Part I Experiences of being lesbian, gay, bisexual, transgender and intersex in the Asia Pacific Chapter 4: Being intersex in Asia and the Pacific KEY QUESTIONS • Are there many intersex people in the Asia Pacific region? • Is intersex people’s right to physical integrity protected adequately? • Can ‘sex-normalising’ surgeries and hormone treatment on intersex infants and children be justified as necessary to protect them from discrimination? • Are intersex infants and children protected under current laws against female genital mutilation? • What forms of discrimination do intersex people experience? • Are intersex people legally recognised and protected? • What remedies and redress should be available for the human rights issues that intersex people face? 4.1. INTRODUCTION Intersex is an umbrella term that describes a wide range of natural bodily variations.234 What these intersex variations have in common is that a person’s physical, hormonal or genetic features do not fit stereotypical notions for male or female bodies. They are naturally occurring variations in humans and are not a medical condition.235 Some intersex variations are visible before birth or from birth, including those that are genetic or that can result in ambiguous genitalia. Two of the more common examples are congenital adrenal hyperplasia and androgen insensitivity syndrome. Some other intersex traits are not detected until later in life; for example, when a child does not progress through puberty in the usual manner.236 A person may not be aware of being intersex until they have a chromosome test or face fertility difficulties. Even then, they may not make a connection between these medical experiences and the term ‘intersex’ or see themselves as part of an ‘intersex community’. Between 0.05% and 1.7% of the world’s population is born with an intersex trait. The lower end of the range relates to where an infant’s sex characteristics are ambiguous enough at birth to become the subject of specialist medical attention. The higher end of the range is based on research that includes a wider range of intersex variations.237 This range is widely accepted, including by human rights bodies.238 234 See Chapter 1. 235 Council of Europe Parliamentary Assembly, Children’s right to physical integrity, 6 September 2013, Doc. 13297; European Union Agency for Fundamental Rights, The fundamental rights situation of intersex people, Focus, 04/2015. 236 Department of Health and Human Services, Decision-making principles for the care of infants, children and adolescents with intersex conditions, February 2013. 237 M. Blackless, A. Charuvastra, A. Derryck, A. Fausto-Sterling, K. Lauzanne and E. Lee, ‘How sexually dimorphic are we? Review and synthesis’ in American Journal of Human Biology: The Official Journal of the Human Biology Council, 12 (2): 151–166 2000. 238 Commissioner for Human Rights of the Council of Europe, Human rights and intersex people: Issue Paper, April 2015; at www. unfe.org/system/unfe-65-Intersex_Factsheet_ENGLISH.pdf. Chapter 4: Being intersex in Asia and the Pacific | 65