The athlete Caster Semenya has recently caused headlines the world over since her gold medal in the Berlin World Athletic Championships caused the IAAF to order tests to ascertain her gender. I personally find it outrageous that the tests could not have been arranged discreetly rather than in the centre of the world media frenzy. The last person this happened to was Santhi Soundarajan who attempted suicide in 2007 after failing a gender test. I hope Caster is able to bear the pressure, and humiliation, that has been put upon her.

But the case does raise interesting questions about who is a man or a woman. I guess the first thing to note is the difference between gender and sex. Gender is a social category bestowed on a child at birth. It is a moral matter. There are great social obstacles for people who want to negotiate a different gender to the one allocated at birth.

Sex, on the other hand, is a biological concept, and surprisingly in human beings, for many individuals it is far from clear cut. The standard line in class room biology is that there are 46 chromosomes including two that determine sex. 46XX and you are a girl, 46XY and you are a boy. But human biology throws up much more variability than this. For example, some men are born with an extra Y chromosome, 47XYY. Such ‘hyper masculine’ men are overrepresented in the prison population due to their extreme aggression. Other variations include 47XXX, 47XXY, 49XXXYY to name but a few. The presentation of people with such genetic makeup can be complicated.

Genetic and biological factors can also interact. For example in one presentation, complete androgen insensitivity syndrome, a biological boy (46XY) is insensitive to the male hormones that trigger the development of male sexual characteristics (foetuses are by default, female). As a result the biological boy develops female sexual characteristics and lives out a life as a woman.

My favourite condition, however, is 5 alpha reductase enzyme deficiency syndrome. In this genetic condition the child has the sexual characteristics of a girl and is brought up as a girl. At puberty, however, male secondary sexual characteristics develop including descended testes and an enlarged phallus. Some individuals even produce serviceable sperm. What is so interesting about this condition is that it is highly prevalent in the Dominical Republic where it affects about 1 in 90 children. The culture is therefore so used to the condition that the children can often very successfully negotiate the transition at puberty from girl to boy.

As you can see, whether you are a boy or a girl is sometimes far from straightforward. In our culture, however, as gender is such a morally layered experience, such inter-sexed children and their families often experience great psychological suffering. My sense is that it is still a matter of ridicule and social ostracism if someone, for whatever reason, tries to realign their gender identity.

Indeed there is a great deal of pressure to be either a man or a women. This in itself is damaging to such inter-sexed persons as, very often, they cannot function convincingly in either role. I can envisage a time in the future where inter-sexed persons are simply allowed to live out their humanity in a way that makes sense for them, rather than in a way that makes sense to us.

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