For several years now, there is an ongoing, intense and often highly controversial social debate about how to deal with gender diversity. People who feel that they belong to a different gender than society expects of them, or who cannot or do not want to fit into the binary gender order of man and woman, often complain of marginalisation and experiences of discrimination. One of the reasons for misunderstanding and confusion in the public debate is that, unlike in English, there is no clear terminological distinction between biological sex and social gender in the German language. When looking into gender diversity, it is therefore essential to bear in mind that this can involve variations of both biological sex and social gender identity.
The term intersexuality refers to ambiguous characteristics of biological sex. It covers deviations in sexual development, the causes of which are also biological, including sex chromosome variations or genetically caused particularities at the hormonal level. Many intersex people strongly oppose the prevalent pathologisation of their individual sexual characteristics. Their criticism of surgical gender reassignment or assignment, which used to be routinely applied as early as infancy, has led to medical guidelines now stipulating that such and similar (e.g. hormonal) procedures should generally only be carried out with the consent of those affected. The possibility introduced in Germany in 2018 to specify the gender of a newborn child as “diverse” in civil status entries also strengthened the rights of intersex people.
Even if the sex seems obvious in view of the physical characteristics of an infant, at any point in time of the individual’s later development the perceived gender identity or social gender can come into conflict with the sex assigned at birth. Such gender incongruence may (but need not) involve discomfort with one’s own body. It can also relate to one’s expected public appearance, sexual orientation or other aspects of gender roles. The strategies chosen by those affected to reconcile with the particularities of their gender identity are correspondingly diverse. In cases of severe suffering, surgical and hormonal gender reassignment procedures may offer a solution. However, difficult ethical problems arise when children or adolescents desire such treatments, because these can have serious sequelae and because gender identity may change in the course of growing up.