by OII Australia, http://oii.org.au/13651/isgd-and-the-appropriation-of-intersex/
[18] European Network of Legal Experts, 15 June 2012, Discrimination against trans and intersex people on the grounds of sex, gender identity and gender expression, http://www.migpolgroup.com/publications_detail.php?id=356
[19] See http://oii.org.au/22160/intersex-health-hid2013-plenary/
[20] Available at http://joy.org.au/hid2013/wp-content/uploads/old/sites/238/2013/06/Plenary-4-Intersex-and-Trans-and-Gender-Diversity-Part-2-Morgan-Carpenter-podcast.mp3
[21] See LGBTI Health 2013: people profiles and perspectives, published in August 2013.
[22] A SameSame report on the LGBTI 2013 Election Forum provides a good example, http://www.samesame.com.au/features/10200/How-much-do-the-parties-really-know-about-LGBTI-issues.htm
[23] The Explanatory Memorandum to the Sex Discrimination Amendment can be found on the Australian Parliament website here: http://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query%3DId%3A%22legislation%2Fbillhome%2Fr5026%22;rec=0
[24] See OII Australia submission on the draft guidelines, at http://oii.org.au/22111/sex-gender-recognition/
[25] See NSW GLRL page on the federal election, http://glrl.org.au/index.php/Get-Involved/Upcoming-Events/lgbti2013
[26] A Gender Agenda submission to Senate Inquiry on involuntary or coerced sterilization, http://www.aph.gov.au/DocumentStore.ashx?id=73758445-d971-4b1e-ab44-e50a62f30a20&subId=16188
[27] See draft program, Geelong Health Care Pathways conference, http://www.geelongaustralia.com.au/common/Public/Documents/8d0791fdb059052-GASP%20Forum%20Brochure%20Attachment.pdf
[28] See https://twitter.com/salgoldsaidso and also http://www.thestirrer.com.au/fresh-g-a-y-branding/

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