Back To the Main SiteBeyond Boxes Blog Series: Introduction and Terms
Peter Hyndal presented at a Men’s Health Conference in Newcastle, last week. A “National Health Gathering” presented by the Australasian Men’s Health Forum. For the conference he wrote a paper named Beyond boxes: Sex and gender diversity and health service provision
We’ll be posting the contents of his presentation over the next few weeks, in tasty bite sized morsels, and the full presentation (with all its references intact) will be available to download at the end of the series.
Todays post, is beyond the jump:
Introduction
It’s been very interesting for me to have spent the last two days at a “mens’ health” conference – where I’ve heard lots of discussion and debate about the definition of “health”. But I’ve heard no discussion or debate around the definition of “men”. The reason for this, of course, is that most of us tend to assume that the definition of “man” is completely self evident and unproblematic.
That’s not the only thing we assume. We assume, when we say the word “man” that all people are, categorically, either male or female. We assume that the attributes that make a man a man are clear, definable, biological, fixed, and that they are categorically different from those characteristics that make somebody a woman. We believe these things to be true to such an extent that we assume that every time we meet someone, no matter how briefly, we will instantly “know” whether they are a man or a woman. And having just met a complete stranger and decided that they are a man, we assume that they identify as a man, that they are happy with this identity, that they always have been a man, that they always will be a man. We assume things about the chromosomes in every cell of their body; about the hormones that are inside their body; and about what their very body looks like underneath their clothes.
None of these assumptions are true all of the time, and this is what I’ll be talking about in this series.
Terminology and Prevalence
Intersex people can be defined as people for whom the development of chromosomal, gonadal, or anatomic sex is not aligned with our notions of a sexually binary biology. That is, there are biological physical differences that “can be seen as both male and female at once, not wholly male or female, neither male or female, or other ways of being that are not captured by current sex binary”. Estimates of the number of intersex people commonly vary from 1:100 to 1:2000 depending on the types of conditions included.
Gender identity is an individual’s internal sense of being a man, a woman, or another gender. Trans people can be defined as people whose gender identity is outside or crosses the social norms of ‘man’ or ‘woman’. I use the term “trans” here to explicitly include people identifying as transsexual, transgender, or genderqueer. Accurate estimates of the number of trans people are also difficult to obtain – most research uses a far narrower definition of “trans” and suggests the prevalence as somewhere between 1:4,500 and 1:8,000. A Gender Agenda’s membership in Canberra suggests that even this figure is an underestimate, and that estimates of 1:500 is probably more accurate.
Virtually no data is captured for trans people who do not seek medical treatment for gender affirmation. The growing number of people who identify as gender queer are essentially unacknowledged in any prevalence statistics. Due to the intense level of stigma associated with sex and gender variance, many intersex and trans people are often invisible to the general population and service providers for fear of discrimination and ridicule.
Terminology is hotly contested and culturally variable. For the sake of brevity and clarity I will be using the term “Sex and Gender Diverse”. This term is used with the specific intent of being inclusive not only of intersex and trans people but also of anyone who ‘falls through the gaps” of our binary sex model.
There is a common misconception that sex and gender diverse people can be identified “by the way they look”. This is generally untrue, and paradoxically, much of the inappropriate health care offered to sex and gender diverse people comes about because they are not visibly identifiable.
Some specific examples health services need to be aware of are that:
Someone presenting as male, who you identify as being unquestionably male may:
- have functioning female reproductive capacity
- require regular pap smears and/or be at risk of ovarian cancer
- identify as a woman
Someone presenting as female, who you identify as being unquestionably female may:
- be at risk of prostate cancer
- be at high risk levels for other ‘mens health” issues
- want to be perceived as male
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