Biology isn't always a neat little binary. Most of us grew up in a world where you're either "Option A" or "Option B," and that’s basically that. But honestly? Nature is way more creative than our middle school health textbooks suggested. When we talk about people with penises and vaginas, we’re usually talking about the intersex community—a group of individuals whose biological traits don’t fit the typical definitions of male or female.
It’s more common than you think.
Roughly 1.7% of the population is born with intersex traits. To put that in perspective, that’s about the same percentage of people born with red hair. You’ve probably walked past an intersex person today and had no idea. Why would you? Many intersex variations are internal or hormonal. But some involve ambiguous genitalia, where a person might have features of both a penis and a vagina, or perhaps a mix of chromosomal and reproductive structures that defy a simple label.
The Reality of Ambiguous Genitalia
Let’s get into the weeds of how this actually happens. During fetal development, we all start out with the same "plumbing." It’s a set of undifferentiated tissues. Around the seven-week mark, triggers—usually driven by the SRY gene on the Y chromosome—tell the body which way to go. Sometimes, the signals get mixed.
Sometimes the body doesn't respond to androgens the way it "should." This can lead to Congenital Adrenal Hyperplasia (CAH) or Androgen Insensitivity Syndrome (AIS). In cases of CAH, a person with XX chromosomes might develop an enlarged clitoris that looks very much like a penis, while still having a vaginal opening. On the flip side, someone with AIS might have XY chromosomes and internal testes, but their body looks female on the outside, often including a shallow vagina.
It’s not a medical emergency. It’s a variation.
For decades, the medical establishment treated people with penises and vaginas as a "problem" to be fixed. Doctors would often perform "normalizing" surgeries on infants without the individual's consent. They’d just pick a side. Usually, they picked the side that was easier to reconstruct surgically, which historically meant "making" the child female. This happened to activists like Hida Viloria and Pidgeon Pagonis, who have spent years speaking out against the trauma of these non-consensual procedures.
Why the "Hermaphrodite" Label is Outdated
You might have heard the term "hermaphrodite" used in old movies or older medical texts. Don’t use it. Honestly, it’s considered pretty offensive and scientifically inaccurate. In the biological world, a true hermaphrodite is an organism that has fully functioning sets of both male and female reproductive organs—think snails or certain fish.
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Humans don't work like that.
While a person might have "ovotesticular DSD" (Disorder of Sex Development), where they have both ovarian and testicular tissue, they don't have two full, independent reproductive systems. The term "intersex" is the preferred, respectful way to describe the lived experience of people with penises and vaginas. It acknowledges the biological reality without the dehumanizing baggage of the past.
The Spectrum of Intersex Variations
It’s a massive umbrella. Underneath it, you’ll find dozens of different conditions.
- Klinefelter Syndrome (XXY): Usually presents as male, but with extra estrogen and sometimes breast development.
- Turner Syndrome (X): Affects those who typically identify as female, often involving shorter stature and different ovarian development.
- 5-alpha Reductase Deficiency: This one is wild. Kids are often raised as girls, but when puberty hits, a surge of testosterone causes a penis to grow. In parts of the Dominican Republic, this is so common they have a specific name for it: guevedoces, which basically translates to "penis at twelve."
These aren't "glitches." They are just different ways for a body to be.
When we look at people with penises and vaginas, we’re seeing the complexity of human genetics in real-time. It’s not just about what’s between the legs; it’s about the receptors in the cells, the levels of hormones in the blood, and the mosaicism of the chromosomes themselves. Some people go their entire lives—even having children—before realizing they have an intersex variation. They might find out during a routine hernia surgery or when struggling with fertility.
Navigating a Binary World
Living as someone with both or "ambiguous" traits is kind of a logistical nightmare in a society obsessed with checkboxes. Think about bathrooms, sports, or even just filling out a form at the DMV.
The sporting world has been particularly cruel. Look at Caster Semenya. She’s a world-class athlete who has been subjected to invasive testing and forced hormone suppression just because her natural biology doesn't fit a narrow definition of "woman." It’s a mess. The World Athletics organization has struggled for years to find a "fair" way to handle intersex athletes, often landing on policies that many human rights groups call discriminatory.
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It’s about autonomy.
The biggest fight right now for people with penises and vaginas isn't about bathrooms—it's about the right to keep their bodies the way they were born. Organizations like interACT are pushing for legislation to ban cosmetic surgeries on intersex infants. They argue that unless there’s a physical health risk (like the inability to urinate), the person should grow up and decide for themselves if they want surgery.
Mental Health and Support
Growing up "different" takes a toll. Many intersex folks report feeling like they were a "medical secret" because their parents and doctors didn't tell them the truth about their bodies. This secrecy breeds shame.
But things are changing.
The internet has allowed people with penises and vaginas to find each other. They’re sharing stories, trading tips on how to find doctors who won't gawk at them, and building a culture of pride. They’re realizing that they aren't "broken" versions of men or women. They are a third thing, or a mix of things, and that’s perfectly fine.
Expert practitioners, like those at the Fenway Institute, emphasize that the best approach for intersex health is patient-centered care. This means treating the person, not the "condition." It means prioritizing mental health support and honest communication over surgical "correction."
The Science of Sex is a Web, Not a Switch
We like to think of sex as a simple toggle switch: On or Off. Male or Female.
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Science says it's more like a massive soundboard with a hundred different sliders. You can have the "penis" slider up halfway, the "testosterone" slider at 70%, and the "chromosomes" slider on XX. You end up with a unique individual.
When you encounter the topic of people with penises and vaginas, remember that you’re talking about human beings with complex lives. They aren't props for a debate or medical curiosities. They’re people who deserve the same bodily autonomy and respect as anyone else.
If you or someone you know is navigating an intersex diagnosis, the first step is education. Don’t rush into permanent medical decisions. Seek out intersex-led organizations. Listen to the voices of those who have been there.
Actionable Steps for Allies and Individuals
- Stop using the "H" word. Switch to "intersex" or "DSD" (if in a medical context), but always follow the individual's lead on how they describe themselves.
- Support bodily autonomy. Advocate against non-consensual cosmetic surgeries on intersex children.
- Broaden your definition of "normal." Recognize that biological sex exists on a spectrum.
- Seek specialized care. If you are intersex, find healthcare providers who specialize in LGBTQ+ and intersex health to ensure you’re getting informed, respectful treatment.
- Listen to intersex voices. Follow creators and activists like Sean Saifa Wall or Pidgeon Pagonis to understand the lived reality beyond the biology.
The world is slowly catching up to the reality of biological diversity. It’s about time we stopped trying to force everyone into two boxes and started appreciating the full range of the human experience. Understanding the lives of people with penises and vaginas isn't just about anatomy—it’s about empathy, human rights, and the simple truth that there is no one "right" way to have a body.
Next Steps for Further Understanding
To better support the intersex community or manage your own health journey, start by reviewing the United Nations' Fact Sheet on Intersex Rights to understand the global legal landscape. Additionally, consulting the World Professional Association for Transgender Health (WPATH) Standards of Care, which often includes guidance for intersex-affirming medical practices, can provide a roadmap for navigating healthcare systems. For immediate community support, visiting interACT: Advocates for Intersex Youth offers a wealth of resources for families and individuals dealing with new diagnoses.