QuestionHi Dr. McNiece,
Ok so this is a really awkward question but I'd really appreciate it if you could give me any kind of advice or answers....I'm 20 years old and I have an intersex condition...so I'm a mostly male person but I have a vagina. (and here it gets more awkward) I'm also a sex worker....and the men that want to see me usually want to have vaginal sex. I've always told them no because it would feel weird to do that when I'm not really a girl, and also because I wasn't sure if my vagina was use-able for sex...but that makes it hard to get work which makes it hard to pay rent so I thought I would see if I could have vaginal sex. There's a guy who I've seen a couple of times who's a really decent human being, so I let him try having vaginal sex with me on the condition that he stopped if I said "stop". So, I ended up telling him to stop and he did, but then he said, "you seem to be bleeding a little". I was actually bleeding a lot--like the amount of blood you get from a moderately bad nosebleed. I know that girls usually bleed after having vaginal sex for the first time because the hymen breaks, and I asked a youth sex information line how much they bleed to compare my situation and see if that's what it was and they said it was only a little bit and usually stopped in half an hour to an hour. Well it's been three hours and I'm still bleeding, and I'm thinking that it's more than "a little bit" of blood. Could there be something different about my vagina because I have an intersex condition and it's not really the same as a fully-female person's vagina? Do you think I've really hurt myself? Should I see a doctor? Sorry, this is such a weird question, but I'm really embarrassed about being a boy with a vagina and I don't want to go to a clinic about this if I don't have to.
Thanks!
Luke
AnswerHi Luke,
I hope you are feeling better.
Intersex conditions present some of the most complex issues in medicine. As you know there are a variety of intersex conditions, but even those within the same genotype (XXY for example) can differ drastically. I don't know of any other series of medical conditions that have a greater global impact. Intersex patients face challenges physically, psychologically, genetically and socially. I admire your courage and I empathize with your situation.
As to your question regarding your female genetalia; yes, absolutely there could be differences between yours and a typical XY female's vagina. The extent to which it is different is the question, but I can't answer that. Even if I knew your genotype I wouldn't be able to know because of a phenomenon called incomplete penetrance of genes. That is a genetics method to describe that a person my have the genes that completely code for a certain structure, but the body does not make the entire structure.
Having said that, I can tell you that if you have been bleeding for three hours from anywhere, it needs to be addressed. You should see a doctor if your resting pulse is greater than 100-120. Always try and apply direct pressure to any bleeding site.
When this heals up and you are feeling better you will be confronted with the decision as to whether to do this again. I would probably not proceed until you have had a physical exam. The most likely explanation for your bleed is that the vagina is incomplete, or very small, however you want to say it. Recall that some younger Intersex females often require a surgical procedure to enlarge their vaginas to enable them to have intercourse. I am not recommending that for you, but I am suggesting that might be where the problem lies. When all else fails, go to the doctor.
Best of luck to you, Luke.
Dr. T.
