Medical Schools Give Intersex Health Just Two Hours, Review Finds

Intersex people—those born with variations in sex characteristics that do not fit typical definitions of male or female bodies—continue to experience significant health inequities and negative encounters within healthcare systems worldwide. A new review published in BMC Medical Education suggests that one of the root causes may lie in the lecture halls and anatomy labs of medical schools themselves, where intersex health remains a strikingly marginal topic. The study, conducted by Gus Heesh Finney of the University of Wollongong’s Graduate School of Medicine, Joyce El-Haddad of the University of New South Wales, and Nalini Pather of Western Sydney University, systematically examined how intersex content is delivered in medical and health education, how confident stakeholders feel about providing intersex care, and whether educational interventions actually close the gap.

The research team searched five major online databases—Scopus, EMBASE, PubMed, ProQuest, and Web of Science—for studies addressing the inclusion of intersex content in medical education. From the resulting pool of literature, thirty-five eligible papers were identified and subjected to data extraction and analysis. The scope of the review covered three interlocking questions: where and how intersex-related material appears in curricula, what students, faculty, and practicing health professionals believe about their own competence in intersex healthcare, and how successful existing interventions have been at remedying identified deficiencies.

The findings paint a picture of systematic underrepresentation. Across the reviewed literature, intersex-related content was most often folded into curricula under the broad umbrella of LGBTQIA+ health, a grouping that the authors suggest risks obscuring the distinct clinical, ethical, and social issues faced by people with variations in sex characteristics. Coverage was highly variable both geographically and between institutions, meaning that the quality of preparation a future physician receives on intersex health depends heavily on where they happen to train. When dedicated teaching time was quantified, the review found that an average of only about two hours across an entire medical program was devoted specifically to intersex topics.

Those two hours, moreover, were not spread evenly across the competencies that intersex patients actually need from their doctors. The content focused predominantly on aetiology, diagnosis, and terminology—the biological and nomenclatural dimensions of variations in sex characteristics such as androgen insensitivity syndrome and congenital adrenal hyperplasia. What received far less attention were the clinical communication skills, ethical reasoning, and advocacy practices that shape real-world encounters. This skew matters because intersex people have historically been subject to non-consensual, cosmetic interventions on infants and children, and because adults with variations in sex characteristics frequently report feeling pathologized, misunderstood, or erased in clinical settings.

The review’s assessment of self-perceived competence was unambiguous. Students, faculty members, and health professionals across the included studies generally rated themselves as not competent in intersex knowledge, in the related clinical skills, and in advocacy. This tripartite deficit is significant because modern frameworks for intersex healthcare—emphasizing human rights, informed decision-making, and psychosocial support—require clinicians who can do more than recite a differential diagnosis. They must be able to communicate sensitively with patients and families, resist pressure toward unnecessary interventions, and advocate within institutions for the rights and dignity of intersex people. A curriculum that teaches terminology without these capacities leaves graduates structurally unprepared.

Encouragingly, the review found that when educational interventions were implemented, they worked. Programs that introduced targeted intersex content improved competency in the very domains where deficits had been identified: knowledge, clinical skills, and advocacy. The evidence therefore reframes the problem not as one of pedagogical impossibility but as one of institutional will and curriculum design. Medical schools that have invested in intersex health education have demonstrably moved their students toward competence, suggesting that the two-hour average reflects neglect rather than any inherent difficulty in teaching the material.

The reports analyzed in the review converged on several key recommendations for building genuinely inclusive curricula. Community and student engagement stood out as central: involving intersex people and their organizations in the design and delivery of teaching ensures that content reflects lived experience rather than purely clinical abstraction. Professional development of staff was another recurring theme, since faculty cannot teach competently what they themselves were never taught. Finally, the review highlighted the value of intentional, longitudinal integration of intersex content at so-called teachable moments—embedding the material across anatomy, embryology, ethics, pediatrics, endocrinology, and clinical placements rather than confining it to a single isolated lecture.

On the question of pedagogical method, the authors argue that sustainable implementation of intersex-health objectives in medical education should incorporate educational strategies that bring in lived-experience perspectives, apply different critical lenses, and adopt non-pathologizing frameworks. This represents a deliberate shift away from older models in which variations in sex characteristics were presented exclusively as disorders to be diagnosed and corrected. Terminology itself is contested terrain: the abbreviation DSD, variously rendered as differences or disorders of sex development, illustrates the tension between clinical classification and community self-understanding. A curriculum grounded in non-pathologizing frameworks equips students to navigate this tension respectfully, aligning their practice with best-practice models for intersex care that prioritize autonomy and human rights.

The stakes of these educational reforms extend well beyond the classroom. Intersex people constitute a measurable portion of the population, with variations in sex characteristics arising through numerous biological pathways, and their interactions with the health system span endocrinology, urology, gynecology, mental health, and primary care. When providers lack knowledge and confidence, the consequences include misinformed counseling, delayed or inappropriate care, and the perpetuation of practices that intersex advocacy movements have condemned for decades. Conversely, a medical workforce trained with competency in intersex health can improve health outcomes directly—by communicating better, by supporting informed choices, and by dismantling the stigma that keeps many intersex people away from routine care.

The review, authored by researchers at the University of Wollongong, the University of New South Wales and its Australian Human Rights Institute, and Western Sydney University, ultimately delivers a clear message to medical educators: intersex health is not an optional enrichment topic but a core competency. The combination of minimal dedicated hours, umbrella-term invisibility, and widespread self-reported incompetence among both trainees and teachers constitutes an educational gap with documented human costs. Yet the demonstrated success of targeted interventions, coupled with concrete strategies—community partnership, staff development, and longitudinal integration—offers a practical roadmap. Equipping students with confidence and competency in knowledge, clinical skills, and advocacy practice, the authors conclude, is the pathway by which medical education can fulfill its responsibility to improve health outcomes for intersex people.

Subject of Research: The inclusion and delivery of intersex health content in medical and health professional education

Article Title: Intersex inclusion in medical and health education: a review

Article References: Intersex inclusion in medical and health education: a review. (n.d.). https://doi.org/10.1186/s12909-026-10541-y

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10541-y

Keywords: intersex, medical education, variations in sex characteristics, health inequity, curriculum, LGBTQIA+ health, clinical competency, health education, inclusive education, non-pathologizing frameworks, advocacy, scoping review