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Differences in Sex Development (DSD) and related conditions: mechanisms, prevalences and changing practice

International Journal of Impotence Research volume 35, pages 46–50 (2023)Cite this article

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This essay provides a general introduction to the field of Differences in Sex Development (DSD) including the history of terminology and an explanation of current categorisations and nomenclature. Toward the end, there is a reflection on how time has altered medical practice. It is accepted that ‘DSD’ is a disputed umbrella term for intersex that has found utility in medical research [1] but which is increasingly reappropriated as a personal and political identity [2] and is not the term of choice for everyone with lived experience.

Terminology relating to differences of sex development (DSD) evolves over time and will mean different things depending on the user. Changes in concepts surrounding DSD are driven by social trends, medical advances and sharing of experiences [3]. There are several key events in history that marked the changing concepts of DSDs. Perhaps the first term to be applied in this area was pseudohermaproditism dating back to the 19th century. In the early 20th century, intersex became the dominant term. In these years before chromosomes were identified, DSDs were described purely in terms of genital appearance and secondary sex characteristics. Medical management became focussed on ‘normalising’ physical appearance. Later, as investigative surgery was more widely applied, it became possible to examine the internal reproductive organs in the pelvis. The gonads could be biopsied to identify microscopic testicular and ovarian structures. Intersex then had two defining criteria, gonadal sex and genital appearance.

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  1. Institue for Womenʼs Health, University College London, London, UK

    Gerard S. Conway

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Conway, G.S. Differences in Sex Development (DSD) and related conditions: mechanisms, prevalences and changing practice. Int J Impot Res 35, 46–50 (2023). https://doi.org/10.1038/s41443-022-00606-z

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