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[Music] most of us think of ourselves as either male or female but every year in Britain around one in 4,000 babies born divide the normal definition the boy of [Music] with anatomically features of both sexes doctors defined them as intersex I don't think of myself as girl really I think of myself as more female than male but no I wouldn't say I'm a female [Music] hi okay I'm half gone hot boy that's good thumbs together I'm cutting a French bastard ever you top of user four years ago intersexuality of hermaphroditism as it was once known as long being cloaked in secrecy and taboo recently however intersex people have begun speaking out and a passionate debate has emerged about how into sexuality should be treated by doctors and be seen by the wider world in this film we follow three families with intersex children as they face the dilemmas of growing up as neither male nor female but somewhere in between [Music] do you ever imagine what it would have been like to have been born a boy um yeah I do but then I also imagine what it'd be like people on a girl or a person with another form of in sexuality and I believe most people do as well obviously not the intersexuality bit because they probably don't understand it as much I've told her that her boys and their girls and their interns it's just another gender that won't have babies I don't have many things like animate babies and let me can have babies but Ella's on I can't have babies and clean you can't have babies [Music] at birth illa sana appeared a normal baby girl but nine months later her parents discovered she had complete androgen insensitivity syndrome or a is a rare intersex condition wherein her body is unable to respond to the male hormone testosterone she had a hernia from inguinal hernia which we later found out is the most common way that AIS first presents itself and she was in a lot of pain so to take it to hospital she went into operation and she came out again and what her mother said the surgeon thing round there's a problem to start off with I knew that she had ambiguous and go nuts as they called it that actually she had testicles there was worry about what might happen was she going to grow beard adolescence because with some conditions she could grow a beard it does lessons so yes it was the kind of concern but also a kind of elation a sort of interest in it because it's fascinating instead of having female X X chromosomes Lily's honor has male XY chromosomes and should be a boy in the womb her body was flooded with testosterone telling her to become male yet because she's unable to respond to testosterone she developed along default female lines outwardly girls with a is look female and most have a vagina but inside where their reproductive organs should be they have testes where the ovaries are basically our testes there is no penis there's obviously no external test teens there's also no uterus there are there is limited secondary sexual development you have breasts but no axial hair and because of court that being on the sort of male side that well being a male hormone because she's insensitive obviously doesn't doesn't work doctors traditionally advised parents to keep a diagnosis of intersexuality secretin for virtually unusually the designers family were determined to be open first I've been brought up knowing it there hasn't really been a time when I've suddenly realized oh okay I am different because I've always known it's just been Who I am and when shown to school we primed the teachers if she says that actually hum neither boy nor girl I'm intersex or whatever because she's quite proud of it if she says that then she should be reinforced in that you know we didn't want teachers going around self don't talk such nonsense doctors recommended that Ella's Anna have her testes removed partly because of a risk of cancer in later life but also to help reinforce her female identity the dilemma for her is that her testicles produce estrogen as well as testosterone and without them she'd have to take replacement female hormones somewhere along the line she will have to make a decision about her testes they're not a dilemma in terms of identity or anything like that they are part of who she is the only reason to take them out would be for medical reasons to do with cancer risk there isn't really an increase in the risk of cancer until a bit later in life and say I can't see any reason to take them out at the moment it'd just be you know an operation that's pointless and it means that I'd be on hormone replacement therapy for the rest of my life and that's just something that I just don't want to be bothered with a is is an inherited condition passed along the maternal line when with her new partner Neal Nancy became pregnant with Xenia there was a one-in-four chance that she too would be intersex when I was pregnant they offered do various tests so they could find out if my child had a is and I asked you know why and naturally it's because if my child had a is they could have bought at what oh yes most certainly um so I had declined the test because I was quite happy having their strand [Music] when I first found out about it by remember feeling quite excited you know wow there's another one like me oh yeah I thought it was quite good when I was born doctors didn't know whether old male or female I had to park the taste day and burn our penis so thought or a boy and some that I didn't have a penis a couple of days later says no you have you've got a girl because they did some tests and found that God Pavin over [Music] Louise was born with true hermaphroditism an extremely rare intersex condition defined by doctors as having part teste part ovary inside at birth her genitalia were so underdeveloped she appeared neither male nor female but because at that time it was easier for surgeons to create a girl rather than a boy a fold of skin was fashioned to resemble the vagina her ovary and teste were cut out and doctors advised her mother to raise Louise as female [Music] they said it will be better to bring them up as a girl they said it'd be idea cuz I got your girls already at home [Music] Sadie not to tell anybody I mean although bad fat by then we'd already announced in the local paper that we'd had to body [Music] and I said you know the only people that really needed to know was a self and the doctor [Music] when I was born it was doctors tell my mother to keep it hush don't tell me what I just me you and me you and the doctors after now that's it fact if you can try and keep it from Louise when Louise was born doctors believed that nurture outweighed nature in determining a child's inbuilt sense of whether they're male or female by raising Louise as a girl the theory was that she would behave like a girl and she need never know of her condition she didn't play with any girl office things at all it was always boys things I bought a bow ties I mean it's husband didn't like not at all you know just should be buying it girls toys but she weren't going to play with them we know Cobain him I mean a favorite toy were a tractor and trailer and she'd set that every word I knew that wasn't normal because I spend a lot of time in hospital I look different felt a bit different as well talk how she'll be feeling mas girls play with dolls and that but I didn't want to I want to play with cars and stuff like that why the interesting no trade photography that's correct yeah I don't do trades button that I train photography it's different I think he stones from when I was a child and new stuff to got out I learned a lot to Great Ormond Street Hospital training thinking's come from that sort of things River in addition to being intersex Louise as a string spending much of her childhood in hospital and confused over her gender her behavior became more and more disruptive I used to do anything to get attention from himself I also used to get picked on a lot as well so like I used to try and do anything I could to try and win friends over Ella because I felt so lonely and loved and the aggression was a form of release it was like a volcano going wash all the anger just getting released all at one girl who did you take it out on I talking about me mum she bring a knife out to me you know cook furniture up and just keep tools in doors and that's I found a photograph that sort of thing that she was to do with to me see me I she dead buttered me just found last night I thought oh I'll keep that out and I'll show you sorts of things just to do it [Music] in the teens Louise was given female almost 20 security Souls [Music] to hide her daughter's interceptions HFS got a computer then she broke the slicer damage to Z I want you to read this and don't show anybody else mom typing this is so hard so please do not take it the wrong way I like like mom I want to ask you something did you now it end up like this with all these problems if so why did you keep me alive for me to go through all the pain and upset I have hardly any friends I'm not likely to get a job and if I do or not veil to keep it will I be honest a lot of the time I think you lied to me please tell me what you know about everything about me and my problems because I want to know what to expect the rest of my life yours lovingly Louise Thompson your loving daughter I just didn't know what cetera and yeah so well all alive and it monster asking questions because I just don't know what to say and she knows that I've always loved her but it's very difficult when you know you don't know what to say and because you really have talked about it to anybody so you know I couldn't talk to her because contour anything [Music] she was one of the doctors when he was checking their newborn they call me in one side and said there was a problem she had a large clitoris and it wasn't for Johnny was actually closed yes as I said they weren't quite sure if she had the ovaries [Music] [Music] Bianca has an inherited intersex condition called congenital adrenal hyperplasia or CAH in contrast to girls with AIS her chromosomes are female and she has a world and ovaries a failure meant that her body as a result her vagina didn't fully form into a small penis [Music] I had before a noble children Bianca was different being a different father if the same 48 genes get together they just produced completely you know 240 genes produce a faulty gene obviously that's what happens in Bianca's case so it's with one in 10,000 so it's very very condition to happen so unfortunately they even asked me for cousins if we were related but now obviously I'm putting keys anything [Music] until very recently surgeons would routinely cut off or reduced the enlarged clitoris of a baby girl with CAH but there's been a furious back life from intersex adults who claim that what was in effect of cosmetic surgery has ruined their sex lives the dilemma for Bianca's mother and the doctors is how aggressive they should be in treating her condition the operation where is finally going to going to be like to restore the vaginal area so they're going to leave the clitoris I said it's because they they made a research all over the world saying that the women wouldn't feel any pleasure sexually so they they decided they're going to leave that intersex activists argue that even limited surgery isn't usually necessary until CAH bills reach puberty and despite most parents natural desire for a normal girl many doctors are now weary in early so she was born at a stage when anti early surgical opinion was probably at his height Bianca I think must have been one of the first patients with CAH where we seriously sat down and discussed with mother the concept of not operating to feminize our genitalia quiet you stop making a racket I think this was extremely traumatic for Bianca's mom of course Bianca would have to look like a little girl because she was a little you know the other side of it is the the appearance of the external genitalia that we are going to sort of correct that so as we will make it as normal look it's going to be for the best that she's going to have this operation and the sooner the better really so she'll um grow up as normal so I'm quite inane dads I'm quite positive and quite happy dance is going to happen now where you're scared ultimately we really made the decision here to go ahead and to offer feminizing surgery she's won 102 37 36 kilos we felt it would be almost impossible for her to be reared in a happy family environment if this surgery did not take place lilia and the doctors have agreed a compromise Bianca's clitoris won't be cut but concealed within a reconstructed vagina and when she's older she will be able to decide whether to have further surgery however since Bianca is one of the very first children in Britain to have this new procedure its long-term results are unknown [Music] do you want a blanket yeah we're gonna take it down now yes they phone for us to go down so the high levels of testosterone that cost we would be anchors body while she was in the room half used her labia and joined her urethra to have vagina if you can see here this is her bladder and that behind is her vagina and that's the urethra the tube that she's draining through and both of these join to form a common channel so one of the main parts of the operation today is to separate that those two so as she'll end up with two openings down below as well as making the anatomy look more normal as well [Music] two half times magnification good depth of field good breath you can see everything going back certainly to late 70s and early 80s this condition that was shrouded in secrecy the tendency was to offer surgical treatment in early infancy with the expressed intention being that the diagnosis of whatever intersex problem it was would not be disclosed and the child would be reared very firmly in the assigned gender the condition would not be divulged usually to evening close relatives and certainly probably not to the child even when they go to a gram [Music] yeah it certainly is true thus the initial approaches were philosophical and make ideological rather than being based on evidence but we are completely lacking in evidence to show that we've delayed approach is going to be any better and in fact we don't even know whether the delayed approach might even be worse in the long term so in a way we are practicing blindly at the present time [Music] [Music] [Music] [Applause] like her half-sister Ellis on ER Xenia as androgen insensitivity syndrome or AIS though outwardly girls they have male chromosomes and testes where their ovaries should be while doctors understand the physical side of their condition much less is known about how being intersex affects a child's behavior an innate sense of gender if I'm looking then I probably see the mixture and probably I see less of a mixture in Xenia because her outer persona is more feminine or her interests in pretty things is no feminine she seemed to me quite girly should I have to do any things some of her behavior can be quite boyish yes you'll be interesting to see what happens at puberty I'm really into karate and Bray dancing and there's a probably seen as quite masculine things I do see a male nurse about me I felt that when you were going through puberty you did display certain grunting characteristic which I've always associated that boys but you also have a strong female side I think you have the sort of best of both worlds it doesn't matter to me if they see themselves as super women or girls with AIS or as inter sexual beings I'm happy to go along with whatever makes them feel comfortable about themselves and if in order to feel comfortable about themselves they feel the need to instruct society at large that there is a neutral gender that's fine as well [Music] usually when I meet someone I'll start talking to them and everything I'll get to know them and I'll let them get to know me and then I'll tell them that actually I'm not as I seem I'm actually an intersexual usually there's like fairly curious about what tool is and what it means and yeah you usually shot comes in their suppressor we live in a society that has these two opposites male and female it's a lie there's a whole plethora of gradations I'm sure he did and is it no I don't think it is do you feel now no you were ever one have you felt it all there was something making you ill I've been stopping you being able to function like this my ears yes you don't work much that is like me this has no because you're an inter [Music] in contrast to Ella's Anna and zinnia Luiz spent most of her childhood not knowing of the true condition only recently has an allowed her daughter to see her medical nails for herself [Music] yeah the first what they're put us fine on diagnosis which was on the 7th of May 1977 was intersex P now a Genesis plus spec topic urethral orifices in in our rectum were there things in there you didn't learn a lot I'm not well what do you I do believe it this girl is 46 X Y chromosome complement I've got an idea but I've just discovered that it does actually give my crumbs on a make up XY normal circumstances is do you think it was a right decision to raise Louise's ago no no unless you're saying that ringer that Tim no it's be truthful I don't think of me at Ryan decision now Louise do you think they probably lose the right decision I said I think it was yes could you imagine life as a not for me not father does don't think he's possible to do that [Applause] [Music] bang with moving razor female couldn't really say what be like being raised in the mail I think it'd be a bit unfair to say whether it was right or wrong but what I do think is that it shouldn't be done children should be given choice when they get older whether they should be brought up as male or female he's buying 85 and 959 89 spit out 16 she was still you know boyish I just asked her she you know she'd like to start a very first Mac you know taught by I'm quite willing you know to go with him we've moved away where suddenly didn't you know where people didn't know us and you know what start again she wants to or did you what do you think about it for a while but no [Music] nine months after surgery to restore her vagina Lilia has brought Bianca to live in their native Madeira Polynesia okay she recovered very well the surgery was a success so very pleased and she recovered really fast they've done the right thing by doing the surgery now because now she will grow like like I mean she would get used to what she is you wouldn't know the difference the anchors condition means that she continues to produce too much testosterone and to prevent her body masculinizing she'll be dependent on drugs the rest of her life yes yes I will but I'll make sure she wouldn't feel like whoo she's different I'll make sure that she understands that could have been worse could be could have been something really really worse really bad so there's nothing to worry about Rinka despite the apparent success of her operation when Bianca enters puberty she'll most likely need further surgery to create a fully functioning vagina when she's older she will have another operation but she will have to decide is not going to be after me to decide is that not better she can't blame you yes that is true you can't blame me but again she can I don't know I mean children we don't know what's going to happen what's going to go in their minds so I know the other that could blame me I don't know [Music] so fat doctors and hospitals involved in my life since the day I was born [Music] I want to worked out couple years ago think about one-point-two operations for every year have been alive they still continue yeah seven years ago louise underwent major surgery to construct a vagina which proved to be unsuccessful now she's come to London to discuss with other urologist about having a second operation you know that at the moment you haven't really got anything that would really pass as a vagina there is some skin there from the previous surgery and the way that we would do this operation is to try and use as much of the skin as you've got done in the crotch and we may be able to use some of your bladder one way or another we should be able to make a vagina some of the tissues in your crotch will be sexually sensitive those are the areas we try our best to preserve but I really couldn't promise you that the vagina would have real sexual sensation I couldn't promise you that you'd be able to have an orgasm with it can surgery if you like cure an intersex condition no it's it's not a curable condition in the present state of our knowledge and the results of complex vaginoplasty in sexual terms are not terribly good Louise that's pretty radical surgery why go ahead with it it'll make me feel whole as a person but the minute I don't know where I am because there's not a lot I can do I mean forget married basically I kind of shakes at the minute so it don't really feel whole at London's Middlesex Hospital Louise is about to undergo major surgery it's a second attempt by doctors to construct a vagina for the operation is complicated by Louise's unique physiology and the mass of scar tissue from previous surgery will do a complex vaginoplasty of this sort probably about four or six times a year but overall it's it's a very unusual procedure Louise does have some sexual sensation last night in the ward she marked out the skin that she feels is sensitive and to be very important to use as much of that as we possibly can right up [Music] yes everything here is rather stuck together which is a normal consequence of previous surgery there are shortcuts to this you just have to pick away at it 26 years ago certainly making a vagina was a lot easier than making a penis now both can be done Louise was born today would you be the sign female gender in the same way I think it's almost impossible to answer that question because her situation is so rare I think in the light of the knowledge we now have about genital function we would probably have tried to raise her as a male five hours into the operation doctors run into a major problem Louise's pelvic bone is masculine in shaman's the art is too narrow and needs to be opened up to accommodate her new vagina the vagina is a little tighter than I would like but I think it's as good as we could have made it chiseling away more of the pubic bone I think would have destabilized it and can make walking a little difficult that Remi dream for it too out there a normal life even have a boyfriend and get married so I was beating me dreams for I was forced into the direction one in but I could have turn around he said no I want to change but no I want to be a woman I feel a woman I know I'm gonna continue my life as a woman [Music] I want to go the full full distance and make myself complete as a woman [Music] I don't really think of it as boys and girls something look I ever have let's just let the individual and how you react to them you say you're absolutely open about being intersex I mean in terms of boyfriends how does that complicate things does it complicate things um it hasn't of yet no I can't see it is a problem because or not for me personally I can appreciate that for other people it could be a problem what it doesn't mean is that you 16 is that something you think about not really so much because I've always thought that you know if I do want children then you know I can adopt it won't be quite the same but you know it's okay tell me about boyfriend you've had to school I was about 14 15 it was about 17 to everyone else he might not appeared the ideal catch but to me was he loved me I loved him we got on rather well had a lot in common had male friends but not relationship wise I'd like the right man to come along mind having a bit of fun in the meanwhile I must be forward [Music] what do you see yourself doing in the future I'm gonna go to that College forming arts course really like the buzzes standing up in front of people going hey this is me or rather this isn't me I suppose [Music] but if that falls through then then I want to do genetics it would change subjects with it the ya know I really like biology in [Music] you