Abstract
Current literature highlights the need for educational settings to be safe, inclusive, and affirming learning environments for learners with innate variations of sex characteristics (IVSCs) to ensure optimal educational experiences and outcomes; however, the research metasynthesizing the existing limited research is lacking. This scoping review brings together existing literature and highlights recommended IVSC-inclusive interventions, support mechanisms, and protective factors needed to support and promote optimal educational experiences, outcomes, health, and well-being. The findings from the 20 articles highlight the detrimental and harmful effects “invisibility” and “endosexim” play in the lives of people with IVSCs in educational settings across the world, and on their educational outcomes. In the limited research, people with IVSCs, parents of students with IVSCs, human rights and IVSC advocates, and scholars stress the need for educational settings to promote inclusive, affirming, humane, safe, and educationally relevant learning environments for people with IVSCs, reflective of human rights and antidiscrimination legislation.
Keywords
According to Intersex Human Rights Australia (Intersex Human Rights Australia, 2021), “Intersex people have innate sex characteristics that don’t fit medical and social norms for female or male bodies, and that create risks or experiences of stigma, discrimination and harm.” Further to this, it is well-documented that people with innate variations of sex characteristics (hereon IVSCs 1 ) experience feelings of being shamed, outcast, facing stigmatization and discrimination, bullying, and being subjected to nonconsented medical interventions while young, collectively influencing their experiences within and outside educational settings (Brömdal et al., 2021; Carpenter & Zavros-Orr, 2019; Intersex Human Rights Australia, 2021; Jones & Jacombs, 2021; lisahunter et al., 2023; Zavros-Orr, 2020).
There are at least 40 known IVSCs translating into variations concerning “chromosomes, genitals, gonads, hormones, and other reproductive anatomy, and secondary features that emerge from puberty” that do not conform with binary notions of female or male bodies (International Service for Human Rights & ARC International, 2017, p. 6), with the prevalence of IVSCs being debated and with lack of consensus (InterAction for Health and Human Rights, 2025). More specifically, broad definitions of IVSCs suggest up to 1.7% of the population (Blackless et al., 2000; Fausto-Sterling, 2000), while more conservative and narrow estimates focusing on visibly “ambiguous” external genitalia suggest a prevalence closer to .02% (Sax, 2002). Recent national population surveys report .3% of Australian respondents above the age of 16 (Australian Bureau of Statistics, 2024) and .4% of New Zealand respondents above the age of 15 (Stats NZ: Tatauranga Aotearoa, 2024) knew they were born with an IVSC. With those varying population definitions and estimates, InterAction “recommend[s] citing a range from .3% up to 1.7%” and stresses the importance of acknowledging “the difficulties of ascertaining a more accurate figure, including legacies of clinical secrecy and non-disclosure, stigma and misconceptions” concerning people with IVSCs (InterAction for Health and Human Rights, 2025). Considering these debated figures, schools are in a unique position, having both the responsibility and accountability ensure they create safe, inclusive, and affirming learning environments for all people, regardless of sex characteristics and any other intersectional factors.
Brömdal et al. (2021) highlight, however, that education settings are failing to engage with and deliver comprehensive relationship and sexuality education content, which encompasses promoting empathy in relation to people with IVSCs. This also relates to other spaces and settings of learning and teaching, such as curriculum, pedagogy, guidelines, and policies across the early years through to tertiary education (Zavros-Orr, 2020, 2021). Moreover, sociological research regarding Australian students with IVSCs reports that they experience bullying, stigma, and discrimination, where 19% of respondents failed to complete secondary school, compared to an Australian average of 2% (Jones, 2016). This is a matter of grave concern. The impact of medical interventions during puberty and the impact of developmental delays were found to be factors in this high dropout rate (Carpenter & Zavros-Orr, 2019; Jones, 2016; Zavros-Orr, 2021). Furthermore, there is a general lack of knowledge about people with IVSCs and how schools contribute to the invisibility of intersex bodies, traits, and lived experiences (Enzendorfer & Haller, 2020).
With the development and employment of a whole-school approach for the inclusion of people with IVSCs in educational settings, intersex rights and health scholars (Brömdal et al., 2021; lisahunter et al., 2023) stress that this will safeguard and enrich educational settings, promoting inclusive, affirming, humane, safe, and educationally relevant learning environments for people with IVSCs, reflective of human rights and antidiscrimination legislation. Indeed, in line with human rights legislation and principles, it is a human right to access an inclusive, equitable, and quality education free from discrimination (Androgen Insensitivity Syndrome Support Group Australia et al., 2017; Carpenter & Zavros-Orr, 2019; International Service for Human Rights & ARC International, 2017; United Nations Human Rights Office of the High Commissioner, 2019).
This scoping review, therefore, seeks to explore, map, and synthesize the existing literature related to the educational experiences and outcomes of students with IVSCs in school settings. As IVSC health and rights advocates, scholars, and community stakeholders, representing diverse sex characteristics (IVSCs and endosex), genders (nonbinary, dissident, and cisgender), and sexuality (pansexual, dissident, queering, and lesbian), we appreciate the challenges students with IVSCs experience navigating educational settings. Likewise, we understand the role educational settings, their staff, and peers play in facilitating or hindering the needs of students with IVSCs—in turn, informing their educational experiences and outcomes. Although research on the educational experiences and outcomes of students with IVSCs has expanded in recent years, it remains fragmented across disciplines and methodologies. Undertaking a scoping review is therefore an appropriate and rigorous approach to synthesize this dispersed evidence base and identify key gaps for future inquiry. All authors played integral roles in the review process, from protocol development to the final draft and authorship of the scoping review.
Review Question
As an emerging area of research, with most literature published in the last 6 years, the following research question was co-constructed by an author team consisting of IVSC health and human rights advocates, scholars, community stakeholders, and importantly, people with IVSCs: What is known in the literature about the experiences people with innate variations of sex characteristics have in educational settings and their educational outcomes?
Theoretical Framework
Theoretically, this scoping review draws on a revised and dynamic socio-ecological model adapted by Clark et al. (2017) and White Hughto et al. (2018), also used elsewhere in educational, mental health–related, and youth settings with vulnerable communities (Day & Brömdal, 2026; Leslie et al., 2025; Turton & Brömdal, 2025; Watson et al., 2024), exploring the complex interplay of structural, interpersonal, and individual barriers influencing and affecting the educational outcomes of people with IVSCs in educational settings (see Figure 1). Topics related to IVSCs are relevant to early years learning and school curriculum, addressing bodily diversity, and in later schooling years, such as those concerning sex characteristics and how endosex (non-intersex) expectations, norms, and power-relations operate (Brömdal et al., 2021; lisahunter et al., 2023). The importance of including this topic in education, with the aim of increasing visibility (Zavros-Orr, 2021), contributes to the elimination of educational barriers, as highlighted in Figure 1. Eliminating these barriers can affect the individual lives of students with IVSCs, including societal views about IVSCs. Collectively promoting positive educational experiences and outcomes for people with IVSCs (also benefiting all students, as students may later in life be given a diagnosis of IVSC, or become parents of an IVSC child) is ultimately about access to knowledge about their own and others’ bodies, including bodily autonomy, development, and diversity (Czerwiec, 2022).
Conceptual framework of structural, interpersonal, and individual barriers implicating the educational experiences and outcomes of students with IVSCs in educational settings.
Regarding the adapted socio-ecological model, at the structural level, unsupportive systemic cultures promoting endosexcentric learning and teaching, curriculum, and educational policies inhibit people with IVSCs from having positive and fruitful educational experiences and outcomes. Furthermore, due to a lack of explicit inclusive policies, guidelines, affirming procedures, and practices in educational settings, this results in people with IVSCs having poor educational experiences and outcomes (Brown, 2022; Chan & Suen, 2023; Enzendorfer & Haller, 2020; Jones, 2015a, 2015b; Jones et al., 2016). Through education, and in alignment with human rights directives (Androgen Insensitivity Syndrome Support Group Australia et al., 2017; International Service for Human Rights & ARC International, 2017), educational settings are in a unique position to raise awareness about and reinforce that IVSCs are natural manifestations of human bodily diversity and can create inclusive and affirming environments. This is intended to help IVSC people feel safe and supported in their bodily diversity, removing barriers that often result in experiencing feelings of shame, secrecy, and invisibility (Carpenter & Zavros-Orr, 2019; Enzendorfer & Haller, 2020; Lum, 2021, 2022; Oikarinen, 2020).
At the interpersonal level, the educational experiences and educational outcomes of people with IVSCs are shaped by the attitudes and behaviors of peers and staff, including the general school ethos (Brown, 2022; Ghattas et al., 2019). Non-IVSC-affirming interactions within educational settings can have a detrimental effect on the health and well-being of people with IVSCs within the interpersonal domain (Carpenter & Zavros-Orr, 2019). From a health and well-being perspective, invisible, nonaffirming, nonsupportive educational environments contribute to numerous negative consequences for people with IVSCs. Stigmatization and hostility toward people with IVSCs occur within educational settings, highlighting current exclusionary practices (Carpenter & Zavros-Orr, 2019; Jones, 2016). In addition, the impact of isolation and alienation that people with IVSCs endure often leads to lower rates of school attendance, poorer academic achievement, and ultimately poorer employment opportunities (Stahl, 2015; Zavros-Orr, 2021). Harmful consequences are also illustrated by poor mental health, resulting in increased rates of suicide and suicidal ideation among people with IVSCs (Carpenter & Zavros-Orr, 2019; Ghattas, 2015; Henningham & Jones, 2021).
Through safe and supportive interactions between educational systems, staff, and peers, Lundberg et al. (2021) stress that there should be opportunities provided for people to have the choice to talk, or not, about their own variation of sex characteristics with staff and peers. Similarly, by providing opportunities and support for people in educational settings to critically think about bodily norms, sex characteristics, and how power-relations inform endosexism, they can collectively offer alternative and empathetic ways of reading bodies otherwise inherently coded within socio-politico-medico-informed systems and settings (Brömdal et al., 2017).
The individual level then concerns the personal characteristics of educational staff, including school psychologists, social workers, counselors and guidance officers, peers and the individual person with IVSCs, and the consequential educational experiences and outcomes of the person with IVSCs. The lack of knowledge and understanding from educational staff and peers about IVSCs can rapidly translate into intersex-invisibility (Zavros-Orr, 2021). In many instances, people with IVSCs may feel it is safer to hide and make invisible their intersex traits to protect themselves from exposure to bullying, discrimination, and physical violence, together with dissociating themselves from others and their schooling, opposed to fear of rejection from peers “knowing” of their intersex variation (Lundberg et al., 2021; Oikarinen, 2020). Inadvertently, this lack of knowledge and understanding can profoundly and negatively affect people with IVSCs’ mental health and well-being due to overwhelming and internalized feelings of shame, loneliness, and social isolation (Berger et al., 2024; Henningham & Jones, 2021; Jones, 2016; Lum, 2019; Nichols, 2023). As such, it is important to raise awareness about the health benefits of being authentically oneself, so that peers and diverse educational staff know how to affirm people with IVSCs and encompass the characteristics of an intersex ally (Intersex Human Rights Australia et al., 2019; Marinus & Cense, 2024). Through a whole-school approach, developed and led by intersex peer advocates and allies (Brömdal et al., 2021; lisahunter et al., 2023), it is recommended to include and mandate intersex-inclusive antibullying policies and guidelines, education on IVSCs in school curricula and teacher education programs, including biology, humanities, and social sciences, and through comprehensive relationships and sexuality education programs. Moreover, the inclusion of intersex-affirming education has the potential to reduce discrimination and bullying toward individuals with IVSCs as well as bodily diversities (Berger et al., 2024; Brown, 2022; Enzendorfer & Haller, 2020).
Methods
Scoping reviews endeavor to broadly map out existing literature on a specific topic or research area, providing the reader with a more holistic overview of the field of study. The effectiveness of this type of research synthesis enables the identification of key concepts, theories, sources, and knowledge gaps to be identified and understood (Arksey & O’Malley, 2005; Joanna Briggs Institute, 2024; Tricco et al., 2016; Tricco et al., 2018). This scoping review drew upon the framework of Arksey and O’Malley’s (2005) five-stage phases, including: 1) identifying the research question; 2) identifying relevant studies; 3) study selection; 4) charting the data; and 5) collating, summarizing, and reporting results. In addition, the implementation of the preferred reporting items for systematic reviews and meta-analyses (PRISMA) extension for scoping reviews (PRISMA-ScR) checklist and flowchart was included and is consistent with both approaches (Tricco et al., 2016, 2018). To ensure a thorough and rigorous selection process, articles were screened and reviewed by two independent reviewers (HK and AB), with any discrepancies reviewed, discussed, and resolved between them and the rest of the author team.
Eligibility Criteria
To ensure our scoping review responded to the aim and research question, inclusion and exclusion criteria were established within the research team prior to conducting the review. More specifically, retrieved articles were restricted to studies that 1) were empirical in nature, whether qualitative, quantitative, or mixed methods; 2) reported on the experiences of people with IVSCs in educational settings and their educational outcomes; 3) were published in English; and 4) had a title, abstract, and full article available online. The retrieved articles were not restricted to date or geographical location. To not dismiss the importance of appropriate gray literature (i.e., information and research outputs that are produced outside of traditional academic publishing channels) into our scoping review, we broadened the scope to include any relevant empirical articles (peer-reviewed journal articles, books, book chapters, thesis, and government reports) to provide a more complete review of the available evidence (Mahood et al., 2014). The inclusion criteria also drew on Joanna Briggs Institute’s (JBI, 2024; Peters et al., 2021) guidelines, including participants, concepts, and context, and are further explored in the following sections.
Participants
Participants within the literature were restricted to people with IVSCs or parents of people with IVSCs attending educational settings, or educational staff working with people with IVSCs in educational settings, reporting on educational experiences and outcomes of people with IVSCs while navigating educational settings.
Concepts
The concept was restricted to educational experiences and outcomes, including educational success, academic achievement, health, well-being, belonging, relationships, quality of life, isolation, shaming, bullying, discrimination, missing school, support, and school refusal (also known as “school can’t”).
Context
The context was limited to early years, primary, secondary, and postsecondary educational settings around the world.
Retrieved articles were excluded when 1) a study suggested to explore the educational experiences and outcomes of people with IVSCs through an LGBTIQ+ lens but did not specifically distinguish participants, data, or findings unique to people with IVSCs. In the case of this exclusion criteria a number of articles fell into this category, such as Waling and Roffee (2018), and something intersex advocates, academics, and people with IVSCs suggest needs careful consideration to ensure the article is not misrepresenting or inadvertently invisibilizing cohorts within the acronym, such as people with IVSCs (Carpenter, 2024).
Search Strategy
The search strategy for this scoping review commenced on February 27, 2024, with many adaptations in consultation with the author team. A final search was conducted on May 18, 2024, with satisfaction that the search strategy and databases had been exhausted in obtaining optimal results. The search included terms relating to sex characteristics and intersex variations, including variations of sex characteristics, differences in sex development, sex development, intersex, disorders of sex development, and hermaphrodite. These searches were combined with terms related to educational settings, including early childhood, kindergarten, school, higher education, tertiary, and university. These concepts were then further combined with terms associated with educational experiences and outcomes, including education outcomes, education success, academic achievement, health, well-being, inclusion, belonging, relationships, quality of life, isolation, bullying, discrimination, missing school, support, and school refusal.
The five quality databases that were accessed included EBSCOHost Megafile Ultimate, Scopus, PubMed for peer-reviewed material, and Trove and Google Advance for eligible gray literature (see Table 1). Collectively, the five quality databases were accessed to gather relevant and comprehensive information in relation to the scoping review. The databases provided a wide range of reliable, empirical, and peer-reviewed literature. For included gray literature, Google Advance was used, enabling further relevant empirical literature to be accessed beyond traditional academic publishing avenues.
Search strategy
Screening Procedure
All literature was screened using the PRISMA three-stage screening process (Peters et al., 2021; Tricco et al., 2018). First, all identified citations, including additional records identified through other sources, were exported into EndNote, duplicates removed by the lead author, then exported to the JBI Sumari platform. The second stage of the screening process included reviewing the titles and abstracts against the aforementioned inclusion/exclusion criteria by HK and AB, with inputs from the rest of the author team. For the last stage, full-text articles were assessed for eligibility against the set inclusion/exclusion criteria by the first and the second author, with inputs from the rest of the author team (Peters et al., 2021). A PRISMA flowchart diagram is provided (see Figure 2), offering a visual description of this screening process (Peters et al., 2021; Tricco et al., 2018).
PRISMA flow diagram of review search for the research question.
Quality Appraisal
Consistent with the methodology of scoping reviews, the quality of the 14 peer-reviewed articles was assessed employing JBI Critical Appraisal Tools (2020). For cross-sectional studies, the analytical cross-sectional studies checklist with a maximum score of 8 assessed aspects such as sample selection, measurement validity, and control of confounders (Moola et al., 2020). Qualitative studies were appraised using the qualitative research checklist, with a maximum score of 10, assessing criteria such as congruity between research methodology and research question, data collection methods, and representation of study participants (Lockwood et al., 2015). These online tools supported the authors in assessing the trustworthiness, reliability, and relevance pertaining to each peer-reviewed article included within this review, including risk of bias in the final articles, while also permitting all 14 articles to be included in the final metasynthesis (Joanna Briggs Institute, 2020). The quality appraisal was undertaken by HK and AB in a blind review, including discussing and solving any discrepancies arising throughout this process. The agreed quality appraisal scores are outlined in Table 2.
Characteristics of peer-reviewed articles (n = 14)
Strategy for Data Charting and Analysis
Using a matrix method, the findings from the peer-reviewed articles and gray literature were metasynthesized to develop themes, connections, and important findings about the educational experiences and outcomes of persons with IVSCs navigating educational settings. More specifically, charting tables (see Tables 2 and 3) were developed to record key findings and recommendations from the extracted data. Drawing on the JBI guidelines (Peters et al., 2021), the following data extraction criteria were charted: 1) lead author, year, and country; 2) aim, study design, and quality rating (quality rating only part of peer-reviewed articles in Table 2); 3) participants and educational settings; and 4) findings and recommendations.
Characteristics of gray literature (n = 6)
Drawing on the revised and dynamic socio-ecological model adapted by Clark et al. (2017) and White Hughto et al. (2018)—also used elsewhere in educational, mental health–related, and youth settings with vulnerable communities (Leslie et al., 2025; Watson et al., 2024; Watts & Brömdal, 2026—the scoping review first deductively explored the intricate interplay between the structural, interpersonal, and individual elements impacting the educational experiences and outcomes of people with IVSCs in educational settings. After deductively applying this framework to the data, a reflexive thematic analysis drawing on Braun & Clarke (2019) was used inductively to identify any subthemes in the literature within those three levels. The six-step phase guide of reflexive thematic analysis consists of (1) familiarizing yourself with your data; (2) generating initial codes; (3) generating initial themes; (4) reviewing themes; (5) defining and naming themes; and (6) producing the report (Braun & Clarke, 2019). This identified further understanding regarding the phenomenon across articles, and any potential gaps, with the end goal of recommending new avenues for research (Robinson et al., 2011).
Results
Multiple database searches were conducted on May 18, 2024, with 14 peer-reviewed articles and six gray articles being included in the final review (see Figure 2). The screening process identified citations through databases (n = 5289), including additional records identified through other sources (n = 17). These were exported into EndNote and duplicates removed to then be exported to the JBI Sumari platform. This first-stage screening resulted in 3,477 article titles and abstracts being assessed for eligibility against the predetermined inclusion/exclusion criteria. Here, 3,435 screened articles were excluded due to not meeting the eligibility criteria. For the third stage, 42 full-text articles were assessed for eligibility against the set inclusion/exclusion criteria. These full texts were independently reviewed by HK and AB, with inputs from the rest of the author team, and all confirmed eligibility for inclusion of the final 20 articles in the review, including the reasons for removing 22 articles not meeting the inclusion criteria (see Figure 2).
As indicated in Tables 2 and 3, 14 peer-reviewed articles were quality appraised. Of these, nine were qualitative, and five were cross-sectional in nature. The remaining six articles, being gray literature, were not quality appraised (see Table 3). As outlined in Table 2, most empirical peer-reviewed articles scored 75% or higher, and most were of excellent quality, with one article scoring modestly with 5/8 (Breu, 2009). No articles were excluded based on quality appraisal scoring.
Study Size and Demographics
The 20 included articles dated from 2009 to 2024. Sample sizes ranged from one participant in Breu (2009) to 367 participants in Chan and Seun (2023). The mean sample size across the 20 articles equated to 77 participants per article. Participant age range varied across the included studies. Nine of the articles reported age ranges for their participants between 9 to 87 years old (Czerwiec, 2022; Henningham & Jones, 2021; Jones, 2015a, 2016; Lum, 2021, 2022; Lundberg et al., 2021; Marinus & Cense, 2024; Oikarinen, 2020), while the remaining 11 studies provided the number of participants only, without specifying the participants’ age.
Tables 2 and 3 summarize the results of the qualitative synthesis and identify the key findings and recommendations of each article. Across the articles, challenges experienced by people with IVSCs in varying educational settings from early childhood to tertiary settings were outlined and discussed. Six of the articles included personal autoethnographic experiences and recounts of people’s journey with IVSCs in schooling environments (Alim et al., 2022; Breu, 2009; Ghattas et al., 2019; Lum, 2019, 2021, 2022), and four included parent participants voicing the educational experiences and outcomes of their child with IVSCs while navigating educational settings (Czerwiec, 2022; New Zealand Ministry of Education, 2019; Nichols, 2023; Oikarinen, 2020). With no limitations on geographical location, articles from a range of countries were included in this review, albeit written in or translated into English.
Of the 20 included studies, five were conducted in Australia, two in South Africa, and one each in Bangladesh, China, United States of America (USA), Poland, Austria, North America, Scotland, England, Norway, Sweden, Switzerland, New Zealand, Finland, respectively. Four articles were broad in their locations, with lived intersex experiences across Europe, Asia-Pacific, and Africa, and around the world (see Tables 2 and 3). Across all articles, 15 were qualitative in methodology, and five were cross-sectional in design. One article focused on primary school settings (Czerwiec, 2022) and three focused on secondary school settings (Breu, 2009; Brown, 2022; Enzendorfer & Haller, 2020). A further 16 articles covered a range of educational settings from primary school to tertiary education (Alim et al., 2022; Berger et al., 2024; Chan & Suen, 2023; Ghattas et al., 2019; Henningham & Jones, 2021; Jones, 2015a, 2016; Jones et al., 2016; Lum, 2019, 2021, 2022; Lundberg et al., 2021; Marinus & Cense, 2024; New Zealand Ministry of Education, 2019; Nichols, 2023; Oikarinen, 2020). From the 20 articles, only three discussed the somewhat positive schooling experiences of people with IVSCs and the parents of children with IVSCs (Jones, 2016; New Zealand Ministry of Education, 2019; Oikarinen, 2020).
The articles included in this scoping review were analyzed drawing on the adapted and dynamic socio-ecological framework developed by Clark et al. (2017) and White Hughto et al. (2018), through structural, interpersonal, and individual-level barriers. Reflective of Tables 2 and 3, 15 articles focused on the systemic and structural barriers impacting the inclusion and visibility of people with IVSCs in educational settings. Further, 14 articles explored the interpersonal barriers and 14 examined the individual barriers affecting the interactions and mental health and well-being of people with IVSCs in educational settings, and the impact this had upon their education. These topics are further considered next.
Structural Level Barriers and Recommendations
At the structural level, 15 articles focused on the structural barriers in educational settings for people with IVSCs, including policies, procedures, norms, and practices experienced by people with IVSCs (Berger et al., 2024; Brown, 2022; Chan & Suen, 2023; Czerwiec, 2022; Enzendorfer & Haller, 2020; Ghattas et al., 2019; Henningham & Jones, 2021; Jones, 2015a, 2016; Jones et al., 2016; Lundberg et al., 2021; Marinus & Cense, 2024; New Zealand Ministry of Education, 2019; Nichols, 2023; Oikarinen, 2020). At this level, policies, procedures, norms, and practices can ultimately dictate the educational experiences and outcomes of people with IVSCs. In some capacity, all articles within this scoping review highlighted the challenges people with IVSCs encounter in educational settings that contribute to, and influence, their educational outcomes—namely, the invisibility of people with IVSCs regarding humane policies, procedures, norms and practices, and unfamiliarity/ignorance and in nonadherence to human rights directives (Berger et al., 2024; Brown, 2022; Chan & Suen, 2023; Czerwiec, 2022; Enzendorfer & Haller, 2020; Ghattas et al., 2019; Henningham & Jones, 2021; Jones, 2015a, 2016; Jones et al., 2016; Lundberg et al., 2021; Marinus & Cense, 2024; New Zealand Ministry of Education, 2019; Nichols, 2023; Oikarinen, 2020).
Notably, within these articles are recommendations from many people with IVSCs concerning the procedures, norms, and practices in which they believe governments and policymakers should be implementing and upholding. This includes educating all learners through a whole-school approach about body variances and differences in sex characteristic development, the inclusion of appropriate and affirming comprehensive relationships and sexuality education and school resources reflective of diverse sex characteristics, and ongoing training for all educational staff on how to affirm, protect, and support people with IVSCs in the schooling environment (Berger et al., 2024; Breu, 2009; Brown, 2022; Chan & Suen, 2023; Enzendorfer & Haller, 2020), in line with human rights directives.
Intersex Invisibility in the Curriculum and Recommendations
According to a study by Jones (2016), education policies and guidelines detailing how to support people with IVSCs are lacking in Australia, despite national and legal protections, with 92% of participants attending schools lacking inclusive puberty/sex education provisions, and 95% of participants attending schools lacking inclusive counseling/referral links. Participants in Brown (2022) reported that South African schooling environments do not protect or affirm diversity in sex characteristics and privileged fixed and binary categories of female and male bodies. They shared their experiences of ridicule, unacceptance, ostracism, and discrimination endured during their primary and secondary schooling due to their IVSCs (Brown, 2022). Many articles (Alim et al., 2022; Breu, 2009; Brown, 2022; Enzendorfer & Haller, 2020; Henningham & Jones, 2021; Jones, 2016; Lum, 2019; Nichols, 2023; Oikarinen, 2020) highlighted the erasure of people with IVSCs due to the absence, silence, and invisibility of IVSC experiences in the teaching and learning material, including the school curriculum, with fixed focus on binary categories of female and male bodies. This invisibility made participants with IVSCs feel excluded, miss classroom participation, or lead to their suspension, including eventual school dropout, and further leading to depression and the adoption of risk-taking behaviors (Brown, 2022). Relatedly, personal experiences of this notion of fixed binary categories of female and male bodies were shared by participants in a report by the New Zealand Ministry of Education (2019):
There’s a farewell event for Year 6 in 2019 which [name] is already dreading and says she won’t go to. There is a dress code where girls have to wear dresses and boys have to wear pants. You can see that [name] is quite the tom boy and likes to dress casually in shorts and t-shirts. You’ll never get her into a dress, she hasn’t worn a dress for years. For her she identifies as female but does not by any means express a feminine side in how she dresses. I’d like to see that the kids could be supported to dress how they like to best suit their personal identities. (Parent of intersex child, p. 17)
A participant from Greece noted that intersex invisibility can have profound negative effects on people with IVSCs—in some instances, life-threatening:
This social pushing towards the only two accepted as “normal” gender stereotypes, while excluding in shame and harm all the others, is adding a lot of social and inner stress to these kids and compromises their physical and psychological health, due to a lot of well-documented dangers (as gender bullying, harassment, personality assaulting, physical violence, depression, school quitting and even youth suicides). (Ghattas et al., 2019, p. 19)
To effect changes that promote the inclusion of people with IVSCs within the educational system, and in accordance with human rights directives, some articles recommended schools educate all learners through a whole-school approach led by peer advocates about body variances and differences in sex characteristic development, through the visible platform of the school curriculum, moreover, to affirm and mandate education on IVSCs in school curricula through comprehensive relationships and sexuality education programs, together with intersex inclusive antibullying policies and guidelines (Berger et al., 2024; Brown, 2022; Enzendorfer & Haller, 2020; Lundberg et al., 2021). Lundberg et al. (2021) reported that including intersex as part of sex education programs can promote agency and well-being by helping young people make sense of their embodiment and form rewarding social relationships, and by changing societal understandings about IVSCs, in turn promoting visibility and greater awareness. Therefore, as asserted in the South African study by Brown (2022), the inclusion of affirming intersex education in schools has the potential to reduce discrimination and bullying towards people’s diverse characteristics.
The provision for ongoing training for all educators within school settings on how to affirm, protect, support, and include learners with IVSCs in the schooling environment is paramount to their success in school, together with educational staff and peers’ understanding on how to react to disclosures about IVSCs in a nondiscriminatory manner (Brown, 2022; Jones, 2016), as further expressed by a participant in Jones et al. (2016):
Staff training on intersex variations, learn about the variations, schools should find places in their curricula to discuss intersex bodies, chromosomes, and the many varied elements of sex as early as possible. Repeat this over the different grades. It will be the ray of light kids like me were looking for, and it is after-all, true. (p. 9)
This sentiment was also repeated in a study in China by Chan and Seun (2023)—to reduce and prevent school victimization, bullying, harassment, shaming, and discrimination toward people with IVSCs, inclusive school policies, and teacher training programs at different levels of schooling are essential to ensure positive educational experiences and outcomes for people with IVSCs, now and into the future.
Interpersonal Level Barriers and Recommendations
At the interpersonal level, the interactions between the education system and the subsequent implications for people with IVSCs were highlighted in 14 articles (Alim et al., 2022; Berger et al., 2024; Breu, 2009; Brown, 2022; Chan & Suen, 2023; Enzendorfer & Haller, 2020; Ghattas et al., 2019; Henningham & Jones, 2021; Jones, 2015a, 2016; Lum, 2022; Lundberg et al., 2021; Nichols, 2023; Oikarinen, 2020). Interpersonal barriers experienced by people with IVSCs are rooted in nonaffirming social interactions within the education system, including the interactions between educational staff, staff and peers, and peer-to-peer interactions. At the interpersonal level, people with IVSCs reported experiences and feelings of loneliness and social isolation throughout varying educational settings compared to their endosex peers, thus negatively impacting their health and well-being (Henningham & Jones, 2021). Absence regarding talking about IVSCs within the classroom also led to feelings of confusion, stigmatization, shaming, discrimination, and victimization, potentially resulting in mental health concerns (Breu, 2009). This silence was further validated by one participant in Jones (2016).
I had a hard time as I looked different and was called names from primary to high school. I was called retard or downs’ syndrome, lots of nasty names. I was physically less mature and that became so tough in high school. I wanted more help from staff than I got, definitely. (p. 14)
In Brown (2022), four of six participants in South Africa dropped out of school from year 10 onwards due to bullying from teachers and peers, repeated failure of school grades, and untreated depression. Non-IVSC-affirming interactions between school staff and other peers, misgendering and misnaming students with IVSCs, and placing people with IVSCs in classes and sporting teams opposite of their affirmed gender can have irreversible and lifelong damaging effects, as expressed by Yvonne.
When I was in high school, I was a soccer player in the school team, and I was a very good player compared to the other girls. One day, after I played very well, the coach of the opposing team said to me, “You are not female,” and they wanted to go and check inside my pants. Knowing that my genitalia was different, I knew I had to disappear and leave all the other games that I was supposed to play in. (Yvonne in Lum, 2022, p. 38)
Similarly, parents of a child with IVSCS in Johannesburg expressed their experience of non-IVSC-affirming interactions between school staff and peers regarding their child, and the humiliation stemming from this.
The Principal was not serious about the matter. It is his job to protect my child. My son was very upset that he was part of the girls’ side of the class register. She [the teacher] first calls the learners according to their gender, boys on one side and girls on the other. Whenever his [her son’s] name was called from the girls’ side the whole class would start laughing. That made me furious, and I went to see the principal about this and other cases of bullying in his school. . . . he said that he will speak to the teacher. I asked that the teacher calls the learners out in alphabetical order. This only lasted one week. (Nichols, 2023, p. 4)
Participants in an Austrian study also reported that coming out as “intersex” was not necessary to become self-empowered or reduce feelings of isolation, loneliness, and otherness; rather, “just hearing about people with intersex variations can be an escape from taboo and loneliness and allow all people to gain a broader understanding of gender, sex, and sex characteristics” (Enzendorfer & Haller, 2020, p. 270). This highlights that schools are in a pivotal position of allyship/advocacy for the inclusion and affirmation of people with IVSCs through effective, meaningful, and social interactions. These are becoming protective factors against barriers for people with IVSC in educational settings.
Schools as Protective Factors
The school experiences and educational outcomes of people with IVSCs are shaped by the interactions, attitudes, and behaviors of educational staff and peers, including the general school ethos. As such, schools are in a unique position to support students through positive social interactions to think about bodily norms and sex characteristics in ways that question presumed norms and develop empathy toward otherwise stigmatized variations of sex characteristics (Brown, 2022; Lundberg et al., 2021). This is illustrated in Breu’s (2009) autoethnographic account.
Teachers who do include intersex issues in their curricula can provide their intersex students with a sense of community. Intersex people, whether children, teenagers, or adults, often feel that they are going through their experiences absolutely alone. For them, realizing that there are others out there with similar experiences, facing similar challenges, can be life-affirming. Having intersex people’s lives and experiences acknowledged, represented, and discussed in the classroom can be profoundly empowering – indeed, it can be life-saving. (p. 107)
In some instances, participants reported situations when intersex topics were discussed openly in the classroom, where they, in turn, were able to trust and speak openly to their educational staff and peers about their intersex variation(s) (Enzendorfer & Haller, 2020). Similarly, in Australia, five participants in Jones (2016) commented that affirming messages were provided to them on specific IVSCs during puberty and sex education classes, together with positive experiences from some teachers and counseling staff who were actively seeking to learn more about people’s intersex variation(s). This supported the needs of people with IVSCs within educational environments. As suggested by Breu (2009), teaching intersex issues in middle and high school classrooms can help people to critically examine students’ stereotypical thinking about sexuality and gender. Furthermore, Lundberg et al. (2021) stressed the importance of educational staff and peers, providing people with IVSCs the opportunity to talk, or not, about bodies and the phenomenon of sex characteristics, and support everyone to think about bodily norms and sex characteristics in ways that question presumed bodily norms and endosexism. This, in turn, can create a positive school culture that listens to, affirms, and acknowledges people with IVSCs (Lundberg et al., 2021).
Individual Level Barriers and Recommendations
Fourteen articles encapsulated many of the individual barriers people with IVSCs are exposed to in educational settings, including the personal characteristics of educational staff, peers, and the person with IVSCs and their resulting experiences and educational outcomes (Alim et al., 2022; Chan & Suen, 2023; Enzendorfer & Haller, 2020; Ghattas et al., 2019; Henningham & Jones, 2021; Jones, 2015a, 2016; Jones et al., 2016; Lum, 2019, 2021, 2022; Marinus & Cense, 2024; New Zealand Ministry of Education, 2019; Oikarinen, 2020). These barriers can manifest in many forms through educational staff and peers’ lack of knowledge and understanding about IVSCs, and in educational staff’s confidence and competence to include IVSC discourses in learning and teaching material (Brown, 2022; Enzendorfer & Haller, 2020; Jones, 2015a; Lum, 2019; Nichols, 2023). Similarly, these barriers can be presented through people with IVSCs being spoken to, and about, in abstract, mythological, and medical ways (Alim et al., 2022; Lum, 2022). In turn, people with IVSCs may avoid sex education and physical education classes (Henningham & Jones, 2021) and avoid using toilets and/or changing rooms (Henningham & Jones, 2021; Lum, 2022), ultimately translating into ignorance, harm, stigma, and shame associated with/towards people with IVSCs, including IVSC invisibility within educational settings. Enzendorfer and Haller (2020) reported in their study how people with IVSCs have a fear of being perceived “not normal” or being caught and exposed as “other,” feelings expressed by many people with IVSCs throughout their schooling years and beyond. Participants also described a lack of words to talk about their intersex variation(s) and a lack of safe spaces for such conversations in school settings to take place, describing themselves as “loners” and “outsiders” (Enzendorfer & Haller, 2020). Lundberg et al. (2021) reported how people with IVSCs feared rejection from peers and struggled with secrecy versus privacy surrounding their intersex variation(s) in educational settings.
Well-being and Implications
In various school settings in Finland, people with IVSCs reported it being safer to “hide” their intersex variation and ultimately a protective factor to safeguard themselves from exposure to bullying, discrimination, and physical violence (Oikarinen, 2020). People with IVSC in China who chose to conceal their identity reported on the immediate relief they felt from not being subjected to victimization in educational settings; however, as reported by the authors, this may have had harmful long-term effects and lead to a greater likelihood of school dropout and lower educational attainment (Chan & Suen, 2023). An example of this was highlighted by Yvonne in Lum (2022), describing the challenges and implications of trying to keep an intersex variation secret in school,
The challenge came when I started school. Despite that me being intersex was largely kept a secret, it happened that some parents were aware of it, and they used to talk about it with their children. As a result, I faced stigma and discrimination. I had some incidents where some classmates used to laugh at me and say, “Look, she has two sexual organs.” This made me feel uncomfortable and I would spend a lot of time alone. I felt I didn’t belong, and this affected my interactions with others and my performance towards schoolwork. At one point, I wanted to drop out of school because of the stigma and discrimination that l was facing. (p. 38)
Additionally, the impact of loneliness and social isolation on people with IVSCs’ mental health and well-being may lead to lower academic achievement and contribute to being part of a lower socio-economic class as an adult in society, thus suffering from psychological distress in adulthood (Henningham & Jones, 2021). At the individual level, reported well-being risks were rated high amongst participants in Jones (2016), with suicidal ideation among participants with IVSCs when learning about their intersex variation—in turn, leading to negative schooling experiences and outcomes. The participants in Jones (2015a) repeatedly emphasized their sense of feeling overwhelmed by having to educate their principals, teachers, school counselors, psychologists, and doctors about IVSCs, in turn negatively impacting their sense of well-being. The lifelong mental health and well-being impact of secrecy and concealing one’s IVSCs can cause immeasurable pain and suffering, as expressed by Irene.
I hated my body so much and never wanted to be seen by anyone changing in the changing room or attempting any kind of physical activity. As a teenager, I filled the pages of my diary with words of pain, self-hatred, suicide and self-harm. I still have the diary, and I feel really sad reading it now. (Irene in Lum, 2022, p. 34)
In supporting people with IVSCs in educational settings at the individual level, Marinus and Cense (2024) stress the important role other people can have to improve people with IVSCs’ self-confidence and well-being by allowing them to share their own stories through narratives and talking openly about intersex issues at school. The authors highlighted the importance of providing people with IVSCs the opportunity to express themselves without humiliation and teach those around them how to be intersex-affirming and an intersex ally (Marinus & Cense, 2024). Other participants in Jones (2015a) and Lundberg et al. (2021) confirmed the need for further education of educational professionals surrounding intersex issues to improve the lives of people with IVSCs, together with finding ways for young people in classrooms to listen to accounts of others and to reflect on how other people in the classroom might be affected by one’s own comments and views.
Discussion
This scoping review set out to explore and metasynthesize what is known in the literature about the experiences of people with IVSCs in educational settings, and their educational outcomes. People with IVSCs reported feelings of exclusion and invisibility, including traumatic experiences of shaming, isolation, discrimination, and stigmatization in educational settings. This negatively affected their educational experiences and overall life outcomes, signaling the urgent need for inclusive and affirming educational policies and practices to be implemented in meaningful and trauma-informed ways across all years of education and settings (Carpenter & Zavros-Orr, 2019; Jones, 2016; Zavros-Orr, 2021).
Additionally, the scoping review revealed how current educational curricula pay little to no attention to the existence of IVSCs and/or offer intersex-affirming material, in turn creating further barriers for people with IVSCs due to inappropriate content and lack of exposure to that of human diversity, with discussions extensively focused on typical sex development pathways rather than exploring diverse possible human phenotypes (Carpenter & Zavros-Orr, 2019). With such a narrow focus, this is creating a lack of comprehension regarding people with IVSC’s existence, diversity, concerns, and needs, adding further exacerbated harm to their self-esteem, self-image, and self-worth (Brömdal et al., 2021). Within this context, Brown (2022) expressed the need for school resources, including textbooks, to be developed and include information about IVSCs in an affirming way, inclusive of intersectional factors. Due to a lack of educational policies, guidelines, and practices exemplifying how to make education accessible for people with IVSCs, poor educational experiences and outcomes for people with IVSCs continue globally (Brown, 2022; Carpenter & Zavros-Orr, 2019; Chan & Suen, 2023; Czerwiec, 2022; Jones, 2016; Zavros-Orr, 2021).
Comprehensive relationships and sexuality education and other curricula in schools are often inadequate (Brömdal et al., 2017; lisahunter et al., 2023), where people with IVSCs continue to report how irrelevant sex education content prior to 18 years of age is in relation to their individual bodies, pubertal experiences, and needs, translating into feelings of invisibility and low self-esteem and how the internet ended up being their source of sex education post 18 years of age (Berger et al., 2024).
Negative schooling experiences and school and university dropout were frequently reported by participants in Finland due to requiring long periods of time away from school for surgeries related to their IVSCs and other intersex-related medical interventions, resulting in fatigue and lack of motivation to continue their education (Oikarinen, 2020). Similarly, many participants with IVSCs reported dropping out of school due to bullying and for the failure of their educational setting in providing inclusive sex education classes and/or counseling services, resulting in participants not completing or obtaining high school certifications (Brown, 2022; Ghattas et al., 2019; Henningham & Jones, 2021; Jones, 2015a, 2016; Oikarinen, 2020). Additionally, from an Australian study, 62% of people with IVSCs had a postsecondary qualification; however, 18% had not completed secondary school, and only a quarter of participants rated their overall experiences with education and schooling positively (Jones et al., 2016).
Lifelong consequences due to ongoing inappropriate and nonaffirming curricula being delivered, including misconceptions that people with IVSCs equate with transgender people (Amnesty International, 2018), result in intersex invisibility. Together with bullying, shaming, discrimination, and stigmatization, they collectively equate people with IVSCs becoming more vulnerable and less resilient in school settings, thus leading to early school dropout and/or attaining below-average academic outcomes (Carpenter & Zavros-Orr, 2019).
Although in the minority, there have been attempts made to bring intersex discourses into the learning and teaching material around the world; however, these attempts have mainly been developed outside the formal national curricula institutions/departments of diverse nations. For example, in Australia, there have been minor attempts made by the Australian Curriculum, Assessment and Reporting Authority (n.d.), in the health and physical education domain, to make IVSC/intersex education visible within the curriculum. However, the limited material pertaining to issues surrounding intersex and diverse sex characteristics is often grouped with other information linked to sexuality and gender diverse students, which is different from the unique lived experiences, needs, and requirements concerning people with IVSCs (Carpenter & Zavros-Orr, 2019; Zavros-Orr, 2021). From a positive perspective, there have been some notable improvements in student experiences and outcomes within Victorian urban schools in Australia with the implementation of the Supporting Sexual Diversity in Schools policy, with participants reporting that their school environment feels more inclusive and supportive (Jones, 2015a). The purpose of this policy is to ensure school support for lesbian, gay, bisexual, trans and gender diverse, intersex, queer, questioning, and asexual (LGBTIQA+) people in schools (Victorian Government, 2023). Additionally, the Malta Ministry for Education and Employment (2015) introduced the Trans, Gender Variant and Intersex Students in Schools Policy, including A Policy on Inclusive Education in Schools: Route to Quality Inclusion (Government of Malta, 2022). Both these policies adopt a whole-school approach concerning people with IVSCs in promoting school environments that are inclusive, safe, and free from harassment and discrimination, regardless of sex characteristics. They also aim to promote the learning of human diversity, inclusive of people with IVSCs, thus promoting social awareness, respect, and acceptance (Government of Malta, 2022; Malta Ministry for Education and Employment, 2015). Classroom resources on IVSCs/intersex and education have also been co-constructed with people with IVSCs, ensuring they have a voice and an affirming presence in educational learning and teaching material and schooling contexts. Here, and in the Australian context, the Safe Schools Coalition Victoria (2016), Sexual Health and Family Planning ACT and A Gender Agenda (2021), and the Department of Education in Queensland Australia (Brömdal & Excell, 2023) have independently developed and distributed age-appropriate intersex and education resources for middle and secondary school settings.
Although in the minority, some participants with IVSC reported that they enjoyed school and had achieved well, with little to no negative experiences, while others outlined negative childhood experiences throughout their schooling, yet were successful in moving on and enjoying post-school studies (Oikarinen, 2020). In the New Zealand Ministry of Education (2019) report “Treat kids like they’re gold,” a parent of a child with IVSCs expressed appreciating and embracing the nongendered language that was used in their child’s educational setting and not making assumptions about things that students will like based on gender or bodily diversity, including colors and hobbies.
With the ongoing support of priorities aimed at educational settings as set out by The Darlington Statement (Androgen Insensitivity Syndrome Support Group Australia et al., 2017), the Yogyakarta Principles Plus 10 (International Service for Human Rights & ARC International, 2017), and the whole-school approach to uphold the rights and health of students with IVSCs (Brömdal et al., 2021), school settings are cognizant of their responsibilities and accountability in creating safe, inclusive, and affirming learning environments for all people, regardless of sex characteristics and other intersectional factors (Zavros-Orr, 2020, 2021). This includes the inclusion of comprehensive, affirmative, accurate teaching and learning resources in curricula regarding sexual, biological, physical, and psychological diversity. Additionally, the inclusion in school curricula of information pertaining to the human rights of people with IVSCs, and ongoing staff training and continuing professional development, ensure staff are well equipped in supporting people with IVSCs in educational settings (International Service for Human Rights & ARC International, 2017). The findings and key recommendations from the included articles aid in the facilitation of shaping and guiding the development of IVSC-affirming policies, guidelines, procedures, and practices. This includes learning and teaching material in educational settings, enhancing staff training and development, and ultimately improving the educational experiences, visibility, and outcomes for people with IVSCs. Importantly, it is recommended that educational settings encourage the agentic involvement of young people with IVSCs in the decision-making processes to facilitate positive relationship formations, in turn supporting the facilitation of positive school experiences and outcomes for people with IVSCs (Henningham & Jones, 2021). Participants further expressed their views on how people with IVSCs in educational settings can be supported toward ensuring positive schooling experiences and outcomes (Jones et al., 2016). This further highlights the importance of initial teacher education training and in-service training for practicing educators/teachers across early years learning through primary and secondary schooling and onwards to competently offer IVSC-affirming learning and teaching material and become future leaders and allies informing structural change (Brömdal et al., 2021; lisahunter et al., 2023; Zavros-Orr, 2020, 2021), in alignment with human rights and antidiscrimination legislations (United Nations, 1948, 2024; United Nations Office of the High Commissioner for Human Rights, 1989).
Limitations
There are several limitations to the current scoping review. As IVSCs are an emerging body of research, there was limited robust scholarly literature available to review. The sparse, however, critically important research that does exist often appears within broader LGBTIQA+ literature and omits IVSC-specific needs. The homogenization of data within some research articles applying the acronym LGBTIQA+ and not specifying or differentiating the findings linked to people with IVSCs was a limitation. This made it difficult to appreciate the experiences, concerns, and educational outcomes unique to people with IVSCs in educational settings. As such, this scoping review had the potential to add more articles; however, this did not occur due to the unclear distinction of the “I” within the LGBTIQA+ acronym embedded across various articles.
Similarly, the scoping review’s inclusion/exclusion criteria being linked to English-only articles offered in full text is another limitation of this review. Although these measures were put in place with good reason to ensure rigor and accessibility, they may have inadvertently resulted in the oversight of suitable and relevant articles for this scoping review. The inclusion/exclusion criteria, in conjunction with a rigorous quality appraisal method and a comprehensive data analysis, endeavored to mitigate potential limitations and, as such, intended to make valuable contributions to the growing body of research regarding the educational experiences and outcomes of people with IVSCs in educational settings.
Significant gaps within the research identified the lack of IVSC visibility, belonging, connectedness, and actionable findings in relation to the experiences and outcomes of people with IVSCs in educational settings. This may be linked to the reality that research concerning people with IVSCs is often included under the umbrella term of LGBTQIA+. In considering future research directions and ensuring people with IVSCs have a sense of voice, visibility, belonging, and meaningful educational experiences and outcomes, it is vital that IVSC-related education research is purposefully pursued by people with lived experience for people with IVSCs. This is to ensure the methodology, data collection tools, and methods of analysis are meaningful and representative of community needs. Similarly, shifting beyond umbrella terms is crucial in fully understanding and exploring the lived experiences of people with IVSCs in educational settings. More specifically, people with IVSCs may not engage in research that seeks to understand the lived experiences of LGBTQIA+ people if the questions, in the main, are sexuality and gender oriented and omit to respectfully engage with issues that concern people with IVSCs (Carpenter, 2024).
Conclusion
In conclusion, this scoping review has critically illuminated and metasynthesized the diverse structural, interpersonal, and individual compounding barriers people with IVSCs face in educational settings and the impact of these barriers on their educational experiences and outcomes. It shifts the conversation from tokenistic inclusion, highlighting the need for structural transformation in ensuring educational systems acknowledge and actively visibilize, include, and affirm people with IVSCs, in alignment with human rights obligations and their right to succeed educationally. Of the 20 articles, 17 included voices of participants with IVSCs sharing firsthand lived experiences and accounts in school environments, including some parents’ voices concerning their child’s experiences with IVSCs while navigating education and the educational setting. The direct inclusion of these voices provided an authentic insight into real-world consequences of structural inequity, marginalization, and invisibility for people with IVSCs in educational settings, reiterating the need for systemic change. The findings also highlight that positive educational experiences are rare, with only three articles providing insight into some positive educational experiences encountered by people with IVSCs from educational staff or peers. The voices and lived experiences of the participants in this scoping review have highlighted the importance of being acknowledged in order to practically move forward within this growing body of human rights, health, and well-being-related research.
There is still much work to be done in this space in relation to providing inclusive and affirming support to people with IVSCs in educational settings. For substantial changes to occur, it is imperative for systematic change to occur at the structural level, which in turn will have a flow on effects through to the interpersonal and the individual level, as such, paving the way for more equitable and just educational experiences and outcomes. At the structural level, educational settings have both the responsibility and accountability to ensure they create safe, inclusive, and affirming learning environments for all people across the years, regardless of one’s sex characteristics and other intersectional factors (Carpenter & Zavros-Orr, 2019; Zavros-Orr, 2021). The findings from this scoping review highlight the necessity for research-driven reform and inclusive pedagogical practices to be implemented throughout educational settings across the years. More specifically, future research in this area needs to be driven and developed in collaboration with people with IVSCs to ensure it is sensitively developed and purposefully targeted to appreciate what an inclusive, affirming, and safe educational environment would look like for them.
The exploration and implementation of appropriate staff training on how to support and accommodate people with IVSCs in educational settings, together with displays of human compassion, is vital, thus improving support and reducing bias. Societal and human rights concerns, and the abolishment of systemic and structural socio-medico-informed endosexism pertaining to fixed binary categories of female and male bodies in society and educational settings, like schools, are vital in ensuring supportive and affirming learning cultures. In mandating intersex-inclusive, affirming, and relevant learning and teaching material and educational policies and governing guidelines in adherence with human rights directives, such as the Yellow Tick (Darlington Consortium, 2020), one may observe positive and fruitful educational changes, experiences, and outcomes for people with IVSCs (Brömdal et al., 2021). It is essential to take note of what the participants in this scoping review have experienced and expressed, and how those educational experiences inform their lives, health, and opportunities to contribute to society in meaningful ways. More specifically, participants in this scoping review voiced their individual needs and expressed how society and educational settings can contribute to intersex visibility, as opposed to the current climate of intersex invisibility, in order for people with IVSCs to have positive educational experiences and outcomes while navigating their educational journey and asserting that governments, education departments, and policymakers ensure their human right to quality education in an inclusive and equitable experience now and into the future (United Nations, 2024).
Footnotes
Notes
HONOR KEANE (she/her) is a primary school teacher at Musgrave Hill State School, 2 Nakina Street, Southport, Queensland 4215, Australia; email:
ANNETTE BRÖMDAL (they/them) is an associate professor in the School of Education and Creative Arts at the University of Southern Queensland, 487-535 West Street, Darling Heights, Queensland 4350, Australia; email:
AGLI ZAVROS-ORR (they/them) lectures on inclusive, humanities, and arts education at the Institute of Education, Arts and Community at the Federation University Australia, PO Box 3191, Gippsland Mail Centre VIC 3841, Australia; email:
lisahunter (they/it) teaches and researches in the School of Curriculum Teaching and Inclusive Education at Monash University, Peninsula Campus, Frankston, Victoria 3199, Australia; email:
KIRSTINE HAND (she/her) is an LGBTQ+ educational consultant and a sessional academic with the School of Teacher Education and Leadership at Queensland University of Technology, Level 3, E Block, 149 Victoria Park Road, Kelvin Grove, Queensland 4059, Australia; email: