আন্তঃলিঙ্গ

আন্তলিঙ্গ মানুষের সংখ্যা একে বোঝাতে ব্যবহৃত সংজ্ঞার উপর নির্ভর করে। মানবাধিকার প্রতিষ্ঠানগুলো ডাক্তারি তালিকায় আন্তলিঙ্গকে সমস্যা হিসেবে চিহ্নিতকরণের বিষয়টিকে যতদূর সম্ভব বাতিল করার দাবি জানিয়ে থাকে,[10][11][12][13] তবে চিকিৎসাবিজ্ঞানে এই সংজ্ঞা এখনও ব্যবহার হচ্ছে। বর্তমানে-স্থগিত ইন্টারসেক্স সোসাইটি অব নর্থ আমেরিকার বক্তব্য এই যে:

বিশেষজ্ঞ চিকিৎসায়, নবজাতকের লিঙ্গ (নারী বা পুরুষ) নিশ্চিত করতে সার্জারি করা হতে পারে।[14] মানবাধিকার সংস্থার নজরদারির কারণে এই বিষয়টি সমালোচিত হয়ে থাকে।[11][13]

ব্ল্যাকলেস, ফস্টো-স্টারলিং এট অল. এর মতানুযায়ী, ১.৭ শতাংশ মানুষের জন্ম হয় আন্তঃলিঙ্গ হিসেবে।[15][14] লিওনার্ড স্যাক্সের মতে, "আন্তলিঙ্গকে ঐ সকল শর্তে সীমাবদ্ধ রাখা উচিত যেগুলোতে ক্রোমোজোমের সেক্সের সঙ্গে ফিনোটাইপীয় সেক্সের কোন সঙ্গতি নেই, অথবা যার ফিনোটাইপ পুরুষ বা মহিলা হিসেবে চিহ্নিত করা সম্ভব নয়।", যা প্রায় ০.০১৮%। এই সংজ্ঞায় ক্লাইনফেল্টার সিনড্রোম এবং অন্যান্য অনেক বৈচিত্র্যকে বাদ দেয়া হয়েছে।[16]

[17] নিম্নলিখিত সংক্ষিপ্ত বিবরণে উক্ত পরিসংখ্যান উল্লেখ করা হল:

কারণ

কুইগ্লি স্কেল হল একটি স্কেল যা ডিজঅর্ডার অব সেক্স ডেভলাপমেন্ট (যৌন ক্রমবিকাশের বৈকল্য) এর একটি প্রকরণ অ্যান্ড্রোজেন ইন্সেন্সিটিভিটি সিনড্রোম বা অ্যান্ড্রোজেনের অণুভূতিহীনতাজনিত লক্ষণে যৌনাঙ্গের ক্রমবিকাশ বর্ণনায় ব্যবহৃত হয়।

কি কি অবস্থা বা বৈশিষ্ট্যের ফলে আন্তঃলিঙ্গ হয় অথবা আন্তঃলিঙ্গ হয় না, তা নিয়ে বহ মতপার্থক্য আছে, যা কিনা ব্যবহৃত সংজ্ঞাগুলোর উপর নির্ভর করে। বর্তমান মানবাধিকার সংস্থাভিত্তিক সংজ্ঞাগুলো যৌন বৈশিষ্ট্যের এক বিস্তৃত বৈচিত্র্য প্রদান করে, যা নারী বা পুরুষ দেহ হতে আলাদা।[1] ২০১৫ সালে, কাউন্সিল অব ইউরোপ,[11] এবং ইউরোপিয়ান ইউনিয়ন এজেন্সি ফর ফান্ডামেন্টাল রাইটস[12] এবং ইন্টার-আমেরিকান কমিশন অন হিউম্যান রাইটস[13] সেই সকল ডাক্তারি শ্রেণীবিন্যাস তালিকাগুলো পর্যালোচনার আহবান জানিয়েছিলেন  যেগুলোতে কোন প্রয়োজন ছাড়াই আন্তঃলিঙ্গ বৈশিষ্ট্যগুলোকে মেডিক্যালাইজ বা ডাক্তারিকরণ করা হয়েছে। [11][12][13]

X/Y	নাম	বিবরণ
XX	Congenital adrenal hyperplasia (CAH)	The most common cause of sexual ambiguity is congenital adrenal hyperplasia (CAH), an endocrine disorder in which the adrenal glands produce abnormally high levels of virilizing hormones in utero. The genes that cause CAH can now be detected in the developing embryo. As Fausto-Sterling mentioned in chapter 3 of Sexing the Body, "a woman who suspects she may be pregnant with a CAH baby (if she or someone in her family carries CAH) can undergo treatment and then get tested." To prevent an XX-CAH child's genitalia from becoming masculinized, a treatment, which includes the use of the steroid dexamethasone, must begin as early as four weeks after formation. Although many do not favor this process because "the safety of this experimental therapy has not been established in rigorously controlled trials", it does allow physicians to detect abnormalities, therefore starting treatment right after birth. Starting treatment as soon as an XX-CAH baby is born not only minimizes, but also may even eliminate the chances of genital surgery from being performed.[14] In XX-females, this can range from partial masculinization that produces a large clitoris, to virilization and male appearance. The latter applies in particular to Congenital adrenal hyperplasia due to 21-hydroxylase deficiency, which is the most common form of CAH. Individuals born with XX chromosomes affected by 17α-hydroxylase deficiency are born with female internal and external anatomy, but, at puberty, neither the adrenals nor the ovaries can produce sex-hormones, inhibiting breast development and the growth of pubic hair. See below for XY CAH 17α-hydroxylase deficiency.
XX	Progestin-induced virilisation	In this case, the excess androgen hormones are caused by use of progestin, a drug that was used in the 1950s and 1960s to prevent miscarriage. These individuals normally have internal and external female anatomy, with functional ovaries and will therefore have menstruation. They develop, however, some male secondary sex characteristics and they frequently have unusually large clitorises. In very advanced cases, such children have initially been identified as males.[21]
XX	Freemartinism	This condition occurs commonly in all species of cattle and affects most females born as a twin to a male. It is rare or unknown in other mammals, including humans. In cattle, the placentae of fraternal twins usually fuse at some time during the pregnancy, and the twins then share their blood supply. If the twins are of different sexes, male hormones produced in the body of the fetal bull find their way into the body of the fetal heifer (female), and masculinize her. Her sexual organs do not develop fully, and her ovaries may even contain testicular tissue. When adult, such a freemartin is very like a normal female in external appearance, but she is infertile, and behaves more like a castrated male (a steer). The male twin is not significantly affected, although (if he remains entire) his testes may be slightly reduced in size. The degree of masculinization of the freemartin depends on the stage of pregnancy at which the placental fusion occurs – in about ten percent of such births no fusion occurs and both calves develop normally as in other mammals.
XY	Androgen insensitivity syndrome (AIS)	People with AIS have a Y chromosome, (typically XY), but are unable to metabolize androgens in varying degrees. Cases with typically female appearance and genitalia are said to have complete androgen insensitivity syndrome (CAIS). People with CAIS have a vagina and no uterus, cervix, or ovaries, and are infertile. The vagina may be shorter than usual, and, in some cases, is nearly absent. Instead of female internal reproductive organs, a person with CAIS has undescended or partially descended testes, of which the person may not even be aware. In mild and partial androgen insensitivity syndrome (MAIS and PAIS), the body is partially receptive to androgens, so there is virilization to varying degrees. PAIS can result in genital ambiguity, due to limited metabolization of the androgens produced by the testes. Ambiguous genitalia may present as a large clitoris, known as clitoromegaly, or a small penis, which is called micropenis or microphallus; hypospadias and cryptorchidism may also be present, with one or both testes undescended, and hypospadias appearing just below the glans on an otherwise typical male penis, or at the base of the shaft, or at the perineum and including a bifid (or cleft) scrotum.
XY	5-alpha-reductase deficiency (5-ARD)	The condition affects individuals with a Y chromosome, making their bodies unable to convert testosterone to dihydrotestosterone (DHT). DHT is necessary for the development of male genitalia in utero, and plays no role in female development, so its absence tends to result in ambiguous genitalia at birth; the effects can range from infertility with male genitalia to male underdevelopment with hypospadias to female genitalia with mild clitoromegaly. The frequency is unknown, and children are sometimes misdiagnosed as having AIS.[22] Individuals can have testes, as well as vagina and labia, and a small penis capable of ejaculation that looks like a clitoris at birth. Such individuals are usually raised as girls. The lack of DHT also limits the development of facial hair.
XY	Congenital adrenal hyperplasia (CAH)	In individuals with a Y chromosome (typically XY) who have Congenital adrenal hyperplasia due to 17 alpha-hydroxylase deficiency, CAH inhibits virilization, unlike cases without a Y chromosome.
XY	Persistent Müllerian duct syndrome (PMDS)	The child has XY chromosomes typical of a male. The child has a male body and an internal uterus and fallopian tubes because his body did not produce Müllerian inhibiting factor during fetal development.
XY	Anorchia	Individuals with XY chromosomes whose gonads were lost after 14 weeks of fetal development. People with Anorchia have no ability to produce the hormones responsible for developing male secondary sex characteristics nor the means to produce gametes necessary for reproduction due to the lack of gonads. They may develop typically feminine secondary sex characteristics without or despite the administration of androgens to artificially initiate physical sex differentiation (typically planned around the age of puberty). Psychological and neurological gender identity may solidify before the administration of androgens, leading to gender dysphoria, as anorchic individuals are typically assigned male at birth.
XY	Gonadal Dysgenesis	It has various causes and are not all genetic; a catch-all category. It refers to individuals (mostly XY) whose gonads don't develop properly. Clinical features are heterogeneous.[14]
XY	Hypospadias	It is caused by various causes,including alterations in testosterone metabolism. The urethra does not run to the tip of the penis. In mild forms, the opening is just shy of the tip; in moderate forms, it is along the shaft; and in severe forms, it may open at the base of the penis.[14]
Other	Unusual chromosomal sex	In addition to the most common XX and XY chromosomal sexes, there are several other possible combinations, for example Turner syndrome (XO), Triple X syndrome (XXX), Klinefelter syndrome, (XXY) and variants (XXYY, XXXY, XXXXY), XYY syndrome, de la Chapelle syndrome (XX male), Swyer syndrome (XY female).
Other	Mosaicism and chimerism	A mix can occur, where some of the cells of the body have the common XX or XY, while some have one of the less usual chromosomal contents above. Such a mixture is caused by either mosaicism or chimerism. In mosaicism, the mixture is caused by a mutation in one of the cells of the embryo after fertilization, whereas chimerism is a fusion of two embryos. In alternative fashion, it is simply a mixture between XX and XY, and does not have to involve any less-common genotypes in individual cells. This, too, can occur both as chimerism and as a result of one sex chromosome having mutated into the other.[23] Mosaicism and chimerism may involve chromosomes other than the sex chromosomes, and not result in intersex traits.

.[24]

• ফ্রী মার্টিন

• Senate of Australia, Community Affairs References Committee (25 October 2013). Involuntary or coerced sterilisation of intersex people in Australia.
• Blackless, Melanie; Charuvastra, Anthony; Derryck, Amanda; Fausto-Sterling, Anne; Lauzanne, Karl; Lee, Ellen (2000). "How sexually dimorphic are we? Review and synthesis". Am J Hum Biol 12 (2): 151–166. doi:10.1002/(SICI)1520-6300(200003/04)12:2<151::AID-AJHB1>3.0.CO;2-F. PMID 11534012.
• Georgiann Davis (2001). "DSD is a Perfectly Fine Term": Reasserting Medical Authority through a Shift in Intersex Terminology, in PJ McGann, David J. Hutson (ed.) Sociology of Diagnosis (Advances in Medical Sociology, Volume 12), Emerald Group Publishing Limited, pp. 155–182, DOI: 10.1108/S1057-6290(2011)0000012012.
• Dreger, A.D.; Chase, C.; Sousa, A.; Gruppuso, P.A.; Frader, J. (2005). "Changing the nomenclature/taxonomy for intersex: a scientific and clinical rationale". J. Pediatr. Endocrinol. Metab. 18 (8): 729–33. doi:10.1515/JPEM.2005.18.8.729. PMID 16200837.
• Alice Dreger (May/June 1998). "Ambiguous sex"--or Ambivalent Medicine? The Hastings Center Report May/Jun 1998, Volume 28, Issue 3 Pages 24–35. http://www.isna.org/articles/ambivalent_medicine
• Anne Fausto-Sterling (2000). Sexing the Body: Gender Politics and the Construction of Sexuality.
• Dan Christian Ghattas and Heinrich Böll Foundation (September 2013). Human Rights Between the Sexes.
• Morgan Holmes (editor) (October 2009). Critical Intersex, Ashgate Publishing.
• Katrina Karkazis (2008). Fixing Sex: Intersex, Medical Authority, and Lived Experience.
• National Advisory Commission on Biomedical Ethics, Switzerland (November 2012). On the management of differences of sex development, Ethical issues relating to "intersexuality", Opinion No. 20/2012.
• Organisation Intersex International Australia, (April 2014). Submission on the ethics of genetic selection against intersex traits.
• San Francisco Human Rights Commission (April 28, 2005). A Human Rights Investigation into the medical "normalization" of intersex people (PDF format via Senate of Australia).
• World Health Organization, OHCHR, UN Women, UNAIDS, UNDP, UNFPA and UNICEF (May 2014) Eliminating forced, coercive and otherwise involuntary sterilization, An interagency statement, ISBN 978 92 4 150732 5.
• Zwischengeschlecht (March 2014). IGM – Historical Overview. Hermaphrodites in the 'Developed World': From Legal Self-Determination to IGM, Supplement 1 in: NGO Report to the 2nd, 3rd and 4th Periodic Report of Switzerland on the Convention on the Rights of the Child (CRC), v2.0, pp. 49–62.