Not everyone is male or female: The controversy over sex designation

Variations in genital anatomy happen more frequently than you might think; they occur in 0.1 to 0.2% of births annually.

Check out your birth certificate and surely you’ll see a designation for sex. When you were born, a doctor or clinician assigned you the “male” or “female” label based on a look at your genitalia. In the U.S., this has been standard practice for more than a century.

But sex designation is not as simple as a glance and then a check of one box or another. Instead, the overwhelming evidence shows that sex is not binary. To put it another way, the terms “male” and “female” don’t fully capture the complex biological, anatomical and chromosomal variations that occur in